PARLIAMENTARY DEBATE
NHS Winter Pressures - 9 January 2023 (Commons/Commons Chamber)

Mr Speaker, I wish to take this first opportunity to update the House on the severe pressures faced by the NHS since the House last met. I and the Government regret that the experience for some patients and staff in emergency care has not been acceptable in recent weeks. I am sure that the whole House will join me in thanking staff in the NHS and social care who have worked tirelessly throughout this intense period, including clinicians in this House who have worked on wards over Christmas. They include my hon. Friend the Member for Lewes (Maria Caulfield), the Minister for mental health, and the hon. Member for Tooting (Dr Allin-Khan), the shadow Minister for mental health.

There is no question but that it has been an extraordinarily difficult time for everyone in health and care. Flu has made this winter particularly tough: first, because we are facing the worst flu season for 10 years—the number of people in hospital with flu this time last year was 50; this year, it is over 5,100. Secondly, it came early and quickly, increasing sevenfold between November and December. It also came when GPs and primary and community care were at their most constrained. When flu affects the population, it affects the workforce too, leading to staff sickness absence that constrains supply just as it also increases demand.

These flu pressures came on top of covid. Over 9,000 people are in hospitals with covid, while exceptional levels of scarlet fever activity and an increase in strep A have created further pressure on A&E. All that comes on top of a historically high starting point. We did not have a quiet summer, with significant levels of covid, and delayed discharges were more than double what they were during the pandemic. I put that in context for the House: in June 2020, there were just 6,000 cases per day of delayed discharge—patients medically fit and ready to leave hospital—whereas throughout last year the figure was between 12,000 and 13,000 per day. The scale, speed and timing of our flu season have combined with ongoing high levels of covid admissions in hospital and the pandemic legacy of high delayed discharge to put real strain on frontline services.

Since the NHS began preparing for this winter, there was a recognition that this year had the potential to be the hardest ever. That is why there was a specific focus on vaccination. There were 9 million flu shots and 17 million autumn covid boosters. We extended eligibility more widely than in the past, to cover the over-50s, and became the first place in the world to have the bivalent covid vaccine, which tackles both the omicron and the original covid strain.

NHS England also put in place plans for the equivalent of 7,000 additional beds, including the introduction of virtual wards of a sort that one can see at Watford General Hospital. That innovation is still at an early stage of development, but has the potential to be significant in reducing pressure on bed occupancy in hospitals; in Watford alone, it has saved the equivalent of an extra hospital ward of patients. In addition, our plan for patients put £500 million specifically into delayed discharge, with a further £600 million next year and £1 billion the year after. Although the funds are already starting to make a difference, efforts have taken time to ramp up operationally with local authorities and the local NHS.

In addition, our 42 integrated care boards, recognising how bed occupancy in hospitals and social care are connected, will fully integrate health and care in the years to come. But likewise, they are at an early stage of maturity, with ICBs having become fully operationalised only in July 2022, less than six months ago.

Our plans involving the integration of hospital care and social care, additional funding for discharge, increased step-down capacity, the equivalent of 7,000 additional hospital beds and a vaccination programme at scale have provided the groundwork for the Government response, but it is clear we need to do more right now in light of the level of flu and covid rates and given that hospital occupancy remains far too high and emergency departments are too congested. Recognising that, we launched the elective recovery taskforce on 7 December, and in the coming weeks, we will publish our urgent and emergency care recovery plans. NHS England and the Department of Health and Social Care have been working intensively over Christmas on these plans, which were reviewed with health and care leaders at an NHS recovery forum in Downing Street on Saturday.

The recovery falls into three main areas of work: first, steps to support the system now, given the immediate pressures we face this winter; secondly, steps to support a whole-of-system response this year to give better resilience during the summer and autumn—as we have seen with the heatwave this summer and with the levels of covid, pressure is now sustained throughout the year, not just, as in the past, during autumn and winter; and, thirdly, our work alongside those two areas on prevention, on maximising the step change potential of proven technologies, such as virtual wards, and on the wider adoption of innovations such as operational control centres and machine reading software to treat more conditions in the community, away from someone reaching an emergency department in the first place.

Let me first set out the measures I can announce today to provide support to the NHS and local authorities now. First, we will block-book beds in residential homes to enable some 2,500 people to be released from hospitals when they are medically fit to be discharged. When that is combined with the ramping up of the £500 million discharge funding, which will unblock an estimated 1,000 to 2,000 delayed discharge cases, capacity on wards will be freed up, which will in turn enable patients admitted by emergency departments to move to wards, which in turn unblocks ambulance delays. It is important, however, that we learn from the deployment of a similar approach during the pandemic by ensuring that the right wraparound care is provided for patients released to residential care. I have asked NHS England to particularly focus on that, so that it is the shortest possible stay on patients’ journey home and into domiciliary care, and indeed it is in the NHS’s own interests for those stays to be as short as possible. Taken together, this is a £200 million investment over the next three months.

Next, our A&Es are also under particular strain. From my visits across the country I have seen and heard how they often need more space to enable same-day emergency care and short stays post emergency care. Our second investment is in more physical capacity in and around emergency departments. By using modular units, this capacity will be available in weeks, not months, and our £50 million investment will focus on modular support this year. We will apply funding from next year’s allocation to significantly expand the programme ahead of the summer. We are giving trusts discretion on how best to use these units to decompress their emergency departments. It might be for spaces for short stays post A&E care, where there is no need for a patient to go to a ward for further observation, or for discharge lounges that previously have not been able to take a patients in a bed—many of those are often simply chairs—or for additional capacity alongside the emergency department at the front end of the hospital.

The third action we are taking to support the system right now is to free up frontline staff from being diverted by Care Quality Commission inspections over the coming weeks, and the CQC has agreed to reduce inspections and to focus on high-risk providers in other settings, such as mental health. Those are the actions we are taking that will have an immediate effect.

I turn to the measures we are taking now that will give greater resilience into the summer and next winter. We now have 42 NHS system control centres in operation across England, staffed 24 hours a day, seven days a week, tracking patients on their journey through hospitals, helping us to identify blockages earlier and getting flow through the system. Where we have implemented these systems, such as the one I saw in operation in Maidstone, they have had a clear impact. We will therefore allocate funding in next year’s settlement to apply these systems more widely.

Similarly, we have also seen how the use of artificial intelligence and data can demonstrably reduce demand and release patients sooner. NHS England has been tasked with clarifying and simplifying the procurement landscape, taking on board best international practice, so that a small number of scalable interventions are taken forward where international experience shows they can deliver meaningful benefits to patients.

Next, we will capitalise on the incredible potential of virtual wards. Last week at Watford General Hospital, I saw how patients who would have been in hospital beds were treated at home through a combination of technology and wraparound care. Patients released sooner are often much happier, knowing that they are receiving clinical supervision and always have the safety net of being able to quickly return to hospital should their condition deteriorate. There is scope to expand these measures to many more conditions and many more hospitals in the months ahead.

We are also opening up more routes for NHS patients to get free treatment in the independent sector and offering even greater patient choice. The elective recovery taskforce is helping us to find spare operating theatres, hospital beds and out-patient capacity.

We must also take steps in primary care. We are clear that our community pharmacists can support many more things to ease pressure on general practice. From the end of March, community pharmacists will take referrals from urgent and emergency care settings; later this year, they will also start offering oral contraception services. But I want to do even more, as they do in Scotland, and work with community pharmacists to tackle barriers to offering more services, including how to better use digital services. The primary care recovery plan will set out a range of additional services that pharmacists can deliver.

Finally, notwithstanding very severe pressures, we know that to break the cycle of the NHS repeatedly coming under severe pressure, the best way to reduce the numbers coming through our front doors is to address problems away from the emergency department. On Friday, we signed a memorandum of understanding with BioNTech —a global leader in mRNA technology—to bring vaccine research to this country, which will give as many as 10,000 UK patients early access to trials for personalised cancer therapies by 2030. This builds on the 10-year partnership we struck with Moderna in December to also invest in mRNA research and development in the UK and build state-of-the-art vaccine manufacturing here.

We are also reviewing our wider care for frail, elderly patients in care homes long before they ever get to A&E or our hospitals. Take the brilliant work being done in Tees valley, where community teams are being used to help with falls to prevent unnecessary ambulance trips to hospitals. We have looked at what more support we can offer elderly patients further upstream. With an ageing population, and many more people with more than one condition, it is clear that we have to treat patients earlier in the community and go beyond individual specialties to better reflect patients with multiple conditions to give the right support to people where they are, which is often at home or in residential homes.

Today’s announcement provides a further £250 million of funding, which recognises the spike in flu on top of covid admissions and high delayed discharge numbers from the pandemic. The funding will provide immediate support to reduce hospital bed occupancy and decompress A&E pressures, and, in turn, unlock much-needed ambulance handovers. This funding builds on the £500 million announced in the autumn statement specifically for discharge, which is ramping up, and the additional funding for next year.

