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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“As so often, my right hon. Friend raises an extremely important point about how we best use the resources and significant investment being put into the NHS. He will recognise that a key part of delivering value for money is looking at the interfaces on the patient pathway through the healthcare system. Handover points are often when we have the most difficulty. I am sure my right hon. Friend will welcome that I recently visited Maidstone to see how we track the patient journey through a hospital and into care—residential care or domiciliary care. We are putting control centres in place through the 42 ICBs, and our reforms are bringing health and social care closer together.”
“I am delighted that the hon. Gentleman raises the additional funding that the Government are putting into social care. In his autumn statement, the Chancellor made the biggest social care spending increase of any Government in history: an extra £2.8 billion next year and £4.7 billion the year after. That is £7.5 billion over two years, on top of the £6.6 billion he put into the NHS over two years. At a time when, as a consequence of the pandemic and the war in Ukraine, inflation is extremely high and there are acute cost of living pressures for constituents across the country, the Chancellor prioritised spending not just on health but, as the hon. Member for Eltham (Clive Efford) helpfully highlighted, on social care. Bringing health and social care together is exactly what I set out in my statement to the House on Monday.”
“The data shows very clearly the profound impact of the pandemic, and the data shows that the impact is not constrained to England. It is acute in— [ Interruption. ] The hon. Member for Bradford East (Imran Hussain) has just had his intervention. If he wants to hear the answer, the reality is that the pandemic has had a profound impact on the NHS in Wales and Scotland, just as it has across Europe. That is what he is ignoring. He does not like the facts, but the facts are clear.”
“I will answer the hon. Gentleman’s first question. I will then give him a second go, as he is chuntering. Hospital flu admissions went up sevenfold in a month. The figure is 100 times higher this year than last year, and that comes on top of the severe pressure from the pandemic—9,000 cases. Perhaps he wants to explain the situation in Wales and why he feels the pandemic has not had an effect.”
“Again, I can understand why the hon. Gentleman does not want to talk about the performance of the Welsh Government, but I was talking about the Scottish, French and German Governments, and about the fact that the pandemic has had a severe impact across the UK and across Europe.”
“I am very open to that idea. For all the sound and fury that there sometimes is within the political debate, I know that there are certain topics within health on which people across the House are keen to work. Cancer is one issue that affects all families and all constituencies, and there is often scope to work extremely closely together on it. Knowing the hon. Gentleman well, I am happy to work with him moving forward.”
“May I just answer the last point, as the hon. Member for Easington (Grahame Morris) raised an important issue, and one that matters to many families? On the substance of his point about equipment, tech and innovation, we are looking at how we innovate. GP direct access is part of that, as it provides direct access to diagnostics. More patients are having their first cancer consultation following an urgent GP appointment. If we take the cohort of more than 810,000 who have started treatment for cancer since March 2020, the statistics show that 94% did so within their first month. Given the seniority of the hon. Member for Westmorland and Lonsdale (Tim Farron), I will take his intervention, but then I must make some progress.”
“Let me check the diaries with the Department. These things are always dangerous because we need to know what the travel plans and various commitments are, but I hear the hon. Gentleman and the hon. Member for Easington, and we will absolutely look at what can be done.”
“I think that it is worth breaking that figure down between the 1 million who require surgery and the 6 million who are waiting for outpatient appointments—either for their first appointment or for their follow-up. The NHS is doing more than 94 million outpatient appointments a year, of which 30 million are for new patients and 64 million are follow-ups. The “did not attend” rate is about 6.5%. This relates to the question of my right hon. Friend the Member for Wokingham (John Redwood) about value for money and how we deliver the reform of which he spoke. If we halved the “did not attend” rate of about 6.5%, it would free up almost 4 million slots. I am very interested in looking at the data and at how we prioritise within that data the wider challenge around the elective care backlog. I hope that that provides him with some reassurance.”
“My right hon. Friend raises an extremely important matter. I was in the Department when the current Chancellor was Secretary of State and when we made that commitment to a 25% expansion in medical undergraduate places. She is absolutely right in saying that it takes time for those cohorts to come through. She is also right that Chelmsford has been a huge success. I am sure that, in the context of the workforce strategy that NHS England colleagues are bringing forward, she will make the case for where any additional capacity should go, but we will, of course, look to that workforce strategy to map out what is needed. Let me turn to elective care backlogs. A number of Members across the House have raised the issue of the 7.2 million people on the waiting list.”
“That shows the Government’s commitment to backing the NHS now and in the future, which is why I commend the amendment to the motion to the House.”
“It ignores the fact that France, Germany and elsewhere in Europe also face significant pressure. The Government recognise, as I set out to the House on Monday, that there are real challenges in the NHS and social care. That is why we set out a three-phase approach: first, taking immediate steps to reintroduce flow to relieve pressure in the emergency department and across the hospital estate; secondly, putting in more capacity to build greater resilience over the course of the year, mindful of the fact that summer is increasingly a busy period—more so than was traditionally the case; and thirdly, making investments in our life science industry, such as the deals with Moderna and BioNTech, to ensure that patients in the UK get the most innovative drugs at the earliest date.”
“It is a good thing to be bringing more funding into healthcare rather than turning it away. However, conscious of your edict, Mr Deputy Speaker, I will truncate some of the areas that I was going to cover, because I am sure that right hon. and hon. Members will bring out some of those points in the wider debate. Labour’s motion ignores the statement that I gave to the House on Monday. It ignores the extra funding that we provided in the autumn statement and the commitment reflected in the Downing Street summit on Saturday to publish recovery plans for urgent and emergency care and for primary care, which we will do in the weeks ahead. The motion ignores the very real health challenges being experienced across the United Kingdom in Wales, Scotland and Northern Ireland, which all face pressures.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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 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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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. 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%.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“] 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.”
“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.”