Health Bill (Fourteenth sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Thursday 9th July 2026 Public Bill Committees

[Edward Argar]

The hon. Gentleman makes a valid point, and I suspect that he has seen this issue in his professional career. Often, when a death occurs in a clinical setting, multiple factors are contributory. I think that that is why my hon. Friend the Member for Sleaford and North Hykeham framed this as she has, as “a contributory factor”—not the sole factor or the individual most significant factor, but that it could reasonably be deemed by a clinician or by those collecting the data that the long wait contributed to the death, because had that patient been seen, for example, in two hours rather than 12 hours, better clinical outcomes might have been achievable.

I take the hon. Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon. Friend the Member for Sleaford and North Hykeham may correct me, but I think that is why she framed new clause 84 as she did, to allow for that degree of a lack of total certainty in such contexts. Nevertheless, the hon. Gentleman makes a reasonable point.

I can see what the hon. Member for North Shropshire is seeking to do in new clauses 12 and 56: not unreasonably, she seeks to cast light on the impact of corridor care on patients, families and those caring for people. My only challenge would be—I will enlarge on this in a little more detail—that a narrow focus on corridor care, while understandable, slightly loses the bigger picture. Corridor care is, for want of a better way of putting it, a subset, a consequence, of a much broader systemic challenge.

The Minister will probably know this as well; when I was first appointed to her job, one of the first conversations I had in the context of secondary care was about the importance of flow through our acute hospital systems, from a patient either presenting at A&E or arriving by blue light at A&E, to being treated, and the ability of A&E to function through those patients being seen, treated, and discharged or put into a hospital bed to become an in-patient. The ability to achieve the latter is dependent on the ability to discharge.

[Helen Morgan]

New clause 56 speaks about the importance of creating capacity across the system, including social care, and about having regard to the outcome of Baroness Casey’s commission on social care to deal with the issue of capacity and flow through the hospital. We have discussed at length in Committee other amendments that would deal with the front door, in terms of GP access and trying to ensure that people are treated at first in the community, rather than ending up in A&E as a last resort. I wonder if the right hon. Gentleman would just acknowledge those points.

[Edward Argar]

The hon. Lady pre-empts me— I am afraid I have rather a few more remarks to come to. I planned to through the subsections and paragraphs of her new clauses to acknowledge exactly that. For example, in proposed new clause 56(4), she highlights capacity, and in proposed new subsection (5) she mentions Baroness Casey’s independent commission and the need to pay heed to it. All that is important, but my slight fear relates to the drafting. While the new clauses note such factors, they do not necessarily reflect the overall interdependency of all parts of the system. I believe that what the hon. Lady seeks to achieve is perfectly reasonable, but I am not convinced by how the new clauses are drafted.

The hon. Lady was right to highlight in her remarks the importance of timely discharge from hospital as a key element of whether we can achieve that flow into hospital beds and have hospital bed capacity to allow an A&E department or emergency department to function. I looked at this issue four years ago, so the situation may well be very different today, but post the pandemic I inherited about 13,000 acute beds across the system occupied by patients who were medically fit for discharge, but whose discharge had been delayed due to a variety of factors. Some were because hospital pharmacies were not open through the night to provide the drugs when patients were signed off to go home; some were because of the unavailability of patient transport; some were because all the necessary clinicians were not present to sign in the appropriate order.

The single biggest factor, as the hon. Member for North Shropshire has alluded to, was the availability of step-down or social care provision, so that patients could safely go home or to another NHS or care facility and be looked after. We managed to get the delayed discharge total down from 13,000 at a given time to about 10,000—possibly just a bit under. I would be interested to hear from the Minister what the current total is for beds occupied by those medically fit for discharge at a given time.

I see where the hon. Member for North Shropshire is coming from with her suggestion of a tribunal comprised of a mixture of people to interrogate the figures and interrogate the Secretary of State. I can see that she is seeking to make the experiences of those undergoing corridor care and their families real to Ministers, who will be accountable. I gently say that I suspect that the Minister and her boss, the Secretary of State, are only too aware of the consequences of corridor care. Such patient experiences very much weigh on them as Ministers, as they did on me and others, day in, day out. We were always very cognisant of them.

I can see the hon. Member for North Shropshire’s intention with new clause 12(4), where she suggests that Healthwatch should be involved in helping put such a tribunal together. I fear that the Government’s direction of travel may have rendered subsection (4) redundant, but I do not disagree with the intention, because I think she and I both share a view on the importance of healthwatch groups and the value that they bring locally to our healthcare system.

