NHS Winter Crisis

Lord O'Shaughnessy Excerpts

Monday 5th February 2018 Lords Chamber

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

My Lords, with the leave of the House I will repeat as a Statement the response to an Urgent Question given by my honourable friend the Minister of State for Health in the other place. The Statement is as follows:

“Winter is challenging for health services worldwide. With a high number of flu cases this year, we have seen an increase of around 35% in A&E attendances from flu—triple what it was last year—with around 3,000 hospital beds occupied as a result of flu, and a further 700 because of norovirus. The NHS saw 1,200 more patients a day in A&E compared to this time last year. The guidance issued by the national emergency preparedness panel sought to free up capacity for emergencies given the high number of flu cases, including two dominant strains of flu co-circulating this year.

It is important to remind the House that the deferment of operations referred to in that guidance applied to around 13% of hospital beds dealing with elective patients, of which around half were protected within the guidance in respect of cancer and other urgent elective treatments. That guidance was updated on 26 January to confirm that further deferment of hospital operations was no longer needed. In terms of the impact that the guidance has had on operations, we will not know this until mid-March, when that data will be published and placed in the Library for the benefit of both sides of the House”.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for that Statement. Before I ask my questions, I also thank the Secretary of State and the Prime Minister for their responses to the United States President’s bizarre attack on our NHS.

Over 95% of hospital beds were full last week, leaving just one bed in 20 available. We saw the highest number of accident and emergency diverts for any week this winter, with 43 incidents across England. I pay tribute to our NHS staff, who have gone the extra mile in very challenging circumstances. We know that 50,000 elective operations were planned to be cancelled, but it would seem that some urgent operations have been cancelled, too. Will the Minister explain to the House why those operations have been cancelled, despite NHS England’s advice to the contrary?

It would also now seem that the accident and emergency targets that are enshrined in legislation and the constitution have been abandoned until March—that is, March 2019. Will the Government bring forward legislation to amend the constitution? Finally, will the Minister accept that the winter plans that have been outlined are now being compromised in the light of the fact that at least 23 trusts are now on black alert, which means that they are under severe pressure?

[Lord O'Shaughnessy]

My Lords, I thank the noble Baroness for her questions. I agree with her that we are all proud of our NHS, on all sides of this House, and I am sure that we all have great pleasure in stating that through whatever means we are required to. I also join with her in paying tribute to the staff, who do such a fantastic job, often in challenging circumstances.

She asked first about urgent operations. It is clear in the guidance that they should not be cancelled when it would negatively affect patients’ outcomes. If that has happened, NHS England is investigating and reinstating those operations. The guidance is quite clear and NHS England has followed that up.

As for A&E targets, we know that they have not been achieved recently. It is important and instructive to look at the extraordinary increase, not just in winter but overall, in the number of episodes that are happening. They really are increasing at a very high rate. Demand is very high—higher than I think could have been anticipated—and it is a credit to the NHS that it has produced the performance that it has. The aim now, with funding given at the Budget, is to get us back to the four-hour target that we all agree ought to happen. That is what will be happening over the coming year.

[Baroness Jolly (LD)]

My Lords, this morning I visited a suburban hospital in London, with an almost brand new A&E unit and a well-managed winter crisis. But despite all that, it has still had to face a bed occupancy rate of 97% on several days, which is stretching its ability to make this work. Money was clearly an issue—the hospital was quite anxious about what its end of year accounts might look like. Today, the Liberal Democrats launched a report looking again at a different way of funding the NHS through the creation of an office of budget responsibility for health and care, long-term health and care funding, and a ring-fenced tax to replace national insurance. Also, there is a clear need for some sort of short-term fix, and we have suggested that £2 billion should be raised by adding a penny to our income tax. Has the Minister looked at this report and will he agree to meet with me to discuss it?

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[Lord O'Shaughnessy]

I thank the noble Baroness for her questions. I am glad she had a positive experience this morning at the hospital she mentioned. She is quite right that bed occupancy is very high at the moment. A good job was done in getting it down below 85% across the system in the run-up to Christmas, but of course it has filled up subsequently. An important part of dealing with this is the social care side, as we know, and the extra funding that has gone in is having some impact on these so-called DToCs—delayed transfers of care—and freeing up a number of beds.

