PARLIAMENTARY DEBATE
Urgent and Emergency Care - 5 September 2022 (Commons/Commons Chamber)

With permission, Mr Deputy Speaker, I would like to make a statement on our support for urgent and emergency care. I know that this is an issue of great concern to right hon. and hon. Members, and I wanted to update the House at the earliest opportunity on the work that has been undertaken over the summer.

Bed occupancy rates have broadly remained at winter-type levels, with covid cases in July still high, with one in 25 testing positive—that compares with about one in 60 currently. This is without the decrease in occupancy that we would normally expect to see after winter ends, and ambulance waiting times have also continued to reflect the pressures of last winter, although I am pleased to see recent improvements. For example, the West Midlands service is meeting its category 2 time of less than 18 minutes.

I would like to update the House on the nationwide package of measures we are putting in place to improve the experience of patients and colleagues alike. First, we have boosted the resources available to those on the frontline. We have put in an extra £150 million of funding to help ambulance trusts deal with ambulance pressures this year. On top of that, we have agreed a £30 million contract with St John Ambulance so that it can provide surge capacity of at least 5,000 hours per month. We are also increasing the numbers of colleagues on the frontline. We have boosted the national 999 call handler numbers to nearly 2,300, which is about 350 more than we had in September last year, and we have plans to increase this number further to 2,500 by December, supported by a major national recruitment campaign. By the end of the year we will have also increased 111 call handler numbers to 4,800. As well as that, we have a plan to train and deploy even more paramedics, and Health Education England has been mandated to train 3,000 paramedic graduates nationally each year, which is double the number of graduates that were accepted in 2016.

Secondly, we are putting an intense focus on the issue of delayed discharge, which, as many Members know, is the cause of so many of the problems we see in urgent and emergency care—I think that is recognised across the House. This is where patients are medically fit to be discharged but remain in hospital, taking up beds that could otherwise be used for those being admitted. Delayed discharge means longer waits in accident and emergency, lengthier ambulance handover times and the risk of patients deteriorating if they remain in hospital beds too long—this is particularly the case for the frail and elderly. The most recent figures, from the end of July, show that the number of these patients is just over 13,000—these are similar numbers to those for the winter months. We have been working closely with trusts where delayed discharge rates are highest, putting in place intensive on-the-ground support.

More broadly, our national discharge taskforce is looking across the whole of health and social care to see where we can put in place best practice and improve patient flow through our hospitals. As part of that work, we have also selected discharge frontrunners, who will be tasked with testing radical solutions to improve hospital discharge. We are looking at which of these proposals we can roll out across the wider system and launch at speed. Of course, this is not just an issue for the NHS. We have an integrated system for health and care and must look at the system in the round, and at all the opportunities that can make a difference. For instance, patients can be delayed as they are waiting for social care to become available, and here too, we have taken additional steps over the summer. We have launched an international recruitment taskforce to boost the care workforce and address issues in capacity. On top of that, we will be focusing the better care fund, which allows integrated care boards and local authorities to pool budgets, to reduce delayed discharge. In addition, we are looking at how we can draw on the huge advances in technology that we have seen during the pandemic and unlock the value of the data that we hold in health and care, including through the federated data platform.

Finally, we know from experience that the winter will be a time of intense pressure for urgent and emergency care. The NHS has set out its plans to add the equivalent of 7,000 additional beds this winter, through a combination of extra physical beds and the virtual wards which played such an important role in our fight against covid-19. Another powerful weapon this winter will be our vaccination programmes. Last winter, we saw the impact that booster programmes can have on hospital admissions, if people come forward when they get the call. This year’s programme gives us another chance to protect the most vulnerable and reduce the demand on the NHS. Our autumn booster programmes for covid-19 and flu are now getting under way, and will be offered to a wider cohort of the population, including those over 50, with the first jabs going in arms this week as care home residents, staff and the housebound become the first to receive their covid-19 jabs.

Over the summer, we became the first country in the world to approve a dual-strain covid-19 vaccine that targets both the original strain of the virus and the omicron variant. This weekend, the MHRA approved another dual-strain vaccine, from Pfizer, and I am pleased to confirm that we will deploy it, along with the Moderna dual-strain vaccine, as part of our covid-19 vaccination programme in line with the advice of the independent experts at the JCVI. Whether it is for covid-19 or flu, I would urge anyone who is eligible to get protected as soon as they are invited by the NHS, not just to protect themselves and those around them, but to ease the pressure on the NHS this winter.