All this work ultimately builds on the much-needed greater integration of health and social care through the 42 integrated care boards, which we will strengthen through the Hewitt review, and through a step change in capability, including operational control centres.

This immediate and near-term action sits in parallel with our wider life science investment, such as the deals with BioNTech and Moderna, and underscores our commitment to recognising the immediate pressures on the NHS and investing in the science that will shift the dial on earlier, upstream treatment at scale, particularly for the frail elderly, long before a patient reaches an emergency department. This is a comprehensive package of measures, and I commend this statement to the House.

I call the shadow Secretary of State.

Happy new year to you, Mr Speaker, and to the rest of the House. I thank the Secretary of State for Health and Social Care for advance sight of his statement.

This winter has seen patients waiting hours on end for an ambulance, A&E departments overflowing with patients, and dedicated NHS staff driven to industrial action—in the case of nurses, for the first time in their history—because the Government have failed to listen and to lead. I notice that the Secretary of State did not talk about the abysmal failure of his talks with nurses and paramedic representatives today. Let me say to him: every cancelled operation and delayed appointment, and the ambulance disruption due to strikes, could have been avoided if he had just agreed to talk to NHS staff about pay. Today, he could have opened serious talks to avert further strikes. Instead, he offered nurses and paramedics 45 minutes of lip service. If patients suffer further strike action, they will know exactly who to blame.

Of course, the Prime Minister has already shown that he is not interested in solving problems; he resorts to the smokescreen of parliamentary game playing by bringing in legislation to sack NHS staff for going on strike. I ask the Secretary of State, in his sacking NHS staff Bill, how many nurses is he planning to sack? How many paramedics will he sack? How many junior doctors will he sack? The Government have the audacity to ask NHS staff for minimum service levels, but when will we see minimum service levels from Government Ministers and the entire Government?

After arriving at the Derriford Hospital in Plymouth, an 83-year-old dementia patient waited in the back of an ambulance outside A&E for 26 hours before being admitted. That was on 23 December, when no strikes were taking place; the Secretary of State should listen. The patient’s family found him in urine-soaked sheets, and since arriving in hospital, he has contracted flu. His daughter said of the hospital staff:

“They’re polite, they’re caring, and they are trying their best. It’s just impossible for them to do the work they want to do.”

Let me say what the Health Secretary and Prime Minister refuse to admit: the NHS is in crisis—the biggest crisis in its history. That is clear to the staff who have been slogging their guts out over Christmas and to everyone who uses it as a patient; the only people who cannot see it are the Government.

What has been announced today is yet another sticking plaster when the NHS needs fundamental reform. The front door to the NHS is blocked, the exit door is blocked, and there are simply not enough staff. Where is the Conservatives’ plan to fix primary care, so that patients can see the GP they want in the manner they choose? After 13 years of Conservative government, they do not have one. Where is the plan to recruit the care workers needed to care for patients once they have been discharged from hospitals, and to pay them fairly so that we do not lose them to other employers? After 13 years of Conservative government, they do not have one. Where is the plan to train the doctors, nurses and health professionals the NHS needs? After 13 years of Conservative government, they do not have one.

Well, we do. The Secretary of State is welcome to nick Labour’s plan to abolish non-dom tax status and train 7,500 more doctors and 10,000 more nurses and midwives every year; to double the number of district nurses; and to provide 5,000 more health visitors—a plan so good that the Chancellor admitted that the Conservative Government should nick it. After 13 years of mismanagement, underfunding and costly top-down reorganisations, however, all the Conservatives have to offer the NHS is a meeting and a photo op in Downing Street.

The collapse of the health service this winter could be seen coming a mile away—health and social care leaders were warning about it last summer—so why is the Secretary of State announcing these measures in the middle of January? Why have care homes and local authorities been made to wait until this month for the delayed discharge fund to reach them? It is simply too little, too late for many patients.

In fact, this Government are so last minute that, after announcing this plan last night, they found an extra £50 million and sent out another press release. I know most of us are happy to find a spare fiver lying around the house that we did not know was there, but this Prime Minister seems to have 50 million quid stuck down the back of the sofa. What on earth is going on? No wonder they cannot get money to the frontline: the left hand does not know what the right hand is doing.

It is intolerable that patients who are fit and ready to leave hospital are then stuck there for months because the care they need is not available in the community. They are not bed blockers, and they are not an inconvenience to be dropped off at a hotel and forgotten about. They need rehabilitation at home, rather than a bed in a care facility. Vulnerable patients deserve proper support suited to their needs, or they will fall ill again and go back to hospital. What about all these beds the NHS is procuring, and what about the capacity that families need? I will tell hon. Members what will happen: they will not get the care, and they will be coming right back through the front door of A&E, with the cycle of broken systems repeating itself again and again. Where is the choice and control for patients and their families who may not want to be discharged to a hotel?

I am afraid that, after 13 years, this just is not good enough. The Prime Minister might not rely on the NHS, but millions of ordinary people do. They are sick and they are tired of waiting. There have been 13 years of Conservative Government now—13 years—and look at what they have done to the NHS. Did the Health Secretary listen to himself as he described the situation in hospitals of people waiting on chairs for discharge, the trolleys in the corridors and people waiting longer than ever? Whose fault is it? It is not that of the NHS staff he is threatening to sack, but of the Conservative Ministers who have made disaster after disaster. After 13 years of Conservative Government it is clear that the longer they are in power, the longer patients will wait. Only Labour can give the NHS the fresh start and fresh ideas it needs.

The hon. Member talks about a fresh start, but even his own shadow Cabinet colleagues do not seem to agree with his plans. His own deputy leader seemed to distance herself from his plans to use the private sector, and his own shadow Chancellor seems to have distanced herself from his plans for GPs. Perhaps he can share with the House exactly how much his unfunded plans for GPs will cost, because the chief executive of the Nuffield Trust has said:

“It will cost a fortune”,

and is

“based on an out of date view”.

The point is that he has no plans that his deputy and his own colleagues support, and he has not set out how he would fund those plans in a way that does not divert resource from other parts of the NHS.

The hon. Member talked about pressure, yet there was no mention of the fact that the NHS in Wales, the NHS in Scotland and, indeed, health systems across the globe have faced significant pressure as a result of the combination of covid spikes and flu spikes, particularly in recent weeks. This is not a phenomenon limited to England and the NHS; this is a pressure that has been reflected internationally, including for the NHS in Wales.

The hon. Member refers to talks with the trade unions, and it is right that we are engaging with the trade unions. I was pleased to meet the staff council of the NHS today. Indeed, the chair of the NHS staff council, Sara Gorton, said the discussions had made “progress”, notwithstanding one trade union leader who was not in the talks giving an interview outside the Department to comment on what had and had not been said in those talks. We want to work constructively with the trade unions on that.

The hon. Member says that we are only announcing measures today, but again, he seems to have written those comments before he got a copy of the statement. The integrated care boards took operational effect in July last year—[Interruption.] Because they are scaling up, we are putting control centres in place and we are integrating health and social care. In the autumn statement, we announced £500 million for discharge, a further £600 million next year and £1 billion the year after, recognising that there is significant pressure, and that is ramping up. NHS England set out its operational plans in the summer, including the 100-day discharge sprint. That, for example, set out the greater use of virtual wards, which is new technology being rolled out at scale. It also announced the extra 7,000 community beds. Indeed, we also set out the additional measures in our plan for patients.

What is clear when we have a sevenfold increase in flu in a month—50 cases admitted last year compared with 5,100 this year—is that there is a combination of a surge in demand on top of the existing high-level position, and the surge in demand corresponds with a constraint on supply as staff absences also increase because of flu, so during the Christmas period community services are more constrained. Those two things together have created significant pressure on our emergency departments. That is why in the engagement I have had with health leaders the two key messages they gave to me were the importance of getting flow into hospitals, which is constrained by the high bed occupancy—that is why getting people out of hospital is so central to relieving pressure—and, within the emergency departments specifically, the need to decompress those services with same-day emergency treatment and having short stay post-emergency departments. That is a better way to decompress those emergency departments—through the triaging and bringing other clinical specialties closer to the front door. We have listened to the NHS frontline and those were the two key requests made to me, alongside other issues such as care quality inspections and how to make them more flexible. However, alongside those immediate pressures, we need to recognise that we had pressures last summer during the heatwave and we had pressures in the autumn, which is why we have announced a wider set of measures today.

So we have listened and we have acted; we have taken measures to deal with the immediate pressure, but we have also set out how we will build further capacity that will go through into the autumn. Alongside that, we have signed deals, for example with Moderna and BioNTech, and we are bringing forward the life science investment so that that has a better impact on pressures on the frontline.

