Elective Treatment

With permission, Mr Speaker, I would like to make a statement on a new, ambitious elective recovery plan—the NHS’s delivery plan for tackling the covid-19 backlog of elective care.

The NHS has responded with distinction during the country’s fight against the virus, caring for over 700,000 people with covid-19 in hospital in the UK and delivering a vaccination programme that is helping this country to learn to live with the virus, while at the same time doing so much to keep non-covid care going. Nobody—no institution—felt the burden of the pandemic more than the NHS. There have been 17 million cases of covid-19 and the NHS has had to respond to the original variant, the alpha wave, the delta wave and, most recently, of course, the omicron wave. Despite these pressures, we had one of the fastest vaccination programmes in the world, including one of the fastest booster programmes in the world.

Sadly, as a result of focusing on urgent care, the NHS could not deal with non-urgent care as much as anyone would have liked. The British people have of course understood this. Despite those exceptional efforts, there is now a considerable covid backlog of elective care. About 1,600 people waited longer than a year for care before the pandemic. The latest data shows that this figure is now over 300,000. On top of this, the number of people waiting for elective care in England now stands at 6 million, up from 4.4 million before the pandemic. Sadly, that number will continue rising before it falls.

A lot of people understandably stayed away from the NHS during the heights of the pandemic, and the most up-to-date estimate from the NHS is that that number is around 10 million. But I want these people to know that the NHS is open and, as Health Secretary, I want them to come forward for the care they need. We do not know how many will now come forward—we do not know whether it will be 30% or 80%—because no country has faced a situation like this ever before. So in developing this plan, the NHS has had to make a number of assumptions. Even if half of these people come forward, this is going to place huge demand on the NHS, and we are pulling out all the stops so that the NHS is there for them when they do. We have already announced that we are backing the NHS with an extra £2 billion of funding for elective recovery this year and £8 billion on top of that over the next three years. In addition, we are putting almost an additional £6 billion towards capital investment for new beds, equipment and technology.

Today we are announcing the next steps, showing how we will help this country’s health and care system to recover from the disruption of the pandemic but also how we will make reforms that are so important for the long-term future. That will allow the NHS to perform at least 9 million extra tests, checks and procedures by 2025 and around 30% more elective activity each year in three years’ time than it was doing before the pandemic. This bold and radical vision has been developed with expert input from clinical leaders and patient groups. It will not just reset the NHS to where it was before covid but build on what we have learned over the past two years to transform elective services and make sure that they are fit for the future.

This plan focuses on four key areas. The first is how we will increase capacity. On top of enormous levels of investment, we are doing everything in our power to make sure that we have even more clinicians on the frontline. We now have more doctors and nurses working in the NHS than ever before. We have a record number of students at medical school and a record number of students applying to train as nurses. The plan sets out what more we will be doing, including more healthcare support workers and the recruitment and deployment of NHS reservists. We will also be making greater use of the independent sector, which formed an important part of our contingency plans for covid-19, so that we can help patients to access the services they need at this time of high demand.

Secondly, as we look at the backlog, we will not just strive to get numbers down but prioritise by clinical need and reduce the very longest waiting lists. Assuming that half the missing demand from the pandemic returns over the next three years, the NHS expects the waiting list to be reducing by March 2024. Addressing long waits is critical to the recovery of elective care, and we will be actively offering longer-waiting patients greater choice about their care to help to bring down these numbers.

The plan sets the ambition of eliminating waits of longer than a year for elective care by March 2025. Within this, no one will wait longer than two years by July 2022, and the NHS aims to eliminate waits of over 18 months by April 2023 and of over 65 weeks by March 2024, which equates to 99% of patients waiting less than a year.

I have heard the concerns that have rightly been raised, including by many hon. Members, about the pandemic’s impact on cancer care. On Friday, World Cancer Day, I launched a call for evidence that will drive a new 10-year cancer plan for England, a vision for how we can lead the world in cancer care. This elective recovery plan, too, places a big focus on restoring cancer services.

The NHS has done sterling work to prioritise cancer treatment throughout the pandemic, and we have consistently seen record levels of referrals since March 2021, but waiting times have gone up and fewer people came forward with cancer symptoms during the pandemic. The plan shows how we will intensify our campaigns to encourage more people to come forward, focusing on areas where referrals have been slowest to recover such as lung cancer and prostate cancer. It also sets out some stretching ambitions for how we will recover and improve performance in cancer care: returning the number of people waiting more than 62 days following an urgent referral to pre-pandemic levels by March 2023; and ensuring that 75% of patients who have been urgently referred by their GP for suspected cancer are diagnosed or have cancer ruled out within 28 days by March 2024.

I am determined that we tackle the disparities that exist in this backlog, just as I am determined to tackle disparities of any kind across this country. Analysis from the King’s Fund shows that, on average, a person is almost twice as likely to experience a wait of over a year if they live in a deprived area. As part of our recovery work, we are tasking the NHS with analysing its waiting list data according to factors such as age, deprivation and ethnicity to help to drive detailed plans to tackle these disparities.

