NHS Winter Readiness

The Chancellor’s Budget announcement today that a 10-year plan will be introduced in the spring will not address the immediate crisis on our doorsteps. It was disappointing to hear very little attention paid to social care, which we know causes a huge number of beds to be used in hospitals. We cannot fix the bed crisis by just buying more beds; we must invest in the workforce that supports those beds. We must ensure that, this winter, my constituents in Chichester do not sleep in corridors or wait in uncomfortable waiting rooms—an experience that is all too familiar for me because, last winter, my grandmother ended up in a corridor, after being admitted in agony, in full view of the public. That would be an incredibly distressing experience for anybody, let alone somebody suffering with acute dementia.

There is no point in throwing money at a leaky bucket if the funding will not get where it needs to go to address the issues across the healthcare system. In my role as Liberal Democrat spokesperson for hospitals and primary care, I have had the opportunity to meet professionals from across primary and secondary care and hear what they are calling for so they can successfully provide a service across the board this winter. They are asking to be able to plan, with budgets that have a shelf life longer than 12 months, and allow them to innovate for the future. Year after year, the previous Conservative Government resorted to spending hundreds of millions of pounds in emergency funds every year to manage the winter crisis.

That emergency funding was a short-term fix that often arrived in those hospitals far too late to address the problem, as my hon. Friend the Member for North Shropshire pointed out. It was short-term fix rather than a comprehensive long-term plan to invest ahead of the crisis. Liberal Democrats have long called for a winter taskforce to oversee a dedicated, ring-fenced fund to build resilience for hospital wards, A&E departments, ambulance services and patient discharge pathways over the next four years.

I have no doubt that this will not be the last time we talk about NHS preparedness for winter. I fear that the Budget today will not have alleviated the concerns and fears of my Chichester constituents, nor those of the staff working in health care in my area. I urge the Government to use our ideas and prepare the NHS for not just this winter but future ones. We are ready to work constructively with the Government to that end.

I welcome the £3.4 million funding provided to general medical and out of hours services, to support GP practices to increase their capacity in light of the anticipated increase in demand over the winter. A figure of £4.3 million has been provided to support GP practices across Northern Ireland to provide proactive support and care to those in nursing and residential care homes. That is again an example of what can be done. I will mention some of the other positive things. I am hopeful that some of the extra money allocated to the NHS today by the Chancellor will filter its way towards Northern Ireland.

The hon. Member for North Shropshire referred to the ambulance service. The Northern Ireland Ambulance Service is increasing its range, capacity and clinical expertise at the ambulance emergency control to help ensure that cases are appropriately managed, without time delays. The enhanced hospital capacity, with 45 beds opened for last winter in my local Ulster hospital, will continue to be funded. Those are some of the good stories and news.

Another is the rolling out of the Pharmacy First pilot service for uncomplicated urinary tract infections in women aged 16 to 64 years. That will expand the current pilot of 62 community pharmacies to the entire pharmacy network of some 500 pharmacies right across Northern Ireland through an investment of £410,000. Again, money is being allocated in the right places to do the right job, which will hopefully make lives better. Over the winter period, it is estimated that this will deliver 12,000 consultations, freeing up capacity in GP practices.

The whole idea of the Pharmacy First pilot service was to ease pressure on GPs, and I know the Minister has always been committed to that. There are good things that can happen, and hopefully after today even more good things will be able to happen. Some £265,000 has been allocated for a new Pharmacy First sore throat test and treat service, which is being piloted this winter. When winter comes, there are colds, flus, sore throats and days off, and everyone rushes to the GP. This will reduce the impact on GPs. These good schemes can be of overall benefit to the NHS. The sore throat service will be piloted in 40 pharmacies, and it is estimated that 8,000 consultations will be delivered this winter, which is good news.

All these measures were welcomed, but none brought the result of an NHS that was prepared last winter. Indeed, that has increased my conviction that we are in a more difficult situation this winter and that the pressure on the NHS cannot be relieved by these small measures. If the Minister can, will she say how the moneys announced by the Chancellor today will be allocated and how that will improve the NHS’s response to this winter?

We need GP practices to be able to refer their patients for an MRI and know that they will be seen in reasonable time, rather than making the referral and then telling the patient to go and spend the day in A&E to get the MRI. Such small but significant things would make a difference and improve the service overall. GPs also tell me that they do not trust the red flag system and that A&E is turning into that red flag system for tests. How can we blame GPs for trying to ensure that they do not miss anything and for using the system in this way?

