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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“Taken together, this will reduce the number of people getting seriously ill this autumn and winter, easing pressure on the NHS at a critical time. Vaccines have always been, and continue to be, one of the best protections we have, both for ourselves and for the NHS. From this heatwave to the foreseeable pressures in autumn and winter, I will continue to work closely with colleagues across health and social care, as well as with Members across the House, to ensure that we can address the challenges ahead. I commend this statement to the House.”
“In England, an estimated one in 19 people tested positive in the week to 6 July, compared with an estimated one in 25 during the previous week, with more than 13,000 patients admitted to hospitals with covid-19. Given those pressures and the expected pressures this autumn and winter from respiratory viruses, we are taking important steps to further align our offers on covid and flu. On Friday, I accepted the Joint Committee on Vaccination and Immunisation’s recommendations for a covid-19 autumn booster programme, focusing on vulnerable cohorts, including everyone aged over 50. At the same time, I took the decision that we should keep offering flu jabs to more cohorts than we did before the pandemic.”
“With services under so much pressure, we must make sure that 999 calls are reserved for life-threatening emergencies. We must also consider what advice we can get through other services such as NHS 111, NHS online resources and local pharmacists. In addition to the immediate steps to mitigate the pressures on 999 calls, ambulance services and adult social care, we will keep building on our operational response, with particular attention to discharge and expanding on our pockets of best practice. That is particularly pertinent, given the current levels of covid, which continue to rise. The latest data from the Office for National Statistics shows that the percentage of people testing positive for covid continued to increase across the UK.”
“The NHS is executing its urgent and emergency care recovery 10-point action plan, which includes action across urgent, primary and community care to better manage emergency care demand and capacity. The NHS medical director and chief nursing officer both recognise that this will place an additional burden on some staff, so they are asking trusts to increase efforts on staff wellbeing and support. Alongside the measures being taken by the ambulance services and NHS trusts, the UK Health Security Agency is leading on public health comms to reduce the burden on NHS staff by making sure that we do not create unnecessary demand. We can do that by following the common-sense public health guidance and by looking out for others, in particular the elderly and the vulnerable.”
“On ambulance handovers, we are asking health leaders to look again at the balance of risks across the system. We know that leaving vulnerable people in the community would have serious implications for patient safety. Equally, we know that keeping people in ambulances for too long carries other risks, especially from heat. NHS leaders are therefore asking hospital trusts to create additional space for new patients in their units. That may involve the creation of observation areas or exploring ways to add additional beds elsewhere in hospitals, including by adjusting staffing ratios where necessary, as we did during covid, and working to identify areas to mitigate additional workload, such as through greater support on wards with pharmacy and administration.”
“Taken together, that has caused significant pressures, which are now being compounded by this extreme heat. We are taking action in a range of areas. In May, NHS England published a tender for auxiliary ambulances to provide national surge capacity to support ambulance responses during the period of increased pressure. Alongside measures in ambulance trusts to assist with call handling and capacity, NHS hospital trusts are taking steps to address handover delays, in the interests of patient safety. On Friday, the NHS medical director, Steve Powis, and the chief nursing officer, Ruth May, wrote to the chief executives of NHS trusts, ambulance trusts and integrated care boards setting out some of the urgent interventions we need to make; most significantly the focus was on improved ambulance handovers and increased hospital bed capacity.”
“We have held numerous meetings with NHS leaders, including the chief executive of the NHS and her senior team, to continue to implement their long-standing heatwave plans. We had a further meeting again this morning. Meanwhile, ministerial colleagues have continued to liaise with our local resilience forums to co-ordinate across both health and social care. Even before this heatwave, ambulance services in England have been under significant pressure from increased demand, just as they have across the United Kingdom. The additional pressure on our healthcare system from covid-19, especially on accident and emergency services, has increased the workload of ambulance trusts; increased the average length of hospital stays; and contributed to a record number of calls.”
“Level 4 does not change the contingency plans in place across the health system, only their likelihood. We have taken a number of steps in response. Cobra has convened several times, including over the weekend and earlier today, to co-ordinate every part of the Government’s response to this emergency, and I have held a series of meetings with the chief executives of ambulance trusts to discuss the specific measures that they are taking. Steps include increasing the numbers of call handlers; extra capacity for ambulances; and extra support for fleets, including the buddy system, so that calls can be diverted to another trust if there are delays in the area people are calling from.”
