Steve Barclay
MP for North East Cambridgeshire · Conservative · United Kingdom
“I speak to my brief exchange earlier with the Minister. As the previous speaker, the hon. Member for Harpenden and Berkhamsted, said, the draft regulations are fairly benign and very welcome to help people who are struggling with their bills.”
“The issue is not the lack of will; the issue is the alignment between procurement, regulation and clinical leadership, particularly in the colleges, as well as the ability to scale innovation—it is not about having more ministerial pilots.”
“Just to localise it to my own constituency, the Cambridgeshire and Peterborough ICB alone paid out £14 million in redundancies last year. It merged with a number of other ICBs to form the Central East ICB, yet we know hear from the Government that it should align with metro mayors, which means going back to exactly what it was before: the…”
“My right hon. Friend is absolutely right: the Government are spending millions of pounds and there is no plan. The measure was announced without working that out, it came as a surprise to many within the system, and it has had a chilling effect on many decisions. That is not isolated.”
“I rise to speak to clause 1 on the abolition of NHS England and clause 6 on promoting innovation. What characterises the first of those is an announcement without any clear plan. That is what has driven the cost and confusion that a number of Members across the House have spoken about.”
“All this is around 18 months on from the actual announcement. The confusion seems to extend to the Government themselves, because they seem unable to answer pretty straightforward written parliamentary questions. Given the time limit, I will give just a few examples.”
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“On greater transparency, for some time voices across the NHS have called for the number of 12-hour waits from the time of arrival in A&E to be published. This is something I know the Royal College of Emergency Medicine has long campaigned for—I can see the hon. Member for St Albans (Daisy Cooper) nodding her head—and there has been criticism of the Government, including from Opposition Members, for refusing to provide this transparency. Instead, the data published to date has been a measure of 12 hours from the point of admission rather than from arrival in A&E. For the commitment to transparency to be meaningful, we must be prepared to publish data, even when that transparency will bring challenges, so today I can inform the House that from April we will publish the number of 12-hour waits from the time of arrival.”
“To put these targets in context, achieving both would represent one of the fastest and largest sustained improvements in the history of the NHS. Underpinning these promises is one more essential commitment: a commitment to better data and greater transparency. On data, the best-performing hospitals have benefited from the introduction of patient flow control centres to quickly identify blockages in a patient’s journey, and e-bed management systems to speed up the availability of beds when they become free. Through this plan, we will prioritise investment in improving system-wide data, both within the integrated care boards and on an individual trust and hospital site basis. This will allow quicker escalation when issues arise and a better system-wide response when individual sites face specific challenges.”
“In the year after that, we will bring waiting times towards pre-pandemic levels. Our second ambition is to improve ambulance response times, with a specific commitment to bring category 2 response times—those emergency calls for heart attacks and strokes—to an average of 30 minutes by next March. Again, in the following year we will work to bring ambulance response times towards pre-pandemic levels. I am pleased that the College of Paramedics has welcomed the plan, saying that it is “pleased to see a strong focus in the recovery of those people in the Category 2 cohort”. Of course, this will not be the limit of our ambition, but it is vital that we get these first steps right and that we are credible as well as ambitious.”
“Today’s plan, developed in partnership with NHS England and social care partners, builds on the actions and investment that I set out to the House earlier this month as we put in place the more substantive changes required to enable the NHS to have greater resilience this time next year. To do that, this plan involves embracing technology and new ways of working to transform how patients access care before and after being in hospital. That in turn will help to break the cycle of emergency departments in particular coming under significant strain in winter. Our plan has a number of commitments that are both ambitious and credible. First, we are committing to year-on-year improvement in A&E waiting times. By next March, we want 76% of patients to be seen within four hours.”
“Today’s announcement on urgent and emergency care does not sit in isolation, but is part of a longer-term improvements plan that builds on the legislative change enacted last year to better integrate health and social care through the 42 integrated care boards, which became operational in July. That was prioritised for additional funding through the £14.1 billion announced for health and social care in the autumn statement. Following the quick spike in flu cases over Christmas, with in-patient flu admissions 100 times that of the previous year and a sevenfold increase in December, we announced £250 million of immediate funding on 9 January for the pressures this winter, giving extra capacity to emergency departments to tackle the issue of patients who are fit to leave hospital but are delayed in doing so.”
“Our primary care recovery plan will be published in the next few weeks, to support the vital front door to the NHS through primary care. Today, together with NHS England, we are setting out our plans to reduce waiting times in urgent and emergency care through an increased focus on demand management before patients get to hospital, and greater support to enable patients to leave hospital more quickly through care at home or in the community, supported by a clinical safety net. In addition, the plan sets out how we will adopt best practice in hospitals by learning from the trusts that have displayed the greatest resilience in meeting the heightened pressures this winter.”