Thirdly, this new chapter for the NHS provides an opportunity to radically rethink and redesign how services are delivered, to bust the backlog and to deliver more flexible, personalised care for patients. The pandemic has shown beyond doubt the importance of diagnostics. Although over 96% of people needing a diagnostic test received it within six weeks prior to the pandemic, the latest data shows that has fallen to 75%. Our aim is to get back to 95% by March 2025.

A major part of this will be expanding the use of community diagnostic centres, which have already had a huge impact. These one-stop shops for checks, scans and tests help people to get a quicker diagnosis and, therefore, the treatment they need much earlier. Sixty-nine community diagnostic centres are already up and running, and the plan shows our intention to have at least 100 in local communities and on high streets over the next three years.

We will also keep expanding the use of surgical hubs, which will be dedicated to planned, elective surgeries. They will allow us to do more surgeries in a single day than can be carried out in out-patient settings, so that we can fast-track operations and ensure that patients are more likely to go home on the same day. We have already been piloting these hubs, and we will now be rolling them out across the country.

Finally, we will improve the information and support for patients. I know the anxiety that patients feel when they are waiting for care, especially if they feel that they do not have certainty about where they sit in the queue, and I am determined to ensure that, as we enter this next phase, we will be open and transparent with patients. We will be launching a new online platform called My Planned Care, which will go live this month, offering patients and their carers tailored information ahead of their planned surgery. They will be able to see waiting times for their provider, so they can better understand their expected wait. A third of on-the-day cancellations are due to people not being clinically ready for treatment, and the new platform will also be able to link patients to the most appropriate personalised support before their surgery. This shows the approach that we will be taking in the years ahead, putting patients at the heart of their care and giving the support that they need to make informed decisions. We will also put in place a payment system that incentivises strong performance and delivers value for money for the public.

Just as we came together to fight this virus, now we must come together on a new national mission to fight what the virus has brought with it. That will mean waiting lists falling by March 2024, strong action to reduce long waiting times, and stretching targets for early diagnosis and for cancer care. This vital document shows how we will not just recover, but reform and make sure that the NHS is there for all of us, no matter what lies ahead. I commend my statement to the House.

I thank the Secretary of State for advance sight of his statement, but it falls seriously short of the scale of the challenge facing the NHS and the misery that is affecting millions of people stuck on record high NHS waiting lists. We have been waiting some time for his plan to tackle NHS waiting times. We were told that it would arrive before Christmas; we were told that it would arrive yesterday; and it is not clear from his statement today that the delay was worth the wait. There is no plan to tackle the workforce crisis, no plan to deal with delayed discharges, and no hope of eliminating waits of more than a year before the general election in 2024. I wonder whether the Conservatives will be putting that on their election leaflets. The only big new idea seems to be a website that tells people that they are waiting for a long time, as if they did not already know.

Perhaps the Secretary of State can tell us whether the plan itself contains two other measures that have been floated in the press: the cancellation of patients’ follow-up appointments, whether they need them or not, and an offer enabling people to seize the opportunity to travel hundreds of miles around the country, if they can find a hospital in England that does not already have a waiting list crisis of its own. What we did hear was a series of reannouncements, including some perfectly sensible proposals for community diagnostic and surgical hubs. We welcome those, but the Secretary of State cannot pretend that they meet the scale of the challenge.

The Secretary of State reaffirmed the Prime Minister’s commitments on cancer, announced only yesterday. He announced a new target that no one should wait more 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. Can he tell us which target he is aiming to meet? Is it the target that has not been hit since 2015, or the target announced yesterday, which seems to lower standards for patients because the Government 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 which was introduced in April and has never been met, and nothing that the Secretary of State has announced today gives me any confidence that it will be met in the future. Given that half a million patients with suspected cancer are not being seen in time, it seems that the Secretary of State declared a war on cancer after more than a decade of disarming the NHS, and is now sending the NHS into battle empty-handed.

I am surprised with the argument and the tone of the hon. Gentleman. It is 2022, not 2024. We have all come to expect the scaremongering that we have just heard from the Labour Benches at election time—that has happened in every election campaign since the war—but what I did not expect is this scaremongering from the hon. Gentleman on the plans to recover in the wake of a deadly pandemic.

I am astonished and disappointed that the hon. Gentleman is willing to stand there and claim that there is no covid backlog. [Interruption.] That is what he just said. He just said that there is no covid backlog. He is well aware that this country has just gone through its biggest health challenge in history. He is also well aware that there has been a national mission across the NHS to deal with that challenge and to recover from it. I paid tribute to the hon. Gentleman just last week in this House—perhaps I was just a bit too early—when he rightly supported the nation’s vaccination programme, because he understood just how important it was. Perhaps some of his Back Benchers have now got to him, so instead of standing up for the British people, he is just thinking about his own leadership prospects in his party—perhaps that is what is actually going on.

Today, instead of doing the right thing and backing the NHS—backing the hundreds of thousands of doctors, nurses and everyone working heroically across the NHS—the hon. Gentleman decided to play party politics. A moment ago, he heard me talk about the 10 million people who the NHS estimates have stayed away from the NHS and who need reassurance from both sides of the House about what the NHS is doing. He should reconsider his approach and work together in the national interest.

