PARLIAMENTARY DEBATE
Health and Social Care: Winter Update - 15 January 2025 (Commons/Commons Chamber)

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

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

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

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

The King’s Fund has said:

“The NHS is facing a toxic cocktail of pressures this winter”,

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

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

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

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

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

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

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

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

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

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

Where to begin, Madam Deputy Speaker? The shadow Health Secretary does a really good line in diagnosing the problem as if these are somehow new facts to him, or to the country. In fact, one does not have to be a Minister of long service in this House, or indeed a Member of long service, to remember that only a short matter of months ago, the shadow Secretary of State was a Minister in the Department. Time and again, he asks questions about the state of the crisis and the challenge in the NHS without showing a shred of responsibility for that crisis, which he played a part in creating.

It is not just the shadow Secretary of State but every one of his predecessors who had a hand in creating the situation that Lord Darzi spelled out: underinvestment and botched reform. It is the situation we see today, with pretty much every part of our health and care services—be it primary care, community care, mental health services, secondary care or social care—under extraordinary and historic pressures. It is all very well criticising from the Opposition Benches, but the shadow Secretary of State demonstrates the same pattern of behaviour as his predecessor: acting like the arsonist criticising the fire brigade for not doing enough, quickly enough, to put out the fire they started. It is truly shameful.

I turn to the questions raised by the shadow Secretary of State. On delayed discharges, in December—the latest data we have—12,000 on average per day were medically fit for discharge but unable to be discharged. Bed numbers are broadly the same as they were this time last year: 102,546, versus 102,226 under the previous Government. That actually says something about what we have experienced in our weekly updates: the work that is taking place between health and social care services to improve the flow of patients is having some effect when we take into account our ability to flex bed numbers up and down against the backdrop of higher occupancy from flu, the added challenge of norovirus, and the other seasonal conditions that we see at this time of year.

The shadow Secretary of State asked about vaccination uptake. As I said in my statement, there have been more flu vaccinations this year than there were last year, but he raised the important issue of vaccination rates among NHS staff. Those rates are lower than we would like or expect, and we have to do some work with staff to understand why that is the case and how we can encourage further uptake. As I said, if staff are suffering with flu having not been vaccinated, not only is that a really unpleasant experience for them, it is an unpleasant experience for their colleagues if staff are off sick, and indeed for patients who are waiting longer.

On critical incidents, the shadow Secretary of State asked about the support that is being provided to NHS organisations. NHS England regional teams are working closely with integrated care boards to ensure appropriate responses are in place to address and mitigate the issues identified within each declared critical incident, all of which will have variations. We have also seen NHS England—rightly, in my view—using the critical incident tool proactively to ensure we can provide wider system support to emergency departments that are under particular pressure.

The shadow Secretary of State asked about additional funding for winter. When I was shadow Health and Social Care Secretary, I was very clear about my cynicism regarding the pattern of behaviour we saw from our predecessors. Year after year, they would arrive in the middle of winter—often after the winter peak—with a gimmicky package of last-minute funding that delivered too little, too late without making any real difference on the frontline, all to give the impression that they were doing something to mitigate the crisis in the NHS, in which they played a serious part. I said that we would not do that, and we are not doing it. As soon as we came into office, looked at the books and saw the black hole, the Chancellor released additional funding for the NHS in-year to ensure that it had the resources it needed not to cut back. Thanks to the decisions taken by the Chancellor, the NHS has received more than £2 billion more in-year than it would have received if the Conservatives had remained in power, so we do not need any lectures on funding. Indeed, they continue to oppose the £26 billion we provided for the NHS.

Finally, the shadow Secretary of State accuses us of capitulation to frontline doctors who were out on strike because of the way they were treated by our Conservative predecessors. I just say to resident doctors who are following these proceedings, and to patients who can see the state of the NHS today and wish it were better, that we are now left in no doubt. Had the country kept the Conservatives in power, doctors would have been on the picket lines instead of the frontlines this winter; taxpayers would have continued to pay a heavy price for failure; and patients would continue to pay the price through delayed, rearranged or cancelled operations, appointments and procedures. It is proof positive that even after it was booted out of office, the Conservative party has not listened, has not learned, and is not fit to govern.

