Winter Preparedness

With permission, Madam Deputy Speaker, I would like to make a statement on winter preparedness. Before I begin, I want to say a very special thank you to all the staff who will be keeping our NHS going over the Christmas holidays and into the new year. When I was a manager in the NHS, I worked on winter planning, so, if I may, I will say an additional thank you to all the people who are often unseen: the managers and admin staff who also keep the system going. I know how hard it is for people to work in the system with the challenges that winter can bring through increased demand and higher rates of infection.

There are things that we cannot predict. Storms Bert and Darragh have added pressure, and we might have a cold snap. I know that many people like a winter cold snap of snow and ice, but it is not something that the NHS ever wants to see. The NHS has excellent people who have done this before and, unlike last year, thanks to the new Government, many of them will not be on strike. While we cannot control the weather, we can plan, prepare and pull together, so today I want to update colleagues with the current picture before moving on to the things that we are doing.

NHS England and the UK Health Security Agency will publish the latest statistics tomorrow morning as usual, but we do know that levels of seasonal illness are high. The most recent figures show that last week there was a 350% increase in flu cases compared with the same week last year, but that is comparable to levels we saw two years ago. Norovirus cases are high, but covid rates are low, and although rates of RSV—respiratory syncytial virus—have been high, we expect them to start coming down over the next few weeks.

I want to make it clear that the current rates for both bed occupancy and ambulance delays are unacceptably high. I will shortly come to measures about how we are dealing with that capacity.

I will not rehearse the Darzi investigation and his findings, except on one thing. I remind the House that he found “a perpetual bed crisis”, particularly during peak periods like winter cold snaps. That means that every winter our staff have been wasting precious time solving process problems, ringing round wards to find beds and desperately trying to hold the system together. We can see that in the figures.

On an average evening in 2009, a patient would have been 39th in the queue when they arrived at a typical accident and emergency department. In 2024, they are 100th. The four-hour A&E standard has not been met for nearly a decade and ambulance response times have not been consistently achieved since their introduction in 2017. In November, the average ambulance response time stood at 42 minutes, which is more than double the NHS constitutional standard. A third of the 2.3 million people who attended A&E last month waited more than four hours, and one in 10 of those people—more than 150,000—waited for more than 12 hours.

Those life and death delays are the result of deep structural issues in the NHS that cannot be fixed overnight. But this winter, NHS staff will be on the frontline, not the picket line, because we took a different approach on how to work with staff and the unions. To resolve the resident doctors’ dispute, we spoke to them on day one, we met them in week one, and by week four we had negotiated a deal to end their strikes. That is why, for the first time in three years, the Government are fully focused on winter and not on planning for strikes.

This is what we are doing. First, the NHS is managing extra demand by strengthening same-day emergency care and offering more falls services for older people, with upgraded 24-hour live data centres. Secondly, we are continuing to support systems that are struggling with direct intervention through the NHS urgent and emergency care tiering programme.

Thirdly, the Secretary of State is chairing weekly meetings with me and senior leaders to ensure that we are managing pressures across the entire system. Last week, he specially convened with trusts and told them to prioritise patient safety by focusing on key metrics, including improving emergency ambulance response times, addressing handover delays and tackling the longest waits in A&E. We have made it crystal clear that we do not want trusts to prioritise patients who can be seen and discharged more quickly over those with the greatest clinical need, because this Government will always prioritise people, not performance. This morning, the NHS published a letter outlining how it is prioritising patient safety.

Fourthly, I am taking steps to ensure that we get a clear picture of what is happening on the ground. I recently visited Newham hospital’s A&E, Bristol Southmead hospital and the head offices of NHS England to see the aforementioned operational control centre, where it receives data in real time and responds to problems as they emerge. Fifthly, we launched a national communication campaign in the autumn to encourage people across the country to take their winter vaccines, with a particular focus on people who are less likely to come forward.

