Health and Social Care: Winter Update

Statement

The following Statement was made in the House of Commons on Wednesday 15 January.

“With permission, Madam Deputy Speaker, I would like to make a Statement on winter pressures.

I start by saying that my thoughts, and I am sure the thoughts of the whole House, are with the nurse who was stabbed in a horrific attack at Royal Oldham Hospital on Saturday. Nurses are the backbone of our NHS. They should be able to care for their patients without fear of abuse or violence. As she goes through treatment for her injuries, we pray for her speedy and full recovery and that she will be left to recover in peace.

I want to thank our NHS and social care staff for their remarkable effort, stamina and care in the most challenging of circumstances. Over the past few weeks, I have seen at first hand that staff are doing their level best in hospitals and care homes across our country—in the south-west, Essex, London, South Yorkshire and the north-west. Even when patients are left waiting far longer than they should be, and in conditions they should never be made to endure, they are still at pains to stress that the staff are doing their best.

I said on day one in this job that I would never gloss over problems in the health service and I would not pretend that everything is going well when it is not. The experience of patients this winter is unacceptable. I visited one A&E department over Christmas where I was told on the way in that I was lucky as I had come on a quiet day. Yet, as I walked through the hospital, I saw patients on trolleys lining the corridors where they were being treated, without the dignity or safety they should expect as a minimum. I saw frail elderly people on beds in the emergency department, many with dementia, crying out in pain and confusion because, ultimately, they were in the wrong place for their care needs. That was supposedly a good day.

The King’s Fund has said:

‘The NHS is facing a toxic cocktail of pressures this winter’,

and it is right. Fourteen years of under-investment and a lack of effective reform have combined with a tidal wave of rising pressures. This has been the busiest year on record for our ambulance and accident and emergency services. We have had severe cold snaps, with temperatures as low as minus 15 degrees in some parts of England. There are 5,100 patients in hospital beds with flu—more than three times the number at this point last year. Alongside the impact on patients, the rise in respiratory infections saw 53,000 NHS staff forced off work sick in the first week of the year. The result has been patients let down by ambulances that do not arrive on time, A&E departments that leave them waiting 12 hours or more, and the continued normalisation of corridor care. This is not the level of care staff want for their patients, and it is not the level of care this Government will ever accept for patients.

I said coming into this winter that 14 years of failure cannot be turned around in six months. It will take time to fix our broken NHS. Since July, we have done everything we can to prepare the NHS for winter. Following four months of silence from the previous Government, I called the British Medical Association on day one, met it in week one, and within three weeks negotiated a deal to end the junior doctors’ strike with a new deal for resident doctors. For the first winter in three years, staff are on the front line, not the picket line. The Chancellor made immediate in-year investment in the NHS to fill the black hole we inherited and prevent us having to cut back on services.

We have introduced the respiratory syncytial virus vaccine, and more than a million people and counting are protected against that virus. In total, 29 million vaccines have been delivered for flu, Covid-19 and RSV, and more patients are protected against flu than at this stage last winter. If anyone is yet to get themselves vaccinated, it is not too late to protect themselves, their family and the NHS. They can check if they are eligible and book through their local GP or pharmacy.

We are working hand in hand with NHS England and care leaders, and I continue to meet regularly with senior leaders in social care, NHS England and the UK Health Security Agency. We have an excellent national operations centre running seven days a week. Its data allows us to zoom in—not just on individual hospitals but on individual patient waiting times—to respond in real time to spikes in pressures, and to manage threats as they emerge. The NHS is now using critical incidents proactively to focus minds and get the system responding to de-escalate and steer back to safer waters. I am happy to report that there is currently one live critical incident, down from 24 last week.

However, I do not pretend that that is good enough. It will take time to get back to the standards that patients deserve, but it can be done. That will require a big shift in the focus of healthcare—out of the hospital and into the community—to free up beds for emergency patients and to prevent people having to call an ambulance or go to A&E in the first place. That is the reform agenda that the Government are enacting.