I wholeheartedly agree with my hon. Friend, and thank her for the work she has been doing this winter on the NHS frontline, providing support to her colleagues at her local hospital—literally rolling her sleeves up and looking after people. She is absolutely right that we need an urgent and emergency care plan to make sure we see continued year-on-year improvements. I can reassure my hon. Friend that that plan is already being written; we are learning the lessons from this winter in order to apply them next winter. As I should have said to the shadow Secretary of State, the right hon. Member for Melton and Syston (Edward Argar), I took the same approach when I was shadow Secretary of State: the very first meetings I held on winter planning were ahead of the general election in access talks with the Department. The first briefing I received on winter preparation was on my first day in office. Throughout the past six months heading into winter, I continued to talk to staff in the Department, NHS England and social care leaders to ensure that we were as well prepared for this winter as we could be. Right now, we are learning the lessons to prepare for next winter.

I thank the Liberal Democrat spokesperson for her usual constructive contribution to proceedings. She is absolutely right to raise the issue of variation in performance across different parts of the country. It is not acceptable, and one thing we will be doing as a Government is to ensure that, as well as creating a rising tide that lifts all ships, we raise the floor in performance so that we see far less unwarranted and unwanted regional variation. She talked about the Shrewsbury and Telford trust, which has had a number of challenges over many years. We have seen some signs of improvement as recently as this week, and we continue to support local leaders as they strive to improve the performance of their system overall.

The hon. Member raises some good and interesting questions about the frequency with which we publish data. It is right that we ensure that data is properly validated so that accurate data is put into the public domain, even as NHS England’s control room monitors live reporting into the centre. I will take into account what she said about her requests both for more live data—collected and published data—about critical incidents and for more localised data in individual trusts, including ambulance services, to monitor variations in response times within a region. Although the points she has raised are interesting, I add the caveat that we would not want to burden the system with more reporting requirements if that causes a distraction from improvement. I tend to lean towards more transparency in data and reporting, however, and I will take into account the representations she has made as we put together our urgent and emergency care plan.

I thank my hon. Friend for that question. The conditions she describes at her local hospital are truly shocking. As I have said, and this is often quoted by the SNP, all roads lead to Westminster, and I am happy to report that up that road from Westminster to Holyrood lies a record uplift in funding for the Scottish Government. They have no excuses for inaction. They need to grip the crisis in the NHS in Scotland, as we are here. The difference, as my hon. Friend states, is that they have a record of 18 years that they cannot defend, and I hope people will consider that record very carefully when they decide who should govern in Scotland at the next set of Scottish elections.

I am grateful to the Chair of the Select Committee for her questions. I cannot give her a commitment to publish those statistics ahead of the next NHS England board, but I can give her an undertaking to go away and look carefully at the rhythm and pace at which we publish performance data, to make sure that we are being as transparent as we can, as fast as we can. That, I think, should be the principle that underpins our approach to the publication of data. She is right to talk about wider system pressures as a result of what we see in emergency departments. We will wait to review the performance of the NHS overall until we exit winter. I think we have seen some effective protection of elective activity throughout this winter, but that will of course vary from provider to provider.

The hon. Member mentioned a whole number of organisations calling for more data transparency. I, too, welcome the very public representations that we have heard from the Royal College of Emergency Medicine and others about the need to tackle corridor care. Let me assure her and all those who have made representations that we are absolutely determined to turn this situation around, and not just improve the performance of urgent and emergency care, but get a better system working. Ultimately, it is through ensuring better patient flows, and ensuring that people get the right care in the right place at the right time, that we will finally get this country out of the cycle, created by our Conservative predecessors, of winter crises.

That is an excellent question from my hon. Friend. This Government have been walking the talk on primary care since we came into office. There was an immediate release of funding, within weeks, for 1,000 GPs, who are to be employed on the frontline by this April, and an £889 million uplift in funding for general practice that we announced prior to Christmas. I think that care in the home and care closer to home will be how we not only get the NHS back on its feet, but make sure it is fit for the future. That shift from hospital to community is one of the three big shifts that will lie at the heart of our 10-year plan for the national health service.

I am happy to report that people will not have to wait three years for action on social care. In fact, we have seen lots of it in the last six months. We have had the biggest expansion of carer’s allowance since the 1970s; the legislation for fair pay agreements in the Employment Rights Bill, brought in within the first 100 days of this Government; the uplift in funding provided by the Chancellor through her Budget; and the expansion of the disabled facilities grant. There will be more for us to do this year, including reform to make the better care fund more effective. Baroness Casey’s first report will in fact be next year. It will set out the action required on social care throughout this Parliament. I hope that reassures people right across the House and, more importantly, right across the country that social care is a priority for this Government. We will seek to do better than our predecessors of all parties—I have made this point before—because we have to tackle this generational challenge facing our country.