I call the Chair of the Select Committee.

There is no doubt that, in some places more than others, patient flow in acute hospitals is the issue gumming up the system, and the Secretary of State is right to say that demand far outstrips supply, in part because of the very high flu numbers. Today’s injection of funding is very welcome as is the additional surge capacity the Secretary of State spoke about in his statement. His mention of prevention is especially welcomed by me; let us do so much more on this. Another £250 million is a lot of the public’s money. What real-time oversight does he have to ensure that NHS England spends it wisely, and may I make a plea that domiciliary care is not overlooked, because the lack of care in people’s homes is every bit as much the enemy of patient flow as the lack of care home places that he has identified today?

My hon. Friend raises an important issue about getting flow into the system, not least because delays in ambulance handovers lead to the highest risk in what is a whole-of-system issue where the patient is not seen and treatment is delayed. That is why flow through discharge is so important, because, while that often concerns the back door of the hospital, it is actually the pressure at the front door that is most acute. The Government recognised that in the autumn statement and that is why there was additional funding with the £500 million for delayed discharge. That has taken some time to ramp up, but we recognise that because of the flu there is an immediacy in the pressure on A&E that we need to address.

My hon. Friend’s point speaks to one of the key lessons from the covid period. It is not simply about releasing patients from hospitals who are fit to discharge; it is also about the wraparound services provided for those patients so that they do not get stuck in residential care for longer, and they are still able to go home and get the domiciliary care packages. NHS England is focused on that so that they have the wraparound services alongside that discharge.

We have seen this year in, year out: money thrown into the NHS at a winter crisis point, too late to spend it sensibly, yet this Government have been in power for nearly 13 years. I could not identify anything new in the Secretary of State’s speech. We have talked about discharge before, and picking up on the point made by the Select Committee Chair the hon. Member for Winchester (Steve Brine), without proper funding for local councils for domiciliary care and for funding care homes, this will never work.

In terms of what is different, there is the block booking that will enable residential care to put the workforce in place and release the delayed discharge of the 13,000 patients who are in hospital but medically fit to be discharged. The accelerated release of those patients will help those at the front door, where the spike in flu is so acute. That is what we are doing; we are responding to what health leaders have said is the key intervention we can take. Of course, that is not being done in isolation. The point is that that is coming on top of the £500 million announced during the autumn statement and is to provide further capacity, recognising the significant pressure that the system is under.

My right hon. Friend is absolutely right to highlight the fact that this is not purely an English issue but one affecting whole systems across the western world. I welcome many aspects of what he said, and I am grateful to staff at Epsom Hospital and those in the ambulance service in my constituency. So much of the time of those paramedics is spent taking frail elderly people from care homes to A&E where, frankly, they probably should not be. What steps can he take to divert some of those frail and elderly people from A&E to take some of the pressure off and get them to an environment where they will be much better looked after?

My right hon. Friend is absolutely right. That is where virtual wards have potential significant benefits in both demand management—avoiding elderly, frail patients coming to emergency departments in the first place—and releasing capacity in hospitals. The virtual ward at Watford General Hospital, equivalent to an additional ward of the hospital, is able to release patients with the comfort of knowing that they are still under supervision. Their medical information is being tracked and monitored and they get a daily phone call from a nurse. They also know that, if they need to come back to the hospital, they can do so much more quickly. That gives patients the comfort and confidence to recover at home, which is often where they want to be. Indeed, patient satisfaction from that trial at Watford was over 90%.

Given that there are currently 165,000 vacancies in social care—a 51% increase in just a year—where will the Secretary of State magic up the people to look after those he wants to put in hotels?

The whole purpose of the £500 million is to put more support into local authorities’ funding for social care. About a quarter of that funding is going specifically on workforce interventions, but we are also using other measures. One of the other things we have been doing is boosting workforce recruitment through international recruitment, with care sector staff on the shortage occupation list.

I welcome the Secretary of State’s statement and in particular the additional money for discharge. Does he agree that, in regard to integrated care systems, we really need to accelerate the integration between health and social care? Notwithstanding what he said about maturity, that is the key to the future integration of health and social care, and that will solve many of the problems that we face at the moment.

My hon. Friend is right. That is why, in the run-up to Christmas, one of the ministerial priorities was to have a whole series of ministerial meetings with the chairs and chief executives of the integrated care boards, because, as the Government have recognised, it is through the integration of those 42 ICBs that we will bring health and social care together. The ICBs have been operationally in place since July and are ramping up at pace. One thing that is making a real difference to them is having control centres that allow patient flow to be tracked through the system—Maidstone is a good example—with the data allowing blockages, as a whole-of-system problem, to be gripped at a much earlier stage.

Staff retention in both the health sector and the social care sector is at the heart of this crisis, but staff cannot be retained if they are not paid and, if they are not paid this year, the issues will not be addressed. Will the Secretary of State recognise that when he set the remit for the pay review body, inflation was not where it is and we did not have a war in Ukraine, so factors have changed and the remit for pay must therefore change this year so that we can retain the staff to deliver what he proposes?

On delayed discharge, the key is having domiciliary care support. That is not about the NHS Agenda for Change contract; it is about funding for those in the social care sector. Around a quarter of delayed discharges are due to delays in what is known as pathway 1, the domiciliary care side. That is what the £500 million in particular recognised. We are putting in more money, but that is about the social care sector so we can get flow through delayed discharge.

The Secretary of State speaks about getting more people treated in the community, and I think we all support that. He will know that in my constituency we have a higher than national average patient-to-GP ratio. It is a major problem for us and has been for a long time. We are short of diagnostic facilities and Essex County Council needs more resources to deal with adult social care for the very reasons he has spoken about. Will he please write to me—he will not be able to do it from the Dispatch Box today—with specific details of when, on all three of those areas, the money he has announced today will come to the frontline in Essex? Our doctors and nurses need the money and resources to do what they joined the profession for: to provide the care they really believe in to members of the public.

First, I am very happy to write to my right hon. Friend with further details. For the benefit of the House, in relation to the £500 million announced in the autumn statement, local authorities gave the Department and NHS England their data returns on Friday. We will have that data, which I will be able to share more specifically in relation to the £500 million. The £250 million for NHS England announced today is for very urgent delivery into systems and that will be going out extremely quickly.

NHS leaders have today told the Health Services Journal that the Government have just seven to 10 days to get the additional funding to discharge hospital patients to the frontline for it to make any difference whatever. The NHS Confederation has said that the next three months in the NHS will likely be defined by critical incidents being declared. Will the Secretary of State promise that the extra funding will reach the frontline in the next seven to 10 days? Will he please finally declare a national critical incident, so that we can mobilise every single bit of our NHS to save lives and save the NHS?

The very purpose of today’s announcement—I have made it on the first day that Parliament is back—is to give that urgent uplift in funding to local authorities and ICBs so that they can act now, knowing that that funding is available. They have the additional £500 million, which is ramping up as well. That is part of a wider package of measures—NHS England putting in community support with 7,000 more beds—but the purpose is to recognise the very real immediate pressure the frontline has been under. It also needs to be viewed as something that other healthcare systems across the globe have faced: a very sudden and very significant spike in flu seven times higher than last month and 100 times what it was last year.

First, integrating health and social care through the integrated care boards. That is what we put in place from July, recognising that actually the pressures on the NHS are often as much about pressure on social care as they are about pressures in the NHS itself. In particular, if we look at ambulances, we see that often it is the delay in domiciliary care that is driving the blockage on the wards, which in turn applies there. Secondly, it is recognising that there are workforce pressures, which is why NHS England has been working on the workforce plan that has been set up.

Thirdly, we have already set out our elective recovery plan. Over the summer, the longest waits—those of over two years—were largely cleared. [Interruption.] Opposition Front Benchers chunter, “How’s it going?” Let us look at how it is going, compared with the Labour Government’s two-year clearance in Wales. Before Christmas, there were about 60,000 people in Wales who had been waiting for more than two years; in England there were fewer than 2,000. We are making progress on the longest waits through the work of Jim Mackey, Professor Tim Briggs and Getting It Right First Time. We are innovating with the surgical hubs and the community diagnostic centres. That, in turn, gives greater resilience to the electives that used to be cancelled when there was winter pressure. With hot and cold sites, they are much more resilient.

Finally, I must take issue with what my right hon. Friend says. In France, Germany, Canada and many other countries, the massive spike in flu and covid pressure, combined with pressures from the pandemic, has placed similar strains on healthcare systems. It is simply not the case that the issue affects England alone.

I am really not clear how, despite all the warnings, the Government have got themselves into this position after the biggest crisis in the NHS. We all know that it is a no-brainer to invest in social care to reduce bed blocking, so what exactly is the purpose of the pilot that has been announced for Hull and the Humber? It will tell us what we already know: that what we need is investment in social care and reform of social care.

