NHS Winter Readiness

[Sir Roger Gale in the Chair]

14:30:00

I beg to move, That this House has considered NHS readiness for winter 2024-25. It is a pleasure to serve with you in the Chair, Sir Roger, and I am grateful to have secured a debate on the crucial topic of preparing the NHS for winter. This is particularly timely on a day when the Government have delivered the Budget and outlined their priorities for the coming year, and indeed, the years after that. We all know that due to the Conservative failure to protect the NHS, winter is a time when pressure on the NHS peaks. Every year, we suffer what we describe as a winter crisis. But for the millions of people stuck on waiting lists, the thousands of people treated in corridors and the legions of staff battling to keep people safe, it must feel like the winter pressure never ends. I am sure we would all agree that the health and care crisis requires long-term action—improving public health, focusing on primary care, training and retaining more doctors, dentists and nurses, fixing the crumbling NHS estate, and fundamentally, finally addressing the crisis in social care. But while we wait for that action, winter is now looming. The clocks have gone back and time to prepare for winter has run out. I am here to find out what the Government are doing both to get the NHS through the upcoming winter and, following the Budget statement, to get the NHS ready for the winters to come. I am aware that the Chancellor has just announced a £22 billion cash injection into the NHS, although further detail on that was scant, so we will put forward our ideas in this debate and hope that they come to fruition over the next few weeks. For the sake of staff and patients, it is crucial that winter crises become a thing of the past. We have reached the point where winter pressure is normal all year around. We should be striving for the reverse, where pressure is relieved and the forecasted crisis does not happen. I am pleased to hear some of the measures that the Government have outlined today, but I remain worried that fundamental issues are still being ignored—most crucially, the crisis in social care. Until that is resolved, we will not be able to fix the NHS. So what is the state of play? Dr John Dean, the clinical vice-president of the Royal College of Physicians, warned that the latest NHS statistics show the health service “is in an extremely concerning position as we head into winter.” He is not alone in holding such concerns, for it has already been a really busy year for the NHS. In fact, it has been the busiest ever summer for A&E departments in England, with NHS staff managing 6.8 million attendances in just the past three months, according to a briefing by NHS England on readiness for winter. Last month, emergency departments had 2.2 million attendances—the highest such number for a September on record—with more than 38,000 people waiting longer than 12 hours after the decision to admit them. Meanwhile, the weekly average of extra bed days for patients remaining in hospital beyond seven days due to delays in discharge was the highest since December 2022. A look at my local hospital trust in Shropshire illustrates the situation well. In Shropshire, at the Shrewsbury and Telford hospital NHS trust, our bed occupancy rate is constantly around the 95% mark. That is not unusual; it has become the norm at acute hospital trusts up and down the country, and not just in winter, but all year around. Hospital staff constantly have to juggle resources to try to secure people the care they need. As the wards fill up, A&E becomes crowded and care moves on to corridors. Every month, I am contacted by constituents who are shocked by what they have encountered in the hospital: being forced to wait for hours in pain on plastic chairs, or having their dignity taken away as they occupy a trolley in a corridor, in agony and in full view of the public. Many people remain unaware of how common that is until they find themselves with a loved one in that situation. The “Dispatches” documentary filmed at Shrewsbury and Telford hospital trust earlier this year brought the reality home to the nation. The issues with hygiene and infection control were startling enough on their own—I am pleased that the trust is addressing those directly—but most stark was the human impact on the patients. Scenes included that of the elderly man who was forced to urinate while on a trolley in a corridor, in full view of staff, or the woman who cried out in agony for hours, with staff being left in despair at the terrible situation they were trying to deal with. That was not in the depths of winter; it was in April and May. Corridor care takes a toll on patients and a huge toll on the staff who are forced to attempt to cope. However, the full scale and the impact of corridor care are unknown, because there is only patchy reporting on the level of care in temporary environments. As we seek to better understand and prepare for pressure in the winter, and all year round, will the Government consider mandating the recording and publishing of the number of patients receiving care in temporary environments, such as corridors? Honesty and transparency are key if we are to properly prepare for the winters to come. Every month, more than 2,000 patients spend more than 12 hours in the A&E department at Shrewsbury and Telford, and one in every three of the many ambulances arriving outside have to wait more than an