We need more capacity for MRIs, CAT scans and mammograms, and we need more trained radiographers. One of the things announced today was a significant investment in radiography, but when it comes to allocating the funds we must consider the need to ensure that we recruit and retain radiographers. The Minister may not have the answers to these questions, but does she know what has been done to train more radiographers and improve our NHS?

As a result of there being too few radiographers, 188,881 people in Northern Ireland—nearly 10% of the population—are waiting for a diagnostic test. The wait means that treatment such as radiotherapy is delayed and cases become more complex. That is the nature of having a health problem; people should get seen early and respond early. For some patients, even a two-week delay can mean the difference between life and death.

This long-term issue needs a long-term vision. That is why I am asking the Minister to take seriously schemes that would encourage our intelligent and capable young people to train here and stay here. I have been a great advocate of this and have raised this issue on numerous occasions over the years. We want these young people to train here and stay here with their skills. University bursaries or forgiveness of student debt in return for a period of employment in the NHS would be a positive way forward. Could the Minister look at that too?

Young people go into debt very early on and find it hanging over their shoulders for years to come. If we offer them a job in the NHS and they commit to staying, we can improve things. We have incredibly capable, intelligent British students, and we need to invest in their long-term careers in the NHS and allow them to work alongside junior doctors. We must prepare them for the marathon of NHS life rather than give them sprints that they cannot sustain. We should get the system moving in that direction. I believe that there is work to do not simply for this winter but for every day of the winters yet to come.

To ease the pressure on our hospitals this winter, we need people to be able to leave acute settings when they are ready, and to keep well enough to avoid going back in. To add to what my hon. Friend the Member for North Shropshire said about delayed discharges of care, that is yet another reason why I find myself completely baffled by the decision of the Conservative-led Norfolk county council to close the Benjamin Court reablement facility in Cromer. I declare an interest as a sitting Liberal Democrat member of that council.

The Benjamin Court facility helps to bring people back into the community, enabling them to recover in a more familiar setting. We know that convalescence works, reducing readmittance and enabling people to spend more time with their families as they recover. The integrated care board for Norfolk and Waveney says it wants to place a greater focus on recovery at home. I appreciate that may work for some, but it will not work for many. I am working alongside the campaign to save Benjamin Court to secure the future of the facility. I would greatly appreciate it if the Minister could take the time to meet me and representatives from the campaign to discuss why that vital service must be maintained.

Winter exacerbates one of the major challenges for people in North Norfolk accessing healthcare, which is our inadequate rural public transport. Wintery conditions and car reliance do not mix well; that is the reality that will present to many if they have an early morning appointment at one of our hospitals. People are faced with multi-hour round trips when using rural buses, and limited times when they could make an appointment, let alone the impact that any winter-led delays will have on their plans. To improve my constituents’ access to healthcare, we must also improve their access to public transport.

I fully support the Liberal Democrat plan to winter-proof our NHS, and a winter taskforce with ringfenced funding will go a long way to building the resilience that we need in North Norfolk. We cannot keep lurching from crisis to crisis each winter, stuck in one of the doom loops that the Chancellor spoke about before the Budget. We need to see a change of approach, a funding settlement that is proactive and not reactive, and an NHS that can fully support people across North Norfolk all year round.

Our community hospitals in places like mid and east Devon are proof that effective healthcare is not just about big hospitals. I would like to see localised, specialised care that prevents and treats issues early and close to home. Community hospitals should offer more than just treatment; they are also about routine check-ups and screenings. They are places that people go to manage chronic conditions and to receive other ongoing care.

I stress that we have excellent healthcare staff in Devon—in the community hospitals, in primary care, in GP surgeries and in the acute hospitals—but year after year they are asked to do more with less. With more community-based teams, working closely with social care providers, we could avoid many of the delayed discharges we see in the acute hospitals. More than one in eight acute beds in England is essentially blocked, with 14,000 patients clogging the system. I do not mean to put it in those terms—I know that individuals filling acute beds because they are unable to be discharged sometimes feel like a burden, and I do not want that to be the case—but the fact of the matter is that there are acute beds that could be released for other needy patients.

Winter brings respiratory infections, flu and respiratory syncytial virus, all of which hit the elderly, the young and those with long-term health conditions the hardest. Flu vaccine uptake in the south-west is not where it needs to be, at only 46.5% last winter, and I urge people with long-term conditions to get vaccinated. When flu and other winter illnesses surge, the community health services and facilities can pick up some of the slack and reduce some of the pressure on hospital beds.