We recognised very early—in fact, NHS England recognised it in the summer—that this winter was likely to be extremely hard, both because population resilience to flu would be lower as a consequence of the pandemic and because of the combination of pandemic backlogs with the ongoing level of covid admissions. As I have said, we have more than 9,000 patients in hospital with covid and a further 5,000 with flu; that comes on top of the other strains from the pandemic that we have seen. The measures taken, such as boosting the vaccination programme, extending it to the over-50s and being the first place to have the bivalent vaccine, were part of the package in NHS England’s operational plan.

We also recognised—this point goes to the heart of the right hon. Lady’s question—that social care is central. That is why, notwithstanding the other economic pressures that the Government faced, health and education were prioritised in the autumn statement, with an extra £6.6 billion in funding for the NHS over the next two years and an extra £7.5 billion in funding for social care. That was recognised with a clear prioritisation in the autumn statement. The reality is that we have had a massive spike in flu cases, meaning that there have been 100 times as many hospital admissions for flu as there were last year.

I welcome the measures that my right hon. Friend has set out for us today; it is absolutely right that we consider a wide suite of measures. With that in mind, may I draw his attention to my region? We have, I think, the second biggest ICB area by geography, but without the population to match. Will he consider giving us an additional community diagnostic hub? For everyone in the area to have access, we need two, not one. Will he look at that, please?

My hon. Friend is absolutely right to highlight the importance of diagnostic centres, which we have particularly prioritised. As she knows, I am extremely keen to accelerate the programme so that where we award community diagnostic centres, they open in 2023. In my view, too many plans were for 2024, so that is a particular challenge that I have been posing. My hon. Friend has campaigned strongly on behalf of her constituents; I know that the Minister of State, my hon. Friend the Member for Colchester (Will Quince), is looking at the proposal that she has shared and will be happy to discuss it with her in the days ahead.

Hospitals used by my constituents in Liverpool and Knowsley have had queues at A&E of 33 hours, 41 hours and 30-plus hours. They have had dozens of ambulances queuing up outside for entire shifts, unable to transfer even one patient. These problems were predictable and—as the Secretary of State has just said—predicted, yet he disappeared over Christmas and the new year when they were going on, only emerging last week to blame them on flu and covid. When will he acknowledge that leaving it until January to deal with winter pressures is too little, too late? When will he take responsibility and apologise for the lamentable situation in which he has left my constituents and many others across this country? The fear, the pain, the worry—when will he say sorry for it?

That simply is not accurate. Let me give the hon. Lady some specific examples. Under the auxiliary contract with St John Ambulance, we invested an extra £150 million in the ambulance service, and we invested a further £50 million in additional capacity for call centres. Taxpayers spent £800 million on the new Royal Liverpool Hospital, and during 2018-19 a brand-new hospital was built at Aintree. However, this is not simply about investing in new hospitals; it is also about looking at the integration between health and care, and that was recognised in the autumn statement, which provided an additional £500 million. It is simply inaccurate to say that there were no measures in the summer. The St John Ambulance contract and the community first responders, and the service for frail and elderly people, will help with demand management and prevent people from going to emergency departments in the first place.

Do the Government recognise the danger of a major increase in pressure on the NHS as a result of any new variant of covid that may be imported from China? How quickly would we be able to identify such a variant and prepare a vaccine against it?

Let me first congratulate my right hon. Friend—along with the whole House, I am sure—on the knighthood that he received from His Majesty.

According to the analysis we have received, the variant in China is the same as the one in the United Kingdom. On the other hand, the data shared by China is often not as clear as we would like. That is why, over the Christmas period, my right hon. Friends the Prime Minister and the Secretary of State for Transport announced proportionate measures involving covid tests for travellers and, in particular, sequence variant testing for those coming into the UK, in order to identify any new variant quickly.

Strikes by nurses and ambulance workers are a last resort for overworked staff, who fear that patient safety is suffering as a result of increased demand and staff shortages. Instead of providing proper pay increases, the Labour Welsh Government have responded by offering Welsh health service staff tokenistic one-off payments, and, reportedly, the right hon. Gentleman’s Government are considering doing the same in England. Can he guarantee that if that approach is taken, one-off payments will be recognised as support with the cost of living crisis rather than proper pay increases, and will be treated as such for tax and benefit purposes?

As we have said previously, we have a process, through the independent pay review body, to look at these issues in the round and, when it comes to the needs of our NHS—my focus, obviously, is on the NHS in England; it is for the Welsh Government to conduct negotiation in Wales—to balance what constitutes the right level of funding for retention and recruitment against the wider issues of affordability for the economy as a whole. However, we are keen to engage with the trade unions, and we had a good discussion with them today. I am pleased that they recognised the progress made in that discussion, and I look forward to further discussions with them.

In recent weeks I have seen a few of my constituents in tears because they have been with loved ones in A&E and seen elderly residents stuck on trolleys. No Member of Parliament wants to deal with that. I know that my right hon. Friend is working hard, and I welcome his announcements, but the public are watching more and more money going into the NHS, and I think we need to hear, very clearly, his assessment of when the further money that has now been announced will lead to meaningful change in Gloucestershire’s A&E departments and elsewhere.

That is a fair challenge. Let me divide it into three sections. First, there is a recognition that the combination of the legacy from the pandemic, the ongoing covid issues and, in particular, the massive spike in flu create an immediate pressure in our A&E departments. The package announced today shows that we have listened to those on the frontline, and have responded.

Secondly, there is a recognition—this is relevant to some of the questions asked today—that the system has been under pressure for some time. Therefore, the second phase looks at innovation, technology, artificial intelligence, virtual wards and ways of doing things differently. To take the example of the frail and elderly, that will address their needs upstream in the care home before they get to the emergency department or release them from hospital quicker, provided they have the safety net of being part of a virtual ward, where they are subject to ongoing clinical supervision. If they need to come back to hospital, they can do so much more easily than would otherwise be the case. That stops the boomerang of patients being released early and then coming back. That second phase includes the modular capacity, because space is needed to streamline and to triage. That compression within the emergency department also drives inefficiency and poor care.

Thirdly, the Government have invested in the life sciences industry. R&D investment of £15 billion to £20 billion is a big marker of that. One of the priorities is to say that we can do certain things at scale with companies such as Moderna that will shift the dial in healthcare. That is a third but significant part of this, particularly in respect of the prevention work that we can do.

The failure to fix social care is having an impact on not only the acute service but the mental health service. I have raised directly with the Secretary of State the problems facing the Humber NHS trust, where 42% of adult learning difficulty beds have been taken by patients with delayed discharge and where 17% of adult mental health beds and 22% of child and adolescent mental health beds have been taken by patients waiting for discharge. What investment and support will be given to provide the right social care and support services, to enable beds to be freed up not just in the acute service but in the desperately needed mental health services?

The hon. Lady is right to highlight mental health, which is an extremely important part of the wider health landscape. That is why the Government are increasing funding for mental health by £2.3 billion. We must also consider how we get better value for money from that spending. The reform of the Mental Health Act 1983 that the Minister for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), is taking forward will help us better target that funding in ways that deliver value for money.

I join the Secretary of State for Health and Social Care in paying tribute to those working in hospitals, such as the Gloucestershire Royal Hospital in my constituency, so intensely and under such heavy pressure. I welcome the changes that he has announced, but will he confirm what progress his Department has made with the Home Office to prioritise tier 2 health visas and to provide a grace period for international GP trainees? Lastly, will my right hon. Friend consider helping staff with parking and out-of-hours food this winter, which has been described by so many as a perfect storm?

As I said at the outset, today’s announcement is part of the wider recovery programme that we discussed with health leaders at No. 10 on Saturday. That will have a number of components, one of which is the urgent and emergency care recovery. Work is ongoing with Home Office colleagues on the visa component. My hon. Friend raises an extremely important point that a number of clinicians on the frontline have raised with me, and I am discussing it with my right hon. and learned Friend the Home Secretary.

More than 5,000 operations have been cancelled at Barnsley Hospital in the last year. What are the Government doing to reassure those in Barnsley who are waiting in pain for delayed operations? Will they ensure that any new staff are deployed first to the areas that need them most?

I share the hon. Lady’s desire to reduce the backlog in the electives programme, which is why the Government have invested a further £8 billion. To ensure that it delivers value for money, the key focus is on building greater resilience into that elective programme through surgical hubs and the better use of community diagnostic centres, in particular by having a distinction between hot and cold sites.

Too often in the past, as winter pressures have surged, elective operations have been cancelled to free up bed capacity. Having the surgical hubs and the hot and cold sites builds greater resilience. I pay tribute to the work of the Getting It Right First Time team, and to Professor Tim Briggs and Jim Mackey, who are leading that programme. We saw the progress that was made in the summer and we are very focused on the next stage, which is 78-week waits. We are working very actively on that.