In recent weeks, we have announced steps to begin rebuilding general practice, and immediate and long-term action in social care. When we came into office, we inherited a situation in which qualified GPs could not get a job, while patients could not get a GP. That is why, within weeks, I found just shy of £100 million to recruit 1,000 more GPs by April. We have recruited hundreds of GPs to the front line already, and we will recruit hundreds more in the months to come. We have announced an extra £889 million in funding for general practice, which is the biggest funding uplift in years, alongside a package of reforms to bust bureaucracy, slash unnecessary targets and give GPs more time to spend with their patients—our first step towards bringing back the family doctor.

Ten days ago, I visited a care home in Carlisle that was offering intermediate step-down care for NHS hospitals. It was able to give patients en suite bathroom facilities in care homes, with rehab, all at half the price it was costing the taxpayer to keep patients in a hospital bed up the road. That is better for patients and less expensive for taxpayers. Yet there are 12,000 patients in hospital beds today who do not need to be there but cannot be discharged because appropriate care is not available. That is why the Government are making up to £3.7 billion of extra funding available for local authorities that provide social care. It is why we are delivering an extra 7,800 home adaptations through the disabled facilities grant this year and next year. It is why we have delivered the biggest increase in carer’s allowance since the 1970s, worth an extra £2,300 to family carers. It is why are introducing fair pay agreements to tackle the 131,000 vacancies in social care. And it is why we have appointed Baroness Louise Casey to help build a national consensus on the long-term solutions for social care.

From visiting emergency departments, monitoring the performance of the NHS over this winter and noting the variation in performance across the country, I know that we can clearly get our ambulance and A&E services working better. Before the spring, we will set out the lessons learned from this winter and the improvements that we will put in place ahead of next winter.

Finally, let me be clear on corridor care, which became normalised in NHS hospitals under the previous Government: I will never accept or tolerate patients being treated in corridors. It is unsafe, undignified and a cruel consequence of 14 years of failure on the NHS, and I am determined to consign it to the history books. I cannot and will not promise that patients will not be treated in corridors next year. It will take time to undo the damage that has been done to our NHS, but that is this Government’s ambition.

Annual winter pressures should not automatically lead to an annual winter crisis—indeed, there were no annual winter crises by the end of the previous Labour Government. That is why this Government are investing an extra £26 billion in our health and care services, and undertaking the fundamental reform that both services need. That will take time, but we will deliver an NHS and a national care service that provide people with care where and when they need it. I commend this Statement to the House”.

15:36:00

My Lords, when this Statement was given in the other place last Wednesday, the situation in the NHS had deteriorated: the weekly influenza hospital admission rate for the last week of 2024 increased to 14 per 100,000, with almost 11 per 100,000 being the figure for the previous week. Thankfully, I can see that the rates for influenza admissions are falling: the admission rate for the second week of this year fell to 9.5 per 100,000, compared to more than 13 per 100,000 the previous week. While this fall in admissions is welcome, may I ask the Minister about the latest advice the Government have received? Do they believe that we are out of the winter woods yet, or are they being warned about the possibility of admission rates for seasonal respiratory viruses rising again, and the need to remain vigilant? Also, do the Government have any indication of whether this improvement is temporary, or whether things will get worse again? If they are planning for a possible rise in admission rates, what plans do they have to put in place sufficient capacity to meet an increase in the number of patients? What options are the Government looking at? For example, are they having conversations with the independent sector on the use of some of its hospital capacity? One of the solutions, surely, to the winter pressures that successive Governments experience is better and faster data reporting. It can often take several weeks for data from hospitals and the front line to filter through to statistical reports. The problem is that there are data time lags, which means that the NHS has less information ready to figure out the gaps in performance and capability. If the NHS is adequately to plan to alleviate pressures, live data reporting must be a priority. May I therefore ask the Minister first to commit to pushing forward implementation of faster and more efficient data collection with her departmental colleagues, in order to ensure reporting to help better plan for future winters? In that vein, how confident are the Government that they will learn the lessons from this year’s winter crisis and ensure that they are better prepared for next winter, in order to deliver on their promise to end the cycle of winter crises in the NHS? I look forward to the Minister’s response.