“Today we have published our new delivery plan for recovering urgent and emergency care services, which has been deposited in the Libraries of both Houses. Given the scale of the pandemic pressures that healthcare systems around the world and across the UK are collectively facing, we are building the NHS back to where we want it to be. That requires the widespread adoption of innovation, building on best practice already applied in specific trusts, together with significant investment in new ways of working, including a £14.1 billion funding boost for health and social care, as set out in the autumn statement. Today’s announcement is the second of three plans to cut waiting times in the NHS. Our elective recovery plan is already in action, virtually eliminating the backlog of two-year waits in England.”
“We have recognised the value of virtual wards, which is why, at North Tees this morning, at Watford last month, or on various other visits, I have been discussing how to scale up those plans.”
“On funding, we are putting an extra £14.1 billion of funding into health and social care over the next two years, which reflects the fact that the Chancellor, notwithstanding the many competing pressures he faced at the autumn statement, put health and social care, alongside education, as the key areas to be prioritised. On virtual wards, I had not quite realised that the shadow Secretary of State was the clinician who had invented virtual wards. I think that the credit for virtual wards actually goes to the staff, such as those I met at Watford, who are driving forward that innovation. It is slightly strange that he sometimes wants to claim ownership of something that has been clinically led by those working on the frontline.”
“[Interruption.] The shadow Secretary of State keeps chuntering. We did not have the pandemic 13 years ago. [Interruption.] I can only surmise that he did not get his remarks quite right the first time, which is why he feels the need to keep chuntering now and having a second, third and fourth go—perhaps next time. On ambition, the shadow Secretary of State ignores the fact that we need to balance being ambitious with being realistic. These metrics, in the view of NHS England, show the fastest sustained improvement in NHS history. Clearly, his remarks are at odds with NHS England.”
“[Interruption.] Labour Members just do not like the response, but the facts speak for themselves. We have 10,500 more nurses this year than last year. The grown-up position, as I was saying, is to recognise that we have an older population with more complex needs, and that the consequences of the pandemic are severe—they are severe not only in England, but across the United Kingdom, in Wales and Scotland, and indeed in countries around the globe. The shadow Secretary of State says that the statement did not cover the plan for GPs. Well, again, I was clear that this was one of three plans. We had the elective plan in the summer, which hit its first milestone. We have the second component today on urgent and emergency care, and we will set out in the coming weeks our approach to primary care. That is the approach that we are taking.”
“He seems to think that they are unique to England alone. We need only look at Wales to see that more than 50,000 people—notwithstanding the fact that Wales has a smaller population—are waiting more than two years for their operations, when we cleared that figure in the summer in England, leaving fewer than 2,000 in that cohort. The shadow Secretary of State talks about the workforce. Obviously, he did not bother to read or listen to what was said in the statement. We are on track to deliver our manifesto commitment of more than 50,000 nurses. We have more than 30,000 so far. We have 10,500 more nurses in the NHS this year compared with last year. The grown-up position is to recognise— [Interruption.] Well, in the first five years we were dealing with what that letter said, which was that there was no money left.”
“The hon. Gentleman started by thanking me for advance sight of the statement, and then he made a series of remarks that simply ignored what was in it. Even his last point shows how riddled with contradictions the Opposition’s approach is. He says in interviews that he supports the pay review body process—that is the official position, or at least it was—but then he says, “No, we should be negotiating individually with the trade unions and disregarding the pay review process.” There is no consistency on that at all. The shadow Secretary of State talks about operational performance —[Interruption.] He has just had his go; he should listen to the answers. He says that it is about operational performance, but in my remarks I tried to be fair and said that these are challenges that are shared across the United Kingdom and globally.”
“The funding to put that in place has been earmarked from the £2.8 billion next year. The key thing is less to do with the funding than the accuracy of the data, which will help us to see where there are gaps in coverage and how we get the right levels of community response. The integrated care boards have been set up to take an integrated approach on that. One of the best enablers will be the control centres that the ICBs will set up, which will allow us to get much greater visibility on where that has been delivered and how we escalate it when it has not.”