Maple ward at Holme Valley Memorial Hospital used to provide much-needed community intermediate care for those leaving Huddersfield Royal Infirmary. Unfortunately, it closed temporarily around six years ago. Does the Secretary of State agree that this is exactly the kind of facility that we now need in the community, not only to give great intermediate care but to free up capacity in our main hospitals?

My hon. Friend makes an important point. Often the debate is about beds, but in reality it is as much the workforce that go with those beds that we need to consider. The point about step-down care is that it has a lighter patient-staff ratio compared with what is necessary for more serious patients at the acute stage. It is important that we look at the end-to-end capacity, and that includes step-down care. That is why NHS England set out 7,000 additional beds in its summer plans. We are also doing things differently using technology. Virtual wards allow some patients to be at home, which many patients prefer, but with wraparound clinical support. Virtual wards and step-down care in the community are part of that wider landscape.

Iqbal fell seriously ill on Christmas eve. His family rang for an ambulance, calling 999 three times and pleading for help. They waited for three hours, but by the time an ambulance arrived, it was too late. Paramedics tried desperately to save his life, but the 58-year-old father tragically passed away. His daughter Minnie was clear about who was to blame, saying that it was not NHS staff but Tory Governments who have left the NHS in what she called a “disastrous state”. Will the Health Secretary heed Minnie’s words and undo 13 years of running down our NHS by giving NHS workers a proper pay rise, ending all forms of privatisation and giving the NHS the funding it desperately needs?

As I said in my opening remarks, I regret the fact that some patients in emergency care did not receive acceptable care in recent weeks, but I gently remind the hon. Lady that the pressure, particularly around flu and covid rates, is something that has put huge pressure on the NHS in Wales and Scotland, as well as across Europe and across the globe.

I thank my right hon. Friend for his statement and I welcome North Yorkshire’s involvement in the trials he has announced today. He has highlighted the increased bed occupancy that has come from the flu surge. NHS North Yorkshire briefed me earlier that flu vaccination take-up in North Yorkshire was 64%. That means that one in three people is not vaccinated. Does my right hon. Friend agree that putting more focus on encouraging vaccination take-up is one way in which we can all help to alleviate this crisis and reduce demand in our hospitals?

I very much agree with my hon. Friend about encouraging greater vaccine take-up. I think we can agree across the House that that is to be encouraged, and I hope all Members will reinforce the UK Health Security Agency’s messages on the take-up of the vaccine. We have expanded the scope to include over-50s, and we have the world-leading bivalent vaccine that targets both omicron and the original strain of covid, but it is important that as many people as possible get their flu jab as well, and I encourage all Members to support that.

The NHS and social care are in unprecedented crisis, even if that is a word that the Secretary of State and the Prime Minister refuse to use. We know that resilience was stripped out of our NHS years before the covid pandemic, and I come back to the level of vacancies: there are 133,000 in our NHS and 165,000 in social care. Will the Minister admit that, as well as growing the workforce, we urgently need to keep the workforce that we have? If so, why are the Government not at least meeting the nurses halfway on pay, as the Royal College of Nursing has offered to do, and why, after 13 years of Tory Government, is the average care worker’s pay less than the pay at McDonald’s or Amazon?

It would have been welcome if, within that list, the hon. Lady had recognised the Government’s significant investment in Brighton’s new hospital. There are also more doctors and nurses in the NHS this year than there were last year.

The Chancellor announced the £500 million in his autumn statement partly in recognition of the pressure on the social care workforce, which is why the funding was prioritised, and Home Office colleagues have put social care workers on the shortage occupation list to enable us better to attract international talent.

My right hon. Friend made many sensible points in his statement, but he will forgive me for focusing on the local pressures in Worcestershire, which remain acute. Our two A&Es saw 14,000 attendances in December, up from 12,500 in December 2021 and 10,600 in December 2020. The hospital trust tells me that, on any given day in December, around 100 patients in hospital beds could have been cared for somewhere else.

Today, I read my right hon. Friend’s press release on extra funding for neighbouring Warwickshire. Will he ensure that a significant amount of this £200-million funding package reaches Worcestershire hospitals? There is an acute need to upgrade our A&Es, which I understand is due to happen this year.

As my hon. Friend knows, I signed off those A&E upgrade plans when I was Chief Secretary to the Treasury, but they have been delayed by contractual disputes on the ground. I share his desire to see them expedited. The Government made that investment, and we want to see a consequent improvement in operational performance.

My hon. Friend is right that today’s announcement will enable ICBs, including those in his area, to accelerate their discharge plans. Plans were already in place because of the funding in the autumn statement, but today’s announcement allows ICBs to go further and quicker in releasing patients, which will in turn take pressure off A&E departments.

It is one thing to talk about blocked beds but, as many Opposition Members have said, care is also about staff. How does the Secretary of State expect care homes to cope with this increased pressure when one in 10 social care posts remains empty and when staff feel overworked, underpaid and exhausted?

Last year, a report commissioned by the Department of Health and Social Care found that the rapid discharge of people from hospital to care homes during the first wave of the pandemic, without adequate covid testing, was “highly likely” to have caused some outbreaks. How will the Health Secretary avoid the fatal mistakes of the past by militating against the seeding of more infections in care homes and, as my hon. Friend the Member for Ilford North (Wes Streeting) said, the danger of unsuitable care leading to hospital readmissions?

The hon. Lady makes a good point about the risk of introducing infections into care homes, as happened in the past. It is worth the House reflecting on the fact that we are in a very different position from the start of the pandemic. First, we now have vaccines in place for care home residents and staff. Secondly, we now have antivirals. Thirdly, we now have huge knowledge about covid. From an infection point of view, the risk of releasing people into care homes is now in a very different place.

On the wider workforce, part of the reason for the £500 million announced in the autumn statement is to support measures for the workforce, but we are also looking to boost numbers through international recruitment.

I welcome what the Secretary of State says about community pharmacists, who have always wanted to do more. They can take a lot of the burden off GPs and, if access to GPs were improved, fewer people would turn up at A&E. It seems to be a win-win-win situation, so let’s do it.

I could not agree more. There is a huge opportunity for pharmacists to do more, and I have asked the Department and NHS England to explore that at pace. I expect to say more on that when I announce our recovery plan at the end of the month.

I think we can go even further because, alongside pharmacists, there is much more scope to work with employers. Staff absences due to cardiovascular conditions are a significant cost to employers, so it is in their interest to work with us on prevention measures.

Much more can also be done through home testing. One of the lessons from covid is that the public will test at home. In looking at the challenge of excess deaths, there is a significant opportunity to do more home testing, employer testing and work in the community, particularly through pharmacists.

When a constituent of mine fell seriously ill recently, his wife rang 999. It was a category 2 emergency that then escalated to category 1, but it still took the ambulance nearly two hours to arrive and, despite the paramedics’ heroic efforts, my constituent sadly died. There are now up to 500 avoidable deaths per week because of A&E delays, according to the Royal College of Emergency Medicine. Will the Government support the Ambulance Waiting Times (Local Reporting) Bill, introduced by my hon. Friend the Member for St Albans (Daisy Cooper), to identify hotspots with the largest waiting times and put support to where it is most needed?

I have seen a lot of speculation in the media about the excess mortality to which the hon. Lady refers. I have discussed the issue in detail with both the chief medical officer and the medical director for NHS England. The point to note is, first, that this is something that has happened internationally. It cannot be ascribed just to one issue, as is so often the case. Some of the excess mortality will be due directly to covid, albeit that that will be a diminishing proportion, and some of the non-covid excess mortality will also be driven by quite a wide combination of factors, so we have to be cautious when those sorts of numbers are bandied around.

I have recently had alarming reports from constituents who have had to wait for more than 20 hours for an ambulance, so will my right hon. Friend set out in further detail how the measures outlined today will also support ambulances to reach patients more quickly?

The measures announced today speak to the heart of that issue: by putting in more capacity to decompress emergency departments, we allow, in particular, more same-day emergency care, where patients can be rapidly assessed, diagnosed and treated without being admitted to a ward. By unblocking capacity on wards, we enable emergency departments to release patients, which in turn creates the capacity for ambulances to hand over patients. The delay in handovers from ambulances is caused where the emergency department is already at capacity and there is an understandable reluctance from clinicians for additional patients to come in. Freeing up capacity within the emergency department is therefore about the operation of same-day emergency care at the front door of the hospital as well as what is happening at the back door with delayed discharge.