That last point is essential, because the best and easiest way to keep people out of hospital this Christmas is to encourage them to come forward and get vaccinated. Last year, people who received a covid vaccine were half as likely to be admitted to hospital than those who did not. So far, we have delivered over 17 million flu jabs and 9.5 million covid jabs, and we have introduced the first ever public vaccination campaign for RSV, with over a million and counting vaccinations delivered to protect young babies and the elderly. In total, we have delivered nearly 28 million vaccinations for this winter, and I thank every person who has come forward to protect themselves and the vulnerable.

Now, I would like to speak directly to anyone who has not yet been vaccinated. No one wants to be separated from their family and stuck in hospital this Christmas, and there is a real risk that people may inadvertently take flu home to loved ones this year. Please protect yourself, your family and the NHS, and book that appointment today, because tomorrow is the last day you can book a vaccine through the NHS app or website, although after tomorrow there will be local solutions.

While we tackle winter pressures in the short term, we are fixing the foundations of our NHS with long-term reform. Two weeks ago, the Prime Minister spoke to the nation about our plan for change, and set out our ambitions for the health service over this Parliament. We will get a grip on waiting lists and return to 92% of patients waiting no longer than 18 weeks from referral to treatment by the end of this Parliament. We are also taking action on social care, introducing the largest increase in the carer’s allowance weekly earnings limit since 1976. We will ensure that carer’s allowance meets its objectives, while reviewing unpaid carer’s leave and looking at the benefits of introducing paid carer’s leave.

We will publish an improved better care fund framework, using £9 billion of funding to provide better, more integrated health and social care for patients and people who draw on care. We are helping disabled people on low incomes adapt their homes through the disabled facilities grant. The Employment Rights Bill is already in Committee, laying the foundations for the first ever pay agreement for care workers as a first step towards building consensus on the long-term reform needed to create a national care service. By the end of our first year in government, we will deliver an extra 2 million operations, scans and appointments through innovation, investment in additional capacity and productivity gains.

We are sharing the best of the NHS with the rest of the NHS, with our Further Faster teams. These are teams of experts that are supporting 20 trusts with long waits to tackle waiting lists and increase productivity. They have been deployed to five trusts so far, and we are already seeing improvements—for example, in theatres. For this financial year, the Government have committed £12 billion more in everyday spending on health and social care than was planned by the last Government in the spring Budget.

We are giving our capital-starved NHS the funding it so badly lacked over the past decade, setting aside at least £1.5 billion next year, which will create additional capacity, including new surgical hubs and diagnostic scanners, and new beds across the estate. That will enable 30,000 additional procedures and over a million diagnostic tests as they come online. That is the difference that a Government of service make. We have also been clear that investment must come with reform. Lord Darzi has given us the diagnosis, and the cure can be found in shifting the NHS from treatment to prevention, hospital to home, and analogue to digital.

Harold Wilson once called himself an optimist who carries a raincoat. As someone who has worked in our NHS at this critical time, I am fully aware of the challenges we face and the effort required. I am making sure that we have a firm hold on problems in the short term, while we do the work of fixing the foundations of our NHS with long-term reform. Over the past 14 years, we have limped from one crisis to the next, improvising and making do with sticking plasters. It cannot go on. It is bad for patient care and it is totally demoralising for staff.

We are building a health service that is fit for the future, ready to face every winter with confidence, and we will publish our 10-year plan for health in the spring. Anyone who thinks that we cannot do it should remember: we have fixed the NHS before, and we will fix it again. The public rightly expect us to put an end to the annual winter crisis, and that is what we will deliver. I commend this statement to the House.

I call the shadow Secretary of State.

I am grateful to the Minister for early sight of her statement—as I have said before, it is typically courteous of her. I echo the gratitude that she expressed to those in our NHS, and also those in the social care workforce who will be working hard throughout the festive period. As she alluded to, the NHS is already feeling the pressure this winter. We know that winter is always tough for the NHS, irrespective of who is in government, but services are feeling the strain even earlier than in previous years. A tidal wave of flu infections has led to a 70% increase in hospital cases in just seven days, and the national medical director of the NHS has warned of a “quad-demic” of health emergencies as cases of covid, norovirus, RSV and winter flu are all on the rise.