If we can shift to a focus on community help, it will be about preparation. I know it is challenging—it must be, or we would have done it in the last three decades—but we now need a concerted effort from national and local leaders to support that shift and support people in managing their own health before they are in crisis, so as to relieve the pressure on acute hospitals.

Nearly every speaker has brought up primary care: everything from doctors and dentists to mental health and public health. Some 22% of the people who arrive at a typical A&E are there because they cannot get a GP appointment. People are turning up with tooth root abscesses, and often end up needing general anaesthetic to sort out dental problems that could have been avoided had they been able to get an NHS dentist.

Desperate mental health patients, who are often already on a waiting list, walking into A&E take up a huge amount—up to 30%—of an A&E department’s time and resources. People wait years after being referred for mental health care by their GP and then end up in A&E, taking up time and resources during the winter crisis. That is not a good use of taxpayers’ money, it is not good for the patients, and it is hugely stressful for the staff. It is always more cost-effective to keep people healthy in their community and treat them early than to treat them in A&E. It is not the place for people in a mental health crisis, people with severe dental issues, or people who just cannot get a GP appointment.

My hon. Friend the Member for North Shropshire mentioned vaccination and when we talk about public health, we talk about prevention and cost-effectiveness. Vaccines are the single most cost-effective health intervention that has ever been developed throughout the world for pretty much any disease, but it is concerning to hear that the number of NHS staff being vaccinated is dropping. That is dangerous both for their health and for patients’ health. We should certainly examine and unpick that, and try to explore why the number of NHS staff taking the flu vaccine has gone down. We need to engage with them to give them the confidence to take the vaccines as well as access to them to ensure that we have as high a vaccination rate as possible.

My hon. Friend the Member for North Shropshire also mentioned this, and we need to act in our communities because of flu, covid and RSV. The situation is always worse in winter. We know that it will be worse and the risk of immunocompromised people turning up to a hospital and waiting in an A&E department, surrounded by other patients who are infectious because they have not managed to get a vaccine, is a huge issue.

The hon. Member for Strangford (Jim Shannon) talked about pharmacies and community care, which are a huge part of the jigsaw in making vaccinations available to the general public. Local pharmacies need all the support that we can give them to ensure that they are open at convenient times—and that they stay open, because a lot of pharmacies have closed. Ideally people—especially vulnerable people—should be very close to a pharmacy so they can get the vaccinations that they need.

Finally, every other Liberal Democrat Members who spoke today talked about the Liberal Democrat winter taskforce and how we would really appreciate the Government looking into our proposals seriously. We are spending the money in bit-pieces every winter anyway, so we should have a much more joined-up and long-term plan about how we deliver healthcare over the winter and ease the pressure on our hospitals. That would be hugely beneficial.

I pay tribute to NHS staff. I imagine that they dread winter coming. This is the time of year when they will be bracing themselves, knowing that they will be busier, knowing that they will be working without the right resources and knowing that some of them will get sick with flu, covid and all the other diseases that come in. We thank them for putting their health at risk and for putting in their time and expertise to look after our health. As the Liberal Democrat mental health spokesperson, I acknowledge what a drain it must be on their mental health to work in such situations.

Finally, I have a question for the Government. We know that winter will come every year; it will come next year as well. What are we doing to ensure that we do not have a planned crisis in the NHS next winter?

As other hon. Members have stated, many NHS hospitals and secondary care settings are working at close to full capacity. For that reason, we must maximise the use of private sector hospitals and other facilities to reduce the pressure on the national health service. The Telegraph recently reported that private health providers have written to the Chancellor and the Health Secretary to propose a major expansion in the use of private sector facilities and staff for NHS treatment. It was stated that private sector investment could help build diagnostic capacity and,

“develop new surgery units and intensive care facilities.”

If I am not mistaken, the Health Secretary has spoken about the use of private sector facilities, so will the Government support the proposals, which would see an extra 2.5 million patients treated in private hospitals with the potential to cut NHS waiting lists significantly?

As we are talking about waiting lists in the winter, I want to turn to the winter fuel allowance, which is being cut. What is the Government’s assessment of the impact and pressure on hospitals from the withdrawal of the allowance? I believe that the Labour party put out an analysis back in 2017 stating that 4,000 people would be at risk of death from such a withdrawal. Can the Minister clarify whether that analysis is still correct and what the thinking is in the Health Department in response to the withdrawal?