The Secretary of State has said that the Government will now block-book residential homes for hospital discharges, but social care is in crisis and has been for many, many years. Care workers are leaving the profession in droves, because of low pay and poor conditions. To prevent care workers from leaving to work for supermarkets or Amazon, what will he do to recognise their incredibly highly skilled work and pay them what they deserve? Unless we retain existing staff, the international recruitment drive is meaningless.

We need to both maximise international recruitment and retain existing staff. That is why the Chancellor, in the autumn statement, with all the other competing pressures that he faced, prioritised putting £7.5 billion into social care over the next two years—the biggest ever increase, under any Government. Alongside the announcement of a further £6.6 billion investment in the NHS over the next two years, that was about recognising the centrality of social care in the wider pressures on the NHS.

Does the Secretary of State agree that many of those who will need to be admitted to hospital in the coming weeks will have reason to welcome the fact that this Government, unlike the Labour party, do not have a prejudice against making use of facilities from within the independent sector?

I agree; I think that it is important that we maximise capacity in the independent sector. That is what we are committed to doing, and I very much agree with my hon. Friend.

Over recent years, I have received sporadic correspondence from consultants based in my constituency complaining about the tax liabilities that they face as a result of their pension contributions, which force them to reduce their hours or to leave public health altogether. I understand that the Government are consulting on this issue and that this is probably a matter for the Treasury, but how close does the Secretary of State think we are to an innovative solution?

The hon. Gentleman mentions a matter that is raised with him. As he can imagine, it is also raised with me by many senior clinicians. He is right that it is a question for the Chancellor, because, as he knows, tax is a Treasury matter. I am happy to share that point though, as I know that it is under consideration by my right hon. Friend the Chancellor.

As the Secretary of State knows, there are serious pressures within the NHS in North Staffordshire. The chief executive of the Royal Stoke University Hospital said on Radio Stoke last week that the key issue to addressing these pressures is dealing with social care. Will my right hon. Friend assure me that the measures will deliver more social care places across North Staffordshire?

I am very happy to give that assurance to my hon. Friend, but it is important to see the measures in the context of the autumn statement and the announcements that were made earlier by the Government around integrating health and social care through the integrated care boards. That will not only provide additional funding, but improve significantly the data, which will address some of our interface challenges in relation to those patients who are medically fit to be discharged from hospital, so that we can better ensure that the different pathways—whether it be domiciliary care, intermediate care or residential care, pathways one, two and three—are operating in a better way.

During this winter period, my constituents took their two-year-old child with severe breathing difficulties to A&E. It soon became apparent that the child needed to be hospitalised, but no beds were made available. After some 34 hours spent in A&E, a bed was found. I am sure that hon. Members from across the House can imagine how scary and exhausting that experience was for the whole family. Does the Minister view this experience as acceptable, and is this the new norm that the public should now expect from our national health service under a Conservative Government?

I recognised the hon. Lady’s second point at the start of my statement. On the wider point around those specific very troubling cases, one purpose behind integrated care systems having control centres is to get much earlier sight of the issues and much clearer escalation, with the result that these issues will get more scrutiny than is currently the case.

In addition to the substantial increase in the number of cases of flu that my right hon. Friend mentioned, the intense cold snap shortly before Christmas put further unforeseeable pressure on hospitals. Stoke Mandeville Hospital in my own constituency saw four times as many broken hips as it normally would in that period, so I pay tribute to all the staff at Buckinghamshire Healthcare NHS Trust for treating those additional patients. I warmly welcome the Health and Social Care Secretary’s announcement on freeing up thousands of beds. Does he agree that putting a real, great focus on intermediate care and intermediate step-down beds is key, so it will be very important for integrated care boards, including the one covering Buckinghamshire, to put an intense concentration on that and on working constructively and effectively with the local authority and the local NHS trust?

I call Clive Efford—

My hon. Friend raises an extremely important point, which is the role of step-down care in freeing up capacity in hospital. I was keen to emphasise, in my opening remarks, the right wrap-around support and care for patients when they are discharged from hospital. Over the next few weeks, it will not simply be a question of discharging those patients; there needs to be the wrap-around care as well. He is also right to point to the fact that there have been significant increases in demand—the fourfold increase that he highlights—which, combined with flu, covid and the pandemic legacy, resulted in very significant pressures. That demand pressure combined with an impact on supply—for example, from flu—also exacerbated staff absences during the Christmas period.

My apologies to the Secretary of State. I now call Clive Efford.

Thank you, Mr Deputy Speaker; I was as enthusiastic to make a contribution as you were for me to make it. What contingency did the Secretary of State put in place for a spike in flu cases? He speaks as if it took the Department by surprise, but it was widely predicted that there would be a spike in flu cases following on from the lockdowns during covid. He has announced 4,500 places to ease pressure, but in his statement he said that in 2020 there were just 6,000 cases of delayed discharge per day—“just” 6,000, as if that is not significant—whereas last year it was between 12,000 and 13,000 cases per day. What he has announced is roughly one third of what he said was the average per day for the last year. Is this not just too little, too late?

First, the central announcement at the autumn statement was the additional capacity to deal with domiciliary care and further support for social care. That £500 million announcement was part of the £2.8 billion next year and the £4.7 billion the year after. The autumn statement recognised the fact—I would have to go back and check the transcript, but there were many comments around that period pointing to it—that this was likely to be the worst-ever winter because of the combination of pandemic pressure, covid admissions and the risk of flu, which has transpired to be the worst for 10 years. That is why, for example, we expanded the cohort eligible for the flu and covid vaccine to the over-50s and invested in the bivalent vaccine. It is why NHS England put in place an additional 7,000 beds. It is why we have been rolling out virtual wards of the sort used at Watford General Hospital, which is able to address the equivalent of an extra ward. Additional measures have been taken but, over the Christmas period, in line with what happened in Wales, in Scotland and internationally, we saw a rapid spike in flu, with a sevenfold increase in cases over a short period, on top of the pressures already in the system.

I welcome the Secretary of State’s statement and the new funding announced. In Nottinghamshire, the Nottingham University Hospitals NHS trust had to declare a critical incident between 29 December and 6 January. It needs this new funding to help to discharge more patients now. Can the Secretary of State confirm when the money will arrive and start making a difference to my constituents in Nottinghamshire, and what his Department is doing not only to attract new people to work in social care, but to try to win back some of those who have recently left?

To address my hon. Friend’s two points, first, the NHS will take immediate action to start arranging additional step-down care; that is a clear message that she can take to her constituents to show that the Government have listened and acted on the very real pressures we have seen. On the wider social care system, an example from Hull—the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) is not in her place now—is the Jean Bishop Integrated Care Centre, which co-locates social care and NHS staff. The feedback I received from those staff was that that integrated model is extremely rewarding for staff and a much better way of operating than working in silos. The workforce themselves have said that that co-location and greater integration between social care and health is extremely beneficial.

Patients living with cancer, their families and the outstanding cancer workforce will be staggered—as am I—that we have just had a statement on NHS pressures that put forward no serious plan to tackle the deadly cancer backlog. Some 17,000 cancer patients in the last three months have had their targets for cancer treatment delayed or missed; 43% of people diagnosed with cancer in south Cumbria waited more than two months for their first lifesaving treatment, and in north Cumbria that figure was 63%. Where is the urgent plan to tackle the cancer backlog? On a practical, cross-party level, will the Secretary of State or one of his Ministers attend the all-party parliamentary group for radiotherapy’s inquiry on 18 January, so that we can work together to come up with some quick technical solutions that will save lives?

It is worth pointing out to the House that 92% of new patients are starting their cancer treatment within four weeks. On the substance of the hon. Gentleman’s point, however, we are rolling out the programme of community diagnostic centres and the surgical hubs programme precisely in order to prioritise cancer treatments. Also, given that it was a central part of the statement, it is rather surprising that the major investment in bringing out the potential of world-leading cancer vaccines from our life sciences strategy, which could be absolutely transformational for cancer patients, was not even referred to by the hon. Gentleman. I hope that he supports it, because it has the potential to be game-changing.

The Secretary of State is absolutely right: nothing about this situation is unique to the UK. There have been record delays at Canadian hospitals, Canadian emergency rooms have been closed because of staff shortages, and some Canadian citizens have had no ambulance cover at certain times, so the role of paramedics has been expanded there to enable them to do more diagnostics and to prescribe.

As somebody who works in this service, I say that it is not just about the delays in getting into hospitals; the demand on the ambulance service is equally driven by the fact that we have more people living for longer with more conditions that sometimes require care at 1 or 2 in the morning, and the only NHS service that will turn up is the ambulance service. What is my right hon. Friend’s vision for the future of community paramedicine? How can we expand paramedic roles, employ more advanced paramedics and, of course, put the proper resources into that service?