Today I have laid before the House a written ministerial statement on further work that we have been doing over the summer, and I want to draw the House’s attention to one particular feature in that statement which has garnered interest in the House in the past. In November 2021, the Government announced it would make £50 million of funding available for research into motor neurone disease over five years. Following work over the summer between my Department and the Department for Business, Energy and Industrial Strategy, through the National Institute for Health and Care Research and UK Research and Innovation, to support researchers to access funding in a streamlined and coordinated way, we are pleased to confirm that this funding has now been ring-fenced. The Departments welcome the opportunity to support the MND scientific community of researchers as they come together through a network and linked through a virtual institute.

I commend this statement to the House.

I thank the Secretary of State for advance sight of his statement, and wish him and the ministerial team well as the new Prime Minister appoints her first Government. I also welcome what he said towards the end of his statement about the importance of vaccination and funding for motor neurone disease.

Emergency care is in crisis. After 12 years of Conservative Governments, the NHS can no longer reach patients on time. The outgoing president of the Royal College of Emergency Medicine said earlier in the summer that ambulance delays had got so bad that the NHS was now “breaking its promise” to the public that life-saving emergency care will be there when they need it. Twenty-nine thousand patients waited more than 12 hours in A&E in June, more than ever before. Ten thousand urgent cases waited more than eight hours for an ambulance last month. It is estimated that the collapse of emergency care that we are now seeing could be costing 500 lives a week. If the statistics did not paint a stark enough picture, no one can ignore the case of 87-year-old David Wakeley, whose family had to build a shelter around him as he waited outside for an ambulance, with broken bones, for 15 hours. What a shameful indictment on 12 years of Conservative mismanagement of the NHS.

There have been recent reports that the NHS will tell patients to

“avoid A&E as the winter crisis bites early.”

That was in August. The simple fact is that we have gone from no crisis in the system in 2010, to annual winter crises, to the situation we have today where there is a crisis all year round—the worst crisis in the history of the NHS. There is no point in the Secretary of State blaming the pandemic or, indeed, the extreme heat we saw this summer, although they do not help. The reality is that, before the pandemic, the NHS had not hit the 18-minute response time target for emergency incidents since 2017. Will the Secretary of State, on behalf of the Government and his party, finally take some responsibility and admit what his colleague the Culture Secretary was honest enough to say, that the Conservatives left our health service “wanting and inadequate” when the pandemic hit?

The NHS needs Ministers to grip this crisis and work tirelessly to get patients the care they need, so where have the Government been all summer? It is almost as if, the moment the Conservative leadership candidates hit the road, the Cabinet turned on their “out of office” and hit the beach as the NHS slipped into the worst crisis in its history and the Government did diddly-squat on the cost of living crisis, which will also exacerbate people’s health problems.

I pay tribute to St John’s Ambulance for the vital work it does, and I am pleased it has now been formally commissioned to provide England’s ambulance auxiliary. Can the Secretary of State confirm that this capacity is being used by the system today? Perhaps he might have a word with his colleague the Secretary of State for Education, or his successor, about recruitment, because the shambles we saw on T-levels and the hand-wringing we saw from the exam boards is unacceptable and risks the pipeline of talent we need to staff the NHS.

Although extra capacity is important, let us be honest that it will not solve the ambulance crisis unless we tackle the delayed discharges that are causing logjams in hospitals. The Secretary of State talked about this, but let me be clear that one in seven hospital beds is occupied by someone who is medically fit to leave but cannot do so because there is no support available—some people are waiting up to nine months longer than needed. What is the answer to this staffing crisis? It has not been to pay care workers a decent wage so that we stop losing them to the likes of Amazon, and it has not been to provide a great career so that people in our country enter this important profession. The answer has been to pull the “immigration lever,” to quote the Government, and to recruit people from overseas on lower pay. How fitting that this Prime Minister’s Government ends with yet another broken promise. One year after promising to fix social care by hiking taxes on working people, where is the plan to tackle the work- force crisis without resorting to immigration every time?

