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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“In the past 12 months, the average waiting time for patients to start consultant-led treatment at hospitals in northern Lincolnshire and Goole was about nine weeks. We recognise that some trusts face particular challenges with their waiting lists due to rising demand. That is why a package of support, including a system-wide improvement board, has been established within the trust.”
“I think the hon. Lady prepared her follow-up before hearing the answer. There is an improvement board established within the trust, chaired by NHS Improvement, that is tasked with reducing waiting times and ensuring that the standard is improved. Currently, the average time waited is 11 weeks for out-patients and seven weeks for in-patients.”
“My hon. Friend is right to point out the need to give support to this trust. That is why a wider package of £1.6 billion of funding has been given to the NHS to improve accident and emergency and elective care performance. Alongside that, we have specific work through NHS Improvement to address some of the particular issues that he alluded to in his trust.”
“The Department wrote to all NHS and foundation trusts in September 2017 to remind them that tax avoidance schemes should not be entered into in any circumstances, but the hon. Lady makes a slightly strange point. She seems to be arguing that NHS hospitals are, in essence, paying too much tax to the Treasury, rather than having that money within the NHS. These subsidiaries are 100% owned by trusts themselves.”
“I admire how the VAT element of the original question was brought into a discussion of exit payments. As my hon. Friend will be well aware, I visited the issue of exit payments frequently as a member of the Public Accounts Committee, and I am happy to discuss it further with him.”
“It is interesting, looking at the comparisons, to see that the NHS in Wales appears to have changed a number of them, to make it more difficult to compare performance between England and Wales. The more scrutiny there is of the performance in Wales—where clinicians say that the best performance often equates to the worst performance in England—the more we will see the need for serious changes in the way in which the NHS delivers its services in Wales.”
“The King’s Fund has said that STPs offer the best hope for the NHS and its partners to sustain and transform the delivery of healthcare, so the King’s Fund endorses this recommendation. As the right hon. Lady will know, we announced an additional £325 million of capital funding in the spring Budget to invest in local areas, and in the autumn Budget we committed an additional £10 billion package of capital investment over this Parliament.”
“The hon. Lady highlights an important point about the variance in performance between trusts and how we look at some of the lessons from, for example, Lords Carter’s work on efficiency, rotas and how to maximise the value of funding. I am happy to consider her specific point, but she is right that how we manage the patient pathway, in particular the 43% of hospital beds occupied by 5% of patients, is a key challenge.”
“My hon. Friend is right to draw attention to the funding going into Corby, and it is a tribute to his campaigning as a constituency MP that there is such progress on that measure. I am happy to look at the specific issue. It is important that the CCG continues to consult both Members of Parliament and the public as it takes that work forward.”
“I am very happy to confirm my hon. Friend’s observation. It is absolutely about improving services. This proposal for a new hyper-acute stroke unit in Basildon will ensure there are specialist nurses and doctors available to manage patients at all times, which very much draws on the lessons from London, where we consolidated stroke services and where health outcomes were improved and lives were saved.”
“As my hon. Friend will be aware, we announced further funding in the Budget and the autumn statement. On the specifics of Telford, which she has raised on a number of occasions, I am very happy to have further discussions with her.”
“I am not aware of the specific case the hon. Lady highlights, but I am happy to look at it and to understand why she feels the rents are disproportionately high. This relates to the point I made earlier in response to the hon. Member for West Lancashire (Rosie Cooper), which was about the variance in the system and how we ensure that we obtain best value for money. The reality of the debate on health is that the Labour party simply sees it in terms of how much is put in, whereas Conservative Members recognise that we need to both invest more in the NHS and make sure we get the best outcomes. That is the key dividing line between the parties.”
“There are good plans in place for getting Worcestershire Acute Hospitals NHS Trust and the Alex, specifically, out of special measures. A package of support is in place to enable the trust to improve its quality of care. Delivery of the acute service redesign plan is a key driver to sustaining services in the medium term and £29.6 million of STP funding has been agreed to support that.”
“May I first pay tribute to my hon. Friend for the work he did in the Department and the high esteem in which he was held by those working in the NHS? On Shrewsbury and Telford, I very much appreciate the importance of the reconfiguration of the trust. We expect a decision shortly on that, although I am not in a position to announce it today.”