While I can see the point about waiting 12 hours from arriving at the hospital to being taken into A&E, but the new clause does not reflect how the system might seek to manage that. It does not explicitly reference ambulance handover times and waiting times. A challenge we have seen in the past is that, in a desire to avoid hospital corridor care, some trusts have not admitted patients from ambulances until they feel that they could manage them in the hospital.

Arguably, that is less safe than corridor care, for two reasons: first, because the ambulance is not able to offload and be available in the community again and, secondly, because although corridor care has negative consequences, none the less in a hospital corridor there is a consultant or clinician very nearby, should a medical crisis occur. That is better than someone being in an ambulance in the car park—or waiting at home, having called an ambulance that is not coming, and not having their condition assessed because the ambulance is still holding a patient that a trust does not want to admit, in order to avoid congestion and corridor care.

I worry that, although the new clause has the best of intentions, the way the system might react and the impact on ambulance handovers and the ability of ambulances to pick up patients might have been overlooked. That is not a reason not to try to solve the problem of corridor care, but we must acknowledge the ambulance part of the challenge in A&E and emergency care, and encourage and incentivise the system to work as a whole to solve the problem, rather than focusing purely on the ED. In saying that, I acknowledge that the hon. Lady has referenced social care, step-down beds and community care, which are all hugely important, and I listened to her speech with interest, as I always do her contributions.

I would be grateful if the Minister could update the Committee on the latest daily figure for how many patients who are medically fit for discharge are still in an acute hospital bed. Perhaps, when the hon. Member for North Shropshire winds up on this group, she might be able to address the ambulance point—she addressed the social care point, but I would be grateful for her thoughts on ambulances.

Health Bill (Thirteenth sitting)

Debate between Edward Argar and Helen Morgan

Tuesday 7th July 2026 Public Bill Committees

[Helen Morgan]

The hon. Lady raises a good point. I do not want to revisit an earlier part of the debate, but it is certainly relevant that where there is not a local authority representative on the ICB and there is not a mayor in place, and the ICB’s area is not coterminous with the local authority boundary, that adds another element to the issue of the separation out of Healthwatch. Does the Minister agree that the independent and locally rooted Healthwatch cannot be replaced by processes that sit within the NHS system? Will she please reconsider the change? There is concern on all sides of the House, given the value that Healthwatch brings to the service.

[Edward Argar]

Clause 65 and schedule 10 focus on local healthwatch arrangements. As I said when speaking to the previous group of amendments, Healthwatch is respected and trusted at a national level, and that is even more the case at a local level. I fear that the Government seek to remove something that works, that is effective and that ensures a strong patient voice in the system.

It simply does not work to have integrated care boards take on those responsibilities, as they will be marking their own homework rather than being the independent patient voice. It is a little like the discussion the Committee had during the previous grouping on HSSIB, in which it turned out that the CQC will be able to investigate itself, but the chief executive of the CQC would decide whether any protected disclosures could be published during that investigation. That measure brings things entirely within the system and removes the independent voice, which is exactly what this clause also does.

The ICB is the voice of the NHS system, not the voice of the patient. We need the grit in the oyster that is provided by an independent voice talking to the ICB. Being in the room with an ICB will not mean that the patient voice is heard more loudly or clearly, or that it will be acted on—it is probably more likely to mean that it is not. As an example from my constituency, the ICB did conduct a consultation exercise on the proposed closure of St Mary’s birth centre in Melton Mowbray, the response to which was overwhelming: the patient voice said that they did not want that to happen. That response was fed into the ICB, but the ICB did what I fear it planned to do all along and closed the centre. Given that that voice in the room came from a consultation exercise led by the ICB, it seemingly did not make a jot of difference to the outcome or decision, or to whether the patient was heard.

On the impact of local authority scrutiny panels, the NHS ICB in Melton previously recognised the need for increased GP provision in the town due to the increasing size of the town and the long waiting times, but just recently decided to reverse that position and say that it did not see the need for that. Members of the scrutiny committee, across all parties, were absolutely clear that they disagreed with that decision, but did that get listened to or make a jot of difference to the ICB? No—the ICB did what it was going to do anyway and changed its mind.

My concern is that we will see less grit in the oyster and patient voice, and more managerialism in the NHS ICB system. We heard from the hon. Member for North Shropshire and the shadow Minister about the challenges there would be, even were that patient voice to happen. Given the Government’s 50% cuts to ICB budgets, which are already impacting frontline services, ICBs will not be able to take on additional responsibilities without the funding that they need. That is quite apart from the principle that they should not be marking their own homework. I fear that “system knows best” will become the default.