The noble Baroness is right of course that money is important, particularly as we have the demands of a growing and ageing population. More money was of course announced in the November Budget for the short term. As for the long term, there is obviously a very informed and lively discussion going on not just among the Liberal Democrats but across the system and across politics about what is the right long-term solution. Obviously, as I have said before, issues of taxation are for the Chancellor and not for me, but I would be delighted to meet her to discuss those plans. What I can say, on behalf of the Secretary of State, is that we understand that there needs to be sustainable, long-term increases in NHS funding. We have to find the right way to do that.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise the concern of the Royal College of Emergency Medicine that the revised way of collecting data by NHS England does not allow meaningful comparisons because it includes walk-in and minor injury units, some of which are off site from the level 1 major emergency departments? Its concern is that this may be giving an overoptimistic impression of throughput and does not reflect the huge pressures on level 1 units. Will the Minister undertake to meet the president of the Royal College of Emergency Medicine with me to discuss some of its concerns?

[Lord O’Shaughnessy]

This is an afternoon of agreeing to meetings—but, yes, I would be delighted to do so. I am not knowledgeable enough about the issue that the noble Baroness mentioned but, while of course there is a huge difference in the kinds of workloads of those different types of A&E, the target incorporates all of them. They all have the obligation to reach the four-hour waiting time standard and we want to make sure that, whatever the situation and whatever the venue, we can do that.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain how, five years after the Francis inquiry, there is a lack of investment in the health and care nursing workforce in England, as outlined in the RCN report published today? That report, Left to Chance, shows that even if we had more beds we would not be able to staff them. In comparison, Wales has invested heavily in new nurses and continued professional development, and is doubling the number of district nurses that it intends to train this year. In England we currently have 4,400 qualified district nurses, but in 2010 we had 7,500. How can we resolve this quickly and ensure that we have more district nurses in training by this September?

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[Lord O’Shaughnessy]

This is a really important point about nursing numbers. I think the particular accusation was about the Francis report and the follow-up to it. Of course, a lot of that was about nurses in NHS hospitals and indeed on wards. The latest figures from October 2017 show that, when compared to May 2010, there has been an increase of more than 14,000 in acute, general and elderly. At the same time, that has meant that some other areas of nursing have been impacted; we have talked about mental health before as well as district nursing. I say to the noble Baroness that the big increases in nurse training places ought to mean that there are more nurses going through not just into acute, general and elderly but into mental health and community nursing as well.

[Lord Campbell-Savours (Lab)]

My Lords, despite the increase in population over the last 30 years, the number of beds in the National Health Service is half what it was 30 years ago. Germany has eight health service beds per 1,000 and in France the figure is six, but in the UK it is two and a half. Is it not about time that we revisited the whole question of the number of beds available in our National Health Service?

[Lord O’Shaughnessy]

The noble Lord raises a very interesting issue. As he rightly points out, that number has been dropping over a long time. It has plateaued in recent years, but it has been falling. This is a difficult situation. We all agree that more care should be delivered in the community, but we also understand that at certain times of year you do need beds in hospitals. I will point to two things: first, making sure that bed capacity is more efficient so that people can stay safely for less time and can spend more time being treated in their homes—which often is where they want to be, and that is why the extra funding for social care is important; and, secondly, the reconfiguration test that has been introduced by NHS England, which is about stopping reductions in bed numbers—which, as the noble Lord said, has happened under successive Governments—where it cannot be proven that any reduction is for the benefit of patients in terms of their overall care.

[Baroness Masham of Ilton (CB)]

My Lords, I declare an interest as president of the Spinal Injuries Association. Is the Minister aware that at Stoke Mandeville’s national spinal centre, a ward that is absolutely necessary has been taken away from the spinal unit and used for general patients? There are waiting lists in the seven spinal units all over the country, affecting seriously ill patients who need specialised treatment. Will the Minister look into the situation?

[Lord O’Shaughnessy]

I was not aware of that but I shall certainly investigate and write to the noble Baroness.