Meanwhile, in October, the longest A&E waits of over 12 hours increased by over a quarter in just one month, reaching the third highest monthly figure since comparable records began in 2010. Of course, all that has come before the cold weather really hits and before more vulnerable pensioners are left in freezing homes, unable to put the heating on after the winter fuel payment was scrapped for a large number. What assessment has the Minister and the Department made of the potential impact of that on hospital admissions this winter?

In government, we recognised that the NHS faces unique challenges in winter. We also recognised, as I know the Minister does from our previous discussions, the importance of flow in the NHS, with all parts of the system working together. That is why last year we provided £200 million to boost NHS resilience specifically during the peak winter months, which was accompanied by £40 million to bolster social care capacity and improve discharges from hospital. That followed the £1 billion announced earlier that year to boost capacity by delivering 5,000 additional beds, 800 new ambulances and 10,000 virtual ward places.

I will do my best to address that range of questions. First, as even a stopped clock is right once—[Interruption.] Yes, twice. On that basis, I agree with the right hon. Gentleman. On correspondence and answers to parliamentary questions, again, the situation we inherited is not satisfactory. I apologise to all Members who are waiting for correspondence—it is something we are taking a grip of. We want to respond positively to questions. The Conservatives did not; we will make sure that starts to happen.

On capacity in the system, again, I remind Members that we came into office in July, which is one quarter of the way through the planning and financial year. We very rapidly looked at the plans that were baked in by the previous Government—I appreciate that the right hon. Gentleman was in the Ministry of Justice at the time, not the Health and Social Care Department—to see whether they were fit for purpose. We wanted to make sure we brought stability to the system. There are, in fact, more beds currently available in the system than last year. If there is a need to increase capacity due to a likely cold snap, the system is absolutely ready to respond in its usual way. That is why we are meeting weekly.

On meetings with clinical and managerial colleagues at NHS England—who, frankly, I see more often than many members of my own family—I can tell the right hon. Gentleman that we started those meetings immediately. I would have to check the exact date, but it was certainly in the summer. I have had fortnightly meetings since September, which, as I said, we can move to monthly meetings, chaired by the Secretary of State. We began getting a grip from day one, knowing that winter was coming, which is why I am monitoring the situation weekly. It is also why we visited the operational centre, to understand in real time what is happening across every single system and every single trust—be that ambulance issues or problems at the front end and in A&E. The one question I do not directly have the answer to is what the daily figures are; I will try to get those figures to the right hon. Gentleman later.

Despite York’s new emergency department, a consultant has described to me the situation in emergency medicine, where patients are waiting for days to be discharged and 50 patients are waiting to be placed on wards. We know we have inherited a broken NHS. Will the Minister say what she is doing first to enable primary care to pull more patients out of emergency medicine, in order to see people in the community, and secondly to invest in social care, which will clearly address some of the backlog and the logjam in patient flows?

My hon. Friend’s comments reinforce how much pressure, we understand, is front facing. A&E is demonstrative of the overall pressure in the system, not just at discharge but, as she rightly says, in primary care. We took action in the summer to improve primary care, increasing the number of GPs available in the system. It is absolutely critical that primary care community services are integral to winter planning at a local level. That is what we expect from every single system. We will continue to monitor that over the winter period and into the spring. If those services are not involved in planning for any particular systems, enabling them to monitor the surge and flow of people, we very much want to understand how that is working.

I call the Liberal Democrat spokesperson.

I express my thanks and those of my Lib Dem colleagues to everyone working over the Christmas period to keep people healthy and safe. Preparedness for winter is absolutely critical for our health and care system, and a quick look at what happened last year shows us why. Ambulances across England collectively spent a total of 112 years waiting outside hospitals to hand patients over, and a quarter of a million people waited more than 12 hours to be seen. Every winter we are warned of a winter crisis. Under the Conservatives, crisis became the norm not just in winter but all year round.

This year is very concerning so far. A&Es have overflowed through spring, summer and autumn. At my local hospital trust, Shrewsbury and Telford, one in three ambulances have had to wait more than an hour to hand over patients, while patients with devastating cancer diagnoses have had to wait months for crucial scan results. Across England, more than 7 million people are on waiting lists.[Official Report, 8 January 2025; Vol. 759, c. 8WC.] (Correction) Meanwhile, I am afraid, we have not heard enough from the Government on fixing one of the root causes of this crisis, which is our broken social care system.