My Lords, I want to echo the comments of the Secretary of State in the other place about the appalling treatment of Achamma Cherian, who was stabbed in the Royal Oldham Hospital last Saturday. It is absolutely intolerable for any member of NHS staff to be treated in this way. Can the Minister reassure your Lordships’ House that staff in A&E especially are protected, but also throughout our NHS? I want also to start by thanking our NHS and social care staff for their remarkable effort. One of the problems that our NHS and social care staff have faced is total exhaustion since the winter of 2019-20. Immediately following the winter pressures, we were faced with a pandemic. Everybody in the NHS is now saying that this winter feels much worse, simply because it is yet another year of winter pressures. Ambulance services have had to change their advice across the country to warn of being overstretched. A leaked memo from the West Midlands Ambulance Service says that patients who had collapsed with abdominal pain and vomiting, which are category 3 and 4 calls, and even, in the periods of highest demand, with heart attack or stroke, which is category 2, were told, “We don’t have an ambulance available to respond to you and it may be hours before one is available. Is there any way you can arrange safely to get to a hospital emergency department?” I am minded to tell the House that, when I got a bus the other day that passed University College Hospital at Warren Street, a number of people got off who were clearly extremely unwell and being taken to the hospital by their families. What are the Government planning to do to support patients who need urgent ambulance services that are not available—for reasons that we understand are often to do with backlogs in A&E, queues and so on? The Statement says that the experience of patients this winter is unacceptable, and we on these Benches agree. It is the opposite of a vicious circle: it is a circle of hell, not just for patients but for staff. I note that the Secretary of State commented in the Statement on what he saw when he was visiting, but worse is to come. We know from the Royal College of Nursing survey published earlier this week that we have patients dying in corridors, with nurses feeling absolutely unable to provide support for them. It is not just 14 years of underinvestment; frankly, we are now seeing the problems of the wrong reforms that happened some years ago now. That has resulted in particular in pressure on primary care. The Statement focuses on hospitals but does not address the real crises that are going on in primary care. In addition to the issues of funds and the planned extra doctors, who will take a while to come in, what are the Government planning to do to prevent hospitals constantly referring patients back to primary care when they need just an X-ray or a test, rather than being dealt with by the doctor they are seeing in hospital? The emphasis of the Statement is obviously on the current high level of infections. It comments on the more than 5,000 patients in hospital beds with flu, but it does not say that we need to add to that RSV, pneumonia and Covid. The problem is that there is no weekly data from the UKHSA, which no longer collects and publishes such data. I hope the Government are prepared to consider reinstating that. An interesting graph on social media about two weeks ago set the peaks and troughs of all these infection spikes over the last three years against the increasingly long absences of NHS staff due to extended sickness, and they mirror exactly. I ask the Minister—who will remember that when she was in opposition, I asked this of many Ministers—what is happening in hospitals to encourage staff, when facing infection spikes, to wear masks and to encourage others to do so? This is about getting the basics right. The Chancellor has made an investment this year. Compared to past winter investments to cover the winter crisis, how much is going to be there for the long term—or, by the time we get to March, will it all have been sucked up by the current winter crisis? The Statement says that it is not too late to get yourself vaccinated. I have to tell noble Lords that, if you are a clinically vulnerable patient—and I count myself in that category—it is. GP services keep being given deadlines, which they pass on to patients. Patients then discover that they cannot get the vaccines at their local surgery. If they are inspired to go and find help elsewhere, that is fantastic. However, I suddenly got lots of texts from my surgery saying, “You haven’t been vaccinated yet. Go and get vaccinated”. I had been vaccinated. The problem is that the pharmacy database does not relate to the GP database. When will that be remedied? I have been going on about this problem for well over a decade. It is ridiculous that I have to intervene and say, “Actually I have had it—at your request”. I have talked before about primary care, and it is shameful that the previous Government did not provide enough vacancies for newly qualified GPs last year. I credit this Government for providing some support and money this year to make sure that is happening. Will this continue to happen in future years or is it one-off, one year’s money? While the extra funding for general practice is welcome, it is not enough without the contractual change between primary care and secondary care. Have the Government taken account of that? It is not solving the real problem, which is that GPs and their staff are facing phenomenal pressure in their systems. To conclude, most people are saying that this is the worst crisis we have faced in years. Unlike other parties, particularly the former Government, I am not prepared to blame the current Government for that. I credit the Government for the steps they are taking, but will they look at the longer-term issues that need to be dealt with to get our NHS back in a stable condition so that patients can rely on the service, from ambulances through A&E, general practice and hospital service?