Finally, the Secretary of State barely mentioned the cost of living crisis. The Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup), has said the Government are worried that if people cannot afford to heat their home, more will lose their life to flu. Has the Secretary of State made an estimate of the number of people who could fall ill as a result of soaring energy bills? As this is rightly a concern, may I point out that there is a plan right in front of him to freeze energy bills, fully costed and ready to go, paid for by a windfall tax on the oil and gas companies? When will the Government stop dithering, delaying and talking to themselves and start acting for the country? Rising energy prices will also push care providers to breaking point, with some facing closure as they are unable to absorb increases of 500% or more. What plans does he have to prevent care home residents from being booted out this winter and to prevent care home doors from closing?

The reality is that this Government are now out of time. A new Prime Minister will be appointed tomorrow who has suggested charging patients to see a doctor. I did not think anything could be worse than fining people for missing appointments, but our new Prime Minister has somehow managed it. Public satisfaction with NHS services is at its lowest recorded level, and patients are struggling to access the care they need. Under Labour, patients could call 999 knowing that an ambulance would come when they needed it, but the longer we give the Conservatives in power, the longer patients will wait.

Let me start with the areas where the hon. Gentleman and I agree. The David Wakeley case was shocking, and we accept that there have been severe pressures, particularly linked to certain trusts; just 10% of trusts account for 45% of ambulance handover delays. His second charge was about what the Government have been doing on this over the summer. We have had a 100-day sprint with NHS colleagues, a taskforce has been set up and I have met those troubled trusts, particularly Cornwall, to look at how we better support them.

Some of the factors affecting ambulance delays are within the trusts’ control. Those include understanding why delayed discharge is much lower at the weekend, and things that they can do within the emergency department. However, as the hon. Gentleman recognised, some factors are beyond the trusts’ control, whether that is variance in performance on conveyancing by ambulance trusts, differences in hear and treat or see and treat, or the challenges in social care. We recognise that, as I said in my opening remarks, the heatwave and a covid infection rate of one in 25, compared with one in 60 now, created significant pressure on the ambulance system.

In addition to the taskforce, we have enacted a whole range of other measures. NHS England has tasked the system with putting in place an additional 7,000-bed capacity for the winter. We have been expanding emergency department capacity. One thing we funded in spending review 2020, when I was in the Treasury, was additional funding for trusts where there are emergency department constraints.

The hon. Gentleman did not mention mental health, but I know he takes an interest in it, so he will be pleased to know that over the summer we have particularly targeted action that can be taken in emergency departments and across the hospital estate in support of mental health, led by Claire Murdoch in NHS England. We have increased staffing by 16% and there is an extra £2.3 billion going into mental health next year compared with 2016. There is additional funding and workforce, because we recognise the pressures.

There is also bespoke action with NHS colleagues. Sometimes, relatively low numbers of patients—for example, patients needing palliative care, patients with dementia and patients with Parkinson’s—are particularly challenging in terms of delayed discharge, and their discharge may be delayed for an extended period of time. Although the quantum of patients may be modest, that leads to delay.

The hon. Gentleman recognised other things we have been doing over the summer, such as the St John Ambulance contract that has been put in place to help with auxiliary ambulances, the work on international recruitment—I do not accept that people are being paid less; that is bringing people in to work in important roles in our care sector—and the consultation on retire and return.

Finally, the hon. Gentleman mentioned the cost of living. He will know that the new Prime Minister has made it clear that she will have further things to say on that over the next week, and I know there will be ample opportunity to debate that further in the House.

My right hon. Friend knows that Worcestershire is at the sharp end of ambulance pressures; I understand that Worcestershire Acute Hospitals NHS trust is one of six trusts that he has met in recent days to discuss those pressures. Can he assure me that he will do everything he can to reduce delayed discharge and address capacity at our A&E, so that I no longer have to witness situations such as the one I saw earlier this summer, with more than 10 ambulances waiting at the door of the emergency department?

I know my hon. Friend is a strong champion for this issue; when I was Chief Secretary to the Treasury, I remember him lobbying me about how a bridge from one bit of the hospital estate to another could provide additional capacity to meet the pressures his trust has faced. That is partly why we have been working intensively with the trusts that have the most severe cases of ambulance delays, looking through the work of the taskforce at best practice and what works best in those settings, and ensuring that the trust chief execs have the right level of support. It is important to recognise that the problem does not always manifest where it is caused. Quite often, challenges on the social care side, or further upstream in the conveyancing rate, put pressure on an emergency department and on the trust.