We have also heard about the geographical challenges. Given that mergers and acquisitions are getting even bigger, ICBs are moving further and further away from what was conceived: for them to have the same geographical footprint as the upper-tier local authority providing social care, to ensure that the two organisations spoke to each other and were better integrated. Removing the representative from the local authority that provides that healthcare from the board, even if they are replaced with a mayor, does not bring about the reconnection with social care provision that is so central. Removing the voice of general practice or primary care from the ICBs again moves that independent challenge away from the system.

I fear that this is a fragmentation of those links at a local level and the weakening, if not silencing, of a patient voice that can challenge publicly and ensure that what patients need to have said is genuinely said. Being in the room does not mean that that voice is heard or acted on, as shown from the examples I have spoken about: there is a consultation exercise, the view is reflected on, and the ICB does what it was going to do anyway and does not change its position. I have genuine concerns about the loss of an independent patient voice in a local context.

The Minister will correct me if I am wrong, but I think she made the point in her opening remarks that we have lacked not recommendations and suggestions for changes but action to fix the issue. But it is not for Healthwatch to take action to fix the issue; it is for the ICBs and the NHS to act on those recommendations. We are proposing to give the bits of the system that have failed to take action and fix the issue not just the responsibility that they already have but the responsibility for reflecting patient voice. The one bit that is working—where patients’ voices are heard—is the bit that we are getting rid of. We are not seeking to fix the bits that have real pressure and genuine levers to compel an ICB to act on those recommendations when they are made independently, rather than simply marking its own homework.

As with my reflections on clause 64, I genuinely fear that in this weakening of patient voice, particularly at a local level, the patient will be the loser because the system will continue to do what it wishes to do. It will do its consultations, and it may have a director of patient experience at an ICB level, but they will be working for the ICB; they will not be there as an independent voice to challenge the ICB—including publicly—on what it is doing.

I hope that the Minister reflects further on the real diminution, if not the neutering, of patient voice that comes with some of these arrangements. As always, I look forward to her reflections when she winds up.

Health Bill (Twelfth sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[Edward Argar]

I do think that the scope of the review, who determined the six organisations and how that was looked at is important, and I am sure that the Minister will be able to clarify that when she makes her concluding remarks. However, there are a couple of other issues that concern me in terms of some of what was in the review, which seems to be the basis on which this is being done. Finding 6 suggests that HSSIB has expanded its

“scope of work beyond the original remit.”

It goes on to say:

“HSSIB was originally established, along the lines of safety investigatory bodies in other industries, to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations.”

I have to say, as the Minister who took the Health and Care Act 2022 through, that is simply not the case. That Act does not limit HSSIB investigations to individual incidents. If I recall correctly, in some of the debates on the HSSIB clauses in the Bill, we alluded as a Committee to the need for it to be able to look beyond individual incidents and try to draw out common themes. What has been said simply does not accord with my recollection of the purposes of the legislation.

Again, my hon. Friend the Member for Farnham and Bordon highlighted this. Recommendation 3 states:

“Most investigations into safety incidents should continue to be managed within provider organisations”.

That is the real challenge here. HSSIB’s independence is what allows it to range across the piece—to have issues raised with it and look at individual organisations. The challenge so often is that the provider organisations are marking their own homework and are simply not getting to the truth, or being as candid with those who have made the complaint as they have a right to expect.

[Helen Morgan]

I wonder whether the right hon. Gentleman has had the experience that I have had as a constituency MP of very senior clinicians who work in the NHS attending my surgery and explaining that if they have raised concerns within their organisation, they have been encouraged either to leave or to retire. They feel frightened to raise concerns about safety that they have experienced in carrying out their duties, so it is really important that this safe space exists. Does he agree with that?

[Edward Argar]

The hon. Lady makes her point extremely clearly, and I do agree with exactly the point she makes, because in any organisation it is a big step for an individual employed by or working in the organisation to make a complaint about their organisation or to whistleblow on something that has gone on or that they feel has not been got right. Key to getting people to do that is that they feel safe and empowered to do it in the public interest, and that is exactly what is at the heart of the air accidents investigation branch and the rail accident investigation branch model, so that the information is brought forward and learnings can be driven by it to improve safety for everyone. As the hon. Member for Bury St Edmunds and Stowmarket said, that safety is patient safety and that has to remain the golden thread that runs through everything we are debating. Whatever difference of perspective we have on this set of clauses, that must remain at the heart of what we are looking for.