“It is important to remind the House that the deferment of operations referred to in that guidance applies to about 13% of hospital beds dealing with elective patients, of which about half were protected within the guidance in respect of cancer and other urgent elective treatments. The guidance was updated on 26 January to confirm that further deferment of hospital operations is no longer needed. In terms of the impact that the guidance has had on operations, we will not know that until mid-March, when that data will be published and placed in the Library for the benefit of those on both sides of the House.”
“Winter is challenging for health services worldwide. With a high number of flu cases this year, we have seen an increase of about 35% in accident and emergency attendances for flu—triple what it was last year—with about 3,000 hospital beds occupied as a result of flu and a further 700 because of norovirus. The NHS saw 1,200 more patients at A&E compared with this time last year. The guidance issued by the national emergency pressures panel sought to free up capacity for emergencies given the high number of flu cases, including from two dominant strains of flu co-circulating this year.”
“Over 1 million more people have been vaccinated for the flu virus, 99% of A&Es have GP streaming and over 3,000 more beds have been made available since November, reflecting the extent of the plan.”
“A party preparing for a run on the pound will be in no place to give funding to the NHS. It is the agreed convention of the House that responses to Opposition day debates are provided by the Department within 12 weeks. The Secretary of State will of course do that within that period, and there is a good reason for that. As I set out in my opening remarks, the data will not be available until mid-March, so the hon. Member for Leicester South (Jonathan Ashworth) is premature in asking this urgent question. The facts are that the NHS was better prepared for winter this year. The number of 111 calls dealt with by a clinician has doubled compared with last year.”
“If the hon. Gentleman would like to compare with the performance of the NHS in Wales, we will undertake a comparison. The reality is that this year, we have had pressure on the NHS as a result of flu. The difference is that in 2009, the Conservative party did not play politics with the flu pressures. This year, the hon. Member for Leicester South has done so. He should compare it with the pressure in Wales and see the excellent performance we have had in comparison.”
“My hon. Friend, the Chair of the Health Select Committee, makes a valid point about the need for much more integration in our approach to the NHS. That is reflected in the appointment of my hon. Friend the Member for Gosport (Caroline Dinenage) as the Minister for Care, to look at that exact point. Part of it is also looking at how we address other areas to deliver better outcomes. For example, 43% of bed occupancy at present is from just 5% of patients—those staying over 21 days. One key issue is how we bring down the current average stay from 40 days to, say, 35 days. That alone would unlock around 5,000 beds. We are looking at a more integrated model to address the pathways that I know my hon. Friend has highlighted in the Health Committee as a key priority.”
“I thank the hon. Gentleman for his more mature approach, in recognising the huge amount of work performed by NHS staff. Indeed, as I pointed out, 1,200 more people a day are being treated in A&E, which reflects how much more is being done in our NHS with more resource, more money, more doctors, more nurses and more paramedics. In terms of the specifics on money, the Government have given £1.6 billion to support performance improvements, which will be used to treat a quarter of a million more patients in 2018-19. The NHS planning guidance also shows that it expects performance to improve in the face of growing demand. That shows how more is being done, and more needs to be done.”
“My hon. Friend is right to highlight the importance of vaccinations. This year we have seen 1 million more vaccinations than last year, which is part of addressing the demand on A&E. The number of 111 calls dealt with by clinicians has more than doubled, which has mitigated much of the demand from the flu virus.”
“Addressing the challenge of funding was reflected in the Budget, with the additional money set aside by my right hon. Friend the Chancellor. On the comments of Simon Stevens, it is important to note what he said about the connection between a strong economy and delivering the finance that the NHS needs. Simon Stevens said: “It has been true for the 68 years of the NHS’s history that when the British economy sneezes the NHS catches a cold.” The reality is that if we are to fund the NHS as all of us want it to be funded, we need to ensure that there is a strong economy and only one party will ensure that that happens.”
“My right hon. Friend is absolutely right. The other issue that puts pressure on beds and hospital finances is many of the legacy private finance initiative deals. We also inherited those deals from the Opposition, which they very rarely seem to want to talk about.”
“I thought the hon. Lady was going to stand up to reflect on the fact that her trust got £2.9 million of additional funding from what the Chancellor set about doing. The reality is that this Government are putting more money into the NHS and addressing the demands on the system.”
“We are in discussion with Health Education England on workforce planning and ensuring that we address concerns about retention and training, part of which is the fact that the Chancellor has lifted the 1% cap as it applies within the health service, and we are of course in active discussions with the trade unions on that point.”