My Lords, I pay tribute to staff in health and social care for their commitment all year round, but particularly when the pressures are on us all in the winter. The noble Baroness, Lady Brinton, mentioned the nurse who was attacked at Royal Oldham Hospital. Our thoughts and prayers continue to be with her, her family and friends, and we wish her a speedy recovery. I can assure the noble Baroness and your Lordships’ House that protection of staff, and freedom to work and move around without abuse, harassment and discrimination, are all very important to us as a Government. There will be more about that as we talk about the workforce plan. Let me make a few general points. I thank the noble Baroness and the noble Lord, Lord Kamall, for their questions and observations, all of which are important. As the Secretary of State said in the other place, it is crucial that we are honest, and I hope by now that your Lordships’ House will realise that we are, as a new Government, not frightened to say what the reality is, which is why the noble Lord, Lord Darzi, was commissioned to look into the state of the NHS. The noble Baroness, Lady Brinton, asked about long-term issues and that is exactly where we are. I acknowledge the significant pressures faced by the NHS this year. However, cold weather, a sharp rise in flu and other infections, and other stresses and strains are not unusual, and we should not be surprised that winter comes every year. It is not acceptable to be going into a crisis every year. We have also taken immediate action. For example, beating the backlog of waiting lists is crucial, as is the 10-year plan because it will create an NHS for all year round. In addition, the emphasis is on getting social care into the right place, both in the immediate and the long term, because—as noble Lords regularly and rightly say—it is inextricably linked with the NHS. Both Front Bench speakers talked about data and planning and preparation. There was a great deal of planning and preparation for what was then the upcoming winter, which we are now in, across health and social care. In the words of my right honourable friend the Secretary of State, we have been doing our best with the hand that we have been dealt. The noble Baroness, Lady Brinton, acknowledged that and I am grateful for her acknowledgement and her support. Annual winter pressures will always exist, but they should not automatically lead to an annual winter crisis. These issues will not be solved overnight. It is going to take time, but we believe it can be done. That is why we are making investments—the noble Baroness asked about investment. The Budget committed an extra £26 billion to health and care—not as a knee-jerk reaction but to allow us to plan now and for the future. On planning and preparation, I assure your Lordships’ House that the Secretary of State meets senior leaders in social care regularly. He also meets the UK Health Security Agency and NHS England regularly. Those groups are key to Ministers keeping on top of this. We also have an excellent national operations centre, which I pay tribute to—that goes to the point raised by the noble Lord, Lord Kamall. The data available from it allows a focus on individual hospitals and individual patient waiting times. As of last week, we were down to one critical incident across the country, which compares positively with the 24 that were in place before. The noble Lord, Lord Kamall, asked about lessons learned—if I might paraphrase it like that. I assure the noble Lord that before the spring we will set out lessons from this winter and the improvements that we will make ahead of next winter. For me, that is very welcome, because that is about acting as quickly as possible and looking to the future. The noble Baroness, Lady Brinton, spoke about primary care, which is key to taking pressure off. I know that the noble Baroness is well aware of the three key pillars of the 10-year plan, which will be available in the not-too-distant future. I am sure that your Lordships’ House will want to discuss that at length, and I will be pleased to do so. To take the points from both noble Lords, that is all about the move from analogue to digital, from treating sickness to prevention, and from hospital to community. Those are not just words; they will greatly assist with the long-term planning that I know both noble Lords are seeking. The noble Baroness referred to primary care. We have committed to recruiting over 1,000 newly qualified GPs through an £82 million boost to the additional roles reimbursement scheme. The key thing about that is that it will increase the number of appointments delivered in general practice. If I might make another point to the noble Baroness, we recently made announcements about GPs being able to make a direct referral for tests and scans to stop the real “around the houses” of sending a patient to see a consultant, who then sends them away for the relevant tests and scans before they can see them in the round. That will do a lot to reduce waiting times and increase access. The noble Baroness was right to raise corridor care. She will have heard the Secretary of State say that “we will never accept or tolerate patients being treated in corridors. It is unsafe, undignified” ”.—[Official Report, Commons, 15/1/25; col. 364.] He has also made it clear that he is ashamed of that situation. I say that in a spirit of honesty. That is a feeling I share. The Secretary of State also said that he could not, in all honesty, promise an end to corridor care by next year because, as he rightly observed, it will take time to undo the damage that has got us to this place. It will be through investment, reform and planning that we will be able to do that. The noble Baroness also asked about winter funding. That is a very important point, because over many years we have seen last-minute winter funding arriving too late to make a difference, no matter the intention. This time, as I mentioned, the Chancellor allocated nearly £26 billion to the NHS for 2025-26 in the Autumn Budget. That means, in comparison with the funding that it would have got under the last Government, that the NHS will receive £2 billion more. For me, perhaps the most important point is the ability to plan ahead and factor in the need to support preparation for winter. There are a number of other points that I could make and I am sure that noble Lords, as we move to further questions, will raise them. In the meantime, I thank both Front Benches for their interest and their questions, but also for their challenge.