Health Bill (Seventh sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Helen Morgan]

I want to draw the Minister’s attention to some of the difficulties relating to cross-border healthcare in a border area. I represent an area on a border. North Shropshire has a very wiggly, for want of a better word, border with Wales, which means that some English constituents are registered with a GP surgery in Wales but receive their secondary care in England. That causes significant difficulties for them because of the lack of joined-up communication between the two Administrations. I seek assurance from the Minister that as ICBs in England will have to pay regard to people who live near the border in Wales, conversations are going on with the commissioners in Wales to ensure that that process is as smooth as possible.

[Edward Argar]

The hon. Member for North Shropshire makes the point very well. Back when I was a Minister, and subsequently shadow Secretary of State, she raised that point with me. The clause is sensible. The Minister articulated concisely and reasonably why it is necessary. It is the nature of any devolution arrangements that a little bit of cross-border co-operation is required along the border to make sure that services work effectively for people. This may have changed, but in my experience the majority of those crossing the border were people from Wales coming for secondary care services in a hospital on the English side of the border, so I think the clause is entirely reasonable.

I echo the hon. Lady’s request: I would be grateful if the Minister updated the Committee on what conversations she has had, particularly with the Welsh Government, but also with the Scottish Government, to ensure that there is reciprocity and that they will put an equivalent provision into their laws to ensure that patients in England are taken into consideration in their healthcare planning.

Health Bill (Sixth sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Helen Morgan]

We do not consider the right to achieve a cancer diagnosis and treatment to be burdensome on the secondary care providers of those treatments; we consider that important enough to enshrine that right within the NHS constitution, and this would be a similar level of right. I would not imagine that a GP would be worrying about somebody taking them to court, but it would confer upon the Secretary of State the duty to ensure that primary care is adequately resourced in order to be able to meet that commitment.

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

I am very grateful to the hon. Lady for giving way; she is typically generous with her time. Can I just seek a little clarification in terms of the right to a GP appointment in new clause 2? Is her intention that that is an appointment with the practice—be that any clinically qualified individual within it—or an appointment with a GP, not with a practice nurse? Would, for example, a telephone appointment constitute an “appointment”, rather than specifically an in-person appointment? I just want to understand a little more about what is expected here.

[Helen Morgan]

The right hon. Gentleman asks an extremely important question, and I am happy to clarify. It would be an appropriate clinician within the GP practice, and it could obviously be a telephone appointment, because that might be more convenient for the patient. Lots of patients are really happy with telephone appointments and we should be using them wherever that is the patient’s choice, because we want—I think we all do—to see an NHS that is patient-led and not politician-led.

--- Later in debate ---

[Edward Argar]

It is a pleasure to serve under your chairmanship, Ms Lewell. My hon. Friends have addressed at some length the Government new clauses and amendments, so the Minister may get a slightly easy ride from me this time, but I want to pick up on new clause 2 and some of the points that my hon. Friend the Member for Farnham and Bordon raised.

The hon. Member for North Shropshire knows that I have huge respect for her. I have worked with her, across the health and social care space in this House, on a number of issues, so I can entirely appreciate where she is coming from on this. She raises an issue that is very important to all our constituents, which is access to primary care when people need it. For example, in Melton Mowbray in my constituency, there have been real concerns in recent months about very long waiting times to access primary care services. That has on occasion caused considerable distress for some patients, who have become more and more concerned.

I have to say that the practice has sought to do a lot to address that. It has brought on board a new annexe and additional services and been recruiting more GPs, but the challenges remain and the concerns are very real and would, I suspect, be shared by all our constituents. One of the key things in how the practice has been seeking to address the issue and how other practices locally, both rural ones and ones in some of the towns in my patch, have sought to address it has been a degree of flexibility and of clinical triage as to what is the most appropriate access point to primary care services for the individual, based on their symptoms and needs.

For me, despite the work being done in Melton Mowbray at the moment to improve waiting times, it remains a very significant concern that despite the integrated care board having a few years ago acknowledged publicly the need for additional GP provision in the town, whether a second GP practice or a new satellite service, it said a few months ago—despite the fact that in the intervening period there has been considerable housing development in the town—that it considers that there is no need at the present time for additional GP provision, and so it does not appear to have a plan to expand that provision. That is obviously concerning. All of us in this House will from time to time have these issues in our constituencies and, I suspect, sometimes get frustrated by the fact that ultimately we can press our ICBs and ask questions of the Minister—who, I have to say, always responds in a courteous and measured fashion—but ultimately the decision maker is the integrated care board’s board and it will do what it wishes to do when it comes to commissioning those services. There is a disconnect there.