“I have already said that I recognise there is increasing demand, and set out many of the measures we are taking through the 111 service and other areas. The hon. Lady’s own trust has received an additional £3.2 million to address many of those pressures, and the key question is how that will be deployed by the trust to address many of the blockages in the pathways at the moment.”
“I absolutely agree with my hon. Friend that the NHS will remain free at the point of delivery. The reality is that for the majority of the NHS’s existence, it has been run by the Conservative party. We know the value of retaining healthcare free at the point of delivery, and the Secretary of State has repeatedly reaffirmed his absolute commitment to that.”
“As the hon. Lady knows, local commissioning decisions are for the clinical commissioning group and local commissioners, but again, not one Opposition Member has recognised the additional funding that has gone in. Her own trust received an additional £3.4 million— [ Interruption. ] Well, it never is enough for the hon. Lady. The question is, how, with the economic mismanagement under their party, Labour Members are ever going to deliver what they want? Her trust received an additional £3.4 million to address the pressures.”
“I very much note my hon. Friend’s bid for further training places, and he is absolutely right: there has been a 25% increase in the number of places. That is part of ensuring that we have more doctors, nurses and paramedics, which this Government have put in, to address the increasing demand that the NHS faces.”
“What the hon. Lady’s question points to is how we better integrate care as between hospitals and the care sector. That is exactly the issue that the Minister of State, my hon. Friend the Member for Gosport (Caroline Dinenage), who has responsibility for care, is looking at in the Department, to ensure better outcomes from the money being put into the system.”
“My hon. Friend is absolutely right. What he points to is the variance in performance between some of the best trusts, such as Luton and Dunstable, and other trusts. One of the key challenges is how we ensure that that best practice is better socialised across the NHS, because unlike Labour we recognise that it is not just about how much money we put into the NHS; it is what we get out for that money. Luton and Dunstable illustrates that point, and more trusts need to follow suit.”
“The hon. Gentleman’s trust has received an additional £1.6 million, so it is simply factually incorrect to say that its budget has been cut.”
“My hon. Friend is an assiduous campaigner for his constituency, and he is absolutely right to highlight both the progress made and the importance of the prevention offered through the increased number of vaccinations. I hope many more people next year will continue to take up the vaccination, including Members of this House.”
“Again, the hon. Gentleman is ignoring the increase in the number of doctors. There are now 14,900 more doctors and 14,200 more nurses in the system. As I alluded to earlier, it is not just the number of beds; it is also how we manage those beds. It is how we manage the fact that 5% of the patient population is occupying 43% of beds that will best address bed occupancy rates.”
“As my right hon. Friend knows, the challenge at Harlow is recognised by the Department. That is why, from memory, its outline business case has been approved and it is now going through the next phase in terms of getting the final business case approved. I am very happy, as always, to discuss the progress of Harlow with my right hon. Friend.”
“Those are all part of the actions taken by this Government to prepare and plan for the pressure of the flu issue we have had to manage.”
“Again, the hon. Gentleman is ignoring the huge number of measures that have been put in place. As Sir Bruce Keogh himself recognised, there was much more planning this year at a much earlier stage. We have had better integration between NHS England and NHS Improvement. We have had a much more comprehensive planning cycle. We have had better access to primary care, reducing pressure on the front door. We have had stronger action on delayed discharges, addressing issues at the back door. We have had changes to the way ambulance services respond to calls, so there is better prioritisation. We have also had financial incentives focused on A&E performance, so there is a huge range of measures, in addition, as I said earlier, to 1 million more people being vaccinated against flu.”
“My hon. Friend is right. There is a desire among Labour Members to avoid the reality of what is happening in Wales, where clinicians said that their best performance is often akin to the worst performance in England. However, we recognise that there needs to be much more integration in the system. That is why the Minister of State, my hon. Friend the Member for Gosport, is looking at how we have better integration in the NHS and the community in terms of domiciliary care, and at how we address some of the issues in the pipeline—the pathways—in hospitals to get a better flow, so that the discharging of patients is not delayed. Much progress has been made, but we recognise that more needs to be done.”
“The Labour party seems to have moved from complaining about the amount of money to complaining that it was not delivered early enough. The hon. Lady’s trust received £3.4 million of additional money, but, as Sir Bruce Keogh has made clear, the point is that preparation for winter this year began much earlier than normal and was far better advanced than has been the case before. That is what the medical director of the NHS has said about how we prepared for winter this year.”
