The following Statement was made in the House of Commons on Monday 5 September.
“With permission, Mr Deputy Speaker, I would like to make a Statement on our support for urgent and emergency care. I know that this is an issue of great concern to right hon. and hon. Members, and I wanted to update the House at the earliest opportunity on the work that has been undertaken over the summer.
Bed occupancy rates have remained broadly at winter-type levels, with Covid cases in July still high, with one in 25 testing positive—that compares with about one in 60 currently. This is without the decrease in occupancy that we would normally expect to see after winter ends, and ambulance waiting times have also continued to reflect the pressures of last winter, although I am pleased to see recent improvements. For example, the West Midlands service is meeting its category 2 time of less than 18 minutes.
I would like to update the House on the nationwide package of measures we are putting in place to improve the experience of patients and colleagues alike. First, we have boosted the resources available to those on the front line. We have put in an extra £150 million of funding to help ambulance trusts deal with ambulance pressures this year. On top of that, we have agreed a £30 million contract with St John Ambulance so that it can provide surge capacity of at least 5,000 hours per month. We are also increasing the numbers of colleagues on the front line. We have boosted the national 999 call handler numbers to nearly 2,300, which is about 350 more than we had in September last year, and we have plans to increase this number further to 2,500 by December, supported by a major national recruitment campaign. By the end of the year we will have also increased 111 call handler numbers to 4,800. As well as that, we have a plan to train and deploy even more paramedics, and Health Education England has been mandated to train 3,000 paramedic graduates nationally each year, which is double the number of graduates that were accepted in 2016.
Secondly, we are putting an intense focus on the issue of delayed discharge, which, as many Members know, is the cause of so many of the problems we see in urgent and emergency care—I think that is recognised across the House. This is where patients are medically fit to be discharged but remain in hospital, taking up beds that could otherwise be used for those being admitted. Delayed discharge means longer waits in accident and emergency, lengthier ambulance handover times and the risk of patients deteriorating if they remain in hospital beds too long—this is particularly the case for the frail and elderly. The most recent figures, from the end of July, show that the number of these patients is just over 13,000—these are similar numbers to those for the winter months. We have been working closely with trusts where delayed discharge rates are highest, putting in place intensive on-the-ground support.
More broadly, our national discharge task force is looking across the whole of health and social care to see where we can put in place best practice and improve patient flow through our hospitals. As part of that work, we have also selected discharge frontrunners, who will be tasked with testing radical solutions to improve hospital discharge. We are looking at which of these proposals we can roll out across the wider system and launch at speed. Of course, this is not just an issue for the NHS. We have an integrated system for health and care and must look at the system in the round, and at all the opportunities that can make a difference. For instance, patients can be delayed as they are waiting for social care to become available, and here too, we have taken additional steps over the summer. We have launched an international recruitment task force to boost the care workforce and address issues in capacity. On top of that, we will be focusing the better care fund, which allows integrated care boards and local authorities to pool budgets, to reduce delayed discharge. In addition, we are looking at how we can draw on the huge advances in technology that we have seen during the pandemic and unlock the value of the data that we hold in health and care, including through the federated data platform.
Finally, we know from experience that the winter will be a time of intense pressure for urgent and emergency care. The NHS has set out its plans to add the equivalent of 7,000 additional beds this winter, through a combination of extra physical beds and the virtual wards which played such an important role in our fight against Covid-19. Another powerful weapon this winter will be our vaccination programmes. Last winter, we saw the impact that booster programmes can have on hospital admissions, if people come forward when they get the call. This year’s programme gives us another chance to protect the most vulnerable and reduce the demand on the NHS. Our autumn booster programmes for Covid-19 and flu are now getting under way, and will be offered to a wider cohort of the population, including those over 50, with the first jabs going in arms this week as care home residents, staff and the housebound become the first to receive their Covid-19 jabs.
Over the summer, we became the first country in the world to approve a dual-strain Covid-19 vaccine that targets both the original strain of the virus and the omicron variant. This weekend, the MHRA approved another dual-strain vaccine, from Pfizer, and I am pleased to confirm that we will deploy it, along with the Moderna dual-strain vaccine, as part of our Covid-19 vaccination programme in line with the advice of the independent experts at the JCVI. Whether it is for Covid-19 or flu, I would urge anyone who is eligible to get protected as soon as they are invited by the NHS, not just to protect themselves and those around them but to ease the pressure on the NHS this winter.