15:55:00

The Minister will be pleased to know that the House was glad that she referred to social care. Every day in the winter there are thousands of patients who no longer need to be in hospital; it is not good for them to remain in hospital, and it is not good for the NHS that they remain in hospital. In addition to the considerations of the social care commission, which will take some time to go through, will it be possible to have a proper endeavour to address these issues before next winter? As the Minister said, there always seems to be a winter crisis now. Would it be possible to get local government and the charities together, but also—and this is not difficult to do—to respect the role of unpaid carers and to provide support for people who are, in effect, taking over the care of patients who would otherwise remain in hospital?

The noble Lord is right to remind us of the challenge of having people in the right place, rather than in hospital when they do not need to be there. We have already taken action, so I am pleased to be able to reassure him that, while the noble Baroness, Lady Casey, will look at long-term solutions for social care, she will present a report within a year from her commencement, which will add to the actions that we have already taken. The noble Lord talked about unpaid carers—and I certainly share the respect that he holds for unpaid carers, so I am very pleased that we have given the biggest boost in income to family carers through eligibility for the carer’s allowance. That has meant an additional —on average, of course—£2,300 a year. That is the biggest boost since carer’s allowance was introduced in the 1970s. We are also legislating for a fair pay agreement, for the first time ever, which will help to tackle the number of vacancies, now standing at 131,000. There will be immediate action, because discharge requires being able to be in the right environment, which might be home but it might need an adaptation. Through the disabled facilities grant there will be a further 7,800 adaptations to homes both this year and next year. So we have taken the immediate action—and, yes, there is a lot more to do.

My Lords, my noble friend the Minister has just reiterated what the Statement said—that one of the key levers for easing winter pressures is NHS reform, particularly moving some hospital services into the community, which could deal with some of the issues raised by the noble Baroness, Lady Brinton, including X-rays, scans, tests and so on. Does she agree that this will require close collaboration between NHS trusts, hospital trusts, local authorities, ICBs and, sometimes, the private sector? Will she work with Ministers in other departments, not only to remove any obstacles there might be to this but to actively encourage it to happen at the local level? By the way, there are some good examples in South Yorkshire of this happening, and proposals for it to happen.