hour to hand over their patient—not in winter, but in every month of the year. Since April, ambulances have lost around 15,000 hours through waiting outside the two hospitals in Shropshire, and one poor patient was stuck in an ambulance in Shrewsbury for 15 and a half hours. As we have discussed many times, that keeps ambulances off the road, and has a knock-on effect on how long people who may be in life-or-death situations have to wait for help. This leads to situations such as the one in my constituency in April this year, where a carer was left alone performing CPR for 23 minutes while being told by the 999 call operator that no ambulance was available. Tragically, the victim died, and the carer who tried so hard to save her has been left traumatised—as, I would imagine, has the 999 call operator. As I mentioned in the Chamber a couple of weeks ago, an 11-year-old in my constituency, Charlotte, has an adrenal deficiency that leads to her needing an urgent injection of hydrocortisone if she has some kind of trauma. When that happens, she is logged as needing an automatic category 1 ambulance response. Recently, a car crash happened involving Charlotte and her mother, and when an ambulance was called for, they were told that none was available, and the family had to make their own way to hospital. That is not good enough. It is endangering lives. The target for a category 1 response time is an average of seven minutes. So far this year in Shropshire, the average has been 11 minutes and 57 seconds. For a category 3 response, which still means that the person urgently needs an ambulance, the average wait is more than two hours, which is more than double the target time. That is not new, but it is very wrong, and it demonstrates the pressure already facing the health service as we head into winter. Perhaps more worryingly, the situation in many areas this summer has been getting worse, rather than better. West Midlands Ambulance Service, which serves my constituency, described a “significant, rapid deterioration of delays at hospital in September which has continued further in October.” The service has been operating with the highest level of risk score for the past year. October is forecast to be the second worst month on record for lost handover hours, with the equivalent of 130 out of 600 ambulance crews in the west midlands being lost to delays every single day—and it is only October. That takes a huge toll on the mental health of the hard-working staff involved at every level. It also undermines staff retention, which will be crucial for any NHS plan, such as the 10-year plan or any winter plan to come. We must retain these experienced professionals; we cannot rely on recruitment alone to solve the staffing crisis in our NHS. These wonderful staff have been stretched to breaking point by years of neglect and mismanagement by the Conservatives. Labour must do better, yet patients and staff are understandably fearful as we approach winter. According to a recent poll commissioned by the Liberal Democrats, one in four people in Britain have avoided calling an ambulance because they were frightened that it would take too long to arrive. Of course, many pensioners are particularly fearful this year. Winter is a perilous time for older people, given the additional diseases that they might catch, and many will be more at risk after being denied the winter fuel payment for the first time. This will be the first winter without the payment being universal, and the annual uprating of the state pension will not make up the shortfall until next spring, which will be too late for people to pay their electricity or gas bill—and if someone in my constituency has to top up their oil tank now, it is too late for that, too. There is a danger, as happened when fuel costs increased two years ago, that people will reduce or turn off their heating entirely, with possible consequences for their health and a knock-on effect on the NHS. So what are the solutions? First, we need to stop throwing money at the fire and instead prepare properly. As we all know, the most cost-effective cure is prevention in the first place. Over the past seven years, the Conservative Government announced an average of £376 million of emergency funding each year to tackle the winter crisis, much of which arrived too late to make any meaningful difference. The Liberal Democrats want to create a winter taskforce armed with a ringfenced fund of £1.5 billion for the next four years. That would be used to build resilience in hospitals, A&E departments, ambulance services and the discharge of patients, and allow integrated care boards and NHS trusts that are struggling to balance their books to plan their budget more effectively in advance to cope with the winter crisis. The taskforce would bring together senior leaders from the NHS and the Government, along with staff representatives, to ensure better co-ordination and preparation for winter. It would be empowered to deliver rapid changes in day-to-day operations to ensure a co-ordinated response—for example, by deploying more beds to certain hospitals or boosting social care capacity where it is most needed. Tackling the issue of patient flow is the most fundamental aspect of steering our health system through this winter and the years ahead. If patients are to be treated on time, they need an ambulance to arrive on time, and that ambulance must be able to hand over its patient to A&E as soon as it