The Secretary of State is absolutely right about the abject failure in care that his Government have overseen over the past 12 years, but his statement did not refer so much to the pressures in A&E. It seems entirely wrong to me that if someone walks into an A&E department they are its responsibility, but if they turn up in an ambulance they are expected to sit in it for hours on end until the A&E is willing to take responsibility. Will the Secretary of State say more about dealing with the issue so that A&E departments realise that however someone arrives—whether they walk through the door or arrive in an ambulance—they should be the responsibility of the A&E, and the ambulance should be out fetching other people in the area?

The hon. Member makes a very fair point. Within the question he raises is the unmet need where an ambulance does not reach a patient in the community, as opposed to the known risk once the patient is within the hospital trust’s purview. On capacity in A&E, as I touched on in my statement, we put in £450 million at the 2020 spending review to upgrade A&E facilities at 120 trusts.

With respect to the hon. Member’s specific point, he may be aware of the letter that the NHS medical director Professor Stephen Powis and the chief nurse Ruth May sent at the time of the heatwave about where risk sits within hospitals. The taskforce has been doing further work on pre-cohorting, post-cohorting and observation bays so that we can better free up that ambulance capacity and get it back on the road.

I very much welcome my right hon. Friend’s statement, particularly the focus on retention, training and recruitment. Earlier this year, I met people from the excellent Chertsey Make Ready Centre. They told me about the challenges that they face with staff wellbeing and staff retention, which are compounded by the horrendous abuse that they receive almost daily. Sadly, it is not limited to our paramedic workers: I met staff at the Crouch Oak practice in Addlestone in my constituency recently, and we spoke about some of the vile messages and threats that they have received. Will my right hon. Friend join me in thanking our health and care service workers for their fantastic work and in condemning the vile abuse that, sadly, some of them receive from a bunch of miscreants?

I am very happy to join my hon. Friend in thanking the staff for their work and in condemning the completely unacceptable violence, intimidation and abuse to which people are subjected. There should be zero tolerance of that from any hospital trust.

We know that 117,000 people have died waiting for treatment on the NHS waiting list, and what we are hearing now is that 500 people a week are dying waiting for ambulances. Can the Secretary of State give us a date by which he can guarantee that people will not lose their lives waiting for an ambulance to come and get them and care for them?

What I can guarantee is that, through the taskforce, we are prioritising how we get ambulances back on the road and how we speed things up to reduce handover delays. We are looking in particular at the 10 trusts in which the issue is most acute, because there is an unmet need in the community if the ambulance is not there.

On the hon. Member’s point about the backlogs with electives, we announced over the summer, as part of the work that we have been doing, a whole series of surgical hubs and community diagnostic centres. We are working with the Getting It Right First Time team, under Professor Sir Tim Briggs, on different patient pathways. A whole range of work is being done to reduce waiting times, which is why we have already cleared the longest waits—the two-year waits—and are now turning to the 18-month waits.

National headlines do not often reflect the hard work of those in our local hospitals. Although there will be—indeed, there have been—cases of unforgivable waits, will my right hon. Friend join me in thanking all the hard-working paramedics, first responders and emergency department teams who serve Medway, Maidstone and Tunbridge Wells hospitals, supporting my constituents in their time of need? Will he update the House on any conversations he may have had with the Department for Levelling Up, Housing and Communities about major planning applications that have progressed without the appropriate healthcare facilities being provided?

I am happy to join my hon. Friend in thanking the paramedics in Medway, in Maidstone and beyond for all their fantastic work, especially given the pressures the system has been under during the summer. As for levelling up, a number of Members have raised with me the need to ensure that developers are making a sufficient contribution as part of their housing plans, and I shall be happy to draw that to the attention of my colleagues in the Department for Levelling Up, Housing and Communities.

The Secretary of State is right to talk about the back door rather than focusing on the front door when it comes to the crisis in social care. About a quarter of the patients in our hospital in York are experiencing delayed discharges. However, if we do not pay care staff, we will never resolve the issue. What consideration has the Secretary of State given to putting those staff on a national pay scale, using “Agenda for Change” as a model?

This obviously involves debates with Treasury colleagues about pay—not just on the social care side, but in respect of the NHS and the interplay with pensions—but it is not just about that; it is also about ensuring that we have the right data, and through the integrated care systems we are acquiring much better data to improve our ability to join up what is being spent on delayed discharge within the NHS with what is being done in the social care setting. I am sure Members will agree that not only is it often very damaging for frail elderly patients to spend a long time in hospital, but hospital is usually the most expensive place in the system for them to be. It is not just a question of having more money, although that is often the default; it is a question of thinking about how to get flow into the system in a way that will deliver not only patient care, but a more efficient service.