“We recognise the huge pressure on social care; that is why, at the autumn statement, the Chancellor set out the biggest-ever increase in funding into social care of any Government, £7.5 billion over two years. We are putting more funding in. On the workforce more generally, the Prime Minister and Chancellor have committed themselves to bringing forward the workforce plan, which will set out the longer-term ambition on workforce and will be independently verified. In addition, we are recruiting more staff, as I updated the House, whether that is the 3% more doctors this year than last year, the 3% increase in nurses, or the 40% more paramedics and 50% more consultants compared with 2010. We are recruiting more staff, but the grown-up position is to recognise that there is also more demand.”
“In early January, I set out a three-phased approach: first, the £250 million immediate response to the pressures we saw from the flu spike over Christmas; secondly, as I announced today, building greater resilience into the system looking ahead to next winter; and thirdly, the major conditions paper on prevention, which is about bringing forward the innovative work that colleagues are doing through the Office for Life Sciences to impact the NHS frontline much sooner than might otherwise have been the case.”
“I am happy to give my right hon. Friend that assurance. I assure the House that our commitment to the cancer mission and the dementia mission through the Office for Life Sciences is absolutely there. He is right that we are bringing that together in one paper—I think we should take a holistic approach—but I share his ambition on prevention.”
“We are bringing times down; I think the current mean response for C2s is much more in the region of 25 or 26 minutes than it was in late December-early January, because across the UK there was a massive spike in flu. The hon. Lady will have seen exactly the same in the Labour-run NHS in Wales. Over December there was a 20% increase in 999 calls, for example. That is why we need to put in place greater resilience, as the plan I have set out to the House does.”
“Within my right hon. Friend’s question is, I think, how we get more flow into hospital: once bed occupancy goes above a certain threshold, lack of flow is the key interaction that drives inefficiency within hospitals. That is why we are putting in the extra capacity. It is also a question of reducing the numbers going to hospital in the first place and speeding up the discharge of those who are fit to leave. Whereas at the moment someone might sit on a ward for three days because they have to have antibiotics every day, if one continuous dose of antibiotics can be administered through new kit at home, not only is that a much better patient experience but it relieves pressure on the wards.”
“It is about looking at the end-to-end bed capacity, not simply at beds within the acute sites.”
“First, I thank the hon. Lady for recognising the steps that we have taken on transparency. That has been an area of challenge and it is part of my wider commitment to transparency. The ambition of the targets has to be realistic, and targets are not a ceiling but a floor. It is about saying, “How do we set a target that is realistic?” Of course, we will aim to do better than that, but it is about setting something that the system feels is achievable, because that in turn gets much more buy-in. On beds, we are increasing capacity, as my right hon. Friend the Member for Wokingham (John Redwood) alluded to. What it is really about is freeing up patients who are fit for discharge from hospital, who should not be there and would actually prefer to be getting care at home.”
“My right hon. Friend makes an important point. Again, within that is patient choice and how we empower more patient choice—providing services that are free at the point of use—to use what capacity there is within the system, including in the independent sector. I absolutely agree that we should be maximising capacity. At Downing Street with the Prime Minister, we had a very useful roundtable with the independent sector about how we can make more use of its capacity. That is certainly an area that we are exploring.”
“First, the hon. Gentleman is right to recognise the work that the staff have been doing. He mentioned a family member; when I made a statement earlier in January, I recognised that there has been huge pressure on the system. We saw the flu numbers and the spike in cases. On the two-year waits, the point is simply that there has been pressure on services—the pandemic impacts—across the United Kingdom, but the two-year wait is far worse in Wales, whereas we have cleared it in England. On recruitment and retention, we are bringing forward the workforce plan. The fact is that we are recruiting more nurses, but it is about meeting demand pressure as well.”
“Community hospitals are key to tackling the issue of delayed discharge. Community settings have been a bit of a Cinderella in the past. The data on community settings tends to be weaker than it is in other parts of the NHS. Alongside domiciliary care and making better use of residential care capacity, the third element for discharge is to look at how we use community step-down in a much more constructive way. One key issue there is to have wraparound services so that people do not simply get transferred to a community setting, but that it is a staging post before getting to the home, which is where most patients want to be.”
“For example—Mr Speaker will be familiar with this—Blackpool often has visitors from out of the area, so the NHS there deals with a number of local authorities, not simply the nearest one. We are working intently on how we support local authorities as part of the wider discharge package.”
“One area of the right hon. Gentleman’s question where I do agree with him is the importance of local authorities. One reason I am keen to see more clarity on data and transparency is that there can sometimes be a tendency for the local authorities to be blamed for discharge, when often it is factors within the NHS that contribute to some of those who are fit to leave hospital not doing so. On the money allocation, the £2.8 billion is targeted to local authorities—funding set out by the Chancellor—with £4.7 billion the following year. We are increasing the money for local authorities, but alongside that we are working with them to improve the data so that we can see where there are blockages due to local authorities.”