My hon. Friend raises a brilliant point—one that I completely agree with—about how we upskill the existing workforce and get more people operating at what is referred to as the top of their licence. One of the key areas in the discussions we had at No. 10 on Saturday was how we can better utilise the existing workforce and their roles, and what regulatory changes we need to maximise that.

I pay tribute to my hon. Friend for the work that he did over the Christmas period as a community first responder. He is absolutely right: looking at how we better integrate the data available to paramedics, for example, and therefore enabling them to do more, is exactly the direction of travel that we want to take. I look forward to discussing that further with him.

Last month, I asked the Prime Minister about a constituent with dementia who waited three hours for an ambulance and then spent 10 hours in the back of the ambulance in the car park at A&E. We have heard much worse examples today. I have now been contacted by another constituent, who went into cardiac arrest at his GP’s surgery. He waited two hours for an ambulance, and the GP eventually ended up driving him to hospital and probably saved his life. Can the Secretary of State give us some confidence that everything he is talking about today will filter through quickly to ambulance response times? At the moment, my constituents are terrified that if they call for an ambulance, it will not come.

Looking at the media coverage, the hon. Lady raises a very fair challenge. To give her a sense of what underscores our approach, 15 trusts are responsible for 56% of ambulance handover delays, so the targeting of additional capacity—particularly how we target what we have announced on the areas where delays are most acute—is obviously one of the central things that we are doing at pace, and there is a significant concentration of that.

There are also opportunities to look at the variation in performance and what is working effectively in other trusts. That combination of control centres and better upstream demand management is absolutely core, particularly for cohorts such as dementia patients. There are significant opportunities to target interventions better—NHS England has been doing a lot of work on that as part of its 100-day sprint exercise—but we can do more and the funding announced today speaks to that.

I put on the record my thanks to the incredible staff at the Royal Stoke University Hospital and the Haywood walk-in centre, who have faced unprecedented pressures. Tracy Bullock and Neil Carr deserve our full respect.

We have two problems in Staffordshire. One is that community first responders do not have blue-light ability, which was taken away by the West Midlands Ambulance Service. When will it be reinstated? The second is that community pharmacies can do more—I am delighted that we will see them do more—but their core funding needs to be increased, which it has not been since 2014. How will that be rectified?

On the blue-light ability, I am very happy to take that away and look at it. As is often the case, these things are slightly more nuanced, as I discovered when we were looking at Ministry of Defence ambulance drivers and their interaction with blue lights. I am very happy to look at that.

The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is looking at community pharmacy and, in particular, how we better enable patients to get the right treatment in the right place. Given that community pharmacies are accessible and sometimes get higher numbers in more deprived communities, there are significant opportunities for us to do more with them, and I know that that is something the ministerial team is working on.

I listened with some incredulity to the Secretary of State’s explanation—that because the integrated care boards are only six months old they are still getting to grips with the link between health and social care. Who does he think was running health and social care before the ICBs were created? It was the very same people, who know exactly what the issues are; what they are lacking is a Government committed to dealing with the systemic issues facing both sectors.

As we have heard, one of those issues is workforce and social care. A quick internet search reveals that there are 200 social care vacancies within a 10-mile radius of Ellesmere Port; we have heard already that there are 165,000 social care vacancies nationwide. I have not heard anything from the Secretary of State today about what he is actually going to do to address those vacancies. In a year’s time, how many social care vacancies does he expect there to be across the country?

On the interaction between vacancies and workforce, NHS England is working on a workforce strategy, as has been said, and we will say more on that shortly.

In his wider point, the hon. Gentleman is ignoring examples such as the Jean Bishop Integrated Care Centre—the ability to bring health sector and social care staff to work together in a more integrated way. Yes, the integrated care boards were operational from July. That is a factual statement; I am slightly mystified about why he thinks that was in some way an unusual observation to make. It is just the factual position. The point is that when one looks at the issue, one sees opportunities, particularly around how the data are better integrated, to understand where the workforce pressures and bed capacity are.

One of the causes of delayed discharge is about the interfaces as well as what is domiciliary care, what is step down and what is residential. There are a number of issues. By bringing them together in more integrated way, integrated care boards will be one of the ways we improve the situation. Indeed, that is what the hon. Gentleman’s former colleague Patricia Hewitt is looking at through the Hewitt review.

I am grateful to the Secretary of State for getting to grips with delayed discharges. As he will know, only a third of such discharges are in social care; most are down to the fact that there needs to be an NHS medical discharge.

I have some good news for the Secretary of State. The bad news is that Spinneyfields in my constituency, a 51-bed social care step-down facility, is going to be closed. If the Secretary of State spent a small proportion of the £250 million, the NHS could take over Spinneyfields and tomorrow 51 beds would be released at the acute hospitals in Northampton and Kettering. Will he agree to that now?

One of the things that my hon. Friend agrees with is that more decisions should be devolved rather than every decision being made in Westminster. Part of the reason for integrated care boards is so that they can look at where best to allocate their funds locally. He raises an extremely important point. He is right that around a quarter of delayed discharges are on the social care side—a fifth actually, in the NHS; there are a number of factors within that, which we will need to disaggregate.

On my hon. Friend’s point about local capacity, the Government are allocating the funding to his local ICB. I am sure he will have a conversation with his ICB on where the spare capacity can be best identified and rolled out at pace.

Last week, I met Hal Spencer, the chief executive of Chesterfield Royal Hospital; the pressures that he and his staff had faced as the hospital went into a critical incident over Christmas were etched all over his face. He spoke about the pressures on A&E registrars, ambulance drivers and nurses and about coming face to face with people who had been waiting 24 hours in a corridor on a trolley or who had been waiting many hours for an ambulance to turn up.

Is not the reality that this is a system-wide failure 13 years in the making? Did the right hon. Member for Gainsborough (Sir Edward Leigh) not hit the nail on the head in saying that Labour has a long-term plan for our NHS and this Government do not?

On the hon. Gentleman’s first point, this is absolutely a system-wide challenge. That is why the use of innovations such as virtual wards in demand management upstream, in the care home or on the home, is important, just as discharge—getting patients to leave hospital who are fit to do so—is important. The focus has often been on ambulances being delayed at A&E or on the significant and real pressures in emergency departments themselves, but the challenge is much wider. That is what the funding in the autumn statement recognised.

In response to his second point about this being a longer-term issue in England specifically, I would just point him to the examples in Wales and the pressures in Scotland. This surge in flu combined with covid and the pandemic legacy that we have seen in England have created so much pressure over the festive period, and it is something with which many other health systems around the globe have also been grappling.

I very much welcome this extra funding, and I look forward to hearing how much will be coming to Southend University Hospital, which has had to deal with not one but two critical incidents declared by the East of England Ambulance Service NHS Trust. It has already innovated with modular units and an active discharge lounge. These NHS workers deserve all our recognition, and what they need is £8 million of capital funding to reconfigure the hospital, which is fundamentally not big enough. In the short term, will the Secretary of State agree to encouraging care homes to take discharges after 5 pm? Every day, 15% of the people who need to be discharged cannot be discharged because the care homes will not take them after 5 pm. That is at least 70 people a week who could be out of hospital. This is an emergency—everyone must put their shoulder to the wheel.

My hon. Friend has raised the £8 million capital request with me previously, and it is something we are looking at. She is right about how capital needs to be looked at in the context of getting flow into a local system and of where triaging can be unlocked. In response to her point about 5 pm, there are two points. First, part of the reason for looking at discharge lounges is that if we have something that is 7 am to 7 pm, there is a cultural change for the patient in going into the discharge lounge in the morning and being off the ward. Looking at other health systems around the world, we see that that can be beneficial in accelerating discharge, rather than there being a point in the day after which suddenly it is easier to leave discharging the patient until the next day.

The second point on 5 pm is that we need to look at what support care homes need to have the confidence to take the patient. To be fair to them, it is not simply a question of whether they are refusing to take the patient after 5 pm; it is also about us looking at the wider wraparound care package, so that care homes are confident in taking that risk not just after 5 pm on weekdays, but at weekends, when there is often a significant drop in the number of patients taken.

One of the key issues in Shropshire is a shortage of staff across every discipline and at every level. It is one of the reasons for the horrifying ambulance wait times that I raised in this place on my first day, 5 January 2022—this is not a new issue for 2023. What is the Minister’s plan to improve staff retention, because staff recruitment on its own will not plug this gap? It has not plugged it in Shropshire, and there are no signs of it plugging the gap across the rest of the country either.

