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.”
The complete record
Every one of 4,327 lines we hold for Steve Barclay, in date order, each linked to its source. Free to read, in full, without an account. Page 24 of 87.
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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 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.”
“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.”
“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.”
“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 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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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 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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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 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.”