I welcome the statement and I am grateful to the Secretary of State for setting out a covid recovery plan to tackle the challenges that lie ahead. Every single Member of the House should support him in that endeavour. I ask him, however, how he will tackle the staffing crisis.

I thank my hon. Friend for her support. Over the past two years, the number of clinicians in the NHS has risen by about 40,000. In the past year, we have 10,000 more nurses, 5,000 more doctors and more people in medical school than ever before, so a huge amount of record investment is going into the workforce. Recently, I also asked the NHS to put together a long-term 10-year-plus workforce strategy and I look forward to receiving it.

The elective care backlog is not the only crisis facing the NHS. Covid has affected the care being delivered by mental health services, primary care, emergency care, community care and social care. In the Health and Social Care Committee’s recent report on tackling the NHS backlog, we recommended that a broader national health and care recovery plan be published to set out a clear vision for how patient care will be improved. Will the Secretary of State confirm that that will be published before April, as the Committee recommended?

I thank the hon. Lady for her work on the Committee. She is right to raise the importance of mental health. Although today’s plan is focused on elective surgical procedures and diagnostics, she is right to talk about other types of care, especially mental health care. I know that she supports the huge amount of record investment going into the NHS for mental health care. Under the NHS long-term plan, it is an additional £2 billion a year. She is also right to raise the importance of patient care. I believe that there is a lot in this plan on patient care that she will support.

I welcome the statement and the national mission. I must say that for the Labour party to try to play party politics with it is a serious misjudgment. Surgical hubs have been successfully piloted in London by the Getting It Right First Time programme. As they are rolled out across the country, will the Secretary of State ensure that GIRFT continues to be properly resourced and is given a key role in leading the programme in future?

Absolutely; I agree wholeheartedly with my hon. Friend. There are already 44 surgical hubs up and running across the country, including in London. I went to see one at Moorfields, which is getting through cataract operations more quickly and seeing more people per day than ever before. He is right to talk about their importance and the funding is there in the plan to see many more of them across the nation.

The key issue seems to be the workforce. It is about trying to ensure that people do not leave the workforce now or do not leave it early. It is also about recruiting enough people, sometimes into specialties that are not necessarily the sexiest ones that people are pushed into at the beginning. For instance, there is no chance of getting diagnoses within the target set in 2018, which we now hope to meet in 2024, unless we train more pathologists every single year. This year, we will not train enough pathologists to meet the number who are leaving this year, so we are going backwards rather than forwards. How will the Secretary of State address that?

I agree with the hon. Gentleman about the importance of the workforce, especially in the context of specialisms, and pathology is a really good example. That is why we are putting record amounts of investment into the workforce and training. It is also one of the reasons why, to get a more joined-up plan in health, I have decided that Health Education England should be merged with the NHS. This will enable more joined-up thinking and much better planning for the future, especially in specialist areas.

I declare my interest as a doctor. Will the Secretary of State look again at how we structure doctors’ pay and remuneration? At the moment, we are training lots of doctors—more and more of them—which is a great thing, but typically they leave in their late 50s, so we are losing a whole decade of productive medical time. That cannot go on. Will he look again to see how we can disincentivise early retirement of medical professionals?

My hon. Friend speaks with great experience and raises a really important issue. The short answer is yes. We have fantastic doctors throughout the NHS and more in training in medical schools than ever before, but we should also focus on retaining talent throughout the NHS. I assure him that that work has already begun.

I am shocked that some Government Members are trying to pat each other on the back, because right now my heart is breaking for all those constituents who have emailed me to tell me that they are in fear and in pain, and what they have just heard is that that may continue for years to come. The Secretary of States talks about new tech, new hubs and new scanners, but without people to operate them they may be of limited use. Where is the plan to fill the almost 100,000 NHS vacancies?

The hon. Lady, like other hon. Members, is absolutely right to raise the importance of workforce. To deliver on this plan, of course we need to do so much more to keep increasing the workforce and make sure all the skills we need are there. Just last week, I believe, the NHS published that it has more doctors, nurses and clinicians than ever before; 40,000 people have joined the NHS over the last two years, including many more doctors and nurses. Also, as I mentioned, I have asked the NHS, with HEE, which will become part of the NHS, to come up with a long-term plan. We look forward to that plan and will invest in it.

People of a certain age, of whom, unfortunately, I am one, are terrified because they think that if something goes wrong, they might have to wait in pain for two years. We cannot wait until March 2024 to join the back of a slightly shorter queue. Then we see our friends who have private health insurance—I am not one of them; we cannot afford it—being seen within days. May I suggest a policy that would be wildly popular with many of our own supporters, which every Conservative Government until 1997 followed, which is to give tax relief to private health insurance? Why not look at every innovative solution that unleashes new money? Before the Secretary of State says that that is a matter for the Chancellor, will he at least put it at the back of his mind, so that when he next talks to the Chancellor they will at least discuss it?