My challenge with regard to new clause 2, despite my being in agreement with the need to improve access to services, is that there is a lack of clarity about how that will be done and there is the fear that it may raise expectations that are not necessarily deliverable on in the current context. The Liberal Democrat five-year plan for GPs is in their 2024 manifesto, and the hon. Member for North Shropshire alluded to the commitment to 8,000 additional GPs. It is not my usual habit, but I have read the Liberal Democrat website, which sets out the background. I appreciate that this is from 2024 and the hon. Lady may have moved things forward a little bit since then, but it states that the five-year plan

“gives patients the legal right to see a GP within a week or 24 hours if needed urgently”.

The hon. Lady may wish to respond on that.

[Helen Morgan]

I am sure the right hon. Member has enjoyed reading the Liberal Democrat website. If he had delved a little further into the policy paper that sits behind that manifesto commitment, he would see that that is with an appropriate clinician and not with a GP. I appreciate that the wording of the new clause says a GP, but it does indicate a GP practice, and would require the Secretary of State to establish a scheme that would achieve that. I expect that clarification could be made at that point.

[Edward Argar]

I am grateful for that, and the hon. Lady has that on the record. As we all know with political campaigning, the headline on the front page of the website may sometimes, although not always, contain the “conditions apply” caveat in the small print. The hon. Lady has read her explanation into the record of the House, and I, as always, take her at her word and accept that explanation.

My concern is how this measure would be paid for—8,000 GPs, of which half were to be new recruits and half were either through retention or by encouraging returners to the profession, with a costing of about £1 billion. That works out at about £125,000 a head, so it is not outside the realms of possibility. That was not going to be paid for through closer ties with the European Union; if I recall correctly, I think it was tagged against hikes in capital gains tax with three new bandings, rather than EU links.

--- Later in debate ---

[Helen Morgan]

I am happy to clarify. Clearly, the world has moved on since July 2024 when we put together our manifesto, but this was a fully costed plan with a number of different changes to tax regimes, including a tweak to capital gains tax and changes to the way that banks were taxed and digital services tax. Since then, we have proposed a number of other alternatives, but the principle of changes to capital gains tax, to the way that windfall profits of the big banks are taxed and to digital services taxes still stands. Plus, we also have a fully fleshed-out plan to actually grow our economy and deal with this problem in the long term.

[Edward Argar]

I am grateful for that clarification. I am conscious that we have to finish at 1 pm, so I will bring my remarks to a conclusion.

We can all see the intent behind new clause 2; we can all feel that intent in correspondence we get from constituents. Having taken legislation through the House, my concern is that often the challenge is in the drafting of such clauses: while the objective may be honourable, the opacity of them, or the lack of some detail, can risk creating an expectation while not actually setting out how that can realistically be met. My worry here is about the practicalities, in an era where expectations are being set and dashed and that is causing challenges for our democracy.

Health Bill (Second sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Tuesday 16th June 2026 Public Bill Committees

[Helen Morgan]

Q Do you think that the health and wellbeing boards, as envisaged by the Bill, will be the right structure to deliver those relationships, and how do you ensure that they have the right skills?

Councillor Wright: I chair a health and wellbeing board, and everyone comes to those; there are really good conversations and really good reviews of what is happening. I think they are in a really good position. What I worry about is how much influence they will have over NHS wider strategy.

I was at a King’s Fund day, and someone said something that I thought was so true: the Health Bill and the NHS 10-year plan is the NHS 10-year plan. The NHS will be judged on how it achieves what it is meant to achieve. Although, as local authorities, we want to help with prevention and those wider determinants of health, ultimately the responsibility sits with the NHS.

It is about trying to work out how we have better conversations with the NHS, to say, “We have done neighbourhood health for years; this is what we do as local authorities. We look at all these things and we use public health and our adult social care system to create healthy environments. We need you to be on board with us.” I therefore think there is something about the power dynamics regarding health and wellbeing boards and how we address them. But overall, I feel that they are the best way of ensuring community health.

The other thing is about geographies. Health and wellbeing boards might not match neighbourhood health geographies, so there are also some challenges in working out how that will work.

[Edward Argar]

Q Having been both a local councillor and a Health Minister, I am very conscious that the real test of any joint working arrangements between different bodies comes when budgets start getting a little tighter. We see that tension growing a little bit with the cuts made to ICBs’ budgets.

I was the Minister who created ICBs, and I sat on that Bill Committee with the current Minister for Secondary Care. I am getting a sense of déjà vu—we are on different sides of the Chamber now, but we sat through the Committee stage of the Health and Care Act 2022 together. I deliberately created ICBs to match the geography of upper-tier authorities because health and social care is essentially one system. If one bit does not work, the other bit does not work.

