Edward Argar
MP for Melton and Syston · Conservative · United Kingdom
“I will not keep the Committee long. I am very pleased to see the hon. and gallant Gentleman, the Minister, still in post, as this is a policy area that he has cared deeply about throughout his life. I share the broad support for the instrument expressed by the shadow Minister, my hon.”
“I appreciate it may be set out in the 2006 or 2025 primary parent legislation to these draft regulations, but if he can, I would be grateful for a little clarification. Finally, paragraph 10.1 of the explanatory memorandum refers to the legislation being continuously monitored.”
“I live in my patch and I know that there will be genuine local fury at the contempt this Government have shown for my constituents in approving a Leicester city land grab, which has cross-party opposition locally.”
“Lady was right to highlight in her remarks the importance of timely discharge from hospital as a key element of whether we can achieve that flow into hospital beds and have hospital bed capacity to allow an A&E department or emergency department to function.”
“That should not be a challenge; I suspect that that data is already extant in some part of the system. She is proposing a very moderate measure, which would pull all that together in one place, and allow it to be focused on and looked at in the round, rather than in disparate little penny packets of data.”
“Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon.”
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“Navigating a complex health and care system to meet those needs can be hard, especially when services are often funded, managed and delivered separately. People too often find that they are having to force services to work together, rather than experiencing a seamless, joined-up health and care journey. If we are to succeed in our goals of levelling up our nation, we must keep working to make integrated health and care a reality across England. Today, we are publishing the integration White Paper, which shows how we will get there. It is the next step in our ambitious programme of reform, building on the Health and Care Bill and the social care reform White Paper, which this Government introduced to the House in December.”
“With permission, I would like to make a statement on the integration White Paper. The covid-19 pandemic has been a living example of the importance of working together as one. Whether it is the extraordinary success of the vaccination programme or the work to identify and protect the most vulnerable, we were at our best when we were working across traditional boundaries towards a common goal. We must learn the lessons of the pandemic and channel this spirit of collaboration. Although huge progress has been made in bringing together our health and care services and local government, our system often remains fragmented and too often fails to deliver joined-up services that meet people’s needs. Thanks to incredible advances in health and care, people are enjoying longer life expectancies, but may be living with more complex needs for longer.”
“Our approach, which combines ambition with realism, has been welcomed by stakeholders across the health and social care space. Ours is the party of the NHS. We are the party that has put the resources into that NHS, with £33.9 billion put into law at the start of 2020, and then record funding through the health and care levy, which the Labour party voted against.”
“Those different White Papers together form a coherent whole, putting forward reform proposals that will make a difference for patients and others alike. I have to say to the Opposition that, much as they may gently chide us on this, in 13 years in government they had two Green Papers, one royal commission and one spending review priority, but still no reforms to improve social care provision in this country. This Government have seized the nettle and brought forward proposals that will genuinely move us forward. Finally, on the hon. Lady’s points about yesterday’s announcement on NHS waiting lists, this Government have been transparent with the British people about the challenge ahead of us and about our plan to meet that challenge.”
“Lady touched on how some of this might work in practice and talked about funding and budgets. We have made it clear—I used to use this when I was a local councillor—that section 75 of the National Health Service Act 2006, on the ability to pool budgets, has been effective, but it is time to go further and explore whether that remains the most effective vehicle by which that sharing of budgets can be undertaken, so it is right that we look at this. The hon. Lady touched more broadly on social care and the NHS. I have to say to her that we announced our White Paper for social care last September. She mentioned the plethora of White Papers. We rightly recognise the different parts of the health and social care system and have clear plans for each of them.”
“That is one of the key points of the White Paper: the next steps in how to deliver place-based solutions and allow the system to continue to evolve organically through that permissive approach that characterises the legislation we are putting through Parliament, rather than the prescriptive approach that the Labour party at times appears to prefer. The White Paper contains new thinking on new ways forward, drawing on not just the lessons of the pandemic but much longer-standing arrangements within localities, recognising best practice for integration between health and social care, and reflecting that organic development that occurs within a place as local leaders, local communities and those using the services work together to deliver services that work best for them. The hon.”