Today I have laid before the House a Written Ministerial Statement on further work that we have been doing over the summer, and I want to draw the House’s attention to one particular feature in that Statement which has garnered interest in the House in the past. In November 2021, the Government announced that they would make £50 million of funding available for research into motor neurone disease over five years. Following work over the summer between my department and the Department for Business, Energy and Industrial Strategy, through the National Institute for Health and Care Research and UK Research and Innovation, to support researchers to access funding in a streamlined and co-ordinated way, we are pleased to confirm that this funding has now been ring-fenced. The departments welcome the opportunity to support the MND scientific community of researchers as they come together through a network and are linked through a virtual institute.
My Lords, as the new Prime Minister is appointing her first Government, I am very glad to see the Minister in his place this evening. I have a sense of despair over the dire situation in the ambulance service that led to yet another Statement. However, I welcome the inclusion of the importance of vaccination and the funding for motor neurone disease. I also pay tribute to St John Ambulance and am pleased that it has now been formally commissioned. Could the Minister confirm that this extra capacity is being used by the system today?
The outgoing president of the Royal College of Emergency Medicine has said that ambulance delays have got so bad that the NHS is now “breaking its promise” that life-saving emergency care will be there when it is needed. The facts are that 29,000 patients waited more than 12 hours in A&E in June—more than ever before—and 10,000 urgent cases waited more than eight hours for an ambulance last month. But this is not just about life and death; it is about the distress and severe discomfort of those who are kept waiting. Analysis by the Financial Times estimates that the deteriorating state of emergency services could be costing 500 lives a week, so can the Minister give an estimate of the number of people the department believes have died unnecessarily because they have been stuck in an ambulance waiting to get into A&E, or because an ambulance has turned up late or not at all?
We have gone from no crisis in the system in 2010 to annual winter crises, and now to there being a crisis all year round. We hear that the NHS will tell patients to avoid A&E as the winter crisis bites early. Can the Minister tell your Lordships’ House when the winter crisis will now start? What is the forecast of how much worse excess deaths will be over this winter? What is the Minister’s response to the QualityWatch report’s assessment that the roots of record waiting lists and delays to ambulance services predate the pandemic?
My Lords, I echo the comments of the noble Baroness, Lady Merron, that it is good to see the Minister in his place, although I notice that since he came into the Chamber his Secretary of State has changed. I wish the new Secretary of State well in her new role.
After many of the angry words over the past few weeks between the contenders to become the leader of the Conservative Party and the next Prime Minister, it is important to say that the crisis we face is not caused by the NHS and its staff, or the same in social care. Ambulance response times are still appalling, so much so that I have a friend who was once again advised by their GP this week to bypass the ambulance system to get their husband direct to hospital. Despite the numbers talked about in the Statement, the situation does not appear to be easing at all in the country.
It was encouraging to read at the beginning of the Statement that resources will be boosted on the front line, but from examining these figures it is quite difficult to follow the real increases on the front line and when they will happen. Some £150 million extra for trusts to deal with ambulance pressures is welcome, and I echo the thanks and congratulations to St John Ambulance; it is good that the Government have finally put on a formal footing the work it has been doing behind the scenes. But the number of extra 999 call handlers to be appointed between June this year and this Christmas is another 150, which, split between the 11 ambulance trusts, is not that many extra call handlers. Of course, they are taking not just health 999 calls.
Similarly, I cannot get to the bottom of the increase in call handlers to 4,800 or find out the previous figure. Call handlers on 111 refer callers mainly to primary care; 64% was the last data I saw. The issue is that there is no mention anywhere in this Statement of the pressure on primary care—whether that is GPs, community nurses or physiotherapists. There is absolutely zero mention, which means that the extra 111 call handlers will essentially be pushing patients into the void that primary care currently faces, given the pressure that GPs in particular are facing.
I thank both noble Baronesses for their welcome that I am still in post; let us see for how long.
I pay tribute to my right honourable friend the former Secretary of State for Health, Stephen Barclay. When he came into office, he was quite clear that he saw the headlines, the issues about access to GPs and primary care and the ambulance waiting times. He said, “Look, I don’t know how long I’m going to be in office, but I’m determined to work on this over the summer”. This Statement is the result of that. Had he stayed in post, no doubt some of the questions that the noble Baronesses, Lady Brinton and Lady Merron, raised would have been answered with other Statements. Hopefully he has set in place the process to enable his successor to deal with some of these issues.