On checking my website, I saw that it was in late 2005—not a period of Conservative government—that my right hon. Friend the Member for New Forest West (Sir Desmond Swayne), the then Liberal Democrat Member of Parliament for Romsey and I were complaining about the closure of in-patient beds in small community hospitals. Does the Secretary of State accept that there is a role for such beds in enabling appropriate discharge from the larger hospitals, thus dealing with one of the main causes of people being stuck in ambulances without being able to be given a bed?

That, I think, relates to the point that I just made about the need for flow in the system and an appropriate step-down capacity. Sometimes patients are not yet ready to be discharged to their homes, but some additional physio or other support may enable them then to go home, which is where they usually want to be. This is all part of taking a much more integrated approach, and part of that must be improving the quality of data in relation to the activity that takes place within community settings.

In July, the average wait time in London for an ambulance needed by someone describing the symptoms of a stroke was more than an hour—more than three times longer than the target time. Many of my constituents have told me that they are living with genuine anxiety and fear that if they or a loved one were stricken by illness or involved in a serious accident, the emergency help that they needed would not arrive in time. The Secretary of State has announced some measures today, but what my constituents want to know is when we can expect the time targets in London to be met once again, so that they can rest easy in the knowledge that if they need an ambulance, it will be there.

One of my reasons for going out with the London Ambulance Service—among others—over the summer was to answer the charge about what Ministers were doing, and to observe at first hand the challenges that the service had been facing. As the hon. Lady will know, performance has improved since the summer, but the service remains challenged. That is why we are considering a range of measures, such as boosting emergency departments, looking at pre and post-cohorting, looking at how we work with the taskforce, and looking at single points of access. One issue that paramedics emphasise to me is the need for, in particular, a better way for frail elderly patients to gain access to a single point for social care provision. We are working closely on that range of measures with colleagues in the London Ambulance Service.

In recent weeks I have been supporting a constituent who has complained to the East Midlands Ambulance Service. The complaint centred on the fact that it took nine hours and 26 minutes following a 999 call for an ambulance to arrive at the home of my constituent’s mother. When she arrived at Scunthorpe Hospital, it took another two hours and seven minutes before she was handed over to the hospital staff. I find it particularly disturbing that the letter from the chairman of the East Midlands ambulance service, after explaining the procedure and protocol that was followed, says:

“I can confirm that the 999 call had been responded to appropriately.”

Needless to say, my constituent, who is a retired senior police officer and well aware of pressures on the emergency services, would not agree that it was dealt with appropriately. If I forward the details to my right hon. Friend the Minister, could he follow up with the East Midlands ambulance service and come back to me? Hopefully, that will mean the service provided to my constituents by the ambulance service can be improved.

I am very happy to ensure that that specific case, which is obviously concerning, is looked at. As my hon. Friend will know from my earlier remarks, we are boosting the number of 999 call handlers—those numbers are up and there are around 350 more call handlers than in September 2021—and we are also training more paramedics. Numbers are going up, but obviously demand has increased exponentially as well.

A nurse in Barnsley East wrote to me about the incredibly traumatic death of her mother. When her mum suffered a brain haemorrhage, her dad called the emergency services twice. They told him to call back as they did not have an ambulance or a responder to help. An hour and 40 minutes later, the ambulance arrived but it was too late for her to receive any treatment, and she later passed away.

Sadly, this is not an isolated incident. Our emergency services are in crisis. They are understaffed and under-funded. What are the Government doing to prevent tragedies such as that from ever happening again?

We are putting in additional funding, whether that is the additional £1.5 billion put into GP capacity in 2020, the £450 million to upgrade A&E facilities across 120 trusts, the extra £150 million specifically put into the ambulance service, the £30 million put into the St John Ambulance contract over the summer, or the further £50 million that has gone into call handling to boost the 111 service. Significant additional funds are going in as part of the support for the significant pressure that we recognise there has been over the summer.

I thank my right hon. Friend the Health Secretary for visiting Kettering General Hospital in July and for his subsequent confirmation in August that the hospital has won £38 million, as a 10% down payment, to start the redevelopment of the hospital. During his visit, he visited the A&E department, which is one of the most overcrowded in the country, and saw the ambulances waiting outside. What is his assessment of the current state of play at Kettering General Hospital and its prospects for the future?

