NHS Winter Update

Lord Allan of Hallam Excerpts

Thursday 11th January 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Government’s urgent and emergency care recovery plan promised the largest and fastest ever improvement in emergency waiting times in the NHS’s history. Yet it has not delivered in preparing the NHS for the winter, which we should remind ourselves is a season that, as sure as eggs are eggs, appears every single year. It should be no surprise to any of us, including the Government.

To take just one shortcoming, the plan talked about lowering bed occupancy rates as “fundamental”, yet in November, at the start of winter, bed occupancy was at its highest level since the start of Covid. It stood at 94.8%, a level which will surely lead to serious issues. Did the Government consider taking any additional action to lower occupancy rates? What steps will they now take to ensure that this is not simply repeated every single year?

Today, there have been a number of reports in the media, and I want to refer to two of them. We have read reports that NHS England has confirmed that the NHS is failing to meet all of its key targets: patients are waiting even longer in A&E, even longer to start routine treatment, even longer for cancer diagnosis and treatment, and even longer to be admitted to hospital or for an ambulance to arrive. This is a damning indictment. Perhaps the Minister could tell us the Government’s response to the reports of NHS England today. Also in the news, the Health Service Journal reported that trusts are being told by service commissioners for Lancashire and South Cumbria that, due to the expected deficit, they should plan for a 10% cut in contract values on top of the annual efficiency savings that they are already planning for next year. What is the Minister’s response to this worrying situation? How will it affect services, not just in winter but all year round? How many other trusts across the country are in a similar position?

I would like to pick up a matter strongly defended by the Secretary of State in the other place when this Statement was first made to Parliament—the matter of 800 new ambulances. These ambulances were promised by the Government to help NHS trusts tackle the crisis of ever-worsening response times. But freedom of information requests found that, across 10 of the 11 ambulance trusts in England, there were plans to order only 51 new ambulances. I would like to give the opportunity to the Minister to share any information that is missing from the responses from ambulance trusts that would show that the information referred to in the FOI request was mistaken in some way. Perhaps the Minister could also provide more detail on what NHS England referred to as a problem in procurement due to the impact of global supply chain pressures, and on whether and when it is expected pressure will subside, so that we will see all the promised new ambulances. What performance improvements are to be expected from the 51 new ambulances that we know have been ordered? How would this compare with the full 800 that were promised, had they been procured?

The Government’s Statement presents as a combination of somewhat selectively chosen numbers and situations that do not recognise the reality of a health service in which patients cannot get appointments with their doctors, dentistry is in crisis, and unprecedented numbers of people are having to wait unduly for surgery, cancer diagnosis and treatment, and their ambulances—and all of this while striking doctors are being blamed for the whole situation. The strike action by junior doctors has been the longest in NHS history, with trusts declaring critical incidents and A&E departments telling some patients to stay away to lessen the load. This is a situation that I am sure the Minister will tell us cannot continue, but it continues to disappoint that the Government do not see it as their responsibility to show leadership and resolve the dispute. Could the Minister advise the House of the steps the Government are now taking, or will take, to ensure that we do not see a continuation of this damaging situation?

Finally, I would be keen to hear from the Minister on an aspect of the winter health situation which was not mentioned in the Statement regarding Covid. In the run-up to Christmas, according to the Office for National Statistics, 2.5 million people were thought to have Covid. What assessment have the Government made of this increased prevalence and what impact has it had on the NHS so far this winter? What assessment have the Government made of how the impact may continue? I look forward to the Minister’s response.

[Lord Allan of Hallam (LD)]

My Lords, we should start by recognising and thanking the nearly 3 million health and care workers whom we depend on all year but who have to work especially hard during the winter months. We should also show our appreciation for the many millions more informal carers who spent the festive period looking after family and friends. That was the nice bit, but I now turn to some questions for the Government on what I thought was a predictably upbeat, “It’s all going swimmingly except for the strike” Statement; yet within it there were some significant gaps, some of which the noble Baroness, Lady Merron, pointed out.

It is notable that the Statement says nothing about primary care but instead focuses very much on hospital beds, which I will come to next. Can the Minister comment on how GP appointment waiting times remain unacceptably long in many parts of the country? This is a poor outcome both of itself and in terms of the knock-on effect it has on emergency services. I hope that the Minister can confirm that the Government have been monitoring GP waiting times during the winter months, and that he can indicate what they are doing about these.

The Government say they have added 3,000 hospital beds as part of their 5,000 target. That target was part of their response to last year’s crisis. Does the Minister have any new data on the utilisation of those beds and whether this matches up with the predictions the Government made when they set the target, and any analysis they made to come up with the 5,000 number in the first place? The Statement also highlights the 11,000 virtual beds that are now available, which instinctively seems like a positive development to me. But the important thing is how a broad range of people experience these and the health outcomes they deliver. What are the Government doing systematically to collect data about those virtual beds and whether they have been able to deliver a comparable level of care for people who are suffering during the winter pressures?

Another key area of delivering emergency care in winter is the availability of ambulances, which was rightly flagged by the noble Baroness, Lady Merron. The Minister may have seen a report in the Health Service Journal from 30 November last year, which said that in some areas there is a mismatch between the number of paramedics recruited and the number of ambulances available. It is great that the paramedics have been recruited, but if they are sitting around in the base stations because the vehicles are not there, that does not deliver the improved waiting times we are all looking for. I hope the Minister can comment on this report and whether the Government are able to deliver the vehicles in lockstep with the newly trained paramedics, which is what we all wish to see.

