National Health Service: Key Targets

Lord Markham Excerpts

Tuesday 16th January 2024 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have in place to ensure the National Health Service meets its key targets.

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

The NHS has made progress against its targets, especially given the challenges of recovering from Covid-19, the changing demography and winter pressures. The Government recognise that there is still a way to go and are working non-stop to support the NHS to do better. I take this opportunity to thank all NHS staff for their hard work to improve performance this winter.

[The Lord Bishop of St Albans]

My Lords, I would like to join in thanking NHS staff, who are doing a fantastic job. There are some structural problems here. In particular, I am concerned about ambulance response times, which are causing a great deal of concern despite the Government having increased the category 2 call response times from 18 minutes to 30 minutes. Category 2 calls deal with such life-threatening events as strokes and heart attacks, so this is deeply worrying. What are His Majesty’s Government doing to reduce the response time? Will they consider returning to the 18-minute response time for category 2 calls?

[Lord Markham (Con)]

I agree with the basic point, as I am sure all noble Lords will, that ambulances are on the front line and are the most important service in all of this. That is why we have invested in 800 new ambulances, with over £200 million of funding. It is early days, but that is starting to take effect. Regarding the category 2 issue, we have managed to halve the time it takes since last year, but it is still too long and we absolutely need to make more progress in this area.

[Lord Bird (CB)]

Does the Minister agree with me that, if you really want to hit the targets for the NHS, you need to deal with the fact that 50% of people who present themselves at the NHS are suffering from food poverty? Why do we not concentrate on lifting the great weight on the NHS by doing serious work on getting rid of poverty?

[Lord Markham (Con)]

I agree with the noble Lord that prevention is key. About half the number of people who turn up at A&E do not need to go to A&E and can be seen in other settings. I completely agree that all the elements in terms of prevention and getting ahead of the problem are key, including where there are issues around food.

[Baroness Browning (Con)]

My Lords, following on from the question from the right reverend Prelate and his reference to stroke patients, given that there is a three-hour window for stroke patients during which, if certain treatments are given, the outcome is so much better, what have the Government done to ensure that, adding on the ambulance time to the time when the patient then arrives at hospital, more patients are being treated within that window? Is there a target specifically for stroke patients? It makes such a difference.

[Lord Markham (Con)]

My noble friend is absolutely correct, and strokes have been a major focus. I am glad to say that was one of the first areas where we rolled out AI everywhere, with the result that we were able to improve treatment times so much—and I will get the precise figures to my noble friend—that the recovery rate has increased by two-thirds as a result. It is absolutely right that this is an area of top focus.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, the Government keep telling us—and I understand why and congratulate them on it—that the number of people employed as doctors and nurses has risen in recent years. Can the Minister explain why productivity over the same time has reduced by 4%?

[Lord Markham (Con)]

The noble Baroness is correct: staff numbers have gone up but, for a number of reasons that we are exploring, output has not gone up by the same amount. It is a key point, and I think all noble Lords agree that making sure we are getting value for money out of the service is important. We are engaged in a productivity study to discover the reasons right now.

[Lord Allan of Hallam (LD)]

My Lords, back in 2013, the Government set a target for the NHS to become paperless by 2018, which they later extended to 2020 when the target seemed too ambitious. This may come as something of a surprise to the millions of people who continue to have regular paper-based interactions with the NHS. Could the Minister tell the House when he now expects the target for the NHS becoming fully digital to be met? Would he agree that it is now even more important that we achieve it than when it was first set over a decade ago?

[Lord Markham (Con)]

I definitely agree that it is more important, and that is why I am pleased that we have made such progress. If we look at one area in terms of hospital records being available and doctors’ records to patients, that has gone up since the beginning of the year from about 1% of GPs to about 90% today. About 90% of all our hospital records are now digitised, compared to less than 3% in Germany. We have made massive progress, and it is key to all of the reform and to improving productivity across the NHS.

[Lord Winston (Lab)]

My Lords, the Minister well knows that we have raised the issue of primary care again and again in this Chamber. Would he be kind enough to tell the House how the Government feel they are doing with regard to the retention of very highly qualified general practitioners at the height of their career, who are currently leaving early? Up to about 50% are considering retirement before the retirement age. Will he comment on how he feels that is going?

[Lord Markham (Con)]

Staff retention, particularly of GPs, is vital. That is why we listened to the number one reason they were retiring, which was the feeling that their pensions were being adversely affected. We changed the rules in the last Budget to try to address that; it is early days, but I hear that that is starting to make progress. Primary care is the front line. That is why I am pleased that we have increased the number of appointments by more than 50 million, ahead of our manifesto target. But it absolutely needs to be a key focus.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. The long-term—and, indeed, the short and medium-term—sustainability of the NHS is critically dependent upon active engagement in research and the adoption of innovation at scale and pace. Is the Minister content that His Majesty’s Government are doing enough to ensure that the NHS is resourced to support that research and innovation agenda?

[Lord Markham (Con)]

It is key, and I think we are all aware that a couple of years ago—this was a result of the report of the noble Lord, Lord O’Shaughnessy—we were not doing as well as we needed to be in the clinical trials area. I am glad to say that, since then, there has actually been a lot of progress towards it, so we are now hitting similar levels to comparative nations. Innovation is at the heart of everything we have done. We have some very good examples of that; I mentioned the stroke AI treatment earlier. We have just set a similar thing in terms of AI for looking at chest cancers, but it is absolutely something we need to make sure we continue to progress.

[Baroness Merron (Lab)]

My Lords, the King’s Fund has highlighted a delay to the release of additional funding to help NHS and social care services prepare for winter, which will of course only worsen the situation of missed targets and wait times for patients. Can the Minister tell the House what the reasons are for this delay and what steps are being taken to unblock the money to get it to where it is needed?

[Lord Markham (Con)]

One of the key learnings from last year, which goes back to the whole question about planning, was actually that if you put social care moneys in too late, you do not get nearly as effective spend. That is why we brought forward the £600 million discharge fund much earlier—actually, into the summer—so that local authorities and care providers could plan on that money. It is starting to make a difference. A key thing that noble Lords have heard me talk about is bed-blocking. Actually, we have seen a 10% reduction in bed-blocking since these measures have come into effect in the last few weeks. It is early days, but we are actually making progress.

[Lord Jackson of Peterborough (Con)]

My Lords, the number of over-85s is due to double over the next 30 years. Would my noble friend the Minister give some consideration to government funding for extra care facilities and at-home treatment, such as physiotherapy, in order that pressure be taken off acute district hospital beds in respect of older people?

[Lord Markham (Con)]

Funnily enough, I had this conversation in terms of productivity just today. The virtual wards—the 11,000 extra beds we have put in—are actually making a real impact on that, because of course it is much better that people can be treated in their own home, knowing they have the comfort of these virtual displays and treatment to look after them. We have 11,000 extra beds, with 72% utilisation, and, yes, it is really working.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister keeps talking about progress being made, but if he looks at, say, the four-hour A&E target, he knows that the latest figures show that the NHS reached only 69% in December. In 2010, his party inherited a performance of 98.3%. What does he think that says about his party’s stewardship of the NHS?

[Lord Markham (Con)]

I can talk about what we are doing now, which is showing real progress. But I have to say that the saying “People who live in glass houses shouldn’t throw stones” comes to mind, because, looking at those same targets, I notice that the Labour-run NHS in Wales never reached the four-hour A&E target; the last time it hit the 62-day cancer target was in August 2010, 14 years ago; and the last time it hit the hospital treatment target was in August 2010. I say politely that the noble Lord might want to get his own house in order first.