“My hon. Friend points to a key point that I have made throughout this session. It is not just about how much money is put into the NHS, but about the outcomes that are delivered as a result. He is right to allude to the fact that in Scotland the SNP has not delivered the improvements it promised on the NHS. That is why there is so much dissatisfaction in Scotland with what is happening in the NHS there.”
“The hon. Lady raises a very valid point. It is exactly why we will have a Green Paper this summer looking at what steps need to be taken to address this issue. On both sides of the House, we recognise that more needs to be done on how we address these concerns, and that is what the Green Paper will tackle.”
“The hon. Gentleman makes quite a serious allegation of my misleading the House. What I was very clear about is that there has been a 35% increase in attendances at A&E as a result of flu this year compared with last year, and that around 3,000 beds are currently occupied by patients with flu and around 700 beds are occupied by those with norovirus. Clearly, that has resulted in significant seasonal pressures this year, which have placed strain on the system. That was recognised by the Government in the additional funding that was put in place. It was recognised by the NHS, as Sir Bruce Keogh set out in the early planning that was undertaken, and it is simply wrong for the hon. Gentleman to ignore the impact of flu this year, given the way that in 2009 the then Opposition were very responsible in recognising its impact.”
“We continually hear this myth about privatisation. The reality is that this Government appointed to run NHS England, first, Sir David Nicholson, who had previously been appointed by the Labour party, and then Sir Simon Stevens, who has worked for both sides of the House. Numbers show that the level of private healthcare provision has not changed this year compared with last year. I understand that the Health Committee is due to look into ACOs and integration within a matter of weeks as part of its deliberations, and I very much look forward to reading the conclusions in that Committee’s report.”
“The impression given by the hon. Gentleman is that he always seems to oppose reconfiguration of any sort. The reality is that most clinicians will say, “We do need to reconfigure. We do need to look at how services are operated.” The evidence of that can be seen within London in terms of the reconfiguration of stroke, which from memory, he opposed—”
“If the hon. Gentleman did not oppose it, I will happily correct that, but he will recognise that the reconfiguration of stroke in London to fewer sites significantly improved outcomes for patients. There is always a discussion to be had about how reconfiguration operates, but clinicians and the royal colleges recognise that the benefits of reconfiguration are better outcomes for patients as well as better outcomes for the NHS.”
“We are also working to support the trust in addressing issues with patient handovers to hospital trusts, which have been an issue in parts of the east of England. We are clear that handovers must take place within agreed timeframes, and we are supporting hospitals to ensure that improvements are made. As I noted earlier, the trust is working with hospitals to ensure adherence to the national guidance on handover delays. It has also deployed patient safety intervention teams to hospitals to undertake patient cohorting where significant hospital delays arise, as well as placing hospital ambulance liaison officers in emergency departments to help ambulance crews to respond more quickly to incoming calls.”
“This review covers the trust’s demand and capacity modelling, staff recruitment and training, and its approach to pricing and contracting in order to enable it to meet the new ambulance response standards. The detail of this work is being finalised and will be presented to the trust board meeting in March. With respect to the ambulance workforce, we are taking significant steps across the country to support staff. Compared to 2010, there are over 3,000 more paramedics in England. We agreed in December 2016 that NHS paramedics will be re-banded from band 5 to band 6 on the NHS pay scale. This moves paramedics significantly up the NHS salary structure, and helps to ensure that we are better able to recruit and retain staff in the future.”
“The evidence behind this new framework is extensive, covering data collected from more than 14 million emergency 999 calls. The evaluation considered a number of key issues for the east of England, including prioritising responses to the sickest patients while helping to reduce long waits for ambulance responses, and ensuring that patients receive the most appropriate response for their condition. That being said, I do recognise that the trust’s performance against these standards needs to improve. As I mentioned earlier, NHS England and NHS Improvement are working with the trust to help it to adapt to the new performance framework, and have also undertaken an independent service review of its operations.”
“Under Sir Bruce Keogh’s review of the NHS urgent and emergency care system, ambulance services are being transferred into mobile treatment centres, making much greater use of “hear and treat”, which is treating patients over the phone, and “see and treat”, which is treating and discharging patients on the scene. In December, the East of England Ambulance Service NHS Trust resolved three out of 10 incidents on the scene without transporting a patient to A&E, freeing up resources to respond quickly to the patients with the most urgent needs. Additionally, in July last year the Secretary of State approved a revision of operational and performance standards for ambulances following the ambulance response programme. These improvements have now been rolled out to all mainland ambulance trusts in England.”