“Following the announcement by the Met Office on Friday of a red warning for extreme heat, I would like to update the House on the impact of extreme weather on health and care, the current covid infection situation and our plans for covid and flu vaccines this autumn. This is the first time in its history that the Met Office has issued a red warning for extreme heat. The warning covers today and tomorrow. In addition, the UK Health Security Agency has issued its highest heat alert. Its level 4 alert, issued to health and care bodies, means that the heat poses a danger to all of us, not just high-risk groups. Although for many the risk from this heat can be mitigated by simple, common-sense steps, the extreme temperature poses a particular risk in respect of cardiovascular conditions, including heart attacks and strokes.”
“Just as the Chancellor of the Duchy of Lancaster set out that he was engaging with the Prime Minister in his role chairing Cobra as Minister for the Cabinet Office, I am happy to confirm to the House that I also engaged with the Prime Minister over the weekend, updating him on the health plans we have put in place. He has been closely engaged on the contingency we have put in place.”
“I am happy to share with the House that I have been on visits to four different hospitals, in Whipps Cross, Hillingdon, King’s Lynn and Bedford; I have been out on two different ambulance shifts, been to three different ambulance centres, been out to see GPs to look at boosting access to their services and been to look at life sciences. I have been engaging, and that sits alongside, for example, the meeting with chief execs of ambulance trusts on Saturday, Cobra on Saturday and other such meetings that I have had in the course of my duties. Finally, the hon. Lady asked about the Prime Minister’s engagement.”
“I do not know whether she is asking for that apology from the Welsh Government or just from the English Government. She may want to clarify that, given the performance of the Welsh ambulance service under the Welsh Government. On the hon. Lady’s point about auxiliary, the Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes, said in her statement that we had seen improvements in May. I referred to that as context, but on auxiliary in particular I can clarify for the House that a contract is being procured for auxiliary ambulance services and is expected to be concluded shortly. Finally, the hon. Lady asked what meetings I have held over the less than two weeks that I have been in post.”
“The hon. Lady also suggested that these challenges, which are being faced across Europe as a whole, were in some way due to the overall investment in the NHS. I remind the House that, to take the resource departmental expenditure limit alone, RDEL in 2010 was just under £99 billion and last year it was £150 billion. That is a good indication of the significant funding. We could also come on to capital investment, not least with the 40 hospitals programme, part of a £22 billion package to 2030, which underscores this Government’s commitment to investing in our NHS—an investment that, most recently, the Labour party voted against when we brought it to the House. The hon. Lady asks about an apology for operational levels of performance.”
“It is also why we have put in specific funding, such as: the additional £150 million of support targeted at the ambulance service; an additional £50 million for 111 calls to build capacity; and as she said, an additional £30 million for auxiliary ambulances, which is what the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield), was referring to in the House last week. The Met Office and the UK Health Security Agency went to level 4 on Friday. As you will know, Madam Deputy Speaker, I updated the House on the first available sitting day after that. The irony will not be lost on the House that this issue is seen as so important that the shadow Secretary of State for Health and Social Care has failed to turn up to this statement in the middle of a heatwave. [Interruption.] Well, he is not here, which speaks for itself.”
“Let me start with the area on which the hon. Lady was correct, which is that I recognise the increased pressure on ambulances and hospitals. That is why we put in place the long-established contingency plans. Since the heatwave in Paris in 2003, it is the case that each year in May, we put in place our heatwave plans. That is what has been activated. Those plans were refreshed as recently as two months ago and sit alongside the work that has been done on urgent and emergency care, including the 10-point action plan that was set out last September. The hon. Lady is right: the House as a whole will recognise the significant pressure on the system, which is why we are taking the steps from our contingency plans.”
“There is also a call for expressions of interest in pioneer science to better use tech and innovation on delayed discharge, and of course there is £2.6 billion of investment in the better care fund to support that integration work through the integrated care boards.”