A further element of the response is the 111 service for less-urgent services, which, again, is not mentioned in the Statement. There are concerns about whether people are being directed to the right place—111, GPs, 999 or accident and emergency departments. Are the Government monitoring the performance of 111 in respect of flu, Covid and other winter respiratory diseases?

Finally, we have often discussed patient flow through hospital and out into the community with the Minister, who I know takes a particular interest in this. We know that some trusts are piloting systems to improve flow that could be described as like hotel booking systems that enable beds to be made available in a much more efficient and timely fashion. Will the Government compare the performance of trusts that have these systems in place with those that do not, as they go through this acute period of pressure in the winter months?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I wish everyone a happy new year and share in the thanks given by noble Lord, Lord Allan—and, I am sure, the noble Baroness, Lady Merron—for the hard work all the staff put in over the Christmas period. We have done a lot of work to prepare for this winter, and that was based on expanding supply. I will go into more detail in answering the questions so far, but that included the 5,000 additional beds, of which 4,000 are currently in place. It included the 11,000 virtual wards and 800 new ambulances, and again, I will answer some of the specific questions about the utilisation of those. It included the £600 million for adult social care discharge and the 141 CDCs, with 6 million more diagnostic tests, and the 50,000 increase in nurses—as well as mental health.

Of course, there have also been 50 million more primary care appointments since 2019, to answer the point made by the noble Lord, Lord Allan. That was accompanied by extensive planning, as I have seen. We have really tried to learn a lot of lessons from last year and get ahead of the curve with earlier plans, putting key management support teams in place to provide help in the areas where it is most needed. Everything is underpinned by a stronger technology infrastructure, digitalisation and the patient flow systems.

We are really trying to get ahead, so we brought forward the flu and Covid vaccines, so that, hopefully, we can make the situation better. I will not say that it is anything more than early days, or that one swallow makes a summer, but there are some promising early signs. On ambulance handovers, we have seen a 20% reduction in lost hours. The figure for category 2 response times is 45 minutes; it is still too long, but it is half that for this time last year. As for patient flow and the use of the system, we have seen a 10% reduction in so-called bed blocking, partly because of the flow mechanisms and partly as a result of early investment in the discharge fund.

All that is against the background of increased activity—and, of course, the strikes. To date, they have cost us 1.3 million lost appointments, 113,000 most recently. I say to the noble Baroness, Lady Merron, that we have tried to behave in a reasonable manner. We have reached agreements with all the other professions—the nurses, physicians, consultants and specialist doctors—and we have shown leadership, alongside the unions, in doing so. In contrast with that reasonable behaviour, the 35% pay demand is not reasonable, and nor is planning strike action at the busiest time of the year. Coming out only twice, when you have been asked 40 times by NHS trusts to act on patient safety, is also not reasonable behaviour. We want to resolve this issue. We have shown a capacity to resolve it in other areas, and we have shown leadership. I ask the BMA and junior doctors to come forward with reasonable expectations, and let us resolve this right now.

I have a polite suggestion to make. I thought that the noble Baroness, Lady Merron, might raise the issue of NHS targets. People know that I am a reasonable person, and the last thing I am going to do is say that all is rosy in the garden, but we are showing some solid improvement. I am definitely not happy with the fact that the England targets for a four-hour wait and 62-day cancer care were last met in July 2015. But I note that they have never been reached in Wales, which Labour has been running. In Wales, the 62-day cancer care target was last reached in 2010. Also, if you are in Wales, you are much more likely to be on a waiting list: 21% of the population are on a waiting list, compared with 13% here. In Wales, you are likely to wait five weeks longer, on average; and 50% of the time, you will wait for more than four hours in A&E, compared with 40% in England.

The England results need to be better, and we are working to make them better, but I politely suggest that the Opposition might want to look at where they are running the NHS and see what they can do to improve that, because on every standard you see a poorer performance from the Labour action in Wales. That is what all the evidence tells us.

I will try to answer some of the specific points. On ambulances, 300 new vehicles have been delivered to date. There is an issue with one supplier, but we are confident that the 800 new vehicles will be delivered. It is those, alongside the paramedics, that are allowing us to address ambulance wait times and bring them down. The 111 number is now on the app and is really directing traffic; it is up 8% versus last year, so, again, we are seeing real improvements. I think I mentioned that patient flow is improving as well.

On Covid, bringing forward the vaccinations has been helpful in terms of prevention. While we would all accept that 2.5 million is a large number, if we look at the number of beds being taken up by Covid and flu this year, we can see that it is half the number that it was last year. It is still a big number, but it is half what it was. We are in the early stages and a lot more work is needed, but one reason we are starting to see these improvements is that we have tried to get ahead of the curve with those vaccinations.

As regards virtual wards, so far we have about 70% utilisation of those. We need to collect the data; noble Lords have heard me say before that the results from virtual wards in places such as Watford and elsewhere show good results in terms of both satisfaction and, most importantly, not returning to hospital. Where people have gone into a virtual ward rather than just going home, there has been a reduction of as much as 50% in people having to return to hospital environments. So we are seeing results.

In terms of primary care, as I mentioned, we have seen 50 million more appointments take place. Pharmacy First, which will be introduced shortly, is a key way of expanding that supply still further. So I say politely that, yes, there is a lot more work that will need to be done, but we really have expanded supply. We have put plans in place, and the early signs are promising. I hope, like all of us, that we will see far more of this and I look forward to updating the House as the season progresses.