We are expanding staff numbers—that is why there are 3% more doctors and 2% more nurses than last year—but it is about more than simply looking at that. We also need to look at the fact that we have more elderly patients, who are presenting with multiple conditions, which in turn changes the demands from a system that has traditionally been more about individual specialties. Now we are looking at treating those patients with multiple conditions, and that then needs to be factored into the skills the workforce have. That is why the point from my hon. Friend the Member for Brigg and Goole (Andrew Percy) is so important. We need to think about what upskilling can be offered to particular roles and how they can take on a wider set of responsibilities. There is also the role of technology in that. For example, many nurses in hospitals currently take time looking for beds. Operational control centres with a different cohort of staff, as is already the case in some hospitals, not only automate much of that process, which is far quicker in getting beds back into use, but free up a lot of nursing time to be used for what nurses would prefer to be doing, which is focusing on the clinical side and taken away from some of those administrative roles.

Norfolk and Waveney has already received £11 million to tackle discharges, which is making a difference. However, today there are 128 patients in the Queen Elizabeth Hospital in King’s Lynn who do not need to be there. This additional funding is welcome, but do these pressures not also underline to the Treasury the long-term importance of investing in modern hospitals that are able to meet demand and the case for including the QEH in the new hospitals programme?

My hon. Friend skilfully combines the importance of discharge at King’s Lynn with the importance of addressing RAAC—reinforced autoclaved aerated concrete—hospitals, on which he has campaigned assiduously. As he will know from my speech at the NHS Providers conference, it is an issue that I very much recognise. I have visited the hospital and seen the challenges at first hand; indeed, my son was born in that hospital, so I know it very well. We are discussing that issue with the Treasury and I hope to be in a position to update the House shortly.

We will not solve the NHS crisis without solving the NHS staffing crisis, which means sorting out pay. However, in talks with the unions today, the Government refused to make a new offer on pay. The unions say that the Secretary of State is ludicrously calling for—demanding—efficiency savings from nurses and other NHS staff. Many nurses and NHS staff are already working 18-hour shifts. When will the Government get real? When will the Government get serious? When will the Government make a proper offer to NHS staff to avoid strikes?

The hon. Gentleman seems to be quoting Onay Kasab, the lead national officer of Unite, who spoke to Sky News outside the Department of Health and Social Care just a few minutes after my discussions with the trade unions. The slightly odd thing was that Mr Kasab was not actually in the meeting on which he was commenting.

It is pleasing to hear from across the House a focus on capacity in domiciliary care, which is a huge priority. Ultimately, that is where we want people to end up: independent in their own homes, as far as possible. I wonder if the Secretary of State could reassure me about some elements of the plan for the NHS to procure care beds. Where does he envisage staff coming from? If it is from the NHS, how will we ensure that more people do not leave domiciliary care for what are often better-paid roles in the NHS? In the same vein, on capacity, how will we ensure that people are able to move on from residential care beds into domiciliary care when there is that shortage of capacity?

As befits the leader of his own county council, my hon. Friend rightly recognises the importance of the integration of health and care. I have pointed to examples where that is already being done extremely effectively in an integrated way. As I recognised in my remarks, the medical director of NHS England has said that helping people to leave hospital with the right support when they are ready to do so is not just clinically the best option for those individuals, but one of the safest options for expanding capacity for everyone who needs care. It is the right thing to do clinically, but his point—one that we are extremely focused on—is about how we then ensure that wraparound service for patients who are released into residential care so that they can move into domiciliary care.

I know that the Secretary of State appreciates that the winter pressures are only exacerbated by the looming strikes. I joined the picket line at Newtownards hospital back in early December. Just before Christmas, I had the opportunity to meet Pat Cullen, the leader of the nurses’ union at St Thomas’s Hospital, just across Westminster bridge, as the protest was ongoing, and we heard in the news that she referred to a glimmer of hope over today’s talks between the Government and nurses. Does the Secretary of State believe that there can be real engagement with not only nurses and midwives, but junior doctors, who are also threatening strikes? Does he agree that it is about not just a pay increase, but an increase in the numbers of staff to secure safety and accountability on shifts in hospitals tonight and every night from today on?

I agree that a combination of pay and wider conditions have an impact on recruitment and retention. That is why we have been keen to engage constructively with the trade unions; we had a good discussion earlier today. We recognise that there is a range of factors. To take the example of paramedics, the feedback from my discussions with a number of paramedics was that their frustration about handover times and the delays that they were experiencing was more important to them than pay. It is important to have discussions through the independent pay review bodies about pay, what is affordable and what is the right balance, but a range of non-pay factors are also extremely important to staff.

The biggest flu outbreak in 10 years has seen Kettering General Hospital become the 28th busiest hospital in the country, with a bed occupancy rate of 96.5% in the week leading up to the new year. The Secretary of State was kind enough to visit it last year and stood in the busy and overcrowded A&E. He was also good enough to visit Thorndale care home, where he was briefed on the fact that the rate of increase in the number of over-80s in Northamptonshire gives it one of the fastest-growing elderly populations in the country. In thanking the Secretary of State for the measures that he has outlined today and the extra funding, I ask whether he will ensure that Northamptonshire, North Northamptonshire Council, the Northamptonshire ICB and, crucially, Kettering General Hospital get their fair share of the funding that he has announced, so that we can tackle these winter pressures quickly and successfully?

My hon. Friend is right to point to the real pressures at Kettering which, as he says, I have visited. Not only am I keen to see it get its fair share, but I know that he will absolutely champion it through his good offices to ensure that that is the case, as he always does. He also raises an important point that the pressure of an ageing population is not universally distributed but is more intense in certain areas than others. Again, in our scrutiny of the data, I am keen to look at how that plays out in the variation in performance between trusts because, as I said, 15 trusts account for 56% of ambulance handover delays and there is significant variation across the NHS. Understanding what is driving that, such as different ageing profiles between different areas, is a key part of our recovery plans.

I spent Friday morning at Warrington Hospital to see the challenges that A&E department staff are facing. One senior clinician said to me that it was the busiest he had seen it in 30 years. The entire hospital was full—there were no beds—and last Monday, 90 people were waiting in A&E to be admitted to a bed. The Secretary of State knows that I am waiting for an announcement on whether a new hospital can be funded in Warrington, and I am keen to hear when that announcement will come, but can he reassure my constituents that the funding announced today will support the staff in Warrington Hospital and the social care staff in Warrington and ensure that the pressures that they are facing will be addressed immediately?

Yes, I can; that is the whole purpose of the announcement. Although my hon. Friend campaigns assiduously for the new hospital, he will concede that, regardless of the decision, that would take time. To his point about the hospital being full, there is an immediate challenge about how we get additional capacity into the emergency department so that it can operate more effectively, because if there are too many people, that impedes an emergency department’s ability to operate effectively. There is also a challenge about how we address the wider occupancy in the hospital as a whole, because that is at the core of getting flow into the system. That is the essence of the feedback that we have listened to and taken on board from the clinical community —as he did on Friday—particularly within emergency departments. Today’s announcement speaks to the exact issue that he raises.

Finally, with the prize for patience, I call Shaun Bailey.

Thank you, Mr Deputy Speaker—I am last but I hope I am certainly not least. Some 700 beds are due to come online thanks to the Midland Metropolitan University Hospital and there is a new primary care centre in Wednesbury, so when my right hon. Friend’s Department delivers, we see the benefit. Clearly, however, that means nothing if we cannot get the processes right. The most pressing issue for my constituents during the winter has still been access to their GPs, as I am sure hon. Members on both sides of the House will agree. I welcome what he has said about the use of technology to ensure that people are seen, but fundamentally, people still want face-to-face appointments, because if they are digitally disconnected, they cannot access that technology. It is as simple as that. I ask him to commit—just after he commits to come to Wednesbury to see our new primary care centre—to work through his good offices with GP practices where there is best practice, particularly in the Black Country ICB, to ensure that we enable people who are digitally disconnected to access GPs.

We are working actively with the primary care community. Indeed, that was a key focus of the Prime Minister’s summit in No. 10 on Saturday and it is part of the work that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) is leading through the primary care recovery plan. Last year’s GP patient survey suggested that continuity of care and face-to-face appointments were extremely important for two fifths of patients, but that suggests that for three fifths—often younger patients—speed of access is more pertinent. Continuity of care is important for those with multiple conditions, particularly elderly patients.

Alongside that, my hon. Friend is right to raise the Midland Metropolitan University Hospital. Four years ago, when I visited as a Minister of State in the Department, it was near completion. As he knows, it has taken a significant amount of time since then to get to its opening, which is why we need to look at doing things differently when it comes to value for money. Looking at the hospital estate programme, nine of the last 10 hospitals were built over time and over spec, so we need to look at modular design, modern methods of construction, and standardisation, which deliver a 35% unit-on-unit reduction in cost and much quicker operational performance, and would enable us to get hospitals up and running earlier.

It is important to do things differently and the new hospital building programme is part of that. We have listened to the concerns of those on the frontline and today’s statement addresses the immediate issue of bed occupancy in hospitals and the pressure on emergency departments.

My thanks to all hon. Members—Front Benchers and others—who have taken part in an important discussion.