“It is a pleasure to see the shadow Minister in her place—she will know that I genuinely mean that, because she and I spent many happy days upstairs in Committee debating exactly these issues. This White Paper sets out clearly the next steps and builds on the strong foundations of integration that that legislation put forward, with the integrated care boards, integrated care providers and integrated care systems, which our deliberations in Committee and in this House demonstrated were clear, understandable and effective in providing locally based governance; bringing together at an ICB level NHS services within a locality, and within an ICP broader ranges of services, including housing providers and others. This has been bringing together the national health service we have with the localised delivery we all seek.”
“One of the key elements of making what he describes work is building up a body of general practitioners who are able to perform such tasks. I pay tribute to his work; we are continuing that work and building on his foundations. I am grateful for his questions and for his contributions.”
“Friend referred to a single responsible professional—not a single point of contact, but someone who brings together an individual’s care. He is right to highlight the importance of general practitioners. May I put on record my gratitude to GPs not only for all their work over the past two years, and for all they do day in, day out, but for the wisdom and care that they bring to addressing their patients’ needs? Since my right hon. Friend’s time as Secretary of State, there has been a continual drive to increase the number of doctors in our health service. Not all will become general practitioners, but we need to continue to make general practice accessible and to encourage people to choose it as an incredibly exciting and rewarding career.”
“I think that there is genuinely something to build on, and the ICSs, ICBs and ICPs at the upper level will be the vehicle to move the process forward. When I was doing it, there was a degree of personal relationship moving it forward, rather than necessarily a systematised approach, but I genuinely think that there is a willingness and a recognition of the need for this. On public access to electronic records, my right hon. Friend’s central point is absolutely right: it is important to recognise that such data is our data and individuals’ data. We must always be wary about doing something to someone, as opposed to in partnership with them. That principle will underpin our approach in this space. Finally, my right hon.”
“My right hon. Friend speaks with typical wisdom and common sense on these issues. I will briefly address each of his three points in turn. On pooled and shared budgets, I have to say that I think section 75 of the National Health Service Act 2006 has worked well. When I was cabinet member for health and adult social care at my council—I had more hair then, and it was not grey—I also sat on a primary care trust board as a non-executive member. I had a senior director of that PCT on my management team; we forged a common purpose, recognising that there would be some areas in which NHS moneys were greater than those put in by the local authority and vice versa, but the shared goal was achievable only when we worked together.”
“I saw the hon. Gentleman’s final point coming. To his original point, we are always happy to speak to the devolved Administrations and learn from their ideas, just as I am sure they occasionally look to England to see what they can learn—that is part of being a member of this Union. I speak regularly to the hon. Member for Central Ayrshire (Dr Whitford), including about such matters. To his final point, all I would say is that since 2010 we have seen around 30,000 more doctors and 38,000 more nurses in the English NHS—I have highlighted the role that my right hon. Friend the Member for South West Surrey (Jeremy Hunt) played in that—so I think we are doing a pretty good job of continuing to grow the workforce. There is much more to do, but we have a plan and we are delivering on it.”
“These plans build on what we are proposing in our legislation. At the heart of the Bill are integrated care systems, which bring together at ICB level and ICP level the local authorities that are elected to represent their areas, local people—Healthwatch will have a key voice in this space—and of course the local NHS.”
“The hon. Lady will have seen yesterday the announcement and publication of our plan to tackle waiting lists caused by the covid pandemic, the investment that underpins that, the approach to the workforce and how we will bring those waiting lists down. This White Paper builds on that; they are complementary and work together. This is about looking to the future to improve how our systems work together, but we set out a clear and comprehensive plan yesterday to do exactly what she speaks of.”
“I am grateful to my right hon. Friend in this respect. Discharge of people from hospital safely, either into a care home setting or back to their own home with support, is vital not only for their own health outcomes but for the flow of patients through our acute hospitals to enable A&Es and other parts of the system to function effectively. Through the national discharge taskforce and through the work we have done throughout the pandemic, we are bringing together acute hospitals and local authorities, and we have made huge strides together within localities in improving this and learning lessons. This White Paper sets out a way in which they can be embedded to ensure that they continue to deliver long-lasting benefits.”
“We have also commissioned from Health Education England and NHS England, now that we have announced their merger, the long-term 10-year workforce strategy, which I look forward to with interest.”
“I am grateful to the hon. Lady for her comments and for highlighting the situation Lynn and Andy find themselves in. What we seek to do, through what I said about care records, is exactly what she and I think they would wish to see, which is to reduce the number of unnecessary or duplicative interactions with the system. She touches on workforce. I set out in my remarks earlier that since 2010, under this Government, there have been over 30,000 more doctors and 38,000 more nurses. In just the past year, we have seen a huge increase in the number of nurses—I think 11,000—and an increase of about 5,000 doctors. We continue to grow the workforce and we are already working to do so. My right hon. Friend the Member for South West Surrey (Jeremy Hunt), who is no longer in his place, set a lot of that in motion.”