My hon. Friend is absolutely right about the challenge caused by the Conservatives’ failure on general practice, which has placed pressure not just on stretched GPs, of whom there were thousands fewer when the Conservatives left office than in 2015, but on other parts of the system. That is not just worse for patients—it is certainly not a pleasant experience at the moment to be sat waiting in A&E for treatment—but more expensive for the taxpayer, because while it costs £40 for a doctor’s appointment, it can cost £400 for accident and emergency attendance. That is the legacy of the Conservative Government: things are worse for patients and more expensive for taxpayers. That is the rotten legacy that we are seeking to overturn.

It is irresponsible, as well as inaccurate, to suggest that the Government have taken winter fuel payments away from vulnerable pensioners. In fact, it is thanks to the decisions taken by the Chancellor that winter fuel payments were protected for the poorest pensioners. They continue to be worth £200 to eligible households, or £300 to eligible households in which there is someone aged 80 or over. We also continue to stand behind vulnerable households by delivering the £150 warm home discount for low-income households and providing £742 million to enable the extension of the household support fund. Of course, over 12 million pensioners will see their basic or new state pension increase by 4.1%, thanks to the Government’s commitment to the triple lock.

This is a running theme from Conservative Members. They seem to welcome the investment in health and social care that the Government are providing at the same time as opposing it. They cannot have it both ways. If they do not support the decisions taken by the Chancellor, they have to admit that had the Conservatives remained in power, this winter, they would have been cutting the health and social care services that pensioners really rely on.

I strongly agree with my hon. Friend. The way that Conservative Members continue to behave should send a message to every resident doctor, and indeed every member of health and social care staff, in the country. Every single one of them will know that thanks to the decision the country took back in July, we have a Government who are committed to the NHS and social care. Had the Conservatives remained in power, we would be going even deeper into the already deep hole that they left the country in. We must never go back there again.

Throughout the winter, NHS providers have continued to flex bed capacity to meet demand. The important thing is that our approach to investment and reform delivers the system-wide improvements that help us to break out of the annual cycle of winter crises. There has been criticism of the Government’s focus on elective recovery—for example, people have asked if that is at the expense of urgent and emergency care—but I will not allow a status quo to settle in which the NHS is in effect reduced to a blue-light, emergency service. The Government will improve urgent and emergency care, elective recovery, primary care, community services and social care, because that is what we need to meet the health and care needs of people in this century, and that is what we will deliver.

I thank my hon. Friend for his question, and for the expertise and experience that he brings to the House. We absolutely need to ensure that we are innovating in our service provision, and are shifting the centre of gravity out of hospitals and towards care and treatment closer to home—indeed, in people’s homes. As we have set out in recent weeks, since the investment announced in the Budget and particularly in the elective reform plan, this Government will continue to innovate, in order to provide services that deliver not only great value for the taxpayer but, even more importantly, great outcomes for patients.

I confirm that we are absolutely up for looking at co-location of different public services, to deliver both better integration and co-operation between different services—particularly the blue-light services that the hon. Gentleman mentioned—and better value for taxpayers. I will ensure that one of my ministerial colleagues makes contact with him.

My hon. Friend is absolutely right. May I, through her, thank health and care staff in her city for the work they are doing to get the people of Birmingham through this particularly challenging winter? What we really need to do to make our health and care system more effective and more sustainable is shift the centre of gravity out of hospital and into the community. We need better and faster access to diagnostics and treatment, as well as a bigger focus on prevention—primary prevention to keep us all healthy and active, and secondary prevention so that fewer people need to call on health services, and particularly emergency departments, which are stretched at this time of year.

I am grateful to the hon. Member for her question and for showing off her constituents’ uptake—that is exactly what we want. Perhaps ahead of next winter, we should launch a parliamentary competition: who can boost uptake most in their constituencies? We will think about the prize.

More seriously, I am always glad when the pressure is to expand access to vaccines—that is exactly the sort of pressure that we want. We follow advice from the Joint Committee on Vaccination and Immunisation. We will review the experience this winter, and the JCVI will review evidence and data this winter and make recommendations, which we will take into account.

I am extremely grateful to my hon. Friend for the spirit of his question. That is exactly how this Government are approaching planning for next winter. I want year-on-year improvement in NHS performance, particularly our response to winter pressures. Of course, there are seasonal variations in infectious diseases, inclement weather and all sorts of other pressures that can impact on NHS services, but the system should be resilient enough to withstand pressures in any given winter. It will take time to get back there, but that is why the Government are already planning for next winter, learning from experience—what has worked well and what has not—so that we can continue to deliver for the people of this country and improve the national health service and social care services.