My noble friend is quite right to highlight the good examples in South Yorkshire. There are good examples across the country and one of our challenges, as the Secretary of State has said, is taking the best to the rest. This is a very good example of that. I certainly agree with her observations. This requires joined-up working locally and nationally, which is why we work closely with other departments in both the immediate term and the longer term as we seek to reform health and social care.

My Lords, I declare my interests as an NHSE board member and a fellow of the Royal College of Nursing. I absolutely acknowledge that the Health Secretary and the team, including the Minister, are trying to resolve many of these problems. However, I echo the comments of the noble Lord, Lord Laming, that we need something much more quickly than the long-term plan. Can serious consideration be given to funding four or six weeks of care as soon as people leave hospital, whether or not there is a legal entitlement to that cost, to get the one in seven people currently lingering in hospital beds out into better facilities so that they can be supported by their families and friends? Also, the criticism of the advertisements for corridor nurses is absolutely incorrect; we need a higher percentage of nurses in A&E and surrounding departments if they have a much higher number of patients than they were originally established for.

I thank the noble Baroness for bringing her comments before the House and for acknowledging our efforts, direction and commitment, because this is not easy and, as she knows, will not happen overnight. However, we need to tackle delayed discharge, following the point made by my noble friend Lady Winterton, through the development of local partnership working between the NHS and social care and making sure that the right support is there to return home—if that is the best place for people—or for an intermediate arrangement. This should not be just an issue of hospital or home; sometimes people need facilities along that trajectory, because they have different needs and their conditions do not stay still. That is why it has to be local partnerships. Every acute hospital has access to a care transfer hub which brings together professionals from the NHS and social care to manage discharges of people with more complex needs who need extra support. We will shortly publish the better care fund policy framework, which will drive greater impact from over £9 billion of public spending on integrated care. Reducing delayed discharge will be a key part of that. I heard the request from the noble Baroness. She will understand that we have to take account of the financial situation we inherited, but we also need innovation, creativity and practicality to find answers to these very long-standing challenges.

My Lords, the nurse who was attacked and injured at work recently and who has been kindly mentioned several times already today is a member of one of our Oldham congregations. I assure your Lordships’ House that she and her family remain very much in our prayers in Manchester. Research by the National Churches Trust published last year shows that the ministry of the UK’s church buildings saves the NHS £8.4 billion every year. Church projects help keep many people out of hospital; they support others when discharged. Other faith communities do similar work and many of them do it in partnership with us. Secondly, the problem in winter—even in the balmy climate of Manchester—is that it gets cold. Part of the work to prevent serious illness lies in keeping people warm and offering them social contexts where some early signs of declining health can be picked up before they become too serious. Many of my churches in Manchester, along with other places of worship all across the nation, take part in the Warm Welcome Campaign which does precisely that. They are open maybe for a morning and offer a free lunch as well as a warm space where people can just socialise and not worry about their heating bills. Does the Minister agree with me that places of worship make a vital contribution to the nation’s health and save the NHS money? Will she not only join me in thanking them but ensure that those of her ministerial colleagues who are presently considering whether the Listed Places of Worship Grant Scheme should be extended beyond the present financial year are apprised of these facts?

I made a call for creativity, and I compliment the right reverend Prelate on his creativity; I will certainly pass on his comments to my colleagues. I am delighted to agree with him about the importance not just of places of worship but of communities, including faith communities. As the right reverend Prelate said, we can find the finest examples of community provision which support the NHS and social care through churches, synagogues, mosques and other places of worship. I pay tribute to and thank all those that do this. Of course, this is overwhelmingly done by volunteers, and I pay tribute to all of the volunteers in faith communities and beyond.