gets there. If A&E is to have more capacity, we need to reduce the amount of people there in the first place through prevention and investment in primary care. We must make hospital beds available so that patients can be moved out of the A&E department and into the medical or surgical part of the hospital, as appropriate. If we are to move patients on when they are ready to go home, when they would be better served in their own home with the proper therapy, we must invest in social care and deal with its capacity issue, which is at the heart of so many of these problems. Half a million people in England are waiting for care, stranded in hospital beds that are so important to free up over winter, and those in power have continually ignored social care for many years. I am extremely worried that the Government have not said an awful lot about social care in the Budget today. The additional money announced for local councils, £600 million of which is for social care, will presumably be gobbled up largely by the increase in national insurance contributions and the minimum wage. It is really concerning that those councils will not be able to meet their social care commitments in the future. We urgently need cross-party talks so that, between us, we can commit to a long-term solution to the crisis in social care. Liberal Democrats believe that we should introduce free personal care along the lines of the model in Scotland. That would help people to stay in their own homes and out of hospital and ease the pressure on the NHS. We should pay for a fairer deal for unpaid carers and a higher carers’ minimum wage, which of course, we saw some movement towards in today’s Budget. We welcome that and look forward to the review of the cliff edge in the unpaid carers’ allowance. Critically, a higher carers’ minimum wage must be fully funded, because councils will be pushed over the edge if they are not given the money to support that, as will many small care providers, which provide the vast majority of paid social care in this country. We need to ensure that people can see a GP when they need one, so that they do not end up adding to the overwhelming pressure on A&E departments. I recently spoke to someone in my constituency who waited seven weeks for a telephone consultation. We must ensure that we focus on the outcome for the patient, which is why we would give everyone the right to see a GP within seven days, or within 24 hours if the need was urgent, and we need to increase the GP workforce by at least 8,000 to deliver that. As I said, it is crucial that that is done through retention as well as recruitment and more training. We also need to reform the NHS dental contract and guarantee access to an NHS dentist for anyone needing urgent or emergency dental care, ending the dental deserts that exist in my North Shropshire constituency and the rest of the country. The biggest reason for a child to go into hospital is to have a tooth extracted, because their teeth are in such a poor state. That is scandalous, and I look forward to hearing what the Government will do to address that issue. We also need to support community pharmacists, who are critical to the preparedness of the NHS, by making sure that everyone has access to the healthcare advice and medicines that they need. Pharmacy First is an excellent idea and helps to relieve the pressure on the NHS, but community pharmacists are closing at an alarming rate, and we risk that good idea going to waste. Are enough people being vaccinated against the “tripledemic” of flu, covid and respiratory syncytial virus, including staff? Analysis by the Health Service Journal showed that 283,000 fewer staff received a flu jab last winter than at the end of 2019, despite the number of frontline staff growing. If staff are not protected, fewer patients will be protected when they get seriously ill, and staff will not be able to go to work to treat ill people. Increasing the awareness of what is on offer at pharmacies and reversing the cuts to the public health grant to increase the health and fitness of people up and down the country are both integral to relieving pressure on hospitals and preparing the NHS for winters to come. Stories and statistics from up and down the country show that the NHS was already under extremely severe pressure this summer. That has been the case throughout this year and last year. It is autumn now, so it is critical that the Government outline their plans to deal with the added pressure of the winter to come. More fundamentally, we need bold, long-term action so that winter crises become a thing of the past. We need to train, recruit and retain staff, and make them proud and happy, instead of tired and stressed, with them then leaving the system. We need to fix our crumbling hospitals so that money can be spent on care instead of fighting fires and draining floods. We need to invest in all aspects of primary care, including dentists, doctors, pharmacists and optometrists, as I reminded Members in the Chamber last week. Most crucially, we must confront the crisis in social care. Earlier this week, the Secretary of State said that the Budget will arrest the decline in the NHS, but I am afraid that that is not good enough. The annual winter crisis costs lives, jobs and patient dignity. It also costs the taxpayer more than we can afford. We must invest now; we cannot afford not to do it. We must invest to save so that we have an NHS fit for the future.