When he came into position, he was quite clear. In fact, he was so clear that he said, “I want the latest numbers on my wall”. He also asked, “Who do I need to talk to?”. He got the NHS England leadership in, contacted the most challenged trusts and the ambulance services and asked, “What can we do to help and how do we understand about discharge?” As the noble Baronesses rightly said, it is about not just ambulances but the whole system of discharge, making sure that there is somewhere in the community for patients to go from hospital. Are there sufficient beds? He has tried to work on this. Clearly, some of this will take time to work through.
Both noble Baronesses referred to the fact that we have contracted St John Ambulance to deliver auxiliary ambulance services. My understanding from when I checked is that this is immediate, but I will have to clarify that to make sure I have given an accurate answer to the question. Because ambulance trusts receive central monitoring and support from the NHS England-funded ambulance co-ordination centre, the Secretary of State worked closely with NHS leadership to look at how to put money into the system and to make sure it gets spent and gets through the system. It is all very well talking about inputs, but how about that? We have provided £150 million extra to improve response times, additional call handler recruitment and investment in the workforce. We have seen an increase of about 12% in ambulance staff and support staff since 2019.
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Ambulance delays are directly related to one in seven hospital beds being occupied by patients medically fit to leave but who cannot be discharged because there is no social or community care to support them. To give but one example, there are reports today of an elderly man who, sadly, died last month in the back of an ambulance after waiting six hours to be admitted to Norfolk and Norwich University Hospital. The chief nurse at the hospital said that the man
“remained in the ambulance due to significant pressure on our emergency department and inpatient wards.”
However, at the same time, more than 200 patients in the hospital were medically fit to be discharged. Will this matter be considered in the investigation? How will situations such as this up and down the country be resolved?
How do the Government intend to ensure that we have the supporting social and community care workforce we so desperately need? Why is there continued resistance to workplace planning and reporting to this House?
Care workers, who are desperate for a decent wage, are being lost to the likes of Amazon. The Government’s answer has been to pull the “immigration lever” and to recruit people from overseas on lower wages. How will this be sustainable? What difference will it make in the long term?
The Statement mentioned the new mandate for Health Education England to train 3,000 paramedic graduates. What is the Government’s reasoning behind conversely capping the equally important number of medical graduate training places, which the Medical Schools Council has criticised?
We all know that the cost of living crisis is likely to be devastating. If people cannot afford to keep themselves warm, they are more susceptible to illness and infections. We know that 10,000 people a year already die as a result of cold homes, and that this could be far worse this year without action. Could the Minister say what the Government will do to address this? Have they assessed the impact of the cost of living, which continues to rise alarmingly, on health outcomes and well-being? Do they have a strategy to help people proactively?
What consideration has been taken of the fact that rising energy costs will push care providers to breaking point, with some homes facing closure, unable to absorb increases of 500% or more? What plans do the Government have to protect care home residents from finding that they have no home?
The reality of the ambulance services’ situation is that things are getting worse, not better. Can the Minister advise your Lordships’ House on what exactly the Government will do to reverse this trend?
I echo the points about the training of more paramedic graduates, but it is outrageous that young people who have just qualified as doctors at university this year have been unable to find jobs because the money has not been found in the NHS for their training places.
It is important to note that the discharge frontrunners “testing radical solutions” will be testing on people in live situations to work out what happens.
On these Benches we welcome the international recruitment task force and particularly the code of practice, which the Government published just over a year ago and have updated in the last few weeks. The code of practice is vital for making sure that this recruitment happens ethically and that staff who come from abroad are supported. It sets out the fair framework for payments that they might have to pay back. But this is still fixing our problem by taking people from other countries. I note that this list includes red countries, which the Minister has referred to in the past, including Pakistan, Bangladesh and some countries in Africa. The rules must be followed very carefully, because those countries desperately need their own staff. While we need to be very grateful to all of them for coming to help us at this time, this is not a long-term solution. I hope the Minister can talk about what that longer-term solution might be.
The Statement makes reference to the better care fund. I am bemused that the better care fund is being used
“to pool budgets, to reduce delayed discharge.”
That is one of the things it was created for at the tail end of the coalition, and it has indeed been the focus of it.
My big worry about this Statement is that ICBs, which we have spent a lot of time discussing in your Lordships’ House over the last few months, are now trying to implement a new system for shared care and shared costings. This Statement says the entire focus will be on delayed discharges, so what extra resources will be available for ICBs?
The Statement also talks about the need for additional beds. It is good that the Government are at last recognising this; 7,000 additional beds is a start, but how many of those 7,000 are real beds and how many are beds in virtual wards—that is, people at home being observed by telemetry? What extra support is going into primary care to support the nurses and doctors who will also be fulfilling some of that? The Statement is completely silent on that.