“My right hon. Friend hits the nail on the head. He is right: it is about how we better manage demand in the community before people get to the emergency department. That is where, for example, action targeted at the frail elderly is so important. It is also about how we enable people to discharge sooner, where they are fit to do so, so that they can recover, whether in a community setting or, ideally, at home, with the right wraparound support.”
“I am keen to make that much more transparent, because to be blunt, as a Secretary of State, I get the transparency anyway when things go wrong. Like the hon. Lady, I would rather have much more transparent data so that ICBs themselves can be better held to account, and indeed that is what the Hewitt review is looking at in terms of that wider transparency piece.”
“I think the hon. Lady was welcoming the transparency on 12 hours—I certainly hope so. The ICBs became operational in July, and we are working with them as to how, by taking a system-wide view, they can baseline the gaps in data, and one key area of that is on the community side. When she talks about matching capacity, part of that is about understanding virtual ward capacity, what conditions that applies to, what the physio wraparound services are, what is available within residential care versus community care and other domiciliary care packages, as the right hon. Member for Islington North (Jeremy Corbyn) touched on in terms of local authorities. We need to look at the data package across the piece on a system-wide basis. That is why we are setting up control centres.”
“I could not agree more, which is why this morning the Prime Minister and I were at University Hospital of North Tees, where it is effective on the ground. It is about looking at hospitals where such measures have been effective and are having an effect on the ground, such as in North Tees and at Maidstone Hospital, and how we take best practice from them. We then have to do what has sometimes been more difficult in the NHS, which is to scale those innovations and get them adopted across the piece.”
“We are dealing with that through additional funding—the £500 million for this winter. That relates to the point made by my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) about the impact on the ground, which will be to give ICBs and local authorities discretion. Some of that £500 million is being spent on the workforce, including in social care, so there is discretion as to how they spend that. There is also the £2.8 billion of local authority and ICB funding that will be in place next year, and £4.7 billion the following year.”
“My hon. Friend makes an important and nuanced point about demographic pressure, which is not evenly spread and is more concentrated in certain parts of the country than others, so the pressure on ICBs is greater in those areas. That is why the ministerial team met almost all the ICBs in a series of meetings with chairs and chief execs in the run-up to Christmas, and it is why we want to bring greater transparency, so that we can right-size solutions for emergency departments and ensure that those facilities keep pace with the increased demand.”
“As I said, we are not setting out that ambition in this statement, because the impact of the pandemic has been so severe. We need to set a target that is ambitious but achievable, which is what we have done. The president of the Royal College of Emergency Medicine said: “This plan is a welcome and significant step on the road to recovery and we are pleased to see it released.” It is about taking best practice from the areas that are working and ensuring that they are socialised across the piece. It is obviously concerning to hear about individual cases, such as the specific one that the hon. Lady mentioned, which are very traumatic for the families. That is why we have set out this plan and why we are putting in the extra funding.”
“We are encouraging integrated care boards to take ownership of individual decisions, rather than trying to make all the decisions centrally from Westminster, so that those closer to the ground and to the issues are in power to make the trade-offs. I am sure my right hon. Friend will want to have those discussions with the chair and chief executive of his ICB. There is a wider issue of how we make greater use of community sites, not least given the workforce pressures and different staffing ratios that they have, and that is absolutely the way we help to get more people out of hospital who are fit to leave.”
“The hon. Gentleman asks how we slow the flow of people going to emergency departments and how we accelerate their discharge once they are fit. The substance of the point he raises is valid and absolutely right. It is why there are schemes such as the community response service and the falls service. We are looking at the likes of the North Tees model and getting more staff into community support, thereby integrating the health and social care side. As I said to my right hon. Friend the Member for New Forest East (Sir Julian Lewis) a moment ago, the trade-offs for individual sites are best determined by ICBs. I am very happy to look with ministerial colleagues at any specific proposals, but it is really for the ICBs to be looking at how to best use their estate.”
“I recognise my hon. Friend’s point, not least as a rural constituency MP myself. I have talked to paramedics, as I am sure he has, and the principal cause of frustration of late has not been the issue of pay—important though that is. It has been frustration over long handover times, which has had a particularly damaging impact. I am happy to look at any specific issues in his area but he is right on the wider point about the pressures in rural areas.”