14:46:00

It is a pleasure to serve under your chairmanship, Sir Roger. I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for bringing forward this important debate on a very busy day for all Members, given the Budget announcement in the Chamber. Last winter was nothing short of a catastrophe for the NHS and everyone who depends on it. NHS figures show that, between November 2023 and March 2024, nearly three quarters of a million people endured A&E waits of more than four hours and nearly a quarter of a million waited for more than 12 hours. In west Sussex alone, there have been 25,000 cases of 12-hour A&E waits so far this year—a 36% increase on the same period last year. Those figures leave patients and staff in my constituency of Chichester deeply anxious as we approach another winter, especially given that we have had the busiest summer on record, with NHS staff managing a staggering 6.8 million attendances over just three months. In many cases, being seen quickly is literally a matter of life or death, especially in acute and emergency settings. Rory Deighton, the director of the NHS Confederation’s Acute Network, warned us that: “Without immediate funding there is a very real risk the NHS falls into crisis this winter, with ambulance response and handover delays, overcrowded A&Es and people stuck in hospital beds because of a lack of community and social care.” It is evident that many of my constituents in Chichester have lost faith in emergency health services. A recent poll conducted by the Liberal Democrats showed that one in four Britons has avoided calling an ambulance for fear that it will take too long to arrive. NHS paramedics, nurses and doctors consistently go above and beyond, and yet the system they are working in has stretched them to breaking point. Patients are bearing the consequences: they suffer each winter as the NHS crisis intensifies. 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.

14:51:00

I am just chewing a sweet, Sir Roger; my apologies. It is a pleasure to speak in this debate. I congratulate the hon. Member for North Shropshire (Helen Morgan) on setting the scene so well. Today, we had some good news in the Chamber: that £22 billion will be spent on the NHS. The good news for us is that, through the Barnett consequentials, some of that will come to Northern Ireland. We do not yet know how much, but we are sure that some of it will come. As the DUP health spokesperson, I join colleagues in expressing concerns for my constituents and their access to good health care this winter. Everyone has spoken about that; we cannot ignore the issue. We hope what the Government have put forward today is a helpful financial solution that will go some way to addressing the issue. I am aware that health is a devolved matter, but funding is not devolved, nor is the obligation of Government to implement their promised NHS reform throughout the entire UK. When I asked the Secretary of State for Health about that reform, he was very clear in his commitment that everyone in the United Kingdom of Great Britain and Northern Ireland would see the benefits. I hope today is a step in the right direction. The Department for Health has released the preparedness document for last year. I welcome some of the impetus, such as strengthening the urgent and emergency care system to provide alternatives to emergency departments, including urgent care centres, urgent streaming services, rapid access clinics and the local phone first services. The hon. Member for North Shropshire, who set the scene, referred to ophthalmology. It is important to include that because there are some questions along those lines. We had an event yesterday called “The eyes have it”. As the party’s health spokesperson, I try to go to as many health events as I can in the House of Commons. Those attending outlined a number of things they wish to see. Perhaps the Minister can give us some ideas on how we can improve ophthalmology across the United Kingdom. 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.