Since then, we have seen significant mergers and larger areas, further removing them from that direct relationship and read-across. Although the good ones do, I fear that a lot of NHS ICBs do not fully reflect the intention behind their creation, which was to see them as a genuinely collaborative exercise with equal voices in the room.

My question is: if we see ever-larger areas or fragmented areas, whether through neighbourhood health plans or mergers and acquisitions among ICBs, how do we maintain genuine local accountability and the relationships that underpin any structure written in law, on a piece of paper or in guidelines?

Notwithstanding what is being done about the health and wellbeing boards’ increasing involvement, do they actually have the teeth they need? In my experience, however good the collaboration, it is within the ICB boardroom that the decisions are actually made. However well things have been discussed beforehand, the ICBs will make their own decisions based on their own priorities. Does the removal of that voice from the ICB strengthen or weaken the ability to see this as one local system and to deliver a genuinely holistic local solution?

Councillor Wright: It will probably weaken it, unless we are given more say in our local health and wellbeing board. Our Thames Valley ICB has one director of public health. Thames Valley ICB I think has nine local authorities, and one chief executive and one director of public health sit on the board, so already the voice on it is quite small. If we lose that voice, where would we have those conversations? That brings me back to the whole thing about health and wellbeing boards needing to be stronger, definitely.

Sally Burlington: We would agree with that. If you take away the voice that is able to speak on behalf of social care, public health and wider public services, it will be harder and an additional job to bring in that consideration. It will be even harder to expect there to be notional teeth in that relationship, so we have concerns about that.

Maria Higson: It is also worth recognising that the delivery of any strategy or plan will require partnership working with local authorities, so whether or not they are in the room, they will be needed for delivery, and the proof is always in the pudding. For me, the partnership is somewhat non-negotiable in order to achieve delivery.

Ambulance Response Times: Shropshire

Debate between Edward Argar and Helen Morgan

Thursday 31st March 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

Just as I had the pleasure of giving the final speech in the final debate before the House went into recess before the last half-term, I have the same privilege today. To that end, I congratulate the hon. Member for North Shropshire (Helen Morgan) on securing this important debate. In the short time in which she has been a Member of this House, she has taken an extremely close interest in the issues of ambulances and healthcare for her constituents more broadly. She has been assiduous in raising them in the House, as she has today, or through other means with Ministers and the Department. I pay tribute to her for that.

The hon. Lady will be aware, as she has genuinely and openly said, that there are complex causes behind the challenges faced by her constituents, and also by people around the country, with the ambulance service and ambulance response times. Ambulance services have faced extraordinary pressures, which have been particularly exacerbated during the pandemic. I am sure the House will join me in expressing gratitude, as she did, to all the ambulance service staff in the NHS for their outstanding work and dedication during this time. I recognise the very powerful individual cases that the hon. Lady cited, suitably anonymised, to illustrate her arguments and her case.

As I have mentioned, the pandemic has placed very significant demands on the service. In February this year, the service answered over 760,000 calls to 999—this is nationally, and I will turn to the hon. Lady’s local situation in due course—which is an increase of 13% on February 2020. That places very significant pressures on the ambulance service and the wider NHS, and I will turn to the broader causes shortly. She was absolutely right to highlight that the issue is often not with the ambulance service itself—the number of ambulances or the number of staff—but about handovers and the ability to do turnarounds having safely deposited a patient at an acute setting in a hospital, but I will turn to that in a minute.

A range of other issues, as well of course as demand, impact on performance, including the need for infection prevention and control measures, which remain in place in hospitals. They may not be as acute or as severe as they were at the height of the pandemic, but they are still there, and that does have an impact. There are the handover delays the hon. Lady spoke about, which are linked to capacity with those infection prevention and control measures, but also to the ability either to treat and discharge or to admit patients to a hospital. In recent months, we have also had high workforce sickness absence rates, often down to covid and covid self-isolation, with staff quite rightly taking the view that when they test positive for covid they should stay at home until they do not.

In spite of these pressures—and this is in no way to diminish the point the hon. Lady made about the impact on her constituents, but is by way of context—the average response time in the west midlands to category 1 calls, the most serious calls classified as life threatening, was maintained at eight minutes and 11 seconds in February 2022. That was despite of a 40% increase in that category of calls on the previous year and a 16% increase locally in 999 calls overall. At a national level, the category 1 response time has been largely maintained at about nine minutes on average over the last several months—so not quite as good as the performance in the West Midlands—despite a 23.5% increase in those incidents compared with before the pandemic. However, we are clear that there have been significant increases in response times in the other categories, which of course we must improve.