The end of the Statement talks about Covid and the new vaccine, which is very good news, but why has Covid testing for staff in hospitals been stopped in the last couple of weeks? Too many patients are still catching Covid in hospital. A friend’s mother in her 90s had been tested on arrival in A&E and was then admitted. Three weeks later, when she was about to be discharged for a care home, the hospital refused to test her. Eventually it was pressed to do so. She had Covid, but it did not test anyone else on her ward. She died of pneumonia, and the death certificate said the reason for the pneumonia was Covid.
Another friend died last week, aged 51. She was on the shielding list and had had all her vaccinations, but had a stroke. She caught Covid in hospital and died. She would have been eligible for Evusheld, so it is very disappointing to hear that the Government still will not approve this drug for the 500,000 who are clinically extremely vulnerable.
Finally, the booster campaign is great, but why have the Government decided to stop giving boosters to under-12s who either are immunocompromised or have family who are immunocompromised? We know that schools where air circulation is still poor are an absolute vector. All the experts are warning us that there is likely to be another wave of Covid, and schools without ventilation will be a real problem. If the Minister cannot answer that question today, perhaps he can write to me.
This Statement admits that our NHS and social care sector are still under the most phenomenal pressure. It is the first time I have heard Ministers talk about the system being “at winter state”. When and how on earth will we cope with the winter months when they arrive?
On the handling numbers, it is really important that it is not just about signposting individuals. There are health professionals on the line who can deal with the patients when they ring up for advice. When I had to call 111 just before the summer break, I spoke to the call handler, who then arranged for a GP to ring me back to have a further, detailed conversation. As a result, the GP then made an appointment for me at the local A&E, so I just had to turn up at an allotted slot. That is what they are looking to do to ease pressure on A&E. Can they deal with it without having to go to A&E in the first place? For the less urgent but immediate cases, can they allocate a time slot?
So we are boosting the 999 and 111 call handler numbers and providing targeted support to some of the hospitals facing the greatest delays. The former Secretary of State was quite clear about looking at the areas where we have the most trouble, seeing what we can do about it and getting all the system leaders together. I am afraid it will not be resolved overnight—I am sure that noble Lords recognise that—but trusts are now closing 12.5% of incidents over the phone, which is nearly twice the pre-pandemic rate. We are also providing investment to upgrade the accident and emergency facilities at more than 120 separate trusts.
There is also the national discharge task force, which is focusing on how we address the discharge problems in particular areas and work with local system leaders to understand those problems. The former Secretary of State has been having those conversations and diving into real detail, either convening people or bashing heads together to make sure that we tackle this. He has put in a place a number of processes, which my right honourable friend the new Secretary of State for Health, Thérèse Coffey, will have to deal with. He has at least put that process in place so she can hit the ground running. As I said, he has taken a close interest in the most difficult and challenged areas.
I will try to deal with some of the specific issues. First, the former Secretary of State was quite clear that we need to think about the winter plan now and not wait until we hit winter. That means preparing for variants of Covid-19, and increasing capacity outside of acute trusts and resilience in 111 and 999 services, as we have mentioned; it means looking at target category 2 response times and ambulance handover delays, at how we reduce crowding in particular A&E departments, and at how we reduce hospital occupancy.
In response to the question from the noble Baroness, Lady Brinton, about the breakdown between virtual beds and hospital beds, I cannot give that data at this point; it might be a dynamic situation, as and when, and will depend on whether individual patients’ homes are suitable to accommodate a virtual bed. They will have to meet certain standards; it is not just a word but a proper virtual bed. We also need to look at how we can ensure timely discharge and provide better support for people at home.
On mortality rates, we see the headlines and, clearly, we have conversations with our officials within the NHS. They do not believe that it is correct to link those performance figures directly to current excess mortality rates but they recognise that there are, sadly, far too many cases of people who should have been seen. There have been deaths but I do not have exact numbers. I will try to get more details for the noble Baroness.
On the overall workforce, as I have said a number of times, I would disagree with noble Lords who say that there is no plan; that is not correct. We have already commissioned Health Education England to work with partners. The department has also commissioned NHS England on long-term workforce planning. As noble Lords will know, the Health and Care Act makes it incumbent on the Secretary of State to publish a report on the workforce and the challenges ahead.
I will stop there for now. I apologise to the noble Baronesses; I will try to answer in writing the questions that I have not answered here this evening.