14:59:00

It is a pleasure to serve under your experienced chairmanship, Sir Roger. I congratulate my hon. Friend the Member for North Shropshire (Helen Morgan) on securing this vital debate. Our rural constituencies share many similarities, and the NHS winter crisis will be as great a source of concern for her constituents as it is for mine. She may or may not have noticed that she was speaking at the same time as the leader of the Liberal Democrats, my right hon. Friend the Member for Kingston and Surbiton (Ed Davey), was in the main Chamber. I am grateful to the Minister for attending the debate at the precise time that her colleagues are responding to my right hon. Friend’s questions. This debate could not be more timely, given the context of today’s Budget and the winter we are rapidly heading into. As I hope many Members will know, North Norfolk is proudly the constituency with the oldest demographic in the country. That means that when our NHS struggles, North Norfolk is acutely vulnerable to its effects. I pay tribute to the hard work going on in Norfolk to prepare for winter in our health services. Our GP surgeries and community nurses are working day in, day out to deliver flu and covid vaccinations for thousands of eligible residents. I encourage anyone eligible who is yet to take up their free vaccinations to contact their GP and do so. That work is vital to building the resilience of our communities ahead of the cold winter months, and I know that local residents are incredibly grateful for it. We are once again heading into a difficult winter. In my constituency we have historically had some of the longest ambulance waiting times in the country. In towns and villages such as Blakeney, Cley and Wells-next-the-Sea, people are subjected to appalling and unacceptable wait times for urgent calls. Nationwide, people are fearful of the crisis, with recent polling stating that one in four people have avoided calling an ambulance because they are worried it would take too long to arrive. This cannot carry on. 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.

15:04:00

It is an honour to serve under your chairship, Sir Roger. I, too, pay tribute to my hon. Friend the Member for North Shropshire (Helen Morgan) for securing and speaking in this debate on a day when she, as the Liberal Democrat health spokesperson, has a lot else to do. As we face another winter, our NHS is under severe strain. In east and mid Devon, where I am from, the situation is all too apparent. We have five community hospitals across Axminster, Honiton, Seaton, Ottery Saint Mary and Sidmouth, where we see hard-working staff do their absolute level best to deliver a whole range of vital services, such as audiology, X-ray and rheumatology. The hospitals have had their services reduced or even removed over time, which has led to the overburdening of the large acute hospitals. The unfortunate reality is that the NHS is struggling in terms of acute hospitals like the Royal Devon and Exeter hospital in Exeter. The statistics in the south-west from last winter illustrate that well. Across Devon, 33% of patients in A&E waited more than four hours in February last winter, which is well above the national average. That means that rather than ambulances being out in the streets and lanes saving people’s lives, they spend 30 minutes or more waiting in queues outside, with 31% of ambulance arrivals at the RD&E last winter unable to offload patients in a timely manner. That might suggest to some that we need to put more money into ambulances and acute care, but that is not borne out in the research as the exclusive solution to the problem. A King’s Fund report recently found that the failure to grow and invest in primary and community health and care services ranks as one of the most significant and long-running failures of health policy over the past 30 years. Today, we heard a Budget from the Government that pledges more funding for the NHS; we worry about what that might mean in respect of the absence of support for social care. Because the system is reactive, we spend increasing amounts on acute hospitals and crisis response rather than on the proactive primary and community care that could reduce hospital demand in the first place. That imbalance means that funding is funnelled into hospitals, where people go once they are very ill, and it leaves the community services that could prevent crises unable to do the preventive work they should be doing. 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.

15:10:00

I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for securing this timely debate. In Winchester, the NHS is the No. 1 issue for nearly everyone, and it will be the same for the rest of the country. Patients and staff are aware that we have a huge challenge every winter. Hospital managers and chief executive officers must be so frustrated that they have to face that challenge every year. From what I understand, having spoken to quite a few hospital managers and CEOs of hospital trusts, over the last few years, at about autumn time, they have applied for extra funding to deal with what will be a winter crisis, and by about November they have heard whether they will receive it and how much they will get. They have then received the money by about January, when we are already halfway through the winter, despite the fact that winter comes every year and we know that there will be a winter strain on the NHS. In the spirit of constructive opposition, I will talk about four issues that we should consider when it comes to future winter challenges. The first, as has been mentioned by nearly everyone, is social care. In the Hampshire hospitals foundation trust, there are between 160 and 200 people at any given time who are well enough to go home but do not have anywhere to go, often because of the lack of social care packages. We have talked about the flow through hospitals; if A&E cannot take patients into hospitals because the beds are occupied, ambulances end up queuing outside hospitals, and the knock-on effect is a huge delay in ambulance response times. My hon. Friend the Member for Chichester (Jess Brown-Fuller) mentioned that one in four people now worry about calling an ambulance over the winter because they are worried that it will be a long time until it arrives. The frustrating thing is that providing social care packages is more cost-effective than keeping someone in a hospital bed, so while not having social care packages in place so that people can be moved out of hospital in a timely way is not good for patients, it is not even cost-effective for the taxpayer. 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?