During the winter months, protecting bed space for elective treatment is particular important for keeping waiting lists down. That is why we must also build on the capacity provided by community diagnostics centres and surgical hubs in recent years. The previous Government invested £2.3 billion to establish CDCs, which represented the largest cash investment in MRI and CT scanning capacity in the history of the national health service. In addition, the Independent Health Foundation has highlighted the positive impact that surgical hubs made in reducing waiting lists and increasing bed capacity. Despite their impact, Lord Darzi’s report on NHS performance made no reference to the role of CDCs and surgical hubs in helping to reduce waiting lists. On expanding the network of surgical hubs, and bearing in mind that the Budget is taking place in the main Chamber, it would be helpful to get some clarity on where the additional funding will be spent. Will the Minister commit to having more surgical hubs so that more patients across the country can access elective care quicker?

Will the Minister also commit to expanding the network of CDCs, which have delivered more than 7 million tests, scans and checks since 2021. The last Government supported national health service trusts to increase elective activity after the pandemic, particularly through the elective recovery fund, which reimbursed trusts for the operations they delivered. However, earlier this month the Health Service Journal reported that Ministers were considering whether to pause or cap the fund. At the election, Government Ministers stood on a manifesto that pledged to reduce waiting times for elective care, such as on hip and knee replacements, to 18 weeks by the end of the Parliament. Pausing or capping the elective recovery fund will surely affect the Government’s pledge to cut waiting times and risk placing further pressures on national health service finances. I am sure NHS leaders would greatly appreciate the Minister providing clarity on that point, so can she rule out the elective recovery fund being capped or paused this year?

To finish, as has already been said, I want to encourage anyone who is eligible to make sure they go and get vaccinated in advance of this winter.

I also remember just how demoralising it was for staff in the early 2000s, coming into work every day to fight fires and sort out the awful trolley waits—not to mention how unacceptable that was for patients and families. The point about the impact on staff’s mental health and morale was well made by the hon. Member for Winchester (Dr Chambers). I also saw, and was proud to be part of, the changes we made under that Labour Government to end those trolley waits, and we will do that again. That is what Lord Darzi’s report shone a searing spotlight on, including the chronic lack of capital investment that has put many hospitals into a perpetual bed crisis, particularly during peak periods such as winter cold snaps.

While we have inherited a broken NHS, it is not beaten. As we have just heard from the Chancellor, this Government have taken the first steps towards fixing the annual crisis with new capital investment. However, one Budget cannot undo the last 14 years of failure, so while we fix the foundations we are also mitigating the immediate risks. At the very least, going into this winter we will be better prepared than we were last winter. That is because the managers in the NHS will be preparing for winter rather than planning for strikes, which is what they had to do the last three years—already a significant improvement.

The health service does face challenges on all fronts, and the figures are sobering. We have heard some of them today. In September, provisional statistics showed that almost one in 10 A&E patients waited over 12 hours to be admitted, transferred or discharged. The mean category 2 response time in September stood at about 36 minutes—around double the NHS constitutional standard. I recently attended a meeting where officials highlighted the number of attendances requiring admissions are already up by 1.8% in September compared to 2023, which is continuing to place increased pressure of patient flow. Those are the results of deep structural issues in the NHS that will not be fixed overnight. But work is already under way to rebuild resilience and manage pressures across the health and care system this winter.

I will come on to the specific work being done, but I assure hon. Members that the Government are taking the issue extremely seriously. I am already meeting senior leaders in NHS England and the UK Health Security Agency every two weeks to ensure that the risks can be identified quickly and that pressures are managed effectively. Once the peak winter period hits, the meetings will move weekly and include the Secretary of State.

Local NHS systems are best placed to determine how to respond to issues in their local area. That is why NHS England has worked with local systems to ensure robust winter plans are in place at a local level. As someone who knows exactly what is involved in that planning, I pay tribute to the staff for their skill, motivation and commitment to protecting every patient this winter.

The party of the hon. Member for North Shropshire has called on the Government to set up a winter taskforce to prepare for an NHS winter crisis. Some might describe what we are doing as a taskforce; I actually think that is my job and the Secretary of State’s job, which, as I have outlined, is why we meet regularly with NHSE. I know that the hon. Member and others are sincere in their efforts to be constructive. I am happy to take away any specific suggestions about what we are not doing to help the NHS, because we all want the system to work well.