“I am grateful to my right hon. Friend for that warm welcome. I was Minister of State when he was Secretary of State, and hugely valued the expertise, diligence and insight that he brought in that role, which provide useful context as I take on my new duties. He is absolutely right; indeed, he will recall, in 2018, looking in detail at delayed discharge, and work on that key issue continues. For example, on 1 July the NHS launched a 100-day sprint looking at all the known interventions. One issue that he and I have discussed in the past is how to socialise best practice and industrialise innovation at scale, and we are looking specifically at that.”
“The hon. Lady brings great practical insight on these issues from her profession as a nurse. The point she raises, as did my right hon. Friend the Member for South West Surrey (Jeremy Hunt), is absolutely right—delayed discharge has long been a key issue. That is why we have made the tough decisions we have on national insurance and why we brought forward the changes on integrated care boards. It is an area of common ground across the House that we need to work better to address delayed discharge, which blocks the pipe and, in turn, delays ambulance handovers and causes problems at an earlier stage. It is a key issue. I have set out a number of practical measures that we are taking, and further work is ongoing.”
“My hon. Friend is absolutely right on mental health and where a patient is violent, as I saw for myself on my visit to Bedford, for example, that can be unsettling for A&E. I am happy to have further conversations with him on what measures can be taken. The fact is there is no single intervention in this space; it is a question of looking at the integrated approach. That is what the call for evidence is about. Also key is understanding the data and seeing where it can better target action on areas such as mental health that can have a disproportionate impact.”
“Local contingency plans are in place to allocate resource to meet that.”
“The principle of subsidiarity is that, as part of the extreme heat plans, local trusts make decisions locally on targeting resource, whether that has an impact on outpatients or other services, to meet the increased pressure. The hon. Lady is absolutely right that there is significant increased pressure, as we see in the call volumes coming in to 999 and 111. Part of the contingency plans that are in place is to surge resource, but it is also partly about being clear where risk best sits. At the heart of the letter from NHS medical director Stephen Powis on Friday was the importance of not pushing risk out into the community where it is an unmet need, or into the ambulance, where it is best that patients are, but having that risk more on the ward, where a patient is known and can receive care.”
“First, I am happy to join my hon. Friend in paying tribute to the work of the local staff in her ambulance trust. She raises an important point about the fleet, and I was very interested in this issue four years ago when I was ambulance trust Minister and discovered that there were, I think, 32 different types of ambulance. When I was out with crews over the past fortnight, one of the issues we discussed was the merits of tailgates so that people are not suffering work absence and musculoskeletal injuries because they are trying to push heavy loads on to an ambulance. I am interested in exploring with her and colleagues how we get the right standardisation and the right fleet in place. Indeed, we have been targeting additional money to support that work.”
“The hon. Gentleman is right that the west midlands in particular has been under significant pressure, and 111 ambulance service response times are significantly challenged, which is driven by wider system pressure and delayed handing over of patients. The measures taken through the national support that is going in include handover delay improvements, on which works is taking place across all integrated care boards. NHS England has allocated an additional £150 million to support the system, and an extra £20 million of capital is going into fleet. Given that I am new in post, I am happy to meet the hon. Gentleman to discuss any specific issues about the West Midlands ambulance service’s performance.”
“My right hon. Friend, partly through the direct experience he brings to these issues, highlights the integrated nature of the challenge we face and in particular the importance of getting the right domiciliary care and care home support in place. Part of that challenge in the coming weeks, ahead of any autumn and winter pressure, will be to understand what the capacity is and what the constraints on it are, so that through the integrated care boards we can better focus on unlocking that capacity to relieve the pressure on ambulance handovers, as he sets out.”
“I broadly agree with the hon. Lady on providing targeted support, particularly to those in domiciliary care; we are working with those in primary care on that. In coming days, that will happen specifically through local resilience forums, but in the medium term it will be more through the integrated care boards. That is part of a wider package of support measures that need to be put in place. It will include working with primary care, looking at mental health support, and looking at what can be done to raise productivity through better use of innovation and technology. We will look at all the interventions available across the board to assist us in dealing with the pressures that she highlights.”