First I acknowledge on the record the campaigning that my hon. Friend and colleagues have done for a new hospital at Kettering. They particularly demonstrated the urgency of addressing issues with the energy plant, so I was pleased that we were able to get that enabling work done. All A&E facilities have been under pressure over the summer, which is why we have announced the additional funding. It is about boosting capacity in call centres, looking at how we address variation in performance among ambulance trusts, particularly on conveyancing, and looking at how we get more flow into hospitals. That is why, along with the hospital, I also visited a care home in my hon. Friend’s constituency, in order to look at how we better address the issue of delayed discharge.

Can I bring to the Secretary of State’s attention the planned closure of the Preston ambulance station on Blackpool Road, Preston, and the closure in Broughton, just outside my constituency, which are to be replaced by an ambulance station 5 or 6 miles away on Sherdley Road in Lostock Hall? The decision was made by the North West Ambulance Service NHS Trust without consulting any staff or hospital heads, including the chief executive of the NHS Trust in central Lancashire, and without consulting trades unions and other stakeholders, including the councils. Will he look into this matter and see what has happened? It will add 26 minutes to a journey from the proposed site to the Royal Preston Hospital, which cannot be in the interest of any patient.

I am happy to draw that case to the attention of the relevant parties and ensure that the hon. Gentleman gets a written explanation.

I think that the Secretary of State is aware of the acute problems at Southend University Hospital and of the fact that A&E capacity is the issue. We are waiting for capital funding that was promised years ago to be released. I know that Health Ministers have been working on this over the summer. There were 15 ambulances there yesterday. Our hard-working nurses and doctors would love news on that funding to be forthcoming.

As I said in my statement, additional funding has been put in to boost A&E capacity. There was some £450 million of funding in the spending review in 2020, which has been applied across 120 trusts. Of course, the ICSs will look at the commissioning priorities in particular areas, and the NHS England taskforce is looking at trusts where there is acute pressure.

I am concerned that people across England and Wales, including in Shropshire, have died as a result of the ambulance delays we have seen for a long period. I have raised the issue a number of times in this place. I welcome the improvement in the response times of the west midlands ambulance service, but I am worried that the regional data masks huge differences between rural areas such as Shropshire and densely populated urban areas. Will the Secretary of State consider the Ambulance Waiting Times (Local Reporting) Bill, which my hon. Friend the Member for St Albans (Daisy Cooper) tabled earlier this year, so that the disparity between urban and rural response times can be properly understood and tackled?

The hon. Lady makes an important point about variation not just between regions but within regions. As a rural Member of Parliament, I get the point that there is often significant variation within a region. That has been a key area of focus. The federated data platform, which is due to come on stream in April, will give her local ICS much better data on what is happening and on what community capacity there is. Over the summer, we have worked with ambulance trusts to look at operational performance data on a much more granular level. That is why I have flagged to the House the issue that a small number of trusts are driving a large proportion of the handover delays. That is exactly the sort of variation that we are looking at.

My right hon. Friend will be aware of the £25 million Government investment in the new emergency village at Blackpool Victoria Hospital, with the new critical care unit opening only a few weeks ago. That will make a substantial difference by easing the pressures at the hospital, which are contributing to unacceptable ambulance waiting times. Will he join me in visiting the hospital to see the substantial difference it will make to my constituents?

As my hon. Friend knows, my parents live very near the hospital in question. I know he has been a huge champion of the additional funding. If the opportunity arises, I would be very happy to visit. I pay tribute to the work he has done to secure the additional facility, which will benefit his constituents and those across the Fylde coast.

In July, I met the Royal College of Emergency Medicine and the chief executive of Hull University Teaching Hospitals NHS Trust to discuss the ambulance delays and the delays at A&E. They both told me the same thing: the problem is actually with exit block. They cannot admit people if they cannot discharge people. I have been told by Hull Royal Infirmary that at points over the summer, more than 170 people were in the hospital who should not have been there because they were waiting for discharge packages. That works out at more than a fifth of hospital beds being taken up by people waiting for adult social care.