“This statement is focused on urgent and emergency care. At Health oral questions and on other occasions, we often discuss the wider capital programme and the increased funding we are putting into that programme. Part of that is about outcomes and how we get more from that investment in capital. That is why through the NHS estate we are starting to standardise our builds, starting with the Hospital 2.0 programme. We will be rolling that out more widely through the estate. I am not familiar with the specific issues at the hon. Member’s local site, but I am happy to look at them after the statement.”
“Again, decisions on the estate are principally for the ICBs, but I am happy to look at any individual proposals my hon. Friend has on how we get more flow into the system, and that is about putting more capacity into the community.”
“The hon. Lady raises a fair and important point about what is in the wider package, alongside the mental health ambulances, which I think are a positive step. Last week, I met Baroness Buscombe as part of the pre-legislative scrutiny of the proposed mental health legislation, which will pick up some of the points that the hon. Lady raises. Examples of innovation include empowering people before they have a mental health crisis to use one of the apps that have been developed to set out their statement of wishes and other information, which is very helpful for paramedic crews when they have a mental health crisis. We are looking at how we use innovation to better give voice to the patient, and often to do that before they have the mental health incident, rather than when the ambulance arrives.”
“In a former role, when I was Chief Secretary to the Treasury, I signed off a significant expansion of A&E facilities. I hope that reassures my hon. Friend of my commitment to putting more capacity into emergency departments, not least because they need a certain level of capacity to be able to ensure same-day access, triage and ways of getting flow into the system. As for the wider site proposal, clearly the ICB for his area will want to prioritise that.”
“I am very happy to meet with the hon. Lady and colleagues to discuss this further. I think most people recognise that, since the huge pressures from flu over the Christmas period, the flu numbers have come down, but of course there is continued pressure in the system.”
“My right hon. and learned Friend has been key to securing the funding. He has assiduously lobbied me and ministerial colleagues to make a powerful case on behalf of his constituents, and I think he should be proud of the outcome, which reflects his and his parliamentary colleagues’ work on this issue. He is right; indeed, the case he made was around how this frees up capacity in the system, which will result in much better care for patients in Swindon.”
“I have addressed that point, in that we are bringing forward the third component of our three plans. I spoke earlier about the elective recovery plan; today’s announcement is on the urgent and emergency care recovery plan; and the third element will be the primary care recovery plan. Of course, alongside the work we are doing on dentistry it is also about access to services, both dentistry and A&E. That comes together in things such as the 111 service and how we review that, as well as the NHS app. It is about looking at how we better manage demand at the front door, and the demand for dentistry is not only through NHS dentistry but often manifests itself through a lot of patients coming forward for dentistry at A&E.”
“I commend my hon. Friend for her assiduous campaigning on behalf of her constituents in Southend, through which she played a key role in securing the extra £8 million of funding. She is right that that will make a material difference not only to flow and capacity within the hospital but through that to the overall standard of patient care.”
“As the hon. Gentleman will know, the additional funding that the Chancellor announced in the autumn statement will lead to an uplift in health funding for Northern Ireland through the Barnett consequentials. On the flexibility within that, the hon. Gentleman will know that I agreed flexibility when I was Chief Secretary; it will of course be for Treasury colleagues to look at the requirements for ongoing flexibility within Barnett consequentials.”
“As a former Minister in the Department, my hon. Friend speaks with great experience on these matters. He is right that the crux of the plan is now in its delivery. As I alluded to in my statement, a key component of that is more transparency in the data so that he and colleagues throughout the House can hold to account not only the ICBs but the local authorities. We need to bring those two datasets more closely into alignment.”
“I am keen to explore with colleagues how we can put more key worker accommodation on to the NHS estate, particularly by making use of modern methods of construction to expedite that. On the workforce plan, Devon is an area that has seen particular growth, given its older population, and greater pressure as a consequence. Those pressures will be worked through in the workforce plan that we will bring forward shortly.”
“They can start to access them now. We announced £250 million at the start of the month, as part of the £500 million that was announced in the autumn statement, and hospitals know that funding of up to £8 billion is coming in the new fiscal year, so this is an opportunity for them to move at pace.”
“I do not think it has been hiding. Flu seasons are not uncommon in the NHS and come round on a periodic basis, and that is why we anticipated it through the flu vaccine. On the hon. Gentleman’s wider point, it is also recognised that as a consequence of covid some resistance to flu may have been lowered, but we have had flu pressures on the NHS in past years.”
“My hon. Friend is right that not every patient accessing an emergency department needs a tier 1 A&E facility. This is about right place, right treatment for the patient, and making better use of urgent care centres. How those centres can better triage patients who can be treated there is a key part of the plan we have set out.”