Ambulance Services in England

Edward Argar Excerpts

Thursday 10th February 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

Reflecting the rest of the week, Mr Deputy Speaker.

I am grateful to the hon. Member for Ellesmere Port and Neston (Justin Madders) for securing this important debate. In the same spirit, this is rather nice; it is like déjà vu: he used to shadow me at that Dispatch Box and in Committee. It is a pleasure to respond to his debate on this occasion.

However, I must say that responding to the hon. Gentleman is a pleasure slightly tempered by caution on my part, because I know the depths of his expertise on this subject after his many years shadowing the Minister for Health—I think he shadowed my predecessors as well. He has great depth of knowledge in this space. He is and has been a notable advocate for our ambulance service and what it needs, and he looks forensically into those issues. I also know that he is a diligent reader of The BMJ, the Health Service Journal and various other excellent trade and specialist publications. It is a genuine pleasure to respond to him on this extremely important issue. It is a shame that the way in which the House allocates debates means that this is the last debate of the day, so there are few Members in the Chamber for it, because it is important. However, those we have in the Chamber are quality, and I look both at the shadow Minister—sorry, the former shadow Minister—and the hon. Member for City of Chester (Christian Matheson).

As the hon. Member for Ellesmere Port and Neston highlighted, ambulance services have faced extraordinary pressures during the pandemic. I am sure that the House will join me and the shadow Minister—the former shadow Minister; by force of habit, I keep calling him the shadow Minister. The hon. Gentleman and I have not always agreed, but we have been as one in paying tribute to all those who work in our ambulance services up and down the country. They have done an amazing job over the past two years, during the pandemic, to the very best of their ability. Of course, they do that amazing job day in, day out; irrespective of pandemics, they always do everything they can to support those who need them.

The hon. Gentleman rightly highlights that the pandemic has placed significant demands on the service. In January 2022, it answered more than 800,000 calls. That is an increase of 11% on January 2020 and is one of the factors placing significant pressures on ambulance services, the wider NHS and the A&E departments to which they will take people when they feel that there is a clinical need. Although 999 calls tend to highlight the demand related to more serious medical conditions, many ambulance services are also responsible for 111 calls, which, in December last year, saw an increase of 15.5% compared with December 2019.

I use those statistics to illustrate the demand pressures, but I understand that behind those numbers, in every case, lies a human story—someone in need of care, someone worried and anxious, with friends and family anxious for them—so before I seek to go into the reasons, statistics and our plans and support, I want to say that I am sorry for patients who have suffered the impact of those service pressures. I want to be very clear that patients should expect and receive the highest standards of service and care.

The hon. Gentleman highlighted some specific examples, including the case of Bina Patel. He is right that the right hon. Member for Ashton-under-Lyne (Angela Rayner) has raised that with me. I have asked for full information because I want to get back to her with as full an answer as I can, and I hope that he can convey that to her, if he speaks to her before I do. I am fully aware of her correspondence raising this on behalf of the family.

Let me turn to ambulance response times and the reasons sitting behind some of the pressures. The ambulance service is facing a range of challenges that are impacting on its performance. The hon. Gentleman will be familiar with many of them, including the impact, still, of infection prevention and control measures not only in the ambulance service but particularly in A&E departments and wider acute clinical settings. Higher instances of delays in the handover of ambulance patients into A&E as a result of some of those factors, which I will turn to, are therefore leading to ambulances waiting for longer in queues and not being as swiftly out and about on the road and able to respond to calls. So there are knock-on effects there.

One of the key challenges, which the hon. Gentleman will be very familiar with, remains the question of flow through an A&E and through a hospital. I am referring to the flow of patients out of ambulances into the A&E, who are then able to be treated in the A&E and discharged, hopefully, or who are then, in some cases, able to be admitted to a bed in a hospital ward. To do that, we have to see discharges continue of patients who no longer meet the criteria to reside because they have recovered sufficiently, and the national discharge taskforce has done a huge amount of work on addressing that challenge.

In recent months, we have seen the combined pressures of winter—the hon. Gentleman and I are familiar with those on an annual basis—and the impact of the omicron variant on the number of hospitalisations, which have not been as high as many feared and predicted, thankfully, but which have still had a significant impact on hospital beds. The combination of those factors, coupled with a high level of workforce sickness absence rates, including through positive covid tests—particularly over recent months with omicron—has created pressures that we would not expect to be systemic or built into the system. That partly reflects longer term pressures, and I will move on to what we are doing to address those, but a large element of it is down to the specific circumstances of the past winter.

The hon. Gentleman touched on the support in place to improve services, and asked what we are going to do about it, and what is being done to address these issues. He is true to form from when he shadowed me, as he will always set out the challenge and ask me what I am going to do or am doing about it, rightly holding the Government to account. Because of the pressures I mentioned we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to the end of March. All trusts are receiving part of that funding, which will increase call handling and operational response capacity, boosting staff numbers by around 700.

NHS England has strengthened its health and wellbeing support for ambulance trusts, recognising the pressure of the job on those working in the ambulance services, with £1.75 million being invested to support the wellbeing of frontline ambulance staff during the current pressures. NHS England and Improvement is undertaking targeted support for the most challenged hospitals, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That is focused on the most challenged hospital sites where delays are predominantly concentrated, with the 29 acute trusts operating those sites being responsible for more than 60% of the 60 million-plus handover delays nationally. That is targeted support for trusts that have particular challenges, either from the current situation or where there are underlying issues that we need to resolve.

There is capital investment of £4.4 million to keep an additional 154 ambulances on the road this winter, and a £75 million investment in NHS 111 to boost staff numbers by just over 1,000, boosting call taking and clinical advice capacity that will better help patients at home, and better help triage those who genuinely need an ambulance and those who can be treated safely in a different context. There is continuous central monitoring and support for ambulance trusts from NHS England’s national ambulance co-ordination centre, and we have also made significant long-term investments in the ambulance workforce. The number of NHS ambulance staff and support staff has increased by 38% since July 2010.

More broadly, alongside the ambitious plan set out by the Government earlier this week, showing how we will invest the significant additional resources in outcomes for patients, just over a year ago we invested £450 million in A and E departments, to help mitigate the impact through increased capacity of infection prevention and control measures. I have regular direct meetings about discharge rates, and what we can do further to improve the flow of patients through hospital trusts within NHS England, with members of the taskforce on that.

I am pleased to reassure the hon. Gentleman that those measures have had an impact, and we are seeing improvements in response times from the peak of the pressures in December. Performance data for January, published today, shows significant improvement against all response time categories. Performance for category 1 calls—the most serious calls, classified as life-threatening—has largely been maintained at around nine minutes on average over the past several months, and improved to eight minutes and 31 seconds in the latest figures. That is despite a 19% increase in the number of incidents in that category compared with December 2019. Average responses to category 2 calls improved by more than 15 minutes compared with December, and the 90th centile responses to category 3 calls by more than two hours.

We recognise that that is welcome progress, as I am sure the hon. Gentleman would agree, but there is much further to go to recover fully from the pandemic’s impact on response times and to sustain that improvement. We welcome the service’s hard work and dedication and pay tribute to it for making those changes and delivering the significant improvements on which I am updating the hon. Gentleman.

[Justin Madders]

As always, the Minister is being courteous and comprehensive in his response. Will he comment on the concern expressed earlier about patients being told, when visited by the service, that they needed to go to hospital but should find their own way there? That is extremely worrying, and we should be clear that it is not what we expect to happen.

[Edward Argar]

I am grateful to the hon. Gentleman—I keep feeling tempted to say shadow Minister; he is a shadow Minister but he is no longer my shadow—for that point. He is right that when people ring 999 they should be given the appropriate clinical advice on whether they need to go to hospital, and if they do, an ambulance should be sent. I suspect that in individual cases a call handler may have made a tough clinical decision about the fastest way to get someone to hospital given the availability of ambulances, but the hon. Gentleman is right that if someone rings 999 and their condition is clinically deemed to require an ambulance and swift transfer to hospital, they should be able to expect an ambulance to come, assist them and take them to hospital.

At a time when the NHS is facing unprecedented demand, ambulance services are absorbing some of the increase in pressure. They are treating more people over the phone and finding other ways to reduce pressure in a clinically safe way. With clinical support in control rooms, the ambulance service is closing around 11% of 999 calls with clinical advice over the phone. That is far more than the 6.5% achieved in January 2020 and saves valuable ambulance resources for response to genuinely more urgent clinical needs.

Let me say a little about North West Ambulance Service, if that is helpful to the hon. Gentleman—I know that he and the hon. Member for City of Chester take a close interest in their local ambulance service. Our support and investment has benefited the North West Ambulance Service. The hon. Member for Ellesmere Port and Neston’s local trust received £6.2 million of funding, which it has used to increase its workforce for operational and contact centre teams. The trust is also engaged with regional NHS England and Improvement and commissioning teams to develop a six-point winter plan that seeks to address six key areas throughout the winter period. As it starts to get a little warmer and the daffodils start to come out, it is tempting for people to think that winter has passed, but winter pressures in the NHS can continue into late February and occasionally a bit beyond. I wanted to add that caveat.

Three systems-led initiatives focus on the reduction of hospital handover times, the improvement of pathways for patients with mental health presentations and ensuring that alternatives to emergency departments—including access to primary care and other non-emergency-department pathways—are available to North West Ambulance Service in a timely and responsive manner.

Hospital handover delays continue to challenge the North West Ambulance Service footprint. Through its Every Minute Matters collaboration, which began three years ago, the trust has been working with other hospital trusts on improvements by working with senior leadership teams in hospital trusts to ensure there is a shared understanding of the risks of handover delays and a lack of ambulance resources to respond to patients in the community, to revisit action cards for operational commanders and, crucially, to recognise and thank staff for their continued reporting of delays and willingness to highlight problems to their managers or to the trust.

The trust’s strategic winter plan has been activated and includes details of the measures in place to handle winter pressures and mitigate the effects of increased demand and a loss of capacity. The plan is comprehensive and covers a wide range of topics and details on the preparation for various scenarios. It includes several continuous improvement initiatives for support during the winter period.

In summary, North West Ambulance Service is increasing its double-crewed ambulance capacity in line with winter funding arrangements, reducing conveyance to emergency departments and reducing the number of lost operational hours caused by day-to-day operational challenges. The trust has already seen significant improvements in the number of patients managed effectively through telephone advice, which helps free up ambulances to be deployed to where they are most needed. The trust has recruited additional paramedics and emergency medical technicians and upskilled its ambulance care assistants to blue light driving standard, thereby enabling the trust to deploy 269 additional frontline staff by the end of December.

I close by reiterating the Government’s commitment to support the ambulance service. We retain regular contact with ambulance services, trusts and those delivering on the frontline to help to ensure that patients and the ambulance service receive the care and support that they need. I am grateful to the hon. Member for Ellesmere Port and Neston for bringing this matter to the House.

Question put and agreed to.

Integration White Paper

Edward Argar Excerpts

Wednesday 9th February 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

With permission, I would like to make a statement on the integration White Paper.

The covid-19 pandemic has been a living example of the importance of working together as one. Whether it is the extraordinary success of the vaccination programme or the work to identify and protect the most vulnerable, we were at our best when we were working across traditional boundaries towards a common goal. We must learn the lessons of the pandemic and channel this spirit of collaboration.

Although huge progress has been made in bringing together our health and care services and local government, our system often remains fragmented and too often fails to deliver joined-up services that meet people’s needs. Thanks to incredible advances in health and care, people are enjoying longer life expectancies, but may be living with more complex needs for longer. Navigating a complex health and care system to meet those needs can be hard, especially when services are often funded, managed and delivered separately. People too often find that they are having to force services to work together, rather than experiencing a seamless, joined-up health and care journey.

If we are to succeed in our goals of levelling up our nation, we must keep working to make integrated health and care a reality across England. Today, we are publishing the integration White Paper, which shows how we will get there. It is the next step in our ambitious programme of reform, building on the Health and Care Bill and the social care reform White Paper, which this Government introduced to the House in December.

This White Paper has been shaped by the real-world experience of people, as well as by that of nurses, care workers and doctors on the frontline, drawing on some of the great examples of collaborative working we have seen, particularly during the pandemic. It will make health and care systems fit for the future, boost the health of local communities and make it easier to access health and care services. It is a plan with people and outcomes at its heart—no more endless form filling, no impenetrable processes and no more bureaucracy that sees too many people getting lost in the system and not receiving the care they need.

First, we will ensure strong leadership and accountability, which is critical to delivering integration. Local leaders have a unique relationship with the people they serve. Our plans will bring together local leaders to deliver on shared outcomes, all in the best interests of their local communities, and encourage local arrangements that provide clarity over health and care services in each area, including aligning and pooling budgets. This arrangement has already been successfully adopted in several local areas. We have suggested a model that meets these criteria, and we expect areas to develop appropriate arrangements by spring of next year. Local NHS and local authority leaders will be empowered to deliver against these outcomes, and will be accountable for delivery and performance against them. They will be supported by a new national leadership programme addressing the skills required to deliver effective system transformation and strong local collaboration.

Integration supports transparency, and joining up NHS and local authority data means that we can provide local people with better insights about how their area’s health and care services are performing. With access to more information, they will be more empowered to make decisions about where and how they access care. There will be a new single accountable person for delivery of a shared health and care plan at local level. In practice, that could mean an individual with a dual role across health and care or a single lead for a place-based arrangement.

Secondly, we will do more to join up care. At the moment, too many people are bounced around the system or have to tell their story multiple times to different professionals to get the care that they need, which is frustrating for people and frontline workers alike. There are so many opportunities here. Closer working between primary and secondary care can allow care that is closer to home, keeping people healthy and independent for longer, and closer working between mental health and social care services can reduce crisis admissions and improve the quality of life for those living with mental illness. The White Paper sets out how we will get there, using the power of data to give local leaders the information that they need to establish new, joined-up services to tackle the issues facing their communities.

Thirdly, we will make the best use of the huge advances in digital and data. We have seen throughout the pandemic how digital tools can empower people to look after their health and take greater control of their care—for instance, through the NHS app or remote monitoring technologies. Where several organisations are involved in one person’s care, there is a real opportunity to bring together data safely to create a seamless and joined-up experience. The White Paper reiterates our commitment to having shared records in place for all people by 2024, providing local people with a single, functional health and care record that everyone involved in care can access in a secure way. That will mean every professional having access to the key facts relating to a person’s condition, such as their diagnoses and medications. That will improve care, too, with professionals able to make care plans in full knowledge of the facts.

We have seen a rapid expansion of digital channels in primary and secondary care services in recent years, but there is plenty more that we can do. This year, one million people will be supported by digitally enabled care pathways in the comfort of their home. The White Paper sets out how we will open up even more ways for people to access health and adult social care services remotely. We will also support digital transformation by formally recognising the digital data and technology profession within the NHS “Agenda for Change”, and including basic digital, data and technology skills in the training of all health and care staff. Integrated care systems will be tasked with developing digital investment plans so that we can ensure that digital capability is strong right across the board. That means data flowing seamlessly across all care settings, with technology transforming care so that it is personalised to the patient.

Finally, the White Paper shows the part that the workforce can play. The health and care workforce is one of the biggest assets that we have, and we want to make it easier for people working in health and care to feel confident in how the system works together in the best interests of those they care for and to feel empowered to progress their careers across the health and care family. To drive that, integrated care systems will support joint health and care workforce planning. We will improve training and ongoing learning and development opportunities for staff. That means creating more opportunities for joint continuous development and joint roles across health and social care, increasing the number of clinical practice placements in adult social care for health undergraduates and exploring the introduction of an integrated skills passport to allow health and care staff to transfer their skills and knowledge between the NHS, public health and social care.

The White Paper represents a further step in our journey of reform, building on the foundation laid in the Health and Care Bill, looking ahead to a future of health and care in this country with people at its very heart. It paints a vivid picture of a health and care system with more personalised care and greater transparency and choice, where early intervention prevents the most serious diseases, using the power of integration to give people the right care, in the right place, at the right time.

[Karin Smyth (Bristol South) (Lab)]

I thank the Minister for advance sight of his statement, which I got about 30 minutes ago, but I confess that I read most of it some 30 years ago when I was developing joint services. After waiting an eternity for the Department of Health and Social Care White Paper, the Government are spoiling us with their third paper of the year. All these papers are necessary to try to remedy the disastrous Lansley Act—the Health and Social Care Act 2012.

We acknowledge that reversing that Act and the integration of health and social care, however it is defined, is extremely difficult, but this integration will not be delivered by the White Paper and it is certainly not well defined. It is not clear how this fits with the Health and Care Bill, which is currently in the Lords. Even the experts involved in the Committee and elsewhere are repeatedly tripping over crucial issues such as the relationship between integrated care boards, integrated care partnerships and integrated care systems. How do they work with health and wellbeing boards? Where is the clinical leadership? Where is the accountability to local people? I banged on a lot about accountability in the Bill Committee so I am glad that somebody was at least listening and that we seem to have a bit of progress, but where are the voices of local people who are increasingly being asked to pay more for less?

Like a house made of crepe paper, this gossamer-thin White Paper collapses with the faintest breeze of scrutiny. Let us be clear: it is not a plan, nor is it even a starting strategy. It is just a series of woolly claims about how things could be better, unsupported by any evidence or analysis of the resources and organisational and funding flow changes that will obviously be necessary. It could have been written at any time over the past 30 years. It contains little that is new and nothing to illustrate new thinking or new attitudes. It relies on the bogus assumption that because something may work for a while on a small scale, it will obviously work everywhere. It is not any kind of plan for integrated care that people will recognise; these are just aspirations about integrated systems.