I welcome the hon. Member’s question, and I agree with the thrust of his question that we need healthcare to shift from hospital into the community, with care closer to, and in, people’s homes. The configuration of services locally is a matter for local NHS leaders. I encourage him in the first instance to be in touch with his local integrated care board. If he gets a particularly unsatisfactory or unreasonable answer, he should feel free to raise it with Ministers.

My hon. Friend brings expertise and experience to the House, and I am particularly grateful for his support and concern for the colleagues of the nurse who was so brutally attacked in Oldham, because I know that they will be acutely affected. In fact, the NHS workforce right across the country will have felt the shiver down the spine that I felt when I read about that horrific case.

My hon. Friend is right that I am fortunate to be able to call on every single one of my Labour predecessors, from Alan Milburn to Andy Burnham, to ask for their advice, experience and insight. As our great late friend John Prescott said, we need

“traditional values in a modern setting”.

I am bringing that modernising tradition to our approach to investment and reform, because the combination of both delivers results. That is how the last Labour Government delivered the shortest waiting times and the highest patient satisfaction in history.

I am grateful to the hon. Member for raising those concerns on the Floor of the House. Thanks to the decisions that the Chancellor took in the Budget, the Department has an additional £26 billion available for investment in our health and social care services, including estates. I cannot promise to fix the backlog that has built up over the past 14 years in a single budget year, but I can confirm that we will publish our mandate for NHS England and, following that, planning guidance and financial allocations, very shortly.

When I was sitting on the Opposition Benches at the tail end of the last Parliament, I saw my predecessor at this Dispatch Box telling us all the wonderful things that she thought the Government were doing and achieving. It was like hearing about a completely different national health service and social care system in another country. I arrived in July and was honest on day one that the NHS is broken but not beaten, and that these are crises of historic proportions that we will never sweep under the carpet, nor will we hide problems to spare political blushes. In the coming months and years, I will continue to be honest about where we have not yet fixed problems, and clear about the action that we are taking to get the NHS back on its feet and fit for the future and to build a national care service worthy of the name.

There are 889 million reasons why GPs should be reassured about their financial sustainability for the year ahead—the £889 million allocation for general practice that I spelled out before Christmas, to provide reassurance to GPs when planning for the financial year ahead. I have been heartened by the response from GPs to that announcement, and I gently say to people who criticise the means of raising it that without the decisions that the Chancellor took in the Budget, we would not be able to invest £26 billion in our health and care services. We cannot have people welcoming the investment but criticising the means of raising it. If people do not support the Chancellor’s decision—a perfectly reasonable political position to take—they will have to spell out what services they would cut or what taxes they would raise.

I would be very happy to write to my hon. Friend to set out the support provided by NHS England to health and care services for his community, and I would be delighted to receive via him feedback from his health and care providers about what Government support they would like next winter and in future years.

I will take that as another representation from the hon. Gentleman on the new hospital programme, and I reassure him we will be setting out our review and its conclusions shortly.

I am delighted to hear of the work Ros is doing as mayor to support health and care services and to take health and care to where people are. I hate hearing that there are hard-to-reach communities; there are no hard-to-reach communities. There are underserved communities and, in our determination to tackle health inequalities, to get care closer to people’s homes and indeed in people’s homes, to do earlier diagnosis and to provide faster access to treatment, we need to make sure that we take health and care services to where people are rather than expecting people to always come to us.

I am really grateful to the hon. Member for raising that question and for the example she gave of the Whittington advertisement for staff specifically to deliver corridor care. I make no criticism of the trust itself in trying to make sure it has the right staff in place to deliver the best care possible in the present circumstances. It is not the fault of the Whittington that there is corridor care; it is a legacy of 14 years of Conservative failure. I would also say that my reaction to seeing that advertisement was the same as hers: it was proof that corridor care has been normalised. I want to reassure her, the House and patients across the country that this Government will not accept corridor care as normal care. We will not tolerate it as being acceptable care. We will do everything we can as fast as we can to consign corridor care to the history books and I reassure the staff working in the NHS in these intolerable conditions that we will work with them to deliver the investment and the reform needed to get the NHS back on its feet and make it fit for the future.

I thank staff on the Isle of Wight for everything they are doing to support communities across the island against a challenging backdrop. Since my hon. Friend arrived in the House he has been an extremely strong, loud and effective voice for the people of his constituency and across the Isle of Wight, and I look forward to working with him and health and care leaders on the Isle of Wight to make sure that they see their health and care services improving as a result of their decision to send a Labour Member of Parliament and a Labour Government here to serve our NHS and his communities.