[Helen Morgan]

I just want to make the point that in Shropshire we are not seeing the same level of service that we see across the west midlands as a whole. I am calling for more granular data because I think some excellent service provided elsewhere in the West Midlands Ambulance Service area is overshadowing some of the specific problems we are seeing in Shropshire. In addition, the number of hospital admissions to the Shrewsbury and Telford Hospital NHS Trust is running roughly at the same level as in prior years, so although the covid pandemic has provided challenges in separating out such patients when they arrive through infection control measures, it is not actually leading to a higher level of admissions.

[Edward Argar]

I am grateful to the hon. Lady, and I will turn to her specific asks in a moment.

However, I will turn now to the Bill introduced by the hon. Member for St Albans (Daisy Cooper), which I am aware of. I have to be honest and say that we do not consider that the Bill would necessarily be the most appropriate way of achieving what she wants. The challenge with that legislation is that, at a time when we wish trusts to be focused on the delivery of frontline services, it is another administrative process of data collection. I would add that trusts of course operate at trust level, not at an individual station or county level, and trusts may cover a number of counties. So while I am aware of her legislation, it is not something that I believe would achieve the outcomes or be practical in the way she wishes, and she and I regularly have a to and fro across the Dispatch Box about a number of issues when she speaks for her party on health and care matters.

There is strong support in place to improve performance. At the national level, as the hon. Member for North Shropshire generously recognised, there was £55 million of investment last summer, in advance of the winter, to help increase ambulance staffing capacity to manage pressures. All trusts received a portion of that funding to expand capacity through additional crews on the road and additional clinical support in control rooms as well as extending hospital ambulance liaison officer cover at the most challenged acute trusts.

On overall staffing, which includes frontline clinical staff and the clinical support staff who work with them, our ambulance service has seen about a 38% increase since 2010—the Liberal Democrats can quite rightly take some credit for that from their five years in government—and, indeed, in the last year we have seen an increase of about 500 frontline staff. So we have increased staff and continue to increase available staff.

The £55 million was supported by an additional £4.4 million in capital investment—these are still national figures, but I will turn to her specific local circumstances—which helped to keep an additional 154 ambulances on the road during winter over and above normal levels. Call handler numbers, which are equally important, are being boosted with more than 2,400 on target to be in place by the end of March—the end of today. That is about 500 more FTE—full-time equivalent—staff compared with September 2021, with potential for services to increase in capacity further during the coming financial year.

NHS England and Improvement is also providing targeted support to the hospitals facing the greatest issues with delays in the handover of ambulance patients, helping them to identify short and longer-term interventions to reduce delays and get ambulances swiftly back out on the road. She is right that that is hugely important, and even more so in areas with large rural populations because of the distances involved. Trusts also receive supportive continuous central monitoring and support by NHSEI’s national ambulance co-ordination centre.

With clinical support in control rooms, the ambulance service is closing just over 11% of 999 calls with clinical advice over the phone, which is an increase of three quarters since before the pandemic. That helps to save valuable ambulance resources to respond to more urgent calls, with that clinical input ensuring that the advice and decisions are right.

The hon. Lady will be pleased to hear that significant local support is in place to improve response times in her county. The West Midlands Ambulance Service is working with community partners to help avoid conveying patients to hospital where there is no clinical necessity, providing alternate treatment and care at home or in the community and helping to avoid unnecessary trips to hospital, thereby freeing up resources and hopefully providing a more pleasant experience for those patients.

In raw numbers, the West Midlands Ambulance Service conveyed over 600 fewer patients to hospital in February based on the clinical advice this year compared with two years ago. It has also introduced a clinical validation team of advanced paramedics who work in control rooms and clinically triage lower urgency cases and, where appropriate, signpost patients to other services, as I alluded to. In February, that team reviewed 967 cases in Shropshire, of which 61% of were not sent an ambulance, 14% were treated on the scene and just 25% were conveyed to hospital. That was based on the clinical triage, which I am sure the hon. Lady agrees should be central to any decisions made. That has played a significant part in helping the service to tackle the pressures.

Other practical solutions include hospital ambulance liaison officers—HALOs—who are paramedics who work with bed managers to smooth out the flow of patients coming to an A&E department. They can provide a constant flow of information about capacity to the strategic command cell at the ambulance service headquarters, escalating any issues and avoiding queueing where possible. There is also joint work to cohort ambulance patients at A&E sites, where a single ambulance crew takes responsibility for three or four patients. That releases crews to respond to outstanding calls in the community more quickly.