There is little to explain how a joined-up system would be managed, how it would be accountable to the public, patients and service-users, how the funding will be allocated and shared or how performance would be assessed and weaknesses addressed. Nothing in the White Paper addresses the key issue of balancing what is locally determined against national standards and national entitlements.

Crucially, there is nothing to address the key barrier to integration—that social care and the NHS are in different empires with no level playing field. One is means-tested and one is not. One has national criteria for entitlement and one does not. The way in which they are governed and funded is totally different and they are kept going by two separate workforces with no aligned terms and conditions.

I welcome the announcement of a skills passport and we will certainly look at the detail of that. However, unless there is pooled funding on a major scale—out-of-hospital funding—there will be no system drivers to really improve integration. This White Paper is again about simply encouraging, but we have had 30 years of that.

The reality is that the White Paper is remarkable for what it does not do. It does not seem to help children and young people. It does not address the challenge of how to care for and support working-age adults with a disability. It does not really value or assist the informal workforce or carers.

Our NHS and care system is under enormous pressure after years of austerity funding made incalculably worse by the impact of the covid pandemic, but the challenges that it faces are manifest, from a legacy of a “hospital first” approach to a decades-long failure to share care records. That runs alongside chronic underfunding and devaluing of public health, huge gaps in the workforce and wholly inadequate social care provision, with more than 500,000 people waiting for assessment and hundreds of thousands more denied access to care of any kind because the barrier for access is far too high.

This is a will-o’-the-wisp White Paper: one minute it is there before us only to vanish at a glance. The truth is that there does not seem to be anything of note that cannot already be done. Fundamentally, what is the point of it? As things stand, the number of patients waiting for care will continue to rise for the next two years, and there is no plan—not even the ambition—to get waiting times and waiting lists down to the record lows seen under the last Labour Government.

Worse still, these proposals will see patients paying more in tax but waiting longer for care. The Government are blaming covid, but will the Minister tell us when the target for NHS patients in England to be treated within 18 weeks was last met? If he cannot remember, it was in fact in 2016, four years before the pandemic. It is clear from the announcement yesterday and here today—just as it is from the decade of Tory mismanagement that left the NHS ill-equipped to cope with covid—that the longer we give the Conservatives in office, the longer patients will wait. Their time really is up.

Today is not a serious endeavour; it is a greatest hits of soundbites and buzzwords, randomly assembled to make a decent press release and get an outing on the evening bulletins. It is a desperate desire to own the news cycle and calm Tory Back Benchers’ nerves. It really is disappointing and it is simply not good enough.

[Edward Argar]

It is a pleasure to see the shadow Minister in her place—she will know that I genuinely mean that, because she and I spent many happy days upstairs in Committee debating exactly these issues. This White Paper sets out clearly the next steps and builds on the strong foundations of integration that that legislation put forward, with the integrated care boards, integrated care providers and integrated care systems, which our deliberations in Committee and in this House demonstrated were clear, understandable and effective in providing locally based governance; bringing together at an ICB level NHS services within a locality, and within an ICP broader ranges of services, including housing providers and others. This has been bringing together the national health service we have with the localised delivery we all seek.

That is one of the key points of the White Paper: the next steps in how to deliver place-based solutions and allow the system to continue to evolve organically through that permissive approach that characterises the legislation we are putting through Parliament, rather than the prescriptive approach that the Labour party at times appears to prefer. The White Paper contains new thinking on new ways forward, drawing on not just the lessons of the pandemic but much longer-standing arrangements within localities, recognising best practice for integration between health and social care, and reflecting that organic development that occurs within a place as local leaders, local communities and those using the services work together to deliver services that work best for them.

The hon. Lady touched on how some of this might work in practice and talked about funding and budgets. We have made it clear—I used to use this when I was a local councillor—that section 75 of the National Health Service Act 2006, on the ability to pool budgets, has been effective, but it is time to go further and explore whether that remains the most effective vehicle by which that sharing of budgets can be undertaken, so it is right that we look at this.

The hon. Lady touched more broadly on social care and the NHS. I have to say to her that we announced our White Paper for social care last September. She mentioned the plethora of White Papers. We rightly recognise the different parts of the health and social care system and have clear plans for each of them. Those different White Papers together form a coherent whole, putting forward reform proposals that will make a difference for patients and others alike. I have to say to the Opposition that, much as they may gently chide us on this, in 13 years in government they had two Green Papers, one royal commission and one spending review priority, but still no reforms to improve social care provision in this country. This Government have seized the nettle and brought forward proposals that will genuinely move us forward.

Finally, on the hon. Lady’s points about yesterday’s announcement on NHS waiting lists, this Government have been transparent with the British people about the challenge ahead of us and about our plan to meet that challenge. Our approach, which combines ambition with realism, has been welcomed by stakeholders across the health and social care space. Ours is the party of the NHS. We are the party that has put the resources into that NHS, with £33.9 billion put into law at the start of 2020, and then record funding through the health and care levy, which the Labour party voted against.

[Jeremy Hunt (South West Surrey) (Con)]

As one in the long line of former Health Secretaries with scars on their back—to quote Sir Tony, if we are allowed to—from when they tried to integrate the health and care systems, I warmly welcome this White Paper. I think it is more than aspirations. But there are three central elements of the plumbing that we have to get right, and I want to ask the Minister, who I know is very committed to this, for his response.

First, previous attempts to have pooled budgets for vulnerable people have been bedevilled by the fact that the NHS has not wanted to pool its budgets with an underfunded social care system. The grant to local government is still not generous, to say the least. The Select Committee on Health and Social Care recommended an increase of £7 billion a year by the end of the Parliament, but it is actually going up by £2 billion a year. What will we do to overcome the resistance in the NHS to merging budgets with a social care system that is feeling very stretched?

Secondly, it is a very big step forward that everyone will have a single electronic health and care record by 2024, but my simple question is whether the public will be able to access the data. Patients are the best guarantors and defenders of their own health, so they should be able to access everything that professionals can see about them.

My third question is about having a single professional responsible for someone’s care. What is the role of GPs in that? For most members of the public, the central person responsible for their care is their GP. Is it not time to go back to the days when everyone had their own family doctor, instead of a different doctor every time they call the surgery? They might not see the same person every time, but there should be someone at the GP surgery who is responsible for their overall care, whether that is in the health system or the social care system.

[Edward Argar]

My right hon. Friend speaks with typical wisdom and common sense on these issues. I will briefly address each of his three points in turn.

On pooled and shared budgets, I have to say that I think section 75 of the National Health Service Act 2006 has worked well. When I was cabinet member for health and adult social care at my council—I had more hair then, and it was not grey—I also sat on a primary care trust board as a non-executive member. I had a senior director of that PCT on my management team; we forged a common purpose, recognising that there would be some areas in which NHS moneys were greater than those put in by the local authority and vice versa, but the shared goal was achievable only when we worked together. I think that there is genuinely something to build on, and the ICSs, ICBs and ICPs at the upper level will be the vehicle to move the process forward. When I was doing it, there was a degree of personal relationship moving it forward, rather than necessarily a systematised approach, but I genuinely think that there is a willingness and a recognition of the need for this.

On public access to electronic records, my right hon. Friend’s central point is absolutely right: it is important to recognise that such data is our data and individuals’ data. We must always be wary about doing something to someone, as opposed to in partnership with them. That principle will underpin our approach in this space.

Finally, my right hon. Friend referred to a single responsible professional—not a single point of contact, but someone who brings together an individual’s care. He is right to highlight the importance of general practitioners. May I put on record my gratitude to GPs not only for all their work over the past two years, and for all they do day in, day out, but for the wisdom and care that they bring to addressing their patients’ needs?

Since my right hon. Friend’s time as Secretary of State, there has been a continual drive to increase the number of doctors in our health service. Not all will become general practitioners, but we need to continue to make general practice accessible and to encourage people to choose it as an incredibly exciting and rewarding career. One of the key elements of making what he describes work is building up a body of general practitioners who are able to perform such tasks. I pay tribute to his work; we are continuing that work and building on his foundations. I am grateful for his questions and for his contributions.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the Minister for advance sight of his statement. I think it fair to say that England is late to the integration game; Scotland and Wales have been legislating and moving in that direction for 20 years. The Scottish Government are pushing forward plans for a national care service to ensure that social care is fit for the 21st century, and have developed the NHS Pharmacy First Scotland scheme to spread the burden of frontline care and make pharmacies the first port of call for patients when GP and hospital visits are not necessary.

What lessons have been learned from the devolved nations? Any new plan for the NHS will not change the reality of the challenges facing the NHS organisation across all four of our nations, including that of vacancies. While Scotland’s workforce has grown by 20% under the SNP, Brexit is still hampering our ability to recruit from EU nations. Will the Minister discuss loosening Brexit and immigration controls with his fellow Ministers to help alleviate that situation?

[Edward Argar]

I saw the hon. Gentleman’s final point coming. To his original point, we are always happy to speak to the devolved Administrations and learn from their ideas, just as I am sure they occasionally look to England to see what they can learn—that is part of being a member of this Union. I speak regularly to the hon. Member for Central Ayrshire (Dr Whitford), including about such matters. To his final point, all I would say is that since 2010 we have seen around 30,000 more doctors and 38,000 more nurses in the English NHS—I have highlighted the role that my right hon. Friend the Member for South West Surrey (Jeremy Hunt) played in that—so I think we are doing a pretty good job of continuing to grow the workforce. There is much more to do, but we have a plan and we are delivering on it.

[Lucy Allan (Telford) (Con)]

I welcome this ambitious and much-needed programme of reform. One of the greatest challenges is ensuring the accountability of NHS bodies to local people, and I wonder whether the Minister could say a bit more about how these plans will ensure that local NHS bodies are accountable to the local people they serve.

--- Later in debate ---

[Edward Argar]

These plans build on what we are proposing in our legislation. At the heart of the Bill are integrated care systems, which bring together at ICB level and ICP level the local authorities that are elected to represent their areas, local people—Healthwatch will have a key voice in this space—and of course the local NHS.

[Stephanie Peacock (Barnsley East) (Lab)]

The clinical commissioning group in Barnsley says that it is struggling with unprecedented capacity issues. With a record 6 million patients waiting for planned NHS treatment across the UK, can the Minister explain how we will tackle the crisis in waiting times through this White Paper?

[Edward Argar]

The hon. Lady will have seen yesterday the announcement and publication of our plan to tackle waiting lists caused by the covid pandemic, the investment that underpins that, the approach to the workforce and how we will bring those waiting lists down. This White Paper builds on that; they are complementary and work together. This is about looking to the future to improve how our systems work together, but we set out a clear and comprehensive plan yesterday to do exactly what she speaks of.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I declare my interest as a doctor. I wonder what the practical consequences of this will be. Can I suggest to my hon. Friend, whom I admire greatly, that one of those practical consequences might be to end the awful business of people waiting for weeks and weeks in acute hospital beds for discharge to more appropriate settings in the community? It does them no good, it is massively expensive to the system, and it prevents them moving on to places that can better care for them and give them what they need while allowing the acute sector to do what it can do, which is to manage people who are acutely unwell. At the moment we have 10,000 people in the system waiting for discharge. That will not do, and I would be interested to know from my hon. Friend how these proposals will help.

[Edward Argar]

I am grateful to my right hon. Friend in this respect. Discharge of people from hospital safely, either into a care home setting or back to their own home with support, is vital not only for their own health outcomes but for the flow of patients through our acute hospitals to enable A&Es and other parts of the system to function effectively. Through the national discharge taskforce and through the work we have done throughout the pandemic, we are bringing together acute hospitals and local authorities, and we have made huge strides together within localities in improving this and learning lessons. This White Paper sets out a way in which they can be embedded to ensure that they continue to deliver long-lasting benefits.

[Daisy Cooper (St Albans) (LD)]

My constituent Lynn is a powerful and loving advocate for her husband Andy, but she is at her wits’ end because she has to repeat the same information time and time again to nurses, consultants, dementia specialists, carers and the Department for Work and Pensions. When will the White Paper make her life a little bit easier? Despite her frustrations, she knows that all those professionals are working incredibly hard, but there just are not enough of them. How can it be that the Minister has said in this statement that he wants integrated care systems to have a joint health and care workforce plan, but he is still refusing to put that commitment to a workforce strategy into the Health and Care Bill?

[Edward Argar]

I am grateful to the hon. Lady for her comments and for highlighting the situation Lynn and Andy find themselves in. What we seek to do, through what I said about care records, is exactly what she and I think they would wish to see, which is to reduce the number of unnecessary or duplicative interactions with the system.

She touches on workforce. I set out in my remarks earlier that since 2010, under this Government, there have been over 30,000 more doctors and 38,000 more nurses. In just the past year, we have seen a huge increase in the number of nurses—I think 11,000—and an increase of about 5,000 doctors. We continue to grow the workforce and we are already working to do so. My right hon. Friend the Member for South West Surrey (Jeremy Hunt), who is no longer in his place, set a lot of that in motion. We have also commissioned from Health Education England and NHS England, now that we have announced their merger, the long-term 10-year workforce strategy, which I look forward to with interest.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering General Hospital and Northampton General Hospital have between them 1,100 beds, 300 of which are occupied mainly by elderly patients who have completed their medical treatment and await discharge either into a care home or a domiciliary care setting. Meanwhile, adult social care is provided by the two unitary authorities, which contract with over 80 different domiciliary care providers. Would the Minister welcome ambitious proposals from Northamptonshire along the lines of those already being pursued by Northumbria Healthcare NHS Foundation Trust, whereby the NHS itself provides domiciliary care? Unless we get those 300 patients into an appropriate setting out of hospital, our hospitals will for ever be clogged up.

[Edward Argar]

I am grateful to my hon. Friend, who quite rightly never misses an opportunity to pay tribute to his local hospital trust. As he knows, I am always happy—as is my hon. Friend the Minister for Care and Mental Health—to hear any ideas for innovation that may improve outcomes for patients and communities.

[Liz Twist (Blaydon) (Lab)]

As we have heard, councils and health service bodies have been taking the opportunity to work together in the absence of Government action. In Gateshead, we have a joint commissioning director for health and care, which has worked out very well. So things have been happening without the White Paper. The key to addressing integration is the workforce. With thousands of NHS vacancies and thousands of social care vacancies, we really need to address that issue. We need a comprehensive, detailed plan on restructuring the social care workforce to ensure it is recognised as much as the NHS workforce.

[Edward Argar]

I am grateful to the hon. Lady, although I am not entirely convinced on her point about the absence of Government action. Yes, co-operation has been happening organically from the ground up, but that has been encouraged and supported by Government action—including various pots of funding, for example relating to discharge during the pandemic—driving that activity and helping to foster that culture of co-operation. She highlights the importance of the workforce and the need for increasing numbers. That is a point I have already acknowledged. I have made clear that the Government have a plan and are already delivering increases in the workforce.

[Richard Fuller (North East Bedfordshire) (Con)]

I welcome the White Paper, not least because we have had to put through a very painful tax increase and want the Government to get on with things, but also because the Minister faces considerable challenges, including demoralising intransigence between competing bureaucracies, a hugely complex task of integrating information systems, and the need to rip up and replace the truly horrendous workforce planning system for change of pay and other conditions, as other Members have said. All those things are going to bog the Minister down, so will he do two things? First, will he set up a special taskforce to look at quick wins to start to deliver improvements? Secondly, reinforcing what my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee said, will the Minister agree to put control of, and full information about, patient records in the hands of patients, so that they can use effective choice?

[Edward Argar]

My hon. Friend is absolutely right. He is, I think, alluding to the fact that quite considerable inputs in the form of taxpayers’ money and resources go into the system. Members sometimes fall into the trap of talking about inputs as the ultimate result, whereas my hon. Friend quite rightly talks about outcomes for patients and ensuring that money is well spent and delivers reform and improved outcomes. That is exactly what this paper is determined to achieve.

On my hon. Friend’s final two points, I will certainly consider taskforces. We have used one on tackling delayed discharge, so I know their value. I also take his point about data, and underpinning that is something that underpins all our work: co-design and doing things with patients, not to them. We must recognise that it is their data and that they should have control of it.

[Margaret Greenwood (Wirral West) (Lab)]

The Minister talks about ICBs, but he knows full well that they are able, under his Bill, to delegate functions and budgets to private providers, which represents a clear Government privatisation agenda.

The Minister talks about transferring skills and knowledge across the NHS, public health and social care, but how will that work in practice? Will the NHS be running training courses for private sector care organisations? If so, why should the NHS hand over valuable intellectual property and spend time gifting it to big business? Will he explain what that will mean for NHS staff?

[Edward Argar]

We have had these debates before. The hon. Lady knows that the pace of privatisation was fastest under the last Labour Government, when the increase in spend on the private sector was much steeper. We have always been clear in our belief in the founding principles of our NHS, which is free at the point of need, but we have also been clear, as have every other Government since the foundation of the NHS, that there continues to be a role for voluntary sector organisations and private sector providers in that context.

On the hon. Lady’s final point, it is important, as in this White Paper, that we bring out the opportunity to help increase knowledge and share skills across the NHS, local authorities and the voluntary sector.

[James Sunderland (Bracknell) (Con)]

Given this excellent statement, it would be remiss of me not to thank the Minister publicly for the decision to retain the Frimley integrated care system, which was absolutely the right thing to do.

Will the Minister outline his plans for lessons from the best-performing ICSs to be shared across all ICSs, so that we can keep costs down and improve efficiency right across the network?

[Edward Argar]

My hon. Friend knows, by virtue of the outcome, the persuasive and compelling case made by him and other right hon. and hon. Members from both sides of the Chamber in respect of Frimley ICS and its boundaries. As so often in this place, my view is, “If you ain’t broke, don’t fix it,” and his ICS is doing a fantastic job and other ICSs can learn from its success. Mechanisms and organisations through which chairs of ICSs get together and share best practice already exist, but we will continue to examine whether that could be better systematised, so that best practice can be disseminated more widely.