My Lords, the Statement mentions 12,000 patients in hospital beds where they do not need to be. The noble Lord, Lord Laming, has rightly drawn attention to the fact that many of those people discharged are dependent on the care provided by their families. In spite of many reports written about the need to plan discharge from hospital—at least one of them written by me 40 years ago—too much discharge still happens at pace and without planning. It is Friday afternoon and suddenly, the consultant needs the bed. Oh, funny that: there is no care available in the local community. Would the Minister agree that all the reports about discharge indicate that you should start planning for discharge the minute the patient is admitted, and that this planning should include those who are going to provide the care, whether that is the voluntary sector or the patient’s own family?

I agree with my noble friend about the need to plan sooner. It gives the opportunity to assess what is, is not, and can be made available. I also very much share my noble friend’s comments about involvement—involvement of the patient themselves but also of their loved ones. I know from the reports that my noble friend has done over the years how she has shone a spotlight on the exclusion of the very people who could assist in the discharge procedure and make it go smoothly. I welcome her comments that the discharge is as important as the admission and the care people get while they are in hospital.

I too acknowledge the commitment and effort being made, and also, of course, the commitment on the front line. I am not a health professional—and I feel particularly conscious of that, given some of the people in the Chamber this afternoon—but I have spent too much time in the last 12 months as a client and had much time to reflect upon the fact that the problems with the health service are much the same as the problems in most other public services. First of all, we do not design the service around the client and the patient, and, whatever I am told, that still seems to me to be so obvious. We do not join up the various services: pharmacies, GPs and district nurses, who I have got to know quite well. We do not make effective use of digital or AI, and we do not make good use of the community and voluntary sector and charities. Sometimes, we resent them, or they are resented. Of course, there is the issue of social care. I think we all know this, and I am hearing the right things coming out of government at the moment, but, actually, these things have been there for 20 years. They have been said about and talked about for 20 years, yet things have not really changed. I really want to be convinced that they are going to change, but I want to be convinced that we are learning from the lessons of past failures and that we are focusing on owning up to those failures, because that is the only way in which we will move on. Can the Minister reassure me that we are looking at why it has taken so long and that we are really determined to take on the barriers?

I am grateful to the noble Lord. These things do not just happen; we are here because of a failure to reform, a failure to invest and a failure to get the right productivity and results that we need. Indeed, there has been a failure over a number of years to do exactly what the noble Lord spoke about. I could not have put it better myself. The noble Lord came up with the most marvellous advert in his comments for the central pillars, to which I referred, of the 10-year plan, which will soon be available, following the biggest ever consultation in the history of the NHS. The noble Lord talked about community. One of the things that we will be ensuring will happen in the NHS is a movement of focus from hospital into community. The noble Lord talked about digital. We will move from analogue to digital. He also talked about services being around the patient. I have frequently said that we need to get the services around the patient, not the patient around the services. There is also the move from sickness to prevention. All these three pillars will completely transform the National Health Service. The noble Lord also referred to the third sector, including charities. We could not deliver much of what we deliver without them, and charities often are extremely well-placed to do things that statutory services cannot, so they are part of the equation and I offer all respect to them.

My Lords, the investment described in additional GPs is really welcome, as are the other reforms in primary care. However, one of the challenges in previous recruitment drives into primary care has been losing people from the other end and not being able to retain. Therefore, will the Minister tell us about retention strategies and how they will counteract that really troubling trend?

The noble Baroness is quite right. It is not just about recruitment, although it gives me the opportunity to speak also on the previous point made by the noble Lord about the importance and effectiveness of interdisciplinary teams. Again, the workforce we need must be one that can provide for the 10-year plan, and that plan means that some things will take 10 years, while we are already doing other things. We have to make sure we have the right training. On the point about retention, we know what staff are saying to us: their morale is low; they are under pressure and feel exposed, and, in many cases, they feel frightened. I am shocked to find the amount of racism that is experienced. It is not possible to overlook any of these things, so in the coming year, as we give more information on the workforce plan—and I am looking forward to doing so—it will be a workforce for now and the future, not the past.