“I am happy to look at that, and I thank my hon. Friend for his service locally. I am keen to follow up on his point, because it is absolutely right. From the feedback from ambulance trusts so far, it seems that category 2 average response times were broadly stable at the weekend, but how we triage, how we categorise calls, and what additional support can be given by considering the skills mix are all factors in improving performance.”
“Through initiatives such as the better care fund and the £2.6 billion of investment, we are looking at how to allocate funds in an integrated way. That requires better integration of data between the care sector and the NHS, and that is an area that I am keen to explore.”
“I know from conversations in recent days that there has been significant work around dispatch, the assessment of calls and the role of clinicians, particularly in 111. There is further work with frequent callers. I went out with the London ambulance service, and one of our visits was to someone who had had 140 ambulances visit him over the past year and a half. There are initiatives, and work going on, on how we assess calls and get dispatch right, but I am very happy to take forward the comments that my hon. Friend makes.”
“I know the hon. Gentleman is co-chairing, with the Minister for Care and Mental Health, a strategy board looking at these issues, and I would be very keen to explore that with him in due course. There is an opportunity—not just from a health perspective, but from a levelling up perspective—to look at the pockets where there are gaps in the way he sets out, and to see how we can get better coverage geographically as well as address the very real health needs he identifies.”
“I do not know the specific circumstances of the case my hon. Friend highlights, but in general good consultation and engagement with stakeholders will of course lead to better and more informed decision making. Where decisions have been taken and the outcomes proceed in a sub-optimal way, I know from my knowledge of my hon. Friend that he will make such a case in the strongest terms.”
“This Government are investing in our NHS. That is why the resource departmental expenditure limit, which in 2010 was £99 billion, went up last year to £150 billion. It is why we are investing more than £10 billion in capital this year alone. It is why the NHS will get an uplift of about £38 billion over the five years from 2019-20 to 2024-25, and it is why this Government have invested in our 40 hospitals programme as part of a £22 billion commitment.”
“That specific point about where risk best sits within the system was addressed in the letter from the NHS medical director on Friday. Of course, the best way of addressing that risk is to address the issue of delayed discharge. We are getting people out of hospital through initiatives such as the better care fund, the £2.6 billion of investment and the use of integrated care boards. Their use will enable us to take a more integrated approach to unblocking those who are in hospital unnecessarily, which is not only very expensive but fundamentally bad for their care. It is important that we address delayed discharge as a key priority.”
“I am happy to look at any specific issues that flow from the hon. Gentleman’s constituency case. The more we can use tech and innovation better to address those issues at pace, the more that will ultimately lead to better patient outcomes.”
“The Government are working closely with the food industry to ensure that the UK’s food security is resilient to shocks. The resilience strategy will be published this summer and will reflect a range of global resilience issues.”
“We are working in partnership with the food industry—indeed, only yesterday I chaired a roundtable with industry representatives—and also working in partnership across the United Kingdom. We had representatives from the devolved Administrations there yesterday for what is a common purpose. We all want to see resilience, given the pressure on food prices, and we are working in partnership with industry representatives to take that strategy forward.”
“One specific area is working with international partners as to how we get the grain out of Ukraine. There is a pressing timescale on that—a four-week window—so the matter is urgent. Indeed, when I met the US ambassador who has newly arrived in her post, that was one of the issues we discussed, as we do with other international partners.”
“The hon. Gentleman raises an extremely important point. I suggest that he looks first at the approach we took in the autumn, when our supply chains were under pressure. We showed considerable flexibility and worked with industry leaders such as Sir Dave Lewis on how to adapt our approach. Obviously, there are schemes such as the seasonal agricultural workers scheme, which has a review mechanism that potentially allows an extra 10,000 workers if required. There is also the opportunity to invest in areas such as agri-tech, and policy from the Chancellor such as the super deduction facilitates that investment.”
“The Government are dedicating significant resources to understanding and countering Russia’s cyber-threat, working with our allies. That has included joint advisories with our Five Eyes partners on how to mitigate that threat.”
“My hon. Friend raises an important point. We are spending £2.6 billion over the next three years to counter that threat. That is additional to the significant funding going into the National Cyber Force, which gives us offensive capability as well. Alongside that, we have a whole of society approach as set out in our national cyber strategy. I know that you, Mr Speaker, will take a great interest in particular in the north-west cyber-corridor, which is about leveraging that investment in the National Cyber Force and making it about skills across the north-west as a whole.”