[Rachel Hopkins (Luton South) (Lab)]

We have heard already how budgets can be pulled, how place leaders can be appointed and, importantly, how shared outcomes can be set between health and care through our health and wellbeing boards with local authorities. Will the Minister assure me that accountability of the single accountable person will come through democratic structures, such as health and wellbeing boards or local authorities, to ensure that that if the public are unhappy, they can change things by voting them out?

[Edward Argar]

The hon. Lady will know from the debates on the Health and Care Bill that we are moving forward with opportunities for local authorities to be engaged not just at partnership level, as some are already, but more directly with the NHS at the ICB level. Health and wellbeing boards will continue to be a hugely important part of that.

[Kerry McCarthy (Bristol East) (Lab)]

There is a lot of what, to me, seems to be rather mind-numbing jargon in the statement, but only one mention of nurses. Could the Minister tell me—ideally without the jargon—about the impact of the statement on the nursing profession?

[Edward Argar]

As I mentioned in my earlier answers, this White Paper needs to be taken in conjunction with what we announced yesterday in respect of waiting list recovery, the September social care White Paper and, more broadly, our approach to growing our nursing profession, through increasing the skills and numbers in that profession. We are already well on target for 50,000 more nurses in the profession.

This White Paper looks at the specific aspect of the integration of social care and health and permissive ways for local areas to come up with their most effective place-based arrangements, many of which are already in development. It is, quite rightly, not specific about any individual profession, nor do we believe it should be, because it is for local places to develop their own local plans to reflect their local needs.

[Madam Deputy Speaker]

I thank the Minister for his statement.

Covid-19: Military aid to Civil Authorities

Edward Argar Excerpts

Tuesday 8th February 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure, as ever, to service under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this debate, and I pay tribute to him for the manner in which he conveyed some challenging personal experiences on the part of his constituents and others. I will turn first to the situation faced by ambulance services, before clarifying for my hon. Friend that many of the expectations in terms of specialist posts are not realistically achievable within the constraints on the military’s resources.

Ambulance services have faced extraordinary pressures over the past 18 months, and I know that all hon. Members will join me in paying tribute to all the staff for their dedication and hard work. The pandemic placed significant demands on the service. In December 2021, it answered almost 1 million calls—a 22% increase on December 2020—placing significant pressures on ambulances services and the wider NHS.

We know the background reasons for that: infection prevention and control measures, higher instances of delays in the handover of ambulance patients into A&E and, crucially, the staff absence rate. Flow through our hospitals, which is always the key determinant of the ability of ambulance services to offload patients to the safety of A&E, is about the ability of that A&E to either get those patients discharged safely or admitted to hospital. A combination of those factors has placed unprecedented stress on the service and driven increased response times to patients in the community. Despite those pressures, performance for category 1 calls—the most serious calls, classified as life-threatening—has been largely maintained at around nine minutes on average over the last several months, despite a 16% increase in these calls compared with before the pandemic, although we are clear that there has been a significant increase in response times across other categories.

It is exactly because of those pressures that we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to March. All trusts will receive part of this funding, which will increase call handling and operational response capacity, boosting staff numbers by 700. NHS England will also strengthen health and wellbeing support for ambulance trusts, investing £1.75 million to support the wellbeing of frontline ambulance staff during these pressured times. More broadly, NHS England is undertaking targeted support for the most challenged hospitals, where delays are predominantly concentrated, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That includes a £4.4 million capital investment to keep an additional 154 ambulances on the road this winter.

The crux of my hon. Friend’s speech was to acknowledge those pressures and to look to the military, through the MACA system, for further assistance. The scale of the challenge we faced, and continue to face, cannot be overestimated. The UK, like every other country in the world, saw its health systems and capabilities stretched to the limit. As many of our civilian agencies and institutions struggled to cope, we should take great pride in the role our armed forces played in assisting them in responding to the pandemic, reacting with skill and agility. However, we must be cautious about the limitations on the numbers of those who are qualified to drive blue-light ambulances, and indeed clinicians. I have to say that, of the 20,000 personnel my hon. Friend spoke of, only a small proportion would be clinically qualified to assist as paramedics or qualified to drive a blue-light service.

[Chris Loder]

I completely understand some of the difficult points the Minister makes, but does he agree that St John Ambulance has a wonderful suite of resources and could play a much more substantial role in supporting our emergency services?

[Edward Argar]

I will address that point and then return to the military point. I had a very productive meeting with St John Ambulance in the past couple of weeks to discuss exactly that. We should not underestimate the huge role it has already played throughout the pandemic in supporting our ambulance and other emergency services.

[Jim Shannon]

This does not cover the constituency of the hon. Member for West Dorset (Chris Loder), but Northern Ireland has a Territorial Army medical regiment based in Belfast. The majority of people in it are probably NHS staff—they are doctors, nurses or whatever —and that is where their interest in being in the TA comes from. Will there be circumstances on the mainland in which the TA medical corps could be used to our advantage and to address staffing shortcomings?

[Edward Argar]

It is important that we take advantage of all opportunities in terms of those qualified professionals and their ability to support our more regular frontline services.

To pick up on the point raised by my hon. Friend the Member for West Dorset about MACAs and military capacity, a large number of those 20,000 were used for testing and helping to build Nightingale hospitals, and they have recently been helping in vaccine testing centres. However, capacity in terms of, for example, clinically qualified Army medics is limited, and they often already serve in the NHS and in hospitals, so there is not a huge pool to draw on. It is important that we are clear about that. Secondly, I mentioned to my hon. Friend the point about those qualified as blue-light drivers. Again, that is not all the 20,000 or anywhere near. We have to be—realistic is the wrong word—careful in our expectations of the capacity to support specific requests, such as the specific types of support that his ambulance service put in for.

More broadly, considerable support has been offered by the military for tasks such as logistics, which my hon. Friend highlighted—for example, in supporting the ambulance service in a range of roles. Currently, the Ministry of Defence provides support to ambulance services in the following ways: 366 personnel in a range of roles, including non-driving roles; 96 personnel continuing non-blue-light ambulance driving support for the Scottish Ambulance Service; and 313 personnel in driver support to the Welsh ambulance service.

My understanding of the specific matter to which my hon. Friend referred is that it was incorporated into the broader request for ambulance drivers between 10 and 31 August last year. The element of that request to be granted was the 28 category C drivers who were provided by the Ministry of Defence. However, I come back to the point that, while he is right that the military are always there to assist us in times of need, we equally need to be realistic about their capacity in specific places.

[Chris Loder]

I appreciate the Minister’s candour. I respectfully remind him that the fundamental issue is that we have constituents—patients—who are in great difficulty for a long time. I fully appreciate the many pressures that he outlined, but what I am looking to achieve through the debate, especially for those families and individuals who have gone through painful experiences —I hope the Minister can help me a little further with this—is that we do not get into this position again, with constituents on their own waiting for such a long time.

[Edward Argar]

My hon. Friend will have heard me set out exactly how we have done that with the extra investment in our ambulance services. That is the key—to reinforce the strength and resilience of our existing ambulance service provision. He is absolutely right to highlight the impact—the patient and familial impact—of long waits for an ambulance, but the real answer is the measures that we are taking to invest in the ambulance service, with the £55 million more, the investment we put into hospitals to ensure that they were ready for winter, and the broader funding across the piece for our healthcare system to strengthen it further. Today, we saw another element of that package in the announcement of waiting list recovery and how we intend to approach that.

My hon. Friend is absolutely right to highlight the military. In extremes, they are there to help in very specific and pressured circumstances, but they are not the solution to the problem in the long term or to avoiding the challenges recurring. That is why we have our plan not only for the ambulance service, but for improving urgent and emergency care. We saw £450 million invested in that over the past 18 months or so to improve A&Es across the country, helping them to function more effectively, in particular in the context of IPC—infection prevention and control—measures. More broadly, we are investing in our acute hospitals to allow for the flow of patients out of A&E and into the hospital or, we hope, home. That is the key to solving this.

[Chris Loder]

I am pleased that the Minister highlighted that. I highlight and thank him again for the £65 million that the Government have dedicated to Dorset County Hospital to address that very difficulty.

[Edward Argar]

I am grateful to my hon. Friend. He is right to highlight that, not least because of his role in continuing to argue for it and in supporting Dorset hospitals in that context.

The military have done, and continue to do, a fantastic job in the context of this pandemic. However, as I say, the key to this issue is long-term investment, which is exactly what we are putting in place. I am very conscious of the challenges faced by all ambulance services over the winter, but I know that my hon. Friend’s local ambulance trust faces specific challenges of geography, distance and location of hospitals, which can be difficult for it on occasion. I appreciate the particular complexities of the system in the south-west, and we continue to work closely with the local system, but also with the military where appropriate, to see where they can support us and help add additional resilience into the system.

However, there is no substitute for the investment we are putting into making those systems more resilient in the long term, the need for which my hon. Friend has highlighted again today. We continue to focus on outcomes for patients—which is, I think, exactly where he is coming from—to avoid or reduce the risk of people having to wait a long time for an ambulance in very challenging circumstances. Tackling and improving the performance of our ambulance trusts remains a high priority in my ministerial inbox. That is in no way a criticism of the amazing work their staff are doing, but they face significant challenges. We continue to focus on those, and I look forward to working with my hon. Friend and his colleagues in Dorset to meet the challenges in the south-west.

Question put and agreed to.

Elective Care Recovery in England

Edward Argar Excerpts

Monday 7th February 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the publication of his Department’s plan for elective care recovery in England.

[The Minister for Health (Edward Argar)]

The covid-19 pandemic has had a huge impact on healthcare systems everywhere. The NHS has performed incredibly, caring for covid and non-covid patients alike and delivering the vaccination programme that has helped us to open up this country once again. Throughout the pandemic, we had to take steps to ensure that we could treat those with the greatest clinical need and that we provided a safe environment for those who needed covid care.

As a result, there is undeniably a huge covid backlog that needs urgent attention. The number of people waiting for care in England now stands at about 6 million, and we know that that figure will get worse before it gets better. Furthermore, our best current estimate is that about 8.5 million people who would normally come forward for treatment have not done so during the pandemic. However, we are pulling out all the stops to help the NHS recover and ensure that patients are receiving the right care at the right time.

Hon. Members will be aware that the Government will have invested more than £8 billion in the NHS in the three years from 2022-23 to 2024-25. As part of the new health and social care levy, we will be putting huge levels of investment into health and social care over the coming three years, and all the time we are announcing new solutions to the problem of how we can ensure that the NHS is on the firmest possible footing for the future.

On Friday we launched a call for evidence that will inform an ambitious new vision for how we lead the world in cancer care. As the Prime Minister announced earlier today, we are setting out some tough targets for the NHS on cancer. We want to ensure that 75% of patients are diagnosed or have cancer ruled out within 28 days of a GP referral, and to return the backlog of people waiting more than two months for their cancer treatment to pre-pandemic levels by March 2023. Today the NHS has also announced the launch of a new platform, My Planned Care, which will provide patients and their carers with relevant and up-to-date information ahead of planned treatment, including information on waiting times for their provider.

I am under no illusions about the fact that our health system is facing an enormous and unprecedented challenge. That is why we are doing everything in our power to support the NHS and its patients, recovering services to reduce waiting times and deliver more checks, operations and treatments. We are faced with a once-in-a-generation challenge. We know that we must get this right. We are working with the NHS and across Government to deliver a targeted and far-reaching plan for elective recovery, and we will update the House at the earliest possible opportunity.

[Wes Streeting]

Thank you for granting the urgent question, Mr Speaker.

This is not a covid backlog; it is a Tory backlog. We went into the pandemic with NHS waiting lists already at a record 4.5 million, and now 6 million people are waiting on those lists—more than ever before. More than 1 million are waiting for scans and tests used to diagnose cancer, and the NHS itself is waiting—waiting for the Government’s plan to deal with the backlog. So where is it? It was due to be published today but was pulled last night. It is like something from “The Thick of It”, but the reality is worse than fiction—a photo op without a plan; the Government’s own NHS recovery plan just another cancelled operation. But there is no need to worry, because there is a website coming that will tell people that they are waiting a long time, even if there is no plan to ensure that they do not-.

Then there is the “reason” for the delay. Briefings from the Department for Health and Social Care claimed that the Chancellor had blocked the plan. As one Government official said,

“it’s pretty obvious it’s about Treasury reluctance to rescue the PM”.

Is this where the shambles of the Conservative party is taking us? Is the Chancellor seriously playing political games while 6 million people wait for care? No wonder the Health Secretary has not bothered to show his face this afternoon. He is probably still recovering from the embarrassment of this morning’s media round, where the big announcement was literally that there was no announcement. So it has been left to the Prime Minister to clear things up, which tends to go almost as well as breakfast television with the Culture Secretary. No wonder she has been dispatched to the middle east.

Let me turn to the “tough targets” that the Minister mentioned. Today the Prime Minister announced a new target that no one should wait longer than two months for cancer diagnosis, but there is already a target for the vast majority of cancer patients to be treated within two months of referral, and it has not been hit since 2015. Is this not just another example of the Conservatives lowering standards for patients because they consistently fail to meet them? The Prime Minister has also announced that three out of four patients should receive a cancer diagnosis within 28 days, but that is an existing target that was introduced last April and has never been met.

The waiting list crisis is the chickens coming home to roost after more than a decade of Tory failure. The Treasury blocked a plan for staffing and it is now blocking the plan to cut waiting times. Is it not now clear, amid the chaos, confusion and spectacular incompetence on display, that the longer we give the Conservatives in government, the longer patients will wait?

[Edward Argar]

I am grateful to the shadow Secretary of State. As he said, 2 million of those on the waiting list have entered that waiting list since the pandemic began. There is undoubtedly a huge covid backlog, as we had to put in place infection prevention and control measures and ensure the availability of beds for those with covid. I am with him, I suspect, on at least one point, which is that I, like him, entirely understand the impact that this has on people’s lives, their anxiety and their health outcomes. That is why this Government are determined to tackle that waiting list. As I said, this is a once-in-a-generation challenge and it is absolutely right that we make sure we get the plan right. We need to ensure that we have the right plan, delivering the right outcomes.

The hon. Gentleman mentioned delays, and I have to say that this plan is delayed. This is a plan we anticipated publishing in December. The reason that we did not do that was because of the omicron variant and the impact it has had on our health services over the winter. We have made sure that we get this plan right.

The hon. Gentleman also mentioned Her Majesty’s Treasury. I have to say, speaking as a Minister in the Department of Health and Social Care, that we could not wish for better partners than Her Majesty’s Treasury and this Chancellor. They have shown strong support to our health and care system throughout the pandemic, with record levels of funding to support it through the pandemic and to help performance to recover subsequently.

Even before the pandemic, when the current Secretary of State for Health was Chancellor, this Government had already put in place a £33.9 billion increase in funding, enshrined in law. It was one of the first pieces of legislation passed by this Government after the election. We have also set out our long-term funding plans through the health and care levy, which I recall the hon. Gentleman’s party did not support.

[Sir Peter Bottomley (Worthing West) (Con)]

We are grateful to the Opposition spokesman, the hon. Member for Ilford North (Wes Streeting), for his sub-leadership bid in raising this important topic. I say to the Minister that today was not an unusual day, in that a constituent wrote saying that she had nothing but praise for the hospital treatment she was getting. Can I pass on my thought, which is that instead of using the word “elective” we should use the words “planned care”, as my hon. Friend did in his response? Through him, I also remind the House that two years into the last Labour Government there was an edict saying that no hospital could do elective care—planned care—until two years past the time when it was booked. Things are much better now and most of us are grateful.

[Edward Argar]

I am grateful to the Father of the House, who once again brings his typical wisdom and experience in this House to our deliberations in the final point that he makes. He is absolutely right. I am happy to join him and his constituents in expressing gratitude to all those who work in the NHS for the work they have been doing throughout the pandemic and that they do every day, irrespective of the pandemic. I know that those on both sides of the House will share in that. The term “elective” is a technical term used within the NHS, but I take his point that it is easy for us in this House to use the technical terms used within our Departments or in the system, but that it is often helpful if we talk in rather more simple terms that mean something to all our constituents.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

As a survivor of breast cancer that was treated in 2019, I was grateful to be seen within 10 days of the referral by my GP and to start treatment within a month. It is frightening that in the months between April and November last year over 90,000 women who might have breast cancer were not seen by a specialist within the target of 14 days of being urgently referred by a GP, and that this year half a million people with suspected cancer will wait longer than the supposed two-week maximum to see an oncologist. The Minister will know that an early diagnosis can be life-saving. What does he think the impact for potential cancer patients will be of the delay to the NHS recovery plan when waiting times are spiralling so much?

[Edward Argar]

The hon. Lady and I often exchange views across the Dispatch Box, and she always asks sensible and reasonable questions. She is right to highlight the importance of cancer care, and that there are some illnesses and diseases like cancer where delay can have a significantly detrimental impact on the outcomes experienced by patients.

Between March 2020 and November 2021, more than 4 million urgent referrals were made for cancer, and over 960,000 people received cancer treatment. Thanks to the amazing work of NHS staff, we maintained cancer treatment at 99.7% of pre-pandemic levels in the latest month for which I have statistics, which is November 2021.

As well as looking to the future with the announcement of community diagnostic hubs and a range of other measures, the plan is not necessary for us to do the work, as we are already doing it. The plan is important for mapping out the future direction of care, but we are not waiting for the plan to improve services, to build back better and to tackle the waiting lists.