A number of months ago, I raised in this place a letter from the Conservative-led East Riding of Yorkshire Council, which said that it did not have the adult social care carers to meet the needs of the population. This situation will only get worse. The Secretary of State has said that he is looking at an international recruitment taskforce. I recommend a simpler solution: pay people more, and then we might get the workers we actually need to deliver adult social care. This is already a crisis and it will only get worse.

A good example from Hull, which I visited over the summer, shows that this is not simply about money, although that is obviously a relevant factor. The hon. Lady will be familiar with the Jean Bishop integrated care centre in Hull, where the social care staff say that no one has left the service because they really enjoy working in an integrated way. The patient feedback is also extremely strong. That shows the sort of innovation we should apply across the system. I hope the hon. Lady would welcome that innovation in Hull being applied more widely.

I know that the Secretary of State is aware of the pressures that Warrington Hospital has been under through the summer, particularly the wait times. I am grateful that he intervened and spoke to the chief executive about looking at some of the issues that it was facing. Having spent some time there and having talked to staff and the management, it is clear—I agree with him—that the real issue is delayed discharge. It appears that there is a 90-bed shortage in step-down care capacity in Warrington. Will he join me in urging Bridgewater Community Healthcare NHS Trust and Warrington Borough Council to make progress on increasing that capacity, so that we can try to address some of the issues in the emergency department?

My hon. Friend is absolutely right that a central role for the integrated care systems in future is to look at how they best use the better care fund, how we better integrate around step-down provision, and how we ensure that best practice is being followed through the delayed discharge, including regarding some of the additional pressures that Warrington faced specifically, as I know from when we spoke over the summer. He will also know that there had been additional funding for new capacity at Warrington, which strangely was not highlighted in the media coverage that I saw.

Two weeks ago, in the west midlands, it was being reported that some were waiting as long as 17 hours to receive service from an ambulance. It was also reported that at least 68 people have died since April while waiting for an ambulance, although that number was backdated to last August. It is now clear that our NHS is at breaking point due to a decade of Tory cuts; welcome to backlog Britain thanks to 12 years of Conservative Governments.

Trusts in the region report being poorly equipped for the burden of treating patients, with many reporting delays due to a shortage of beds. This crisis will only get worse in the coming months as we enter the cold period—a winter in the midst of one of the worst crises in living memory. What measures will the Secretary of State introduce immediately in response to the increased pressures that our NHS is facing, which are costing lives? Will he provide the extra measures that the NHS desperately needs to deal with this crisis—a crisis that was made by 12 years of Conservative Governments?

I fear that the question was written before the statement. In the course of the statement, we have covered the significant additional funding that is going in, whether that is in primary care with the £1.5 billion on GP capacity, the £450 million on A&E capacity, the £150 million on ambulances, the £50 million on 111 call-handling or the £30 million on St John auxiliary ambulance capacity—to name just a few areas.

As to the hon. Gentleman’s wider charge on Government funding for the NHS, I remind him that health funding is on track to be £4 in every £10 of day-to-day Government expenditure, which is a significant increase on 2010. We have also just been through a pandemic in which the fiscal response, as the former Chief Secretary to the Treasury, my right hon. Friend the Member for Chelsea and Fulham (Greg Hands) will know, was about £400 billion. Significant funding has gone in, and the statement today has shown that a number of factors, in particular the integration between social care and the NHS, are at the heart of solving the issue of delays on ambulance handovers.

For the week ending 12 August, there were nearly 1,000 excess deaths. We know that that is just the tip of the iceberg and it is likely to get worse; that is about 10% more than the five-year rolling average. What are the Secretary of State’s estimates of how much worse it is going to get over the winter months, and what is he going to do about it?

I have set out a range of things that we are doing to tackle what we recognise are significant pressures facing the NHS, whether that is through the taskforce that we have set up, which is targeted on delayed discharge; the intensive work that has been undertaken with, in particular, the 10 trusts that account for 45% of ambulance delays; the improved capacity within our call handling; or looking at our data, as was raised earlier, on the variation in performance between ambulance trusts on areas such as conveyancing or within the integration between the NHS and social care. I pay tribute to the huge amount of work that is being done within the NHS and social care in recognising that there are significant challenges within the system, which is why so much work has gone into addressing that over the summer.

The Secretary of State might recall that in his previous Health incarnation, he responded to a debate about the crisis in the ambulance service in my constituency. It is worse today—much worse. I take the point about delayed discharge, but, even so, is it not better to have people moving into a hospital setting, rather than people not being picked up by ambulances? That is where the real risk is. Will he also guarantee that I get an answer to my letter asking that Rochdale, which lost its A&E service some years back, gets it back? That would make a material difference.