15:17:00

It is a privilege to serve under your chairmanship, Sir Roger, and I thank the hon. Member for North Shropshire (Helen Morgan) for securing this debate on what is an important day. As the hon. Member for Winchester (Dr Chambers) has, I pay tribute to NHS staff who are dealing with significant demands in urgent and emergency care, which are particularly acute in a post-pandemic world. In the time that I have available, I will press the Government on the actions they are taking to increase vaccination uptake and to make use of available private sector capacity. Vaccination was the key to protecting the population from covid-19 and to ensuring that the virus could be managed and contained like other respiratory illnesses. Delivering the successful vaccination programme was one of the many benefits of leaving the European Union, which was a cause championed by the previous Government. We must continue the push to protect the most clinically vulnerable and to reduce hospital admissions for RSV, flu and covid-19. I welcome the national RSV vaccine programme that was launched earlier this summer, and I would welcome an update from the Minister about the uptake of that vaccine among eligible groups. I am concerned by recent data that shows that the uptake of the flu and covid-19 vaccines among eligible groups is lower compared with the same time last year. Figures on the uptake of the flu vaccine in the week commencing 20 October 2024 showed that the vaccination rate was 48.2% for all those aged 65 or over, which is lower than it was in October 2023. That means the picture for those people is worse. In the clinical risk group, only 20.8% of people had been vaccinated, which again is a worse uptake rate than that for last October. Given these worrying figures, what actions will the Government and the NHS take to promote vaccinations among eligible groups, particularly those at greater clinical risk? 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.

15:23:00

It is a pleasure to serve under your chairmanship, Sir Roger. I thank the hon. Member for North Shropshire (Helen Morgan) for securing the debate and hon. Members for taking part. We have all just rushed from the main Chamber and I think I am the only person here who has come out enthused and excited after what we heard about the massive support offered—particularly for the NHS. It is the first Labour Budget delivered after the 14 years of the coalition and the Tory party’s time in power, and it lays the foundations for fixing our economy. Just in case people did not clock all the figures, there will be £22.6 billion in day-to-day extra spending on the health budget, including a £3.1 billion increase in the capital budget, £1 billion of which helps address the backlogs of repairs that have been allowed to fester over the past 14 years. There is also an additional £1.5 billion for beds, new capacity for diagnostic tests, surgical hubs and diagnostic centres, to address the key point made by the hon. Member for Meriden and Solihull East (Saqib Bhatti). Let us take some of that funding and not just stop the decline but fix the foundations, setting the path for the next 10 years, as we have clearly articulated in the few weeks that we have been in government. When I speak to my constituents in Bristol South, they are most concerned about the NHS spending every penny of taxpayers’ money wisely, properly and where it needs to be focused. That is why we have concentrated on our three shifts and launched this national conversation—I hope everyone takes part. We all know the problems, and that is what Lord Darzi helped us address. We also know that winter is a difficult time for our health and care system. Although we cannot predict the severity of the weather, we can predict much of the activity, we know what is likely to hit us most of the time, and we can certainly plan better. I remember working on the issue as a NHS manager back in the day, across primary, community, and secondary care, as well as with ambulance services and local authorities. A systems response is needed, and it is important that we are all involved in preparing and planning. 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.

There is no better choice the Government can make than committing that money to the NHS—we all welcome that. Anybody who does not would be insane. I always try to be constructive in my contributions. I asked about staffing and made the suggestion to retain students wherever they do their training. Sometimes they come to the end of it and go somewhere like Australia or New Zealand to get a job. Instead of that, if Government were to consider a bursary-type system to retain the staff, I think we would be able to address some of the pressure that we have.