[John Redwood (Wokingham) (Con)]

If the Treasury was not holding up the plan, can we be told what was holding it up? When will we get the plan?

[Edward Argar]

I am grateful, I think, to my right hon. Friend for his question. As I set out, it is important that this is the right plan and that it does the job for which it is intended. We are working closely with other Departments to make sure the plan, when it is published, does the job for which it is intended, and I look forward to its imminent publication.

[Grahame Morris (Easington) (Lab)]

It is essential that we address cancer treatment capacity. The Minister talks about diagnostics, which is important, but it is a horse and cart or a hand and glove. I know he is aware of the enormous unharnessed potential of high-tech radiotherapy as a solution to time-critical cancer backlogs, but it still receives only 5% of the cancer budget. Such investment could take enormous pressure off the NHS, especially at this time. Will he arrange a meeting with the Secretary of State so that we can explain to him the important role that advanced radiotherapy could play in tackling the cancer backlog?

[Edward Argar]

The hon. Gentleman and I have previously met to discuss this issue, and I share his view on the value of radiotherapy in helping to tackle the cancer backlog, and more broadly as a treatment. Ministers and I are always happy to meet him.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

My hon. Friend spoke earlier of this Government’s record level of investment in the NHS, but each patient waiting for cancer treatment is undergoing a very long and frightening experience as they wait longer than needed. As he focuses on reducing this backlog, how will he ensure that the record level of investment is focused directly only on measures that will reduce the backlog and is not wasted?

[Edward Argar]

My hon. Friend knows of what she speaks, as a serving consultant in our NHS. She is right that investment is important but that the outcomes are what really matter. We have set out measures such as the community diagnostic hubs, which are bringing diagnostic capacity to local communities and making it more accessible. That is just one example of how we will ensure that the money delivers the required outcomes.

[Daisy Cooper (St Albans) (LD)]

Health conditions do not wait until a medic or a bed is available. They deteriorate, often very quickly, and every single one of the 6 million people on the waiting list will have to rely on their GP for extra appointments and extra treatment, and they will possibly rely on their GP to deal with severe complications. What support will there be for primary care while all these people are waiting for their planned secondary care?

[Edward Argar]

The hon. Lady makes a very important point, and I take this opportunity to put on record my gratitude to all those in general practice for the amazing work they have been doing over the past two years. Again, they are the front door to the NHS for patients and all our constituents. Last year we set out the additional funding being made available to help general practice recover from the changes that had to be made during the pandemic, and we continue to look at the system as a whole, not in its component parts. She is right that general practitioners are often the people our constituents go to if their operation is delayed or if they need additional care while waiting for an operation, so it is important that we provide support to general practice, too.

[Dr Jamie Wallis (Bridgend) (Con)]

Given that health service waiting lists are higher in Labour-controlled Wales and that my Bridgend constituents are being told that they are going to have to wait until at least 25 March to find out what Labour’s plan is in Wales, does my hon. Friend agree that much of what the Opposition have said here today would be better directed down the M4 towards their Welsh Labour colleagues?

[Edward Argar]

I am grateful to my hon. Friend, who puts his finger on an extremely important point. I believe that one in five in Wales is on a waiting list. This Government have put in place measures already to help bring down waiting lists, and the plan is due to published imminently, but we are still waiting to see what the Welsh Government intend to do—or whether they even have a plan.

[Chris Bryant (Rhondda) (Lab)]

May I urge the Government to abandon this talk of a “war on cancer”? It was Richard Nixon’s term and it was thought to be outdated back then. To many people, when Ministers talk about fighting cancer and how somebody has been particularly plucky or courageous for fighting cancer, it feels as though they are telling off the people who do not survive for not being courageous enough. I know that that is not what anybody means, so may we completely change that language? As I understand it, the Prime Minister has also announced another cancer target today: to get to 75% of all cancer diagnoses being made at stage 1 or stage 2. How on earth is he intending to get to that?

[Edward Argar]

I am grateful to the hon. Gentleman for his remarks. He speaks often on this topic from experience, and it is right that we listen carefully to him. I take his point about the importance of language and how different terms and approaches to it will be interpreted by people who are undergoing treatment or a diagnosis for cancer, and I take the point in the spirit in which he meant that observation. On the Prime Minister’s target, the Prime Minister is unapologetically ambitious in seeking to tackle waiting lists and improve performance on cancer care. That is why we are investing record levels in our NHS and bringing forward new diagnostic hubs. It is also why the hon. Gentleman will see measures in the plan, when it is published imminently—coupled with the plan that the Secretary of State set out on Friday—that will help to reassure him, but I am always happy to talk to him about these issues.

[Mr Andrew Mitchell (Sutton Coldfield) (Con)]

My hon. Friend is surely absolutely right, first, to prioritise this vital catch-up programme for our constituents and, secondly, to ensure that we deliver real value for money. At a time of high taxation overall, my constituents want to ensure that for every pound of hard-earned taxpayers’ money spent on this vital programme they are really getting 100p of value as a result in delivery. I assume it is for that reason that this programme is slightly delayed.

[Edward Argar]

The reason this plan is delayed is, as I have alluded to, the omicron variant and the impact it had on our NHS. My right hon. Friend makes an important point about our prioritising tackling waiting lists and waiting times. He is also absolutely right: this is a once-in-a-generation challenge, and it is right that we get the right answer—the right outcomes for patients and for taxpayer. That is what we will do with this plan.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

These waiting times are misery, pain, frustration and agony for my constituents, and then there is the mental anguish of not knowing what is happening or going to happen. I have constituents who are begging and borrowing the money to go private because they cannot stand the pain. Is that the Minister’s plan for the NHS: driving people into the private sector? If it is not, what is his plan?

[Edward Argar]

The hon. Lady is right in some of what she says. We can all appreciate what she says about the impact that a wait for treatment can have on those waiting, in terms of health outcomes and, as she rightly mentions, challenges for people’s mental health as they worry about their diagnosis or when they are going to receive the treatment they need. That applies not only to those who are diagnosed with a life-threatening condition, but to those who have a life-limiting condition or who need orthopaedic surgery, eye surgery or similar, where it has an impact on their quality of life, their ability to work and so on. She makes an important point about that.

As I have set out to the House, we have already made significant strides, as we have come out of this pandemic, in setting out—through the community diagnostics hub and through our approach to surgical hubs—how we can rapidly ramp up the number of planned surgeries that are undertaken. We have to be honest with people that that list will get worse before it gets better, because people who have not come forward will do so. Equally, the golden thread running through is our NHS workforce, and we have to recognise that the people who will be tackling this waiting list are the same people who were working flat out through the pandemic. We have to make sure we give them the space and the support to recover physically and emotionally.

[Holly Mumby-Croft (Scunthorpe) (Con)]

I thank my hon. Friend for his work on this matter. He will know that in order to tackle waiting lists, our NHS staff need the very best buildings and equipment. We have seen some fantastic investment in Scunthorpe General Hospital, but will he meet me to discuss our plans for a longer-term investment in and upgrade to the hospital?

[Edward Argar]

My hon. Friend is a champion in this House for Scunthorpe General Hospital, and since her election she has never ceased to lobby, politely but firmly, on its behalf. I am delighted to agree to meet her.

[Clive Efford (Eltham) (Lab)]

If we are going to deal with this backlog, we need to deal with vacancies in the NHS. That means we do not have time to wait for doctors and nurses to be trained; we need qualified staff now. Can the Minister say where he is going to get those staff? Is he looking abroad? Where is he going to find them?

[Edward Argar]

The hon. Gentleman makes a sensible and serious point. As I said earlier, it is about the workforce. Buildings and technology are fantastic, but it is the people who operate them who really make the difference. I can offer him the reassurance that we are already well on target to meeting our 50,000 nurses pledge from the 2019 manifesto. In October 2021 there were thousands more doctors and thousands more nurses in our NHS compared with October 2020. We continue to grow that workforce from a whole range of sources, including the additional medical school places that this Government delivered a few years ago.

[Steve Brine (Winchester) (Con)]

There is no question but that the waiting list is impacting on my constituents’ quality of life, but I fail to see how taking £36 billion out of the system would help. Can I ask my hon. Friend to look further upstream and tell me how the very welcome 10-year cancer plan announced on Friday will improve our health and prevent more complex future interventions? Will he confirm that the 28-day cancer standard, which does sound familiar—I left office three years ago next month—is a maximum, not a target? In other words, we always want to do much, much better, because we know that the quicker cancer is caught, the better the outcome.

[Edward Argar]

I am grateful to my hon. Friend for touching on the 10-year cancer plan. He is absolutely right that the earlier the diagnosis, the better the outcome, as a rule, in cancer treatment. Yes, we set targets, but we always hope to exceed them. It has been incredibly challenging to do that over recent years, and that is why we as a Government are not only investing the resources, but putting in place the reforms that are needed to achieve these targets.

[Kim Johnson (Liverpool, Riverside) (Lab)]

I start by thanking all the NHS workers, who have done a tremendous job throughout the pandemic. My mum has been waiting for shoulder replacement surgery for more than two years, and the delay in this plan means that she will live with excruciating pain. Can the Minister give us assurances that this backlog will be dealt with in a timely fashion, and that that work will be adequately resourced and funded?

[Edward Argar]

I join the hon. Lady in gratitude towards all those working in the NHS. I am sure that every Member of this House will receive correspondence from constituents who are in the position she outlined. Understandably, they will be distressed and often in pain. This plan is not a necessary precursor for work to be done to bring that waiting list down and get it under control; such work is already under way. As I said, not only is record investment in resources going into it but, while the Government focus to a degree on that, we also focus on what that taxpayers’ money does in delivering outcomes for people—hence why we have already announced the community diagnostic hubs and set out plans for surgical hubs. We are very grateful to all the charities and campaigning organisations that have, over recent months, engaged with us to help to advise on interventions that they think can make a genuine difference to waiting lists, but also to keeping patients informed and supported while they do wait.

[Dr Julian Lewis (New Forest East) (Con)]

How much greater would the backlog be if we had not successfully resisted the entreaties of those modellers, and indeed politicians, who wanted another shutdown over the Christmas period?

[Edward Argar]

It is always hard to prove a counterfactual, as my right hon. Friend will know, but we do know that the necessary measures we took during the pandemic to help to tackle this dangerous virus inevitably had a significant impact on waiting lists. Due to infection prevention and control measures and a range of other things, normal levels of surgery and planned surgery were not able to go ahead. He may be able to extrapolate from that, but, as I say, it is slightly difficult to come up with a detailed counterfactual.

[Mr Toby Perkins (Chesterfield) (Lab)]

My mother died prematurely of lung cancer in her early sixties, so I know, as many others in this House do, that when it comes to cancer, waiting times do not just inconvenience; they literally mean the difference between life and death. I agree with the Minister that this is about not just investment but outcomes, and it is purely on outcomes that this Government are failing. Does he agree that the briefings from his Department suggesting the political games at the top of the Conservative party—“Who’s up, who’s down, who’s going to be the next leader?”—are influencing and impacting on the Government’s ability to get this plan out, and that that will not be forgiven by those people who are waiting for cancer treatment right now?

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Gentleman for his willingness to share with the House his personal experience in respect of his mother. I think that in doing so he probably speaks for a number of Members of this House, and certainly a number of our constituents. He said it is important that we focus on cancer, and he is absolutely right. Clinical prioritisation will be a key part of how we address bringing the waiting lists down, because it is right that we focus on the illnesses and diseases where the longer the delay, the greater the risk of not making a full recovery or of a negative outcome. He is right to highlight the focus on cancer as on certain other key areas. On his final point, I do not share that view. I believe it is right that we get this plan right so that it delivers the outcomes we need. As I have said to a number of hon. and right hon. Members, I do not believe that the plan is a necessary precursor for getting on with taking a number of steps, as we have done as a Government, to start to bring the waiting lists down.

[Mark Pawsey (Rugby) (Con)]

Does the Minister agree that there must be an important role in this programme for smaller hospitals such as St Cross in Rugby, where on a recent visit I saw some brand new operating theatres providing important extra local capacity?

[Edward Argar]

I am grateful to my hon. Friend for his shout-out for his local hospital. He is absolutely right: we need to utilise the resources and the capacity of the whole system, and this is the approach we are adopting. Often, the debate can focus on the large, acute district general hospitals, but he is absolutely right that smaller hospitals, community hospitals and indeed community facilities all have a part to play in helping to tackle this waiting list.

[Carol Monaghan (Glasgow North West) (SNP)]

Long delays in diagnosis and inappropriate and sometimes outdated treatment are typical for those living with the condition ME. As chair of the all-party parliamentary group on ME, I was pleased to see the new National Institute for Health and Care Excellence guidelines on treatment of the condition. Can the Minister detail what steps are being taken to implement those and to ensure speedy diagnosis and appropriate treatment?

[Edward Argar]

The hon. Lady raises an important point. I know that the House is grateful for her work on this important issue. She highlights the NICE guidelines, which are an important step forward. We continue to work with NHS England on how to most effectively ensure that patients with ME get the early diagnosis and treatment that they need. I or the relevant policy Minister will be happy to meet her to discuss progress and her and the APPG’s thoughts and ideas in that space.

[Mr Peter Bone (Wellingborough) (Con)]

The Minister is right in what he says again and again. I remember a few years ago, a close relative had liver cancer. They went to see the consultant and were given a one in three chance of surviving but managed to pull through. At the same time, another Government plan for the NHS was announced. I said, “What about that?”, and they said, “Well, we just ignore it, because they’ll change it again in a few years. What we actually do is get on and do best practice now.” I think what the Minister is saying is happening at the moment. What the Government could do in the plan is cut red tape in the NHS, which might speed up the construction of the hospital that we need in Kettering, which is so welcome.

[Edward Argar]

I am grateful to my hon. Friend not only for his well-timed plug for his local hospital in Kettering but for his important point. The NHS and the Government have been getting on with improving things and trying to bring service levels back to pre-pandemic levels. Notwithstanding his comment about plans more broadly, it is important for us to have a clear long-term strategic approach to it, because the sums of money involved are significant. The waiting lists and the impact on those are significant. It is right to ensure that we have a clear plan and clear metrics to show how that public money will deliver the outcomes that we all want to see delivered and that those patients want to see.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

Waiting lists for joint replacements are at a record high. I have been contacted by dozens of constituents with arthritis who are waiting in a lot of pain. What can the Minister say specifically about joint replacements to the more than 600,000 people who are waiting for them nationally? Has he met Versus Arthritis about the issue?

[Edward Argar]

The hon. Lady makes an important point. Orthopaedic surgery, for want of a better way of putting it, is a hugely important part of the planned care and surgery that the NHS does. Although it does not have a direct impact on someone’s life chances in the same way that oncology does, it certainly affects their quality of life and their ability to enjoy it. I hope that I can give her some good news: I believe that I am due to meet Versus Arthritis, with which I have spoken in the past, later this week to discuss its work in this space and its ideas on how we can incorporate that in our work.

[Alun Cairns (Vale of Glamorgan) (Con)]

One in nine people in England are on a waiting list, which is clearly too high. I take confidence from my hon. Friend’s statement and the constructive tone with which he is responding. The figure in Wales is one in five. Does he share my disappointment and dismay at the tone that has been taken by the shadow Front-Bench team in particular, when waiting times in Wales are much longer and the number of people waiting is much higher?

[Edward Argar]

My right hon. Friend makes an important point, which was made by my hon. Friend the Member for Bridgend (Dr Wallis) earlier. I am sure that the shadow Secretary of State will be asking his colleague in the Welsh Government where their plan is.

[Munira Wilson (Twickenham) (LD)]

The Minister will be aware of the shocking 77% rise in the number of children needing specialist mental health care for suicidal thoughts and self-harm between 2019 and 2021. Headteachers in my constituency cite that as a No. 1 issue, but their staff simply cannot cope with the numbers and severity of need. Parents are beside themselves as their children in crisis are sometimes waiting a year to access treatment. As it is Children’s Mental Health Week, will the Minister make a commitment to children, young people and their parents up and down the country that children’s mental health will be an urgent priority alongside all the urgent operations that need to be done?

--- Later in debate ---

[Edward Argar]

Since the hon. Lady was elected, she has had a long track record of interest and campaigning on that issue. She is absolutely right to raise children’s mental health. Before I was a Minister, I took a close interest in eating disorders, which are an element of that—I worked with Beat the eating disorder charity—and in the challenges that parents face in getting access to child and adolescent mental health services for a first consultation and for the required treatment. I absolutely reassure her that mental health, including children’s mental health, remains a priority for the Government.

[Henry Smith (Crawley) (Con)]

I very much welcome the record high levels of funding the Government are putting into the national health service and the rolling out of rapid-diagnostic centres throughout the country. May I seek an assurance from the Minister that the diagnosis and treatment of blood cancers will be a key element of that rapid diagnosis?

[Edward Argar]

I can give my hon. Friend that reassurance. The clinical decision making will rightly inform the approach we adopt to the diagnosis and treatment of cancers, as my hon. Friend would expect, but he is absolutely right that we cannot neglect blood cancer in that context, and nor will we.

[Rachael Maskell (York Central) (Lab/Co-op)]

The elective recovery fund had perverse thresholds written into it, so those hospitals that really struggled and battled with the pandemic were the very ones that did not get any money. Will the Minister ensure a fair distribution of funding in his plan, so that hospitals such as my local one in York that are still battling with very high levels of covid get the resources they need?

[Edward Argar]

I am happy to reassure the hon. Lady that our approach, and that of NHS England and Improvement, is designed to ensure that all hospital trusts can make progress—hopefully rapid progress—in tackling their waiting lists and get the resources they need to do that.