“My hon. Friend is right on that. I know that he has taken a close, long-term interest in the issue, so he will be aware both of the provisions in the National Security Bill on capturing foreign interference as an offence and of the measures in the Online Safety Bill that will force big tech platforms to take action on disinformation.”
“The assessment is a sobering one. If I just take online scams as one example of cyber risk, there has been a fourfold increase from 2020, with the national cyber strategy seen as thwarting 2.7 million online scams. I am sure the hon. Member and the House will agree that this is a UK-wide threat. That is why we are working closely with the devolved Administrations and industry to look at our skills, taking both a whole of society approach and a whole of the United Kingdom approach to countering that risk.”
“One of our first actions on taking office was to create the Office for Veterans’ Affairs to co-ordinate support across government. As we approach Armed Forces Week later this month, the Cabinet Office remains focused on our goal to ensure that the UK is the best place in the world to be a veteran by 2028.”
“Mr Speaker, I feel I should have started with a birthday tribute; I think the credit for that goes to the Opposition Front Bench. After the wonderful platinum jubilee, which I know colleagues across the House enjoyed, I pay tribute to the work of civil servants across government, who played a key role in facilitating it. As part of the platinum jubilee celebrations, a civic honours competition was held for city status. The Government were pleased to announce that Her Majesty the Queen had commended city status to Bangor, Colchester, Doncaster, Douglas, Dunfermline, Milton Keynes, Stanley and Wrexham, and that lord mayoralty status was granted to Southampton. I know Members will take great interest in those awards. Colleagues will have seen the work of our armed forces, as part of our work for the jubilee.”
“It is such a luddite approach from Opposition Members to suggest, when businesses such as Amazon are showing exactly what technology can deliver, that the Government who are there to serve the taxpayer and the public should not embrace the same technology that we see in our best companies.”
“Let me take that question on directly. First, the situation has got better, and the response has been addressed in Prime Minister’s questions and in other questions today. To be specific about how we are dealing with this, we are looking at business and the scope of machine learning and technology. At the moment, only a very small proportion of the passport application process is automated. If the photo is taken in a booth as opposed to at home, that significantly increases the level of automation that can be delivered and that, in turn, reduces the number of staff who are manually required.”
“That is why it is a luddite approach to see any change that brings in technology and new ways of working as a threat to the trade unions that support Opposition Members.”
“Usually, one would expect the House to value corporate memory and experience and the fact that the reforms initially put forward by Lord Maude were a cornerstone of the declaration of civil service reform, signed by the Cabinet Secretary and my predecessor as Chancellor of the Duchy of Lancaster, my right hon. Friend the Member for Surrey Heath (Michael Gove). If one looks, for example, at the changes in Government relating to functions and the role of developing functional expertise—whether that is in the Government Property Agency or is about commercial contracts or digital and IT—one can see the value for money that is delivered by bringing in that expertise. This is about learning from the best in the private sector.”
“My hon. Friend will know, having been a senior business figure before coming to the House, that it is about linking resource to outcomes. We have increased resource in the Passport Office on a temporary basis; we have put in 650 staff since April last year to address the surge in applications as a result of the backlog from covid. At the same time, there needs to be a change in how we deliver public services, and particularly in how we digitalise access to them. Too often, the same information has to be entered multiple times when addressing things from the Government. We will streamline that through the single sign-on process, and the Passport Office will be one of the beneficiaries of that programme.”
“The hon. Lady raises an extremely important point. In the work of the equalities unit in the Cabinet Office, a key focus is on variations in the data across social groups, place and economic background, so that we can learn the right lessons. I am sure that, as part of the inquiry review, Judge Hallett will be looking closely at the data, particularly where there are variations within it.”
“I very much recognise the considerable interest in and concern about that issue across the House. A cornerstone of our procurement legislation is much greater transparency about the £300 billion of taxpayer spend consequent on that legislation each year. That transparency will better enable the House to have discussions about exactly the point that my hon. Friend raises.”