I will come on to staffing to address some of those points. The hon. Gentleman makes an excellent point about staff recruitment and retention, which is a key part of our future look at the system. On winter planning, the Government should not be micromanaging people in local systems as they do their job. Rather, we need to focus our efforts on where they are needed the most. Notwithstanding the excellent work of individual staff, let me repeat: the NHS is broken. None of us should underestimate how difficult this winter could be, but we are taking immediate steps to cushion the blow. First, we have set out our national winter planning priorities to NHS systems, local authorities and social care providers to support operational resilience over the coming months. Secondly, we are standing up the winter operating function seven days a week to respond to pressures in real time. Thirdly, we are expanding the operational pressures escalation levels framework to give us a clearer picture of what is happening on the ground in all our systems. The framework uses comprehensive data to keep track of hospital pressures, and this year we are expanding its scope to mental health, community care and 111. Fourthly, we are continuing to support systems that are struggling the most through the urgent and emergency care tiering programme. Those are direct interventions to help systems get back on their feet and make the necessary improvements in performance. Fifthly, we are providing targeted, clinically-led support to 19 of the most pressured hospital sites across the country, to help long waits in A&E and avoidable admissions over winter. Those measures are in addition to the aforementioned meetings that I hold with NHS England and UKHSA every fortnight. I am chairing every one of those meetings to ensure that we identify risks as soon as they arise, while supporting NHS England to mitigate them. 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.

There has been no mention of increasing social care packages. Today, I spoke to the CEO of Hampshire hospitals trust, which runs Winchester hospital, and she said the single biggest thing that would make a difference over winter for that hospital, and probably every other one in the country, would be increasing the number of social care packages and ensuring that those well enough to leave hospital can be treated and cared for elsewhere. Why is that not the main focus of the winter measures that the Minister is talking about?