[Jacob Young (Redcar) (Con)]

A key way in which we could get more money directed towards frontline services and elective care would be to fix Labour’s disastrous private finance initiative deals. Will the Minister meet me and the South Tees Hospitals NHS Foundation Trust so that we can look into how we can fix Labour’s PFI debt at hospitals such as the James Cook?

[Edward Argar]

My hon. Friend is right to draw attention to the huge financial challenges that trusts were saddled with following Labour’s PFI deals and I am of course delighted to agree to meet him to see what we can do to try to untangle the worst of them.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his answers, which reflect the fact that he understands the need to do better and wants to improve. Will he outline what discussions have taken place among the devolved Assemblies and the Government here to prevent healthcare from becoming a postcode lottery in the UK? Does he acknowledge the fact that, although waiting lists for appointments were worsened by the covid crisis, they were poor beforehand, so all regions need to work together to address the issue of recovery?

--- Later in debate ---

[Edward Argar]

I am being open and honest at the Dispatch Box about the scale of the challenge and about the challenge for us in tackling it, and the hon. Gentleman is right to highlight that. In respect of the devolved Administrations, I regularly speak to—I would like to meet in person but we regularly meet remotely—the Northern Ireland Health Minister, Robin Swann, whose work in this space I pay tribute to. We talk about a range of issues, not just waiting lists and the impact of covid, but the hon. Gentleman is absolutely right and I am always happy to have conversations with my opposite numbers in the devolved Administrations.

[Tom Hunt (Ipswich) (Con)]

I appreciate the fact that 2 million people have been added to waiting lists throughout the pandemic—it is foolish to try to pretend that that has not made a big difference—and I also appreciate the Government’s £12 billion-a-year plan to help to address the situation. Needless to say, many of our constituents continue to wait in pain for elective surgery, including hip and knee replacements. The Minister will know my views about orthopaedic services in Ipswich and some of the concerns I have had about the new centre in Colchester. It could be that the increased capacity in Colchester cuts waiting times, but there is still an issue about people getting to Colchester so that surgery can take place. Will the Minister meet me to update me on how he is ensuring that Ipswich people are at the heart of all future developments when it comes to the hospitals trust?

[Edward Argar]

I am always happy to meet my hon. Friend. Following his election in 2019—a fantastic result in Ipswich—he was one of the first new colleagues I was able to visit and, with him, I saw Ipswich Hospital for myself. He makes an important point: in looking at the healthcare system in Ipswich and Colchester, it is important that we ensure that the people of both Ipswich and Colchester get access to the best possible facilities, which is exactly what my hon. Friend campaigns for.

[Selaine Saxby (North Devon) (Con)]

I thank the Minister for the work he and his Department are doing to support our NHS. Can he confirm that the 100 new community diagnostic hubs will speed up referrals processes, particularly in coastal communities with historically poorer health outcomes, ensuring that residents receive diagnoses and treatments swiftly?

[Edward Argar]

My hon. Friend is exactly right in what she says. The whole purpose of these community diagnostic hubs is to bring cutting-edge diagnostic facilities to the heart of our towns, our rural communities, our seaside communities and our cities to make it much easier for people to access the diagnostic tests they need.

[Duncan Baker (North Norfolk) (Con)]

Cromer Hospital is the jewel in the crown of our hospital facilities in North Norfolk, but as my hon. Friend will know, it is 25 miles from the nearest main hospital, the Norfolk and Norwich, and I have many older residents. Will he meet me to discuss the viability of an urgent treatment centre? That would not only be a huge benefit to my demographic, but would go hand in hand with tackling the elective backlog.

--- Later in debate ---

[Edward Argar]

I am always cautious to caveat any example with “subject to funding available and Her Majesty’s Treasury”, but I am always happy to meet hon. and right hon. Members to discuss their ideas in respect of their local communities and the services those communities need, because it is hon. and right hon. Members who know their communities best.

[Ruth Edwards (Rushcliffe) (Con)]

I draw the Minister’s attention to an exciting new proposal for a model surgical hub in the east midlands, which would tackle the backlog by focusing solely on elective surgery. The plan is being developed by surgeons in Derbyshire, Nottinghamshire and Leicestershire, including my constituent Dr Tony Westbrook. Will the Minister join me in welcoming this innovative plan and thanking everyone involved in drawing it up? Will he join me in calling on regional health authorities to give it serious consideration?

[Edward Argar]

My hon. Friend makes an important point. What we have seen throughout this pandemic, and we continue to see it now as we look to tackle the waiting lists, is people across the health and care system innovating and coming up with exciting new ideas and new ways to achieve the outcomes that we desire. I will certainly look into the specifics that she talks about, and I congratulate all those involved on their willingness to innovate and come up with new ways of doing things.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

I welcome today’s statement, and I take this opportunity to thank all those healthcare workers who have worked on the frontline throughout the pandemic, particularly nurses, who have worked so hard to keep services operating. I am therefore reassured that we have seen a 21% increase in nursing applications in the past year alone. Will my hon. Friend confirm first that that will help us meet our manifesto commitment to recruit 50,000 extra nurses, but, more importantly, that it will help make their lives easier by reducing their workload somewhat?

[Edward Argar]

My hon. Friend is right on a number of counts: first, to pay tribute to the work of nurses up and down the country during this pandemic; and, to highlight the significant progress we have made on the trajectory to meeting our 50,000 nurses manifesto commitment. The reason we made that commitment is exactly as he says: we know we need more nurses in the NHS, and we are committed to recruiting them, which will have a positive impact on all those already in our NHS as they are joined by many newly qualified professionals to help share that load.

[Scott Benton (Blackpool South) (Con)]

Blackpool was one of the first areas to receive additional funding to tackle the NHS covid backlog, and this funding is already making a difference on the ground for my constituents. When further moneys are allocated, will the Minister commit to prioritising those areas, such as Blackpool, that have some of the worst health outcomes in the entire country?

[Edward Argar]

My hon. Friend is a strong champion and a strong local voice for Blackpool in this House. We are clear in this Government that in the investment decisions we make, we are committed to making sure that we level up across this country and that that money goes to where it can make the greatest difference in improving outcomes for all patients and all those who use our NHS.

Covid-19: Purchasing Effort

Edward Argar Excerpts

Thursday 3rd February 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

With permission, Mr Deputy Speaker, I will update the House on our purchasing efforts in response to the covid-19 pandemic.

A little over two years ago, we and the whole world found ourselves in unprecedented circumstances. We were faced with a virus about which we knew very little, but we knew from day one that our absolute priority was to save lives and protect our most vulnerable. Throughout the pandemic we have worked night and day to make sure those performing heroics on the frontline have the protection they need. This includes making the tough but necessary decisions needed to keep the country safe.

With the pandemic pushing health systems across the world to breaking point, we acted quickly and decisively to protect the NHS and to help it continue providing world-class care to the public. In a highly competitive global market, and with many countries imposing export bans, we were none the less able to secure the personal protective equipment needed. We secured billions of items of PPE, we obtained 30,000 ventilators by the end of June 2020 and we delivered more than 17.5 billion items to protect our frontline workers.

The supply of these vital items helped to keep the NHS open throughout the pandemic, but the scale of the challenge we faced in sourcing them should not be underestimated. The unique and unprecedented situation during the early days of the pandemic led to huge inflation in prices and intense global competition to secure scarce supplies. For instance, the average cost of nitrile gloves increased over sixfold at the height of the pandemic, compared with pre-pandemic levels.

At that time of national emergency, when lives were on the line, we simply had to change our approach to procurement and our appetite for risk. We had to balance the risk of contracts not performing and supplies being priced at a premium against the risk to the health of frontline workers, the NHS and the public if we failed to get the PPE we so desperately needed.

We make no apology for procuring PPE at the pace and volume we did, based on the information we had at the time. The action we took protected thousands of frontline healthcare workers in the NHS and social care. However, now that the world market for PPE has stabilised, the value of some categories of goods is inevitably much lower than the price at which they were originally purchased.

I reinforce to the House that 97% of the PPE we ordered was suitable and fit for use, with only a small proportion deemed unsuitable, and we are actively seeking to recover costs from suppliers wherever possible in those cases. Throughout the pandemic, the Department’s anti-fraud unit acted quickly to investigate all allegations of fraud, and we will be looking to recover any money for damaged or inadequate stock.

We are now in a position where we are confident that we have sufficient stock to cover all future covid-19-related demands, even in the face of the omicron variant. The PPE stocks we secured allowed us to meet demand through 2020-21 and 2021-22, and our existing PPE stocks will continue to support us throughout 2022-23.

We will keep working to maximise value from our stockpile, as the high standards of protection we have set for NHS workers mean that some of it may be able to be used in alternative settings. The Department has set up a redistribution team to identify alternative uses for stock that we do not intend or expect to use. For example, we are donating masks to both the Department for Transport and the Department for Education to aid compliance with face covering requirements on public transport and to support schools following their reopening in March 2021.

Medical professionals in my Department have also been working closely with colleagues in medical surveillance authorities to review stock that has exceeded its manufacturers’ use-by date but is not necessarily unusable. We have also begun a tender for a third-party medical laboratory to provide official testing of PPE products, with a view to extending their shelf life.

During the pandemic, we have taken steps to strengthen this country’s PPE supply chain, including manufacturing more PPE here in the UK. We have now signed contacts with more than 30 UK-based companies, reducing our reliance on manufacturers overseas, and we now have high confidence that we have sufficient stock to cover all future covid-19-related demands.

Getting PPE to those who need it has been one of the toughest logistical tasks of the pandemic. We make no apologies for taking the steps that were necessary so that we could save lives and protect this country in its time of need.

I commend this statement to the House.

[Wes Streeting (Ilford North) (Lab)]

I thank the Minister for advance sight of the statement. But what a disgrace that the Secretary of State did not come to the House today, to account for the inexcusable and unacceptable level of waste in his Department, or when the Department first published the accounts, or two days afterwards, when they were reported on the front pages of several newspapers and on broadcast news. Perhaps the Secretary of State’s silence and absence tell us that he is relaxed about losing billions of pounds of taxpayers’ money, or perhaps it is simply that he is too ashamed to show his face. He had to be dragged to the House and when he was, he bottled it and sent his deputy.

The Department of Health and Social Care snuck out its annual accounts on the final day on which they were legally required, 10 months after the end of the financial year, and, I am sure by total coincidence, at 5.30 pm on the day Sue Gray published her update. Buried on page 199 was the revelation that the Department lost a staggering £8.7 billion on PPE. That is more than two thirds of the Department’s total spend on PPE written off as losses, double the amount it is spending on the hospital building programme, and almost as much as we spend on the salaries of every nurse in England for an entire year. Why? Because the PPE was unusable, going out of date, and bought in at eye-watering prices because the Government were in a state of desperation having run down our supplies before the pandemic arrived.

We know that many Conservative Members privately—sometimes even publicly—agree with Labour that the national insurance rise is an unfair hit on working families facing a cost of living crisis. How will they explain to their voters that, taken together with the £4.3 billion they handed out to fraudsters, this Government have thrown away more than a year’s receipts of the national insurance rise that they are now imposing on working families?

It is not just that the Conservatives are the party of high taxes because they are the party of low growth; they are the party of high taxes because they are the party of waste and incompetence. Think of what the NHS could have done with those funds. It could have reduced waiting lists and waiting times, improved access to GPs and rebuilt hospitals for the 21st century.

Of course covid came as a shock, but that does not explain why the Conservative Government ran down Britain’s supply of PPE before the pandemic, leaving us exposed to price hikes and profiteering. Perhaps the Minister can explain why a global pandemic necessarily leads to Conservative party donors and the former Secretary of State’s pub landlord receiving special treatment and hundreds of millions of pounds of taxpayers’ money.

It is not just PPE. Why did the Department fail to collect shipments from ports on time, costing taxpayers £111 million in additional fees? Why did the Department fail to pay its bills on time and incur late fees of £1.6 million as a result? Why did the Department spend £250 million on testing materials, ventilators and medical equipment, none of which can be used?

Is not it the case that when this Conservative Government thought no one was watching, they abandoned any pretence of being careful stewards of public finances, bunged millions to their mates and donors, and now working families are footing the bill? What would Mrs Thatcher, the grocer’s daughter, whose father instilled in her the value of thrift, make of this lot?

Is not the truth that the Conservative party has changed? You cannot trust this Conservative party to show respect to the people or to Parliament. You cannot trust this Conservative Party to keep taxes low. You cannot trust this Conservative Party to spend taxpayers’ money wisely. Indeed, the only thing that has not changed about the Conservatives is the age-old truth that you cannot trust the Tories with the NHS.

[Edward Argar]

It is always a pleasure to appear opposite the shadow Secretary of State. I will not take it as a personal affront that he would prefer it to be the Secretary of State rather than me.

The hon. Gentleman raised a number of important points. He cited Mrs Thatcher, and suggested that the Government had changed their position. If we are talking about sudden changes in position, I feel that I should quote the present shadow Chancellor, the hon. Member for Leeds West (Rachel Reeves)—formerly shadow Chancellor of the Duchy of Lancaster—who, in April 2020, wrote to my right hon. Friend the Chancellor of the Duchy of Lancaster:

“We need Government to strain every sinew and utilise untapped resources in UK manufacturing, to deliver essential equipment to frontline workers. This must be a national effort which leaves no stone unturned.”

She was right. I agreed with her sentiment then, and I still do—and we did do that—but it appears that the Opposition do not agree with it any more.

Let me turn to the hon. Gentleman’s other points. He kept suggesting—it makes a good headline for him, I am sure, but sadly I fear it is simply inaccurate—that this is money lost or wasted. It is not. As the hon. Gentleman knows from his days as a shadow Treasury Minister, this is a reflection of buying PPE at the height of the market, at the height of a global pandemic—

[Wes Streeting]

Why? Were there not enough masks?

[Edward Argar]

I will come to that point in a moment. It is a reflection of that, and now, in accounting terms, a reflection of what its value is today.

The hon. Gentleman should also be aware that the vast bulk of that £8.7 billion is down to exactly the same reason: PPE purchased at the height of the market. Now that we have a stable market, we have a sustainable supply. I make no apologies, and I know that my right hon. and hon. Friends will make no apologies, for doing exactly what the shadow Chancellor said we should do, which was to strain every sinew to make sure that the NHS had the PPE that it needed. We achieved that.

[Wes Streeting]

She did not say “by giving a contract to a pub landlord”.

[Edward Argar]

That is an important point, and I will turn to it in just a second.

The hon. Gentleman was also wrong to say that the money was thrown away. He knows that that is not what has happened here. He knows that this is about stock that has been written down in value, not written off. He knows that the vast bulk of that remaining is fit for use. We set very high standards in the NHS, but it is fit for use in other settings, and we are ensuring that we explore those other avenues, so that it can be used.

The hon. Gentleman talked about pub landlords. He will have heard my right hon. Friend the Member for West Suffolk (Matt Hancock) make this point in the Chamber. No contract was awarded to that individual, so I would caution him to be a little bit careful about the allegations he makes, and to check his facts before he does so.

Let me now turn to one of the broader themes raised by the hon. Gentleman. He talked about running down PPE stocks. Can he name any country in Europe that did not also have to buy vast amounts of PPE at the height of the pandemic, at the height of the market? This pandemic was unprecedented. We learned more about it with every day that passed. When we first started purchasing PPE, we were confronted with horrific pictures from hospitals in Bergamo in Italy. We saw the challenges that were faced, and we moved fast to ensure that our frontline had what it needed. We strained every sinew, and we got the PPE that our country needed.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

Does my right hon. Friend agree that the revaluation of the stock simply reflects global market price fluctuations? Will he confirm that the PPE is being used? Will he also disregard the comments from Opposition Members, who are peddling known inaccuracies and whose comments on the finances show them to be utterly economically illiterate?

--- Later in debate ---

[Edward Argar]

My hon. Friend puts it even better than I could have done. He is absolutely right to emphasise that this is a reflection of our straining every sinew to buy what we needed at the height of the pandemic, with inflated global prices, to give our NHS workers the protection that they needed. The global market has now returned to normal levels, and that, coupled with the fact that we have helped to stimulate and build a UK manufacturing base for PPE in this country, is a simple fact of economics. The shadow Secretary of State, who I think was formerly a shadow Exchequer Secretary, should know that. Sadly, the fact that that is not reflected in his comments, for whatever reason, causes me to question how much the Labour party has really learned about how to manage our nation’s finances and economy.

[Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)]

I thank the Minister for advance sight of his statement. Yet again, this Government are set rigid on making the working poor pay for their ineptitude and mismanagement. We know that £4.3 billion has been wasted, written off as covid loan fraud. We know that the Government spent £12 billion on PPE in England up to March 2021, of which £9 billion has been declared by the Government themselves as “wasted”—[Interruption.] We have some chuntering from those in a sedentary position, but I will continue.

Does the Minister believe that wasting all that money spent on PPE is a sign of good governance, when £2 of every £3 spent on VIP lane contracts was wasted due to so-called errors in supply? Now hard-working people will be taxed £12 billion by this Government to pay for their mismanagement, when the Bank of England has just told us that UK households must be warned to “brace themselves” for the biggest annual fall in living standards in 30 years, since records began, and inflation is set to soar to 7%. Why is his Government not vigorously pursuing companies that provided £9 billion-worth of useless PPE equipment to ensure that they pay it back? Will he assure the House that his Government will pursue that with complete vigour?

Kleptocracy is defined as a situation where politicians enrich themselves or their associates through the funnelling of public money and assets to their connections outside the rule of law—a statement we know all too well in this House. Given that the UK Government’s VIP, Tory crony fast lanes for Tory party associates have been declared unlawful in the Court of Session and seen billions of pounds wastefully funnelled to politically connected friends of this Tory Government, does the Minister agree that his Government are fast becoming a kleptocracy?