On the hon. Gentleman’s second point, I will ensure that that particular letter to the Department is highlighted following this statement. On his first point, as I said in my statement, I agree that the greater risk is the unmet need if an ambulance does not arrive, rather than a patient who is in hospital. That is why Professor Stephen Powis and chief nurse Ruth May wrote to the system when there was pressure during the heatwave, flagging that as a specific issue. We have been working with trust leaders, including leading figures such as Anthony Marsh, on pre-cohorting and post-cohorting, capacity in emergency departments, and where risk sits in the system. I recognise the hon. Gentleman’s point.

This is about a lack of planning. I could say the same about the monkeypox response, because we still do not have the vaccines; they are now being watered down to half strength, because we have run out, they have not been delivered and we still have 100,000 to order. The ambulance situation is also about a lack of planning. My grandmother was admitted to the Royal Cornwall over the summer via A&E. The person before her waited 24 hours in an ambulance to be discharged. The person behind had been in a car crash, but the ambulance did not turn up for five hours and they had to make their own way to the hospital with a damaged lung. In Brighton, the Royal Sussex’s A&E has been given a very poor Care Quality Commission report. All of these cases are because of the lack of move on beds in social care. In Brighton, a senior care worker can receive less than £10 per hour to work. People get more working in shops on the high street. This needs to be addressed urgently. Is it not time for a national pay, and terms and conditions, for care workers? It would cost the Department nothing, but would stop the loss of many of our workforce.

Far from there being a lack of planning, the very essence of integration between social care and the NHS through the ICSs is that we recognise the importance of both aspects working much more closely together. That is why we are bringing forward initiatives such as the federated data platform.

Monkeypox is outside the scope of today’s statement, but I know the issue is of particular interest to the hon. Gentleman. He will know that, fortunately, we have not yet had any fatal cases in the UK and the rate of infection has been falling. We purchased the maximum number of vaccines that we could; I wrote to the relevant charities with the details. Although smaller doses are being delivered compared with the initial 50,000, we still have doses in the system. We expect a further 20,000 very shortly and a further 80,000 later this month. We have procured doses, we are getting them out and it is fortuitous that cases are falling, but we are obviously keeping the situation under close watch.

This summer I have heard some horror stories from constituents with life-threatening conditions about the dangerous delays they have faced. When one constituent raised the issue with the NHS, she was told by the senior consultant at the A&E department that the NHS has collapsed. If senior frontline clinicians are saying that in the summer, God help us when we get to winter. I really fear where we are going to be, because there is no doubt that my constituent is very lucky to be alive. We have heard a lot of figures today about the number of excess deaths this year. Will the Secretary of State give us his estimate of the number of people who have died unnecessarily because they have been stuck in an ambulance waiting to get into A&E, or because an ambulance has not turned up at all?

Again, despite that colourful language, we have more doctors, more nurses and more paramedics. We are training more and meeting more demand, and significant additional funding has been applied to ambulance trusts, call handling and other parts of the system, including primary care. Part of reducing the demand on the ambulance system is related to GP capacity, which is why—to take that as an example—an additional £1.5 billion of funding has gone in.

I thank the Secretary of State for his statement and for his clear financial commitment to trying to address the issue of ambulance response. I also congratulate the new leader of the Conservative party. In her statement at dinnertime, the right hon. Member for South West Norfolk (Elizabeth Truss) said that the NHS is one of her main priorities.

The Secretary of State will know that this week is Air Ambulance Week, which runs from 5 September to 11 September. Today, Air Ambulance Northern Ireland stated that it has had its busiest year ever, so will the Secretary of State allocate additional funds to the devolved Administrations, particularly in Northern Ireland, to help cope with the increasing use of air ambulances due to delayed response times and extortionate waiting lists?

I very much agree with the hon. Gentleman on the importance of the air ambulance. As a rural MP, I know full well the importance of the service it provides across the Cambridgeshire fens, and I know that it provides an essential service for his constituents. Again, if there are any specific issues, I am happy to ensure that the Department looks at them, but he is absolutely right to draw attention to the importance of the air ambulance within the wider response.

I thank the Secretary of State for his statement and for responding to 25 questions. We now move on to the final statement today, which is on energy prices.