I will come on to social care, but I will make the broader point that every system is different, and the pressures in every system are different. Some systems suffer worse from poorer levels of primary or community care. Others, particularly those across borders, struggle with discharges and packages of care. One thing I am keen to do, and we are doing it, is try to understand the different drivers of performance in different parts of the system. I think we all have a role to play in that. I very much support constructive advice from local Members of Parliament, in consultation with their local trusts, about the real drivers in their systems, because we know that some systems are performing much better. We as a new Government want to address that issue, to ensure that taxpayers’ money is being directed to the best place to make the system work better. That is something for the hon. Member for Winchester to take back. The flow is affected for different reasons in different parts of the system. Several hon. Members have mentioned vaccinations. A key part of winter planning is the annual vaccination campaign, which began on 3 October. I thank the hon. Member for North Norfolk (Steff Aquarone), the hon. Member for Winchester and the Opposition spokesperson, the hon. Member for Meriden and Solihull East, for mentioning their support for vaccination programmes, which is absolutely welcome. People talk about verifying the figures, but my understanding—I am happy to be corrected—is that we cannot verify the actual figures now. We have started different vaccination rates at different times, so the figures are not directly comparable. We will not really know that until the year works through, which I think people understand. It is too early in the vaccination season to draw firm conclusions, but we all have a role to play in driving and encouraging people to uptake vaccinations across the piece. I recently visited a local hospital in my city of Bristol which has staff hubs and encourages staff to go into the clinics. All Members’ efforts to help with that is really helpful. Vaccination programmes play an essential role in protecting people, particularly the elderly, children and the clinically vulnerable from serious illness during the winter months and in relieving pressures on hospitals and the wider system. Data from the UK Health Security Agency shows that last year people who received a covid vaccine were around 45% less likely to be admitted to hospital compared with those who did not receive one. That is why we are delivering our usual campaigns for covid and flu for the clinically vulnerable in addition to the RSV work that is going on. With regard to elective activity, for patients who are referred to a hospital we want to do everything we can to bring down waiting lists, which stood at over 7.5 million in August. The NHS is prioritising patient safety, urgent and cancer care and will continue to do its best to maintain appointments and elective procedures by separating elective care facilities and diagnostics wherever possible. In the longer term, we are going to return to 92% of patients waiting no longer than 18 weeks from referral to treatment in our first term, a standard that has not been met consistently for patients for a decade. Our hospitals do not operate in isolation. Improving resilience across the whole system, including social care, is essential to winter planning. On 17 September we wrote to all local authorities setting out our priorities for improving resilience across social care ahead of winter, emphasising the importance of close partnerships and joint planning between the NHS and local authorities. We want people to have fair access to locally delivered services that start at home and support them to live independently for as long as possible. That will include building bridges between the NHS and social care services, getting people home from hospital as soon as they are ready, and providing much-needed support to families and friends who are involved in a loved one’s care. We will also work to ensure that people are not stuck in hospital beds when they are well enough to go home. We cannot forget that the backbone of social care is carers. We have made it clear to all local health and care systems that they must continue to support people providing care for their family and friends throughout the winter. I am sure all hon. Members will join me in supporting the Chancellor’s Budget announcement today to support our carers more widely. We want to make sure that carers can access the support they need to look after their own health and wellbeing, not just that of the people they care for. The better care fund includes funding that can be used for short breaks and respite services for carers. The Government are clear that people who draw on care and support, and their families and carers, should be closely involved in decisions about their care. However, in the long term we clearly need reform. That is why the Secretary of State has called for a new national consensus on social care. The Government are committed to building a national care service. My hon. Friend the Minister for Care is introducing the first ever fair pay agreement for care workers. Again, we have seen today our commitment to further support carers with improvements to carer’s allowance. That is a start, but we know we have a long way to go. We are working radically to reform the NHS through the 10-year plan, building a health service that is fit for the future and ready to face every winter confidently. Lord Darzi gave us the diagnosis; the cure can be found in shifting the NHS from treatment to prevention, hospital to home and analogue to digital. That is why last week we launched an extensive engagement exercise with the public, staff and stakeholders to inform that plan. Some right hon. and hon. Members might be keen to see some of the public’s wilder ideas, perhaps, but alongside some of those we have already had many considered and thoughtful responses, and we look forward to outlining our specific plans in the spring. With regard to the point made by the hon. Member for Strangford (Jim Shannon) about individual training and bursaries and the large number of suggestions about the important issue of recruiting and retaining our staff, we will look closely at the long-term workforce plan—we are already doing that. We are open to suggestions. We need to build a workforce for the future that lines up with our three shifts. It will be a tough process to get right and to keep up with modern technology, but all those ideas will inform that. I commend the hon. Member for North Shropshire for securing the debate today and colleagues for shining a spotlight on the difficulties that our constituents face. I hope colleagues are reassured. As someone who has worked on winter planning in the NHS, I am fully aware of the challenges that we face. That is why we have taken a strong grip of it from the get-go. I know we cannot go on as we have done for the past 14 years, limping from one winter crisis to the next, improvising and making do with sticking plasters. The Government are winter-proofing the NHS with long-term reform, but until that day we will put every hand on deck to tackle the problems as they arise this winter.

15:39:00

I thank you, Sir Roger, the Minister, the shadow Minister, all my Liberal Democrat colleagues and the hon. Member for Strangford (Jim Shannon) for coming to this debate on a very busy day. I am grateful for all their contributions, which were positive and constructive, as always. I thank the Minister in particular for her comprehensive response. It is reassuring to hear that she has considerable expertise in this area. We welcome the investment that was announced in the Budget, including significant investment in day-to-day NHS spending, capital investment and investment to deal with the repairs backlog, which needs urgent attention. We called for the Government to address the backlog in our general election campaign, because we recognise its importance. However, the very nature of the Budget statement means that we have been a bit light on detail today, and that is why we want to provide constructive opposition and ideas to move this forward. I reiterate my concerns about social care. Little was said about it today, but many social care providers are small businesses that will be heavily impacted not only by the increase in the minimum wage, which is welcome for carers, but by the increase in employer national insurance contributions. We risk a real crisis in those companies and in local government budgets, which are perilously stretched, if we do not have a plan to fund those carers and their wages. I leave the Minister with that thought, and thank everybody for attending. Question put and agreed to. Resolved, That this House has considered NHS readiness for winter 2024-25.

15:41:00