[Edward Argar]

In general, and certainly after that contribution, I will take no lessons in financial illiteracy from the SNP. The hon. Gentleman regularly, in that contribution, referred to £8.7 billion or £9 billion—rounding, if he wishes to—as wasted. He will know that, as I have set out, it is not wasted. It is a write-down on the value of stock, but it is not wasted. That stock is available. That is the point I make to him. The vast majority of that stock is available and in warehouses. This is an accounting point about the value of what was paid at the time compared with its value in a recovered market.

I will pick up one point I missed with the shadow Secretary of State, who I hope will forgive me. He mentioned ventilators, and I apologise for not answering that point. In the case of ventilators, we followed the scientific advice at the time, which was that ventilators were the most effective way of treating those who were severely ill. Thankfully, due to amazing advances by our clinicians and scientists and to the action taken by this Government, we did not need them and the treatments available improved significantly. Again, I make no apologies for our being prepared for all eventualities.

To conclude on the contribution of the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), I reiterate the same thing: we make no apologies for having strained every sinew—in a global pandemic, at the height of the market, when some countries were imposing export bans—to purchase the PPE to protect our frontline workers. I also pay tribute to the officials who worked flat out, often through the night, sourcing the PPE. They were the ones assessing it, and they were rigorous in their assessments. I put on record my tribute and my gratitude—

[Steven Bonnar]

indicated assent.

[Edward Argar]

I think the hon. Gentleman nodded assent, so we may be in agreement on that point. I put on record my tribute and my gratitude to them for all their hard work to protect the frontline.

[Mr Peter Bone (Wellingborough) (Con)]

In reality, back at the beginning of the pandemic, the Opposition were calling for the Government to go faster. It seems to me that one of the great success stories of this Government is that they got the PPE and the ventilators and, by doing so, saved a lot of lives. Does the excellent Minister agree that, unfortunately, the rhetoric coming from the Opposition now is completely different from what it was at the time of the pandemic?

[Edward Argar]

I am grateful to my hon. Friend. Far be it from me to suggest that hindsight characterises the approach adopted by Opposition Front Benchers, but he is absolutely right. I mentioned the shadow Chancellor, the hon. Member for Leeds West (Rachel Reeves). She also said in this place:

“Those who look after the sick and the vulnerable deserve our protection, and getting PPE to them is the priority of all of us.”—[Official Report, 4 May 2020; Vol. 675, c. 412.]

She was absolutely right and remains right, and that is why this Government did exactly that. Protecting the taxpayers’ pound is hugely important. Equally, so too is procuring the kit that protects lives. In the unique circumstances that we faced at the time in 2020, I believe that this Government made the right choices.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

For context, £9 billion would have given every NHS nurse a 100% bonus on their salary or it could provide the funding needed to solve the issue of autistic people and people with learning disabilities being detained in inappropriate units because no funding is available to support them in the community. Instead, it is clear that large amounts were wasted on unused and unsuitable PPE, some of which, we understand, will have to be burned. I remind the Minister that we could have had a stockpile of PPE in this country if Exercise Cygnus in 2016 had been handled responsibly. Exercise Cygnus showed gaping holes in our emergency preparedness and we have to learn the lesson from that.

[Edward Argar]

I am grateful to the hon. Lady; to be fair, we may not always agree, but she always makes thoughtful points and knows this subject well. However, many right hon. and hon. Members across the House have regularly said that Exercise Cygnus gave everyone everything they needed to know in how to manage this pandemic, which is completely not the case. That was a flu pandemic exercise with a number of preconditions, one of which was that, at a certain point, it was assumed that antivirals would become available within—I think, off the top of my head—nine weeks of the pandemic beginning. That was not the case, because we were dealing with a completely new virus, so although there are valuable lessons to be learned, we need to be very careful about drawing direct parallels.

The hon. Lady rightly talked about the sum of money and highlighted the impact. She is right that £8.7 billion is a very significant sum of public money, but she also must acknowledge that that £8.7 billion was not wasted, because the PPE exists. This is an accounting point about what the purchase price was compared with the value now, with a stable marketplace for that. Only a very small fraction of that stockpile has been deemed not fit for use and, in those cases, we continue to investigate, through contractual mechanisms and elsewhere, what we can do to recover that money.

[Mike Wood (Dudley South) (Con)]

The embassy of one of our major international partners had to send staff to Sofia with a suitcase of money handcuffed to their wrist in order to procure PPE for their health and social care. Does my hon. Friend not think that the Opposition would be better off celebrating the herculean efforts that meant that PPE could be got to our NHS providers and our local authority and social care providers, rather than engaging in such transparently cynical party political point scoring?

[Edward Argar]

I agree entirely with my hon. Friend. As I said in response to the SNP Front-Bench spokesman, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), I hope the whole House could agree on paying tribute to all those civil servants and others who moved heaven and earth to ensure that we got the PPE that we needed for the frontline. That is the most important factor. We did what we needed to get the PPE to protect people and to protect lives.

[Nick Smith (Blaenau Gwent) (Lab)]

Private Eye has uncovered £600 million of PPE contracts awarded to Unispace Global, an interior design company, through the VIP lane. The Department has paid the money to Unispace but it is not shown on the company accounts, so will the Minister strain every sinew and will there be an investigation to account for the £600 million of public money?

[Edward Argar]

In any circumstance where a contractual obligation has not been met or where goods that have been supplied do not meet that—I am not suggesting that is the case in this situation—we will look into it. The hon. Gentleman mentions company accounts, but that is a matter for the company and its filing of accounts; it is not a matter for Her Majesty’s Government.

[James Sunderland (Bracknell) (Con)]

There has been a lot of unhelpful speculation about loss and wastage of PPE in recent weeks. Some of this speculation is blatantly false, and it is important that we do not overly politicise the issue, because the Government acted to do the right thing at the right time. The use of language is also really important. Does the Minister agree that this is not about outright loss and that it is about accounting write-down?

[Edward Argar]

My hon. Friend puts his finger on the issue absolutely. I mentioned in response to the hon. Member for Worsley and Eccles South (Barbara Keeley), who is no longer in her place, that a small proportion of this £8.7 billion went on PPE that did not meet the standard, and we continue to pursue those contracts and investigate them. However, my hon. Friend is right to say that the vast majority of this money purchased PPE that was delivered and is usable, and the difference in money reflects the fact that we bought at the height of a global pandemic, doing whatever was needed to get the supplies we needed. Of course, in the two to two and a half years since, that market has stabilised, with significantly more manufacturing also in this country.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

The Minister mentioned in his statement that the Government took these difficult decisions to keep the country safe. The hard-working staff in St Thomas’ Hospital in my constituency took the decision to come to work every day during this pandemic to keep the country safe. The Minister mentions that this is a value of accounting and it is not real money. Can he tell me: how much more could we have got for nurses for that £8.7 billion? My local nurses who are watching this statement are thinking that they could have done with that pay increase.

[Edward Argar]

The hon. Lady will know that I have not said that this is not real money; I have said that what has been published here in the accounts is what is required for an accounting purpose. The PPE was purchased, and that was done at the height of a global pandemic and at extremely inflated prices, because every country was desperately seeking to acquire the PPE that was needed. That situation has stabilised over the past two years and PPE can now be purchased for a much, much cheaper rate. Again, I make no apology for our purchasing this PPE to protect these very nurses, who did an amazing job in her local hospital, from the effects of covid.

[Jacob Young (Redcar) (Con)]

This Government acted quickly and decisively to secure as much PPE for the frontline as possible and as many vaccines as possible, while the Labour party carped from the sidelines, attacked the vaccine taskforce and played politics, just as it is doing today. On vaccines, will the Minister join me in welcoming the decision by the Medicines and Healthcare Products Regulatory Agency to approve the Teesside vaccine, Novavax, which is being manufactured in Teesside for use in the UK?

[Edward Argar]

That was a dexterous way of weaving together PPE and vaccines, but my hon. Friend is right to pay tribute to the amazing work done by the vaccine taskforce and by officials and others across Government in meeting the needs of our population during the pandemic. Of course I join him in welcoming the Novavax vaccine and the opportunities it presents for wonderful Teesside.

[Owen Thompson (Midlothian) (SNP)]

I do not think anyone in this Chamber has said, at any point, that things should not have moved quickly to secure PPE. Nobody, on this side at least, has said that this should involve the use of a VIP lane, crony contracts or contracts for pals. I am sure that the Minister will say that all these allegations are entirely unfounded, and I understand his point of view on that. Given that, will he put Government backing behind my Ministerial Interests (Emergency Powers) Bill, to ensure that such actions could not happen in the future without this House being made fully aware of them?

[Edward Argar]

I pay tribute to the hon. Gentleman for, as ever, dextrously mentioning his Bill. I think he has done that to me once before when I have been at the Dispatch Box discussing similar issues. I am sure that Ministers, and indeed the Leader of the House, will read it very carefully.

[Mr Philip Hollobone (Kettering) (Con)]

In the early months of the pandemic, getting PPE to Kettering General Hospital and local care homes was the absolute No. 1 priority. A very sophisticated distribution network had to be established involving the Army to ensure PPE was delivered to the right place at the right time, as best as possible. I believe that, starting from scratch, only 1% of certain PPE products were actually made in this country and over the course of the pandemic that has been increased to 70%-plus. Can my hon. Friend the hospitals Minister assure me that, God forbid, were we ever to have a pandemic again, we could source most of our PPE requirements from British manufacturers and that we now have a robust and resilient supply and distribution chain?

[Edward Argar]

I am grateful to my hon. Friend and join him in paying tribute to the work of his local healthcare system during the pandemic. He makes a couple of points. First, he is absolutely right to highlight that this was ramped up at pace. Initially, the NHS supplied PPE directly to about 250 hospital trusts and other trusts. In the early months of the pandemic, that was ramped up to supplying it to well over 50,000 different settings. That is a phenomenal ramping up of logistics and distribution capabilities. To his second point, he is absolutely right that, from about 1% of PPE being manufactured in the UK before the pandemic, we now have the capacity to manufacture about 70% of the PPE it is currently assessed we need in this country. That is a great British success story.

[Clive Efford (Eltham) (Lab)]

What is absolutely clear from Exercise Cygnus is that the specific recommendations on PPE were not implemented by the Government. That led to the massive rush to purchase PPE during the pandemic. That added to the problem; it was not the only reason for it. The Government’s defence on the scandals of the contracts seems to be that we had to act very quickly. If that is the case, it does not explain why a disproportionate number of the contracts ended up in the hands of people who were members of the Conservative party, close associates of members of the Conservative party, or had given money to the Conservative party. If you were casting your net far and wide, you would not expect that to come to light, would you? You would expect there to be quite a wide number of contracts being issued. So the Government’s excuse does not hold water, does it?

[Edward Argar]

I take the hon. Gentleman’s point about speed and the context in which we were operating. I have to say all contracts were assessed through an eight-stage process undertaken by neutral civil servants. As the National Audit Office found, Ministers were not involved in the award of contracts.

[Helen Morgan (North Shropshire) (LD)]

As a chartered accountant, I am au fait with the concept of an accounting write down and the scale of this one really does indicate reckless waste. I am sure that, in my constituency of North Shropshire, the £9.7 billion carelessly wasted could have been put to better use. It could have been used to tackle the extremely high ambulance waiting times, to help the local accident and emergency tackle the huge challenges it faces in getting patients through, or to deal with the £50 million black hole that social care in Shropshire is facing in two years’ time. Across the country, the story is very much the same. Local health services are struggling to find the money to deal with those issues. I am sure Members across the House know those issues all too well. That is why £9.7 billion wasted on PPE is so shocking. What are the Government doing to allocate resources to sufficiently recover that money?

[Edward Argar]

I welcome the hon. Lady to her place. I do not think I have had the opportunity to respond to a question or a speech from her previously, so I congratulate her, slightly belatedly, on her election and welcome her to this place. I will just correct one thing. She mentioned £9.7 billion. The sum involved is actually £8.7 billion.

To the hon. Lady’s point, first, it is not wasted. As I made clear, it purchased PPE. There is a small amount in these accounts which has been made clear. The shadow Secretary of State said that it was snuck out. If I recall, I tabled a written ministerial statement to draw attention to these issues to be open and transparent with the House, as I always endeavour to be. We did whatever was needed at the time, in the context of the highly inflated pricing in the midst of a global pandemic.

More broadly, the hon. Lady touched on NHS funding and pressures. I appreciate that she was not a Member of this House at the time, but this Government have put in record funding for our NHS. One of the first Acts after the 2019 election enshrined in law a £33.9 billion increase by 2023-24, and we are also putting in place the health and care levy to both assist our NHS and provide that sustainable footing for social care in the future. I acknowledge entirely that she was not a Member of this House, so it would be wrong to draw any inference as to how she may have voted, but I want to put that record investment on the record.

I also gently say that the Liberals’ stance on this issue shows, even by their standards, a degree of political contortion and a stretching of credibility. I think I am the only Member who has been a Health Minister throughout this pandemic, and I recall them desperately calling in 2020 for whatever it took to get and buy more PPE to protect the frontline. I agreed with that stance, but now they are suggesting that the Government got it wrong by prioritising whatever it took to get the PPE that the frontline needed.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The Minister has said that we were prepared for all eventualities, but I think he knows that the truth is that that was not the case. As illustrated in comments by Members across the House, we did not plan ahead sufficiently for what was needed in a pandemic.

The Minister said in his statement that 97% of the PPE ordered was suitable for use. Obviously, that means that 3% was not. He also said that the Government are actively seeking to recover costs from suppliers where possible in those cases. Does he not realise that that is a very weak way of responding to that challenge? What safeguards were put in place in those contracts, and will he publish for the House updated data on suppliers that are not refunding the taxpayer—suppliers that took public funds and did not deliver the goods?

[Edward Argar]

I am grateful to the hon. Lady for asking a sensible and serious question. We have already recovered, through prevention or termination of contracts, £157 million of potential fraud. We continue, with our anti-fraud unit, to look into a number of contracts where there is either a contractual dispute or a risk of fraud. There are contractual mechanisms for reconciling or trying to manage situations in which both parties have different interpretations of whether what was delivered is what was ordered. We are already looking into more than 100 contracts in that respect. As those investigations develop, I hope I will be able to update the House further, but it necessarily takes time to have conversations with contractors through those contract dispute mechanisms and to investigate. I hope that, as we are able to bring forward more information, we will make it available to the House.

[Allan Dorans (Ayr, Carrick and Cumnock) (SNP)]

Good afternoon, Madam Deputy Speaker. Can the Minister confirm whether any of the promised £350 million a week advertised on the side of a bus as a benefit of leaving the European Union has been used to purchase PPE for the NHS?

[Edward Argar]

The NHS and the Department get their annual budgets and spend them on what is necessary to meet the health and care needs of the nation. On the hon. Gentleman’s specific point, he might characterise the £33.9 billion increase by 2023-24, which we have enshrined in law, as part of the Brexit dividend.

[Madam Deputy Speaker (Dame Eleanor Laing)]

And finally, I call Jim Shannon.

--- Later in debate ---

[Jim Shannon]

It grieves me in my heart, and I suspect that it grieves the Minister in his heart as well.

[Edward Argar]

I am grateful to the hon. Gentleman for his question. I have made it clear throughout that our priority was getting the PPE that we needed to give that protection and to save lives but, equally, every pound of taxpayers’ money is valuable. Where fraud or failure to deliver contracts is evidenced, we will go after that money, quite rightly, and seek to recoup it for the taxpayer.

On the amount that is, for want of a better way of putting it, lost through goods not being fit for use, that is £673 million, but that is what we are investigating through those contract dispute resolution mechanisms and through anti-fraud work. The other amounts of money in here did purchase PPE, which was delivered and which we have. Different settings require different standards of PPE, so some that was purchased may not be of the standard for the NHS but can be used elsewhere. We are exploring all options to make sure that the PPE we have, where it can be, is used.

Kettering General Hospital

Edward Argar Excerpts

Wednesday 2nd February 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate. By my tally, this is the fourth debate I have responded to that he has secured on the future of Kettering General Hospital and its redevelopment. That fact reflects his commitment to this issue on behalf of his constituents, and his typically courteous but tenacious approach to the matter. I will put on record, as they are unable to be here, the work done by my hon. Friends the Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove) in this respect. I welcome the intervention from my hon. Friend the Member for Northampton South (Andrew Lewer).

The topic is not a new one for this House to discuss, but it is an extremely important one. I hope that I might move matters a little bit further forward in this debate for my hon. Friend the Member for Kettering. It was a pleasure to meet him, my hon. Friends the Members for Wellingborough and for Corby and Simon Weldon on 17 January to discuss Kettering General Hospital and receive an update on its plans. I join my hon. Friend the Member for Kettering in paying tribute to Simon and all of the team at Kettering General Hospital and at Northampton General Hospital for the work they have done, not only in the past two years, but day in, day out every year, to support the local community and provide first-class care.

My hon. Friend the Member for Kettering made, as ever, a generous offer to visit Kettering General Hospital with him. It was a pleasure to do so in 2019, when he gave me a very warm welcome in Kettering. I also take his suggestion of visiting Northampton at the same time. Without setting a specific date, my aim is to try to visit him during the February recess—I will discuss this with him. It is not a long haul for me from my constituency in Leicestershire to his in Kettering or Northampton, so that is what I will hope to do, subject to that working for the trust. Ministers are often surplus to operational requirements in a busy trust at busy times, but I suspect that Simon will welcome me to explain what progress he has made. That is my commitment to my hon. Friend.