A new same-day emergency centre—SDEC—has been opened at the Royal Shrewsbury to divert patients, as clinically appropriate, away from A&E, improving handover times. In the two and a half years that I have been a health Minister, I have discovered that there are probably almost as many acronyms in health as in the Ministry of Defence. Surgical SDEC capacity at the Royal Shrewsbury has also been expanded and all SDEC units receive ambulances directly for suitable patients.

The hon. Lady rightly mentioned hospitals, and I am grateful that my hon. Friend the Member for Telford (Lucy Allan) is here and made an intervention. During her seven years in the House, she has been a regular and vocal advocate for her local hospital in Telford. I pay tribute to her, because it was due to her campaigning and tenacity that there is an A&E locally at Telford. That is still seeing patients and helping to alleviate the pressure in Shropshire. She should rightly be proud of that, having successfully campaigned for it.

Action is being taken locally to improve the patient flow through hospitals by discharging patients more quickly to create bed space. The aim is not only to increase the number of discharges a day, but to bring more discharges forward to earlier in the day, when it is clinically safe to do so, to allow the effective discharge and transition back to care at home or in a care home. Health and care system partners locally are looking to create additional community and social care capacity to support timely discharge, create bed space to take patients from A&E and reduce ambulance handover times.

At a national level, we have set up a national discharge taskforce. As a Minister, I get almost daily statistics about where we are on delayed discharges across the country. It is a complex picture, with a variety of reasons behind delayed discharges. The hon. Member for North Shropshire is correct that some are about delays in getting into care homes or getting domiciliary care packages or rehabilitation packages at home. Some are also down to delays in the hospital in sign-offs and procedures, and there is more that we continue to do to drive those delays down.

Construction is also under way on a new modular ward at the Royal Shrewsbury site, with 32 additional beds in service by spring 2022. That is alongside a £9.3 million upgrade of the emergency department at the Royal Shrewsbury, delivering additional cubicles, a new and improved majors department, a new designated emergency zone for children and young people and a new clinical decisions unit. The first phase of that work is complete and all areas will be finished by spring 2022.

The hon. Lady raised a number of other issues, including the Future Fit model. We have been clear that funding of £312 million was allocated for that project, and that remains allocated. The challenge we face is that, thus far, the trust has not proposed a solution that meets that budget. We continue to work with the trust and to encourage it to do so. I hope that it will so that we can continue to drive that important project forward.

I will very gently push back on what the hon. Lady said about there being £10 billion of PPE that is not fit for purpose. She will know that that is not correct. In the statement that was made about write-downs, not write-offs, the amount was about £8.7 billion, and it was not all PPE, by any means, that was not fit for purpose. Only a tiny proportion of that was the case. A significant element of that was essentially due to over-ordering at the height of the pandemic to make sure that the frontline had the PPE that it needed. We were buying at the height of the market, and there is currently a glut of PPE, so its value has inevitably declined. Not all of it will be used, because we got more than we needed to make sure that clinicians and others on the frontline were not exposed.

The hon. Lady touched on local ambulance Make Ready stations and the changes to them. Decisions on reconfigurations and changes to that are made locally by the trust; it consults, but it makes those decisions. The Government do not have any power over those matters. The Health and Care Bill, which we debated yesterday, would give the Secretary of State greater power over such reconfigurations in the way that she asked, but her hon. Friend the Member for St Albans argued against that. I gently say that that is a matter for the local trust and the usual NHS processes on reconfigurations.

The hon. Lady touched on, I think—forgive me if I am wrong—asking the CQC to look into this issue. It is entirely open for her or others to raise it with the CQC, and the CQC will make a decision or a judgment on whether it believes that it is appropriate or otherwise to look into the matter.

In the few seconds that I have left, before Mr Deputy Speaker calls me to order, I say that I recognise and do not in any way diminish the significance of the issues that the hon. Lady raised. I hope that I have given her some reassurance that we are working through these issues and that we continue to put the support in place to help her constituents in Shropshire and more broadly.

Finally, the hon. Lady requested a meeting, and I am conscious that she has raised the issue of correspondence. I have asked for that; I believe that that has happened since Christmas, as the Department works through the backlog. There is still a delay in correspondence, but I have pulled that out and asked for it, and I am happy to meet her and her fellow Shropshire MPs, together with the ambulance trust, to discuss their collective concerns or reflections that they would like to put to me as a Minister.

I conclude by wishing the hon. Lady a very happy Easter and by thanking her for bringing this to my attention and the attention of the House.

Covid-19: Purchasing Effort

Debate between Edward Argar and Helen Morgan

Thursday 3rd February 2022 Commons Chamber

[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.