The scale of the crisis is demonstrated by the challenges facing ambulance services across the country at the moment. October—before the winter—was the third worst month ever for handover delays at West Midlands ambulance service, which covers my constituency. The equivalent of 130 ambulance crews are out of action, waiting every single day. Now these overstretched ambulance services are formally changing their advice to reflect the pressure they are under. At times of peak demand, even category 2 patients—those suffering a heart attack or a stroke—will be asked to make their own way to a hospital. People in North Shropshire have long had to put up with some of the worst ambulance waits in the country, and they have come to harm as a result. It may no longer be the case that they can rely on an ambulance arriving.

I think I have addressed the Government’s plans on social care. The hon. Lady makes an excellent point on ambulance delays, which we know to be a problem, and particularly so in the west midlands. That is one of the things I have asked the system to look at particularly, so that the Government and hon. Members can better understand the particular problems in their particular systems. We know that ambulance and handover delays are a particular problem in some systems. We are making sure that clinical and managerial leads from NHS England are visiting those systems and that they are understanding in depth the process issues in some places, where they may not be adopting the best practice that can be learned from others.

We need to roll out best practice across the country. When the Secretary of State and I visited the operational centre of the London ambulance service, we sat in on some hear-and-treat calls; in dealing with people in mental health crises, in particular, some places are doing that better than others. Those are the sorts of examples we want to learn from. I absolutely hear what the hon. Lady says about the unacceptable delays in particular parts of the country. That is very much on our priority list.

I call a member of the Health and Social Care Committee.

Last week, I visited Basildon hospital, which is relied on by my constituents and people across Essex. Staff in the emergency department told me that they were operating under intense pressure all year round, and that it is indeed winter all year for them. That is due to a lack of beds, the terrible condition of parts of the estate and inadequate primary care services, meaning that people turn up at the ED when they should be somewhere more appropriate. What steps is the Minister taking to turn the page on 14 years of decline, and to ensure that Basildon and hospitals across the country have the resources and structures they need to better manage seasonal and year-round pressure?

My hon. Friend has already been a fantastic advocate for her local NHS services. Like the hon. Member for North Shropshire (Helen Morgan), my hon. Friend is absolutely right to highlight the acute pressures all year round. We did not always have winter crises under the last Labour Government. It was tough; I worked during some of that time, and it did happen, but getting used to such levels of bed occupancy and pressure in the system all year round is a direct legacy of the Conservatives and what they did to the NHS, particularly with the Lansley reforms, and their refusal to take a grip of it. This matter of a summer crisis going into a winter crisis is a real problem. That is why we are committed to these short-term measures to stabilise and support the system over the winter. However, as I said in my statement, we will also look at medium and longer-term reform so that we do not have to revisit this scenario year on year.

I call the Chair of the Health Committee.

Last Friday, I visited Sherwood Pharmacy in Abingdon. Ben, who owns it, told me that local pharmacies stand ready to help. In fact, they are more than keen to help, but there are two things that he needs from the Government. First, there needs to be a real push for GPs to refer people to pharmacies, in particular for vaccinations, so that we are not collecting patients in one already overstretched part of the system and they can do what they do best. Secondly, there needs to be a general plea to the public that they can go to their pharmacies for those things. I note that in her statement the Minister did not mention pharmacies once. Let us be honest, this question is not going to do it either. How do we ensure that the message—“Go to your pharmacy and get vaccinated, you can do it faster there”—gets out there this winter?

I thank the Chair of the Select Committee for her point. She is right that I did not mention pharmacies, which was an omission on my part. We are running an advertising campaign, “Think Pharmacy First”, to ensure people use pharmacies. She is absolutely right that they stand ready. I will visit mine over the next few days to make sure I am vaccinated. Their support, working with primary care, is critical. Again, in some places relationships are working well and pharmacies support people in the community—that is apparent in the statistics. We are absolutely committed to ensuring that that works better, as part of our long-term reforms.

I call a member of the Select Committee.