As my hon. Friend set out, Kettering General Hospital is part of the broader foundation trust, and continues to work closely with the central programme team in taking forward the rebuild of Kettering General as a new hospital for his community. It is part of the broader programme to build 40 new hospitals by 2030. On 13 January, Natalie Forrest, who is the senior responsible owner for the new hospital programme, and officials attended a virtual meeting with the chief executive and staff from Kettering General to discuss progress and provide an update on the scheme in the context of the programme. As my hon. Friend knows, Kettering General Hospital NHS Foundation Trust has received £4.4 million of funding to develop its plans for the rebuilding of Kettering General Hospital. They were successful in securing funding back in 2019, at that stage for a new urgent care hub, which would transform the provision of urgent and critical care in the area. I know that officials are in discussion with the chief executive of the hospital trust regarding the trust’s plans for enabling works on the Kettering General Hospital site and have set out what will be required for these proposals to be assessed as quickly as possible, once business cases are received from the trust, which is in line with what my hon. Friend would expect of appropriate processes for spending public money.

I will provide a little background. The Department wrote to the chief executive on 16 June last year to confirm that, at his request, the urgent care hub and new hospital programme schemes could be brought together as a single pot of money, to maximise the benefits that local people could derive.

Essentially, my hon. Friend asked why things have not progressed since 2019. That is largely because the trust changed its plans. That money was ringfenced for an urgent treatment centre. We had discussions about that with the trust and accepted its proposal to merge the two pots of money. That then necessitated their coming forward with proposals about how they would spend that money as part of the enabling works for a broader scheme. If changes are made, it is right that those changes are justified, in the context of the appropriate stewardship of public money.

The hub and the new hospital that are to be built both share a set of common enabling works, which have been factored into the new hospital development plans. As a result, the trust is incorporating the urgent care hub delivery into that broader plan. It means that the hub will now be part of the first stage of the building of the new hospital, enabling the more efficient use of resources to deliver better results.

In respect of the business case for that plan—I know that my hon. Friend is keen that there is progress on that as swiftly as possible—my officials have been in touch with the trust recently, most recently yesterday and before that on 26 or 27 January, asking the trust to put forward its proposals for those enabling works. We need those to progress the business case. My officials continue to nudge the trust gently, saying, “Please submit your proposals for that and the business case for it”. My commitment is that my officials will consider those proposals as swiftly as they can, once they have received them. As I understand it, given the scale of the enabling works, they would not need to go through the full internal approvals process, but the trust needs to submit a business case for that element.

The second element, which I know my hon. Friend and the trust are keen to see being advanced as swiftly as possible, is the new boiler room and power plant. Essentially, that would have to go through the full approvals process, but I understand that the board of the trust is due to meet in April to agree and finalise its proposal and business case on that work. As soon as it submits that, I can commit to my hon. Friend that—assuming that it is up to scratch, which I am sure it will be—it will go before the first joint investment committee of the Department following its submission, so that it can be considered as swiftly as possible.

At the moment, if I may put it this way, the ball is in the trust’s court, for it to send its proposal and business case over. However, my commitment is that as soon as the trust does so, I will task officials with considering them as swiftly as possible.

[Mr Hollobone]

I thank the Minister for his very helpful comments. I think that the ball, in part, may be in the trust’s court, but there is perhaps another ball with the new hospitals programme team. I say that because the hospital submitted its strategic outline case to the NHS a year ago and what the trust requires is feedback on that, to inform the development of its outline business case. So would the Minister be kind enough to look at that feedback?

[Edward Argar]

I am happy to look at that. The point I am making to my hon. Friend is that for the moneys that he and the trust wish to draw down from the £46 million, we do not have the business cases from the trust that would enable that work. I suspect that they will be winging their way to the Department pretty swiftly following this debate and as soon as they arrive we will look at them. Regarding the broader business case for the overall scheme, I will turn to that, if I may, in just a moment.

All the new hospitals that will be delivered as part of the programme, including Kettering, are required to work with the central team and, with the support of regional and local trust leadership, to design and deliver their hospitals in keeping with a consistent and standardised national approach. This collaborative approach is intended to help each trust to get the most from its available funding, while avoiding repetition of work and design, and ensuring that adherence to the principles, which my hon. Friend alluded to, of repeatable design, modern methods of construction and net carbon zero, is embedded from the outset, to maximise the potential benefits of the programmatic approach, as well, of course, as providing better value for money for the taxpayer.

All the projects that are part of that 40-hospital programme need to ensure that their approach is consistent with the programme, which that has been developed over the past year and has reached a greater level of maturity. Therefore, there will be individual conversations with trusts about where they align with the programme, or where they may need to adapt to meet that national approach.

My hon. Friend touched on the trust’s desire to go faster and begin the main project construction in 2023. In the spirit of openness, my only caveat to that is that, in the nature of funding through multiple spending review periods, it is not the case that a pot of money is earmarked for each programme and is just waiting to be drawn down; there is a profiling of moneys made available by the Treasury. I appreciate the trust’s eagerness to go faster, and I appreciate my hon. Friend’s clear steer that he believes it is capable of going further and faster, but we need to look at it in the context of all the other schemes and the availability and profile of moneys being made available. I just sound that slight note of caution, so I will not commit to a date, much though he tempts me to do so.

[Mr Hollobone]

I appreciate the Minister’s comments. I would just highlight that there are some very large new hospital programmes out there that will not be achieved on time. Kettering is a relatively small, flexible and modular scheme that is perfectly placed to pick up on any slippage from some of the larger schemes.

[Edward Argar]

I am grateful to my hon. Friend, because I was about to turn to his final ask, which was whether the Department would look favourably on Kettering’s scheme if there was slippage from other schemes in the course of the spending review period. Although I cannot prejudge in this place that Kettering will be top of the list, he makes a strong case. It is absolutely right that we look at schemes and have a list of schemes that we believe could fill the gap if moneys are not going to be spent in year. It is important that that contingency is built in, and my hon. Friend makes a strong case for Kettering to be one of the hospitals that is considered for acceleration if it is ready and the moneys become available. I will not prejudge the advice that I will be given by officials as to which schemes are most mature, but he makes his case clearly and forcefully on the Floor of the Chamber.

I am grateful to my hon. Friend not only for the opportunity to discuss and debate Kettering General Hospital, but for the opportunity to visit Kettering. On my last visit, I received a very warm welcome from him and the team at the hospital. In what I have said today, I hope I have ensured that I get an equally warm welcome when I come and see him this month. Like him, I am keen to see all these schemes progress, and I am keen to see the benefits that the schemes will realise.

In the context of Kettering General Hospital, my hon. Friend continues to be an incredibly powerful advocate for the interests of his constituents and those in the wider area of Northamptonshire who are served by the hospital. I look forward to continuing to work with him very closely in the future, as well as with the trust’s chief executive and team, other hon. Friends from Northamptonshire and my team in the Department, to help progress these very exciting and important plans, which will make a huge difference to his constituents’ lives in the years ahead.

Question put and agreed to.

Cystic Fibrosis: Prescription Charge Exemption

Edward Argar Excerpts

Wednesday 2nd February 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure as always to serve under your chairmanship, Mr Sharma. I congratulate my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) on securing this important debate and thank all hon. Members who have taken part. Although this issue falls within Lord Kamall’s ministerial portfolio rather than mine, it is privilege to answer in this place and to engage in this debate.

Nobody here today, and nobody viewing our proceedings or reading them when they are written up in Hansard, can fail to have been moved by the experiences and stories that we have heard. Hon. Members on both sides of the House told moving stories about their constituents—in the case of my hon. Friend the Member for Ashfield (Lee Anderson), who spoke of his very personal experience, it was his wife, Sinead. As hon. Members have said, it is always incredibly powerful and moving in this place when an hon. Member is willing to share their own experiences, not just with this House and colleagues but essentially with the public. It was powerful, it was personal and it was poignant, and I thank him for that.

I also thank the hon. Member for Bristol East (Kerry McCarthy) for her contribution, in which she set out—again, very movingly—very personal stories, to make this real. It is very easy in this place for us to slip into talking about policies and grand strategies and to not always relate that to people and individual lives and experiences. I am very grateful to the hon. Lady. I do not always agree with her on everything in a political context, but I certainly agree with her on EDMs. I share the experience. I remember Bob Russell from the time before I was a Member, when I worked for previous Members in this place. I admire his belief in the power of EDMs, although I have to say that I do not share it and, like the hon. Lady, I occasionally have to explain to constituents and others who understand-ably think that an EDM moves the agenda forward, that it rarely does, but that it may, on occasion, put down a marker.

As ever, I am grateful to the hon. Member for Strangford (Jim Shannon) for his comments. He mentioned that he has been in just about every debate on this subject, along with the hon. Member for Bristol East. Given his assiduity in attending debates in this House, that could be said for a vast array of subjects, on which he has given well-informed and eloquent contributions, not only representing his constituents, but putting issues of national concern on the agenda.

[Jim Shannon]

The Minister referred to the former Member, Bob Russell. I recall him standing at the door to be No. 1 on EDMs. I put in at least two EDMs every week. Their purpose is not to change policy, but to raise awareness or congratulate some person or group that has been active in the community. For me, that is what EDMs are about.

[Edward Argar]

I am grateful to the hon. Gentleman for his spirited defence of early-day motions, of which he makes powerful use, as he does with every opportunity he has to speak in this place.

My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) is no longer able to be here, but he made a valuable contribution, and I am grateful to you, Mr Sharma, for allowing him to speak—even if, as a former Minister, he should have known better the consequences of seeking to tempt me to make policy at the Dispatch Box without cross-Government agreement, which might have led to an early termination of my ministerial career. He made a powerful point, as all hon. and right hon. Members have done, and I will turn to some of those points in a moment.

Before I do so, I want to recognise the fantastic work undertaken by the Cystic Fibrosis Trust, which does a fantastic job on behalf of people living with cystic fibrosis and their families, and in bringing the condition and the needs of people with it to the attention of this House, and more widely. I also acknowledge the work of the Prescription Charges Coalition, of which the Cystic Fibrosis Trust is a member. It has worked tirelessly to raise awareness of the help available to patients with the cost of their prescriptions and campaigns on an issue that its members feel strongly about. In our democracy, whether or not we agree on the policy position, it is right that we recognise those who get out there, campaign and seek to drive change and policy. It is important to recognise those who are active in our democracy in that way.

As we have heard, cystic fibrosis is a life-limiting condition affecting many thousands of people in the UK. It is not only a life-limiting disease but, as we heard from my hon. Friend the Member for Ashfield, a disease that can impact on the quality of life and the life experiences of those affected and their families. While there is no cure for cystic fibrosis, there are treatments available on the NHS to help reduce the effect of symptoms and make it easier to live with.

It is not that long ago that conditions such as cystic fibrosis saw life expectancy so low that many were advised not to expect to live beyond their teens. Thanks to advancements in treatments, better care and the work of organisations such as the Cystic Fibrosis Trust, people with cystic fibrosis are now living for longer, with a better quality of life, with half of those with the condition living past the age of 40. Children born with cystic fibrosis today are likely to live longer than that. That is a positive story and a reflection on our medical and scientific advances.

I turn to the crux of the debate. When the medical exemption list was drawn up in 1968 in agreement with the British Medical Association, it was limited to readily identifiable, permanent medical conditions that automatically called for continuous, lifelong and, in most cases, replacement therapy without which the patient would become seriously ill or even die. As the shadow Minister, the hon. Member for Enfield North (Feryal Clark), alluded to, there has been a review since 1968—only one—which resulted in the addition of cancer in 2009.

When the exemption list was drawn up, decisions on which conditions to include were based on medical knowledge at the time—for instance, children with cystic fibrosis were not expected to live to see adulthood—and it is entirely understandable that, given advances in treatment and increases in life expectancy, those who are now living with cystic fibrosis for a lot longer should wish to pursue exemption from prescription charges to help them maintain their quality of life with the drugs that are essential to their quality of life. The issue of prescription charges was reviewed more broadly in the round in the 2010 Gilmore report, which did not recommend further changes at that stage.

As the hon. Member for Enfield North alluded to, I know that the answers that Ministers have given, stating that the Government have no immediate plans to review the list, will have caused disappointment to right hon. and hon. Members and to those with this condition. We do think it would not be right in this context to look at one condition in isolation, separate from other conditions, because others would rightly argue that their condition was potentially equally deserving of an exemption if it fitted the same criteria. My hon. Friend the Member for Blackpool North and Cleveleys has rightly advanced the case of cystic fibrosis, and I entirely understand why, but I know that he will also recognise that other conditions might qualify for consideration in the same way, or for the same case to be made for them by right hon. and hon. Members.

When the exemption list was first put in place in 1968, 42% of items on prescription were free; now 89% are free. There has been considerable change in that space, but to go to the heart of what right hon. and hon. Members have asked for today, were my right hon. Friend the Member for South Holland and The Deepings in his place, I would disappoint him by saying that, as he will appreciate, I cannot make policy standing at the Dispatch Box. It is important that everything is considered carefully. Although this is not my policy, I will continue to reflect on the points that have been made by right hon. and hon. Members today and by campaigners on this issue. I will also ensure that I will not only speak to my noble Friend, the Minister with portfolio responsibility for this issue, but draw to his attention the transcript of today’s debate.

[Kerry McCarthy]

I have just realised that it is groundhog day—I missed an ideal opportunity to weave that fact into my speech, as I think all of us would have done. Is there anything the Minister could say that does not makes us feel like we have been here many times before? He has said that he will reflect on these points, but is there not something a little bit more concrete that he can give us a commitment on, so that we feel that we are perhaps making some progress?

[Edward Argar]

I am grateful to the hon. Lady. She may or may not always agree with me, but I will always endeavour to be straight with the House, even when the message may not always be the one that Members want to hear. I cannot stand here now and say that there will be a review of that list; it is important for me to be honest with her. What I can say—which she may feel is insufficient, and I entirely respect her if she does—is that I will reflect on the points made today and the issues raised. I will discuss this issue with my noble Friend and ensure that the points that have been made in this debate are conveyed to him, but it would be wrong of me to commit to something that I am not in a position to commit to. The hon. Lady rightly presses her case, but I know that she will appreciate my position, and it is important that I am honest with the House in that respect.

I touched on the help with prescription costs previously, and the number of items. While I know that this is not at the heart of the point made by my hon. Friend the Member for Blackpool North and Cleveleys, it is still important that I put on record the point that I alluded to: when medical exemptions were introduced, only 42% of all NHS prescription items were dispensed free of charge. That figure is now around 89%, and around 60% of the English population do not pay prescription charges at all. Many people with medical conditions not on the exempt list already get free prescriptions on other grounds, as my hon. Friend the Member for Blackpool North and Cleveleys said, with current exemptions providing valuable help for those on the lowest incomes.

[Jim Shannon]

In my contribution, I referred to Scotland, Wales and Northern Ireland, where prescription charges are free. I have knowledge of Northern Ireland, though not of Scotland and Wales, and understand that we follow the rules of the National Institute for Health and Care Excellence in the UK but have some liberty about what we add on. I understand that the Minister is not responsible for this. He is a good man who has been honest with us. What we wish to be conveyed from this debate, to the person who is responsible, is that the same should happen here as in Northern Ireland, Scotland and Wales.

[Edward Argar]

I am grateful to the hon. Gentleman. I will finish the point I was making and then respond to his. We have already heard about the annual certificate, which can be purchased by direct debit in instalments, meaning that a person can have all the prescribed items they need for just over £2 a week. I take the point from the hon. Member for Bristol East that that may still not solve the problem for everyone, but that route provides a significant potential reduction in costs.

I shall now respond to the point raised by the hon. Member for Strangford on the devolved Administrations, and the broader approach to prescription charges. Although we have surprisingly managed to stray away from it for quite a while, any debate on this subject will touch on the different positions of England and the devolved Administrations, given the latter’s abolition of charges for prescriptions. I suspect that many people will ask why there is that difference in approach. Health is a devolved matter and the devolved Administrations have full discretion over how they spend their budgets and the choices they make, presumably choosing to spend a proportionately larger share of those budgets on prescriptions.

We have opted for a different approach in England. We also recognise that prescription charges, more broadly, raise significant revenue, which provides a valuable contribution directly to NHS services in England. In 2019-20, they contributed just over £600 million in revenue to NHS frontline services. There is always a balance to be struck, and I suspect that we shall return to this topic, with Members taking different views.

With regard to the key point made by the hon. Member for Strangford, although I am not directly responsible for this area of policy I will continue to reflect on that. In this House, there are times when individual debates or speeches—I look at my hon. Friend the Member for Ashfield—resonate, and cause Ministers to turn them over in their head and reflect on the points made. All hon. Members will be able to point to speeches they have heard on different topics in the main Chamber that stay with them. They go away from that debate, still reflecting on what that right hon. or hon. Member has said. My hon. Friend the Member for Ashfield has had that effect today. I will reflect carefully on what he said, within the context that I cannot make policy at the Dispatch Box. In response to the point made by the hon. Member for Strangford, I will pick up that issue and convey the sentiments of Members speaking today to my noble Friend Lord Kamall, and ensure that he has a copy of the transcript of the debate.

I conclude by thanking all hon. Members for their contributions. Often, people judge what goes on in this place by the half an hour or 40 minutes that they see at 12 noon on a Wednesday on both sides of the Chamber and what happens there. Many people do not see what happens in Westminster Hall, where, in a measured and sensible way, people can discuss, debate and sometimes disagree on issues that really matter and impact on the lives of individuals or particular groups of people. This debate is one that those that clears a very high bar for the quality of the contributions, for the importance of the subject and for its ability to cause us to leave this Chamber continuing to reflect on what we have heard.

[Paul Maynard]

I thank all those who have participated, particularly my hon. Friend the Member for Ashfield (Lee Anderson). We are all grateful to him for not just speaking on a personal basis, but illuminating a debate far better than I could from my more dry, academic analysis. I thank him for his personal contribution, and I thank all hon. Members for a constructive debate. I recognise the point that the Minister made; making a commitment on the hoof at the Dispatch Box can be career-limiting. I know that myself, as I reflect on what I once said on rail and aviation, which I suspect led to my defenestration. Saving High Speed 2 can be terminal for a career, perhaps. None the less, I hope he will take the issue back to Lord Kamall, and that he might encourage him to meet me and other interested Members to hear what the Gentleman whose brief it is thinks of the matter.

[Edward Argar]

I am happy to reassure my hon. Friend that I will certainly convey his request for a meeting to my noble Friend.

[Paul Maynard]

We have something concrete on which to conclude the debate.

Question put and agreed to.

Resolved,

That this House has considered prescription charge exemption and cystic fibrosis.

Future of the NHS

Edward Argar Excerpts

Monday 31st January 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to my hon. Friend the Member for Stockton South (Matt Vickers) for leading this debate on behalf of the Petitions Committee. I am pleased we were able to find time to hear from the hon. Member for Middlesbrough (Andy McDonald); I offered to take an intervention from him, which I suspect was a brave offer on my part given the intervention that might have come my way. I am pleased he got to give his speech.

I am grateful to the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). I think this is the first time we have properly been opposite one another since his appointment to this role on the Opposition Front Bench. Although I did not agree with everything he said, he made a typically well-informed and well-argued speech. He is right to pay tribute to all hon. Members who have spoken today, regardless of whether one agrees with the positions advanced. This has been a passionate debate. At its heart is, perhaps, the most precious of our country’s institutions; understandably, right hon. and hon. Members and our constituents have very strong views on the subject.

Before turning to the substance of the debate, and although I may not agree with their position, I pay tribute in a broader context to the work of Unite, Unison and other trade unions. I do not always agree with the stance they adopt, but they play a hugely important role in our democracy and society. It is right to put that on the record. As always in these debates, and as the shadow Minister has done very clearly, I also put on the record our gratitude—from both sides of the Chamber equally—to all NHS staff and those working in social care, local government and other key workers across the country for what they have done across the past two years and, indeed, what they do every year, day in, day out.

As I have said before, the Health and Care Bill reflects evolution, not revolution. It supports improvements already under way in the NHS and, crucially, builds on what the NHS recommended and consulted on back in 2019.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will make a little progress before giving way; I will always give way to the hon. Lady. The Bill is backed by not only the NHS but many others working across health and social care. In a joint statement, the NHS Confederation, NHS providers and the Local Government Association state that they

“believe that the direction of travel set by the bill is the right one”,

noting that local level partnership is the only way we can address the challenges of our time.

[Margaret Greenwood]

The Minister is talking about a consultation that, as I recall, took place over the Christmas period, when NHS staff are absolutely exhausted. He talks about these changes being requested by the NHS, but what percentage of NHS staff does he actually think took part in the consultation?

[Edward Argar]

As the hon. Lady will know, the former chief executive of the NHS, Lord Stephens, was clearing in saying that the

“overwhelming majority of these proposals are changes that the health service has asked for.”

We should do the right thing by them and by patients. It is the right time for the Bill: it is the right prescription at the right time.

The substance of the petition, which has framed many speeches by hon. Members today, calls for the Government to renationalise the NHS. I have to say that it has never been denationalised. The NHS is and always will be free at the point of use. The Government are committed to safeguarding the principles on which the NHS was created. The hon. Member for Denton and Reddish set that out very clearly. We have no plans for privatisation.

[Catherine West]

Will the Minister give way?

[Edward Argar]

I will make a little progress; if I have time, I will give way to the hon. Lady, with whom I sat on a committee of London councils when we were looking at social care reform way back in 2010.

We all recognise the importance of preserving this great national asset for the future and ensuring that the NHS remains comprehensive and free at the point of use, regardless of income, on the basis of need. The Government remain steadfast in their commitment that the NHS is not, and never will be, for sale to the private sector.

We are determined to embrace innovation and potential where we find it, but that is different from many of the accusations in the speeches we have heard today. I know it is tempting to scaremonger and set out accusations about what this Act does, even when people know better, as I know hon. Members do, but that reflects scaremongering rather than reality. There has always been an element of private provision in healthcare services in this country. Labour Members should know that because, as the Nuffield Trust said in 2019,

“the available evidence suggests the increase”—

in private provision—

“originally began under Labour governments before 2010”.

[Catherine West]

Will the Minister give way?

[Edward Argar]

I will just finish this point and then give way to the hon. Lady. The hon. Member for Liverpool, West Derby (Ian Byrne) made the point, which the hon. Member for Middlesbrough touched on as well, that it is important to look at the extent of the involvement of private sector providers, which accelerated when the Labour party was in power. The hon. Member for Liverpool, West Derby talked about the 2012 legislation and “any qualified provider”, but that was not brought in by the 2012 legislation; it was brought in by the Gordon Brown Government in 2009-10, under the term “any willing provider.” The name was changed, but nothing substantive changed from what the Labour Government had introduced in terms of the ability to compete for contracts.

[Christian Matheson]

Will the Minister give way?

[Edward Argar]

One more sentence and I will give way to the hon. Member for Hornsey and Wood Green (Catherine West); then I will try to bring in the hon. Gentleman.

One of the key changes allowing private sector organisations to compete for and run frontline health services came in 2004, again under a Labour Government, when the tendering for provision of out-of-hours services by private companies was allowed.

[Catherine West]

The Minister is being very gracious. How is the Act going to ensure that there is no conflict of interest between private providers who sit on integrated care boards and who then provide services? Are we going to end up with another Randox scandal?

--- Later in debate ---

[Edward Argar]

The hon. Lady will know that when it comes to integrated care boards we, as a Government, introduced an amendment building on the already clear provisions in the Bill to prohibit conflicts of interest. I do not know whether she voted for the Government amendment, but it did exactly that, making it clear when the Bill was on Report that private providers and those with significant private interests could not sit on NHS integrated care boards.

[Christian Matheson]

The Minister is being generous with his time. Let us get the history right. The reason why the Labour Government increased the involvement of private sector bidders was simply to be able to increase capacity quickly—to get the waiting list and waiting time backlogs down, which they had inherited from the previous Conservative Government and that were massive. In terms of the 2009 Bill, I seem to remember that there was a provision in there that gave preference to NHS bidders.

[Edward Argar]

I am grateful to the hon. Gentleman. Although we occasionally cross swords in the main Chamber or here, he knows I have a great deal of respect for him. All I would say gently on the point about the 2004 changes is that they came seven years into a Labour Government, so I do not know the reason why they had not been able to make progress before then.

We continue to work closely with the NHS to implement the changes that it has asked for, so that we can build back better and secure our NHS for future generations. As the shadow Minister, the hon. Member for Denton and Reddish, rightly said, the covid-19 pandemic has tested our NHS like never before, and all our NHS staff have risen to meet these tests in extraordinary new ways.

Hon. Members on both sides have rightly raised the point about the pressure that NHS staff have been under. Those who have been under pressure dealing with this pandemic are the people who will also be working flat out to deal with waiting lists and backlogs. We need to ensure that we are honest with the British people and that those staff have the time and space to recover, emotionally and physically, from the pressures they have been under. That is hugely important and we acknowledge the workforce.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not give way to the hon. Lady now. I have given way to her before. I will try to make progress, but if there is time I will try to give way to her.

We have seen innovative new ways of working: new teams forged, new technologies adopted and new approaches found to some old problems. There is no greater example of that than the phenomenal success of our vaccine roll-out. That would not have been possible without the staff, who are the golden thread that runs through our NHS. As we look to the future and a post-pandemic world, we know that, as the shadow Minister said, there is no shortage of challenges ahead of us: an ageing population, an increase in people with multiple health conditions and, as he rightly says, the challenge of deep-rooted inequalities in health outcomes and the need to look at the broader context. I do not know the shadow Minister as well as I knew his predecessor, but both his predecessor and I had a career in local government as councillors. I suspect that the shadow Minister may have had one too, so he may well know that I understand his point about the broader context.

[Jim Shannon]

Will the Minister give way?

[Edward Argar]

I will make a little more progress. If I can, I will then try to give way to hon. Members.

More needs to be done, and we are giving the NHS the support that it needs and has asked for. In addition to our historic settlement for the NHS in 2018, which will see its budget rise by £33.9 billion a year by 2023-24, we have pledged a record £36 billion for investment in the health and care system over the next three years. The funding will ensure that the NHS has the long-term resources that it needs to tackle the covid backlogs and build back better from the pandemic.

[Jim Shannon]

The hon. Member for Stockton South referred to recruitment within the NHS. What is the Government’s response to that, to ensure that we have the recruitment and the staff in place?

[Edward Argar]

As the hon. Gentleman will know, there are 1.2 million full-time equivalents in the NHS—a record number of staff. Take one example: our pledge for 50,000 more nurses by the time of the next scheduled general election in 2024. Last year alone, we saw the number of nurses in our NHS increase by 10,900. We have a plan in place, and we are recruiting and training more staff through increased numbers of places—at medical schools, for example.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not, because I have only two or three minutes left. If I make sufficient progress, I will try to give way, but I cannot promise the hon. Lady.

We know that different parts of the system want to work together and deliver joined-up services, and we know that when they do, it works; we have seen that with non-statutory integrated care systems over the past few years. The petition calls for the Government to “scrap integrated care systems”, but to do so would be to let down our NHS. The reforms have been developed by the NHS, and integrated care systems are already in place. The Health and Care Bill places them on a statutory footing to allow for that integration and joined-up working to continue.

In the minute or two I have left before I hand back to my hon. Friend the Member for Stockton South, I will touch on PFI contracts, which is an issue that he and other hon. Members have raised. In 2018, the Government announced that PFI and PF2 will not be used for any future public sector projects, including those in the NHS. The Government will honour existing PFI contracts, as wholesale termination would not necessarily represent good value for money. We need to look at each on its merits; many have clauses for early termination, which would cost a lot more than the life of the contract.

However, we have committed to undo the worst of the contracts inherited from the previous Government. The hon. Member for City of Chester (Christian Matheson)—I hope he will let me tweak his tail a little on this—chided my hon. Friend the Member for Stockton South by saying he should be careful about references to PFIs. Of the 124 significant PFIs currently in place, 122 were signed between 1997 and 2010.

Mr Gray, I think you want me to give my hon. Friend the Member for Stockton South some time to sum up, so I will conclude. We believe that this Government are doing everything necessary to ensure that the NHS remains free at the point of use. We are working with the NHS to deliver what it has asked for through the Health and Care Bill. There is huge support from those working in the system for the direction of travel. The Bill will create a more efficient and integrated healthcare system that is less bureaucratic, and allegations that this is privatisation by the back door are simply misleading. Through the legislation, we will ensure better and more joined-up services, improving health and care outcomes for all.

Covid-19: Purchase of Critical Supplies

Edward Argar Excerpts

Monday 31st January 2022 Written Statements

[The Minister for Health (Edward Argar)]

This statement is on the accounting impairment impact of equipment purchased in response to the covid pandemic

Today, we are publishing information relating to our purchasing efforts for critical supplies that have helped this country in our fight against the pandemic.

Since this unprecedented global pandemic erupted our absolute priority throughout has always been saving lives.

In a highly competitive global market, where many countries imposed export bans, we secured billions of items of PPE and have delivered over 17.5 billion items so far to protect our frontline workers. The Government acted quickly to achieve the target of obtaining 30,000 ventilators by the end of June 2020. The supply of these vital items has helped to keep the NHS open throughout the pandemic and enabled it to deliver a world-class service to the public.

The scale of the challenge we faced in sourcing these goods should not be underestimated. Globally there were significant logistical challenges in sourcing, procuring and distributing goods. The rapid rise in international infection rates during the early stages of the pandemic created unparalleled demand.

The disruption to the market, coupled with the unprecedented spike in demand, resulted in a huge inflation in price for goods and intense global competition to secure scarce supplies. For example, the average cost of a nitrile glove increased over six-fold at the height of the pandemic compared with pre-pandemic levels.

In this unique situation, we had to change our approach to procurement and our appetite for risk. The risk that contracts might not perform and that supplies were priced at a premium needed to be balanced against the risk to the health of frontline workers, the NHS and the public if we failed to get the PPE we so desperately needed. We make no apology for procuring PPE at pace and volume so that we could protect thousands of frontline healthcare workers in the NHS and social care.

The Department assessed PPE requirements at the beginning of the pandemic. However, as this was a new disease, we did not have data on actual levels of need. The Department of Health and Social Care developed a sophisticated model to assess demand. Our estimates of demand relied on reasonable worst-case scenario planning, information about the prevailing IPC guidance and the likely number of patient interactions in every healthcare setting. The Department’s approach to cover all settings for healthcare workers means that we have additional stock of £0.8 billion.

Our planning also had to take into account the likely non-performance of contracts. Our buying activities were more successful than we predicted, such that 97% of the units purchased have been assessed as adequate to provide protection for health care workers. A small proportion (3%) of items have been deemed not suitable for use, equivalent to £0.7 billion.

We are now in a position where we have high confidence that we have sufficient stock to cover all future covid-19 related demands, even in the face of the omicron variant. The PPE stocks we secured have allowed us to meet demand through 2020-21 and 2021-22. Our existing PPE stocks will continue to support us throughout 2022-23. Indeed, the high standards of protection we set for NHS workers means that we have an additional 10% of units that may not be suitable for use within the health and social care sectors but may have alternative uses than those we originally envisaged—£2.6 billion.

Within the Test and Trace and Ventilators programme the high standards we have set means that we have items of kit and other equipment that are not suitable for use—£0.3 billion.

As part of the Department’s annual reporting, we have prepared a statement outlining the diminishment in value of the Department’s covid stock holding at 31 March 2021 due to:

For stock we expect to use, changes in global prices between the point of purchase and market prices at 31 March 2021. As the world market has now stabilised and we are returning to more “business as usual” conditions, the value of some categories of goods is now much lower than the price they were purchased for. For example, we now estimate the value of aprons that we purchased is a third of what we paid during the height of the pandemic.

Stock that has failed quality testing and/or technical assurance and is considered not fit for use in any setting. In these cases we are seeking recovery of funds from suppliers wherever possible.

Stock that we do not intend to use for its original intended purpose, perhaps because it was bought as a contingency or has characteristics that prevent its use in a UK healthcare setting but could be considered for alternative use or resale; and,

Stock in excess of current forecast requirements where alternative use or resale is required to maximise the value of the stockpile and prevent wastage through future date expiry.

Our efforts to manage the stockpile effectively, and in doing so maximise its value, are ongoing. The Department has established a redistribution team to identify alternative uses and resale potential for inventory we do not intend or expect to use. For example, donating masks to both the Department for Transport and Department for Education to aid the reopening of the economy on public transport and to support schools following their reopening in March 2021. Any repurposing or resale of inventory is carefully considered as maintaining adequate supplies for frontline workers remains our priority.

Medical professionals within the Department’s quality control and assurance function and colleagues within Medical Surveillance Authorities have recognised that stock which has exceeded its manufacturers use-by date, is not necessarily unusable. The Department has begun a tender for a third-party medical laboratory to provide official testing of PPE products with a view to extending shelf life to maximise the usefulness and therefore value for money from the PPE purchased without compromising the quality of goods made available for use.

In addition, the Department is currently working through a revision to the pandemic preparedness stockpile, incorporating the learnings from this pandemic. We now have a more strategic approach to our supplier base, signing contracts with over 30 UK-based companies, reducing our reliance on established manufacturers in the far east and our carbon footprint. Environmental considerations are at the heart of the Department’s strategy for the ongoing management of the covid inventory stockpiles, including inventory disposals.

[HCWS572]

NHS Constitution and Handbook

Edward Argar Excerpts

Thursday 27th January 2022 Written Statements

[The Minister for Health (Edward Argar)]

Statutory report on the effect of the NHS constitution and updates to the constitution handbook

In accordance with the Health Act 2009, I have laid before Parliament a report on the effect of the NHS constitution. The report has also been published on the gov.uk website, alongside an updated version of the handbook to the NHS constitution.

The NHS constitution, like the NHS, belongs to us all. It empowers patients, public and staff by bringing together in one document the founding principles and values of our NHS. It sets out the legal rights to which patients, the public and staff are entitled and the pledges that the NHS has additionally made towards them. Just as importantly, it makes clear the responsibilities which we all have for supporting the NHS to operate fairly and effectively.

Throughout this extraordinary time where we have seen the huge impact of the pandemic on staff, patients and society as a whole, our NHS workforce have strived tirelessly to protect the people we love. It is therefore more important than ever that patients, public and staff know their rights, responsibilities and what they can expect from their NHS.

The report is based on an independent survey of staff, patients and the public. It describes how they view the impact of the NHS constitution, and its value in promoting and raising standards of care.

While the report shows that public awareness of the constitution is still low, we are pleased to see it has increased since the 2018 report, and staff awareness remains significantly higher than public awareness. We know that those informed about the NHS constitution are more likely to use it and so there is further work to do in improving awareness to ensure we all get the most out of our interactions with the NHS.

Looking forward, a full review of the NHS constitution itself is due in January 2025. The scoping for this review, including a statutory consultation with patients, carers and staff will begin this year. We will use the findings from today’s report to shape the consultation and explore how to increase awareness and use of the NHS constitution across all public and staff groups.

Alongside this report we have also published a revised version of the handbook to the constitution. The handbook explains each right, pledge and responsibility in the NHS constitution. It is designed to give the public, patients, their carers and families, and NHS staff fuller information about what the constitution means for them. This revision ensures the information given in the handbook remains accurate and up to date.

[HCWS564]