“I am grateful to my hon. Friend, who quite rightly never misses an opportunity to pay tribute to his local hospital trust. As he knows, I am always happy—as is my hon. Friend the Minister for Care and Mental Health—to hear any ideas for innovation that may improve outcomes for patients and communities.”
“I am grateful to the hon. Lady, although I am not entirely convinced on her point about the absence of Government action. Yes, co-operation has been happening organically from the ground up, but that has been encouraged and supported by Government action—including various pots of funding, for example relating to discharge during the pandemic—driving that activity and helping to foster that culture of co-operation. She highlights the importance of the workforce and the need for increasing numbers. That is a point I have already acknowledged. I have made clear that the Government have a plan and are already delivering increases in the workforce.”
“My hon. Friend is absolutely right. He is, I think, alluding to the fact that quite considerable inputs in the form of taxpayers’ money and resources go into the system. Members sometimes fall into the trap of talking about inputs as the ultimate result, whereas my hon. Friend quite rightly talks about outcomes for patients and ensuring that money is well spent and delivers reform and improved outcomes. That is exactly what this paper is determined to achieve. On my hon. Friend’s final two points, I will certainly consider taskforces. We have used one on tackling delayed discharge, so I know their value. I also take his point about data, and underpinning that is something that underpins all our work: co-design and doing things with patients, not to them. We must recognise that it is their data and that they should have control of it.”
“We have had these debates before. The hon. Lady knows that the pace of privatisation was fastest under the last Labour Government, when the increase in spend on the private sector was much steeper. We have always been clear in our belief in the founding principles of our NHS, which is free at the point of need, but we have also been clear, as have every other Government since the foundation of the NHS, that there continues to be a role for voluntary sector organisations and private sector providers in that context. On the hon. Lady’s final point, it is important, as in this White Paper, that we bring out the opportunity to help increase knowledge and share skills across the NHS, local authorities and the voluntary sector.”
“My hon. Friend knows, by virtue of the outcome, the persuasive and compelling case made by him and other right hon. and hon. Members from both sides of the Chamber in respect of Frimley ICS and its boundaries. As so often in this place, my view is, “If you ain’t broke, don’t fix it,” and his ICS is doing a fantastic job and other ICSs can learn from its success. Mechanisms and organisations through which chairs of ICSs get together and share best practice already exist, but we will continue to examine whether that could be better systematised, so that best practice can be disseminated more widely.”
“The hon. Lady will know from the debates on the Health and Care Bill that we are moving forward with opportunities for local authorities to be engaged not just at partnership level, as some are already, but more directly with the NHS at the ICB level. Health and wellbeing boards will continue to be a hugely important part of that.”
“As I mentioned in my earlier answers, this White Paper needs to be taken in conjunction with what we announced yesterday in respect of waiting list recovery, the September social care White Paper and, more broadly, our approach to growing our nursing profession, through increasing the skills and numbers in that profession. We are already well on target for 50,000 more nurses in the profession. This White Paper looks at the specific aspect of the integration of social care and health and permissive ways for local areas to come up with their most effective place-based arrangements, many of which are already in development. It is, quite rightly, not specific about any individual profession, nor do we believe it should be, because it is for local places to develop their own local plans to reflect their local needs.”
“The UK, like every other country in the world, saw its health systems and capabilities stretched to the limit. As many of our civilian agencies and institutions struggled to cope, we should take great pride in the role our armed forces played in assisting them in responding to the pandemic, reacting with skill and agility. However, we must be cautious about the limitations on the numbers of those who are qualified to drive blue-light ambulances, and indeed clinicians. I have to say that, of the 20,000 personnel my hon. Friend spoke of, only a small proportion would be clinically qualified to assist as paramedics or qualified to drive a blue-light service.”
“NHS England will also strengthen health and wellbeing support for ambulance trusts, investing £1.75 million to support the wellbeing of frontline ambulance staff during these pressured times. More broadly, NHS England is undertaking targeted support for the most challenged hospitals, where delays are predominantly concentrated, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That includes a £4.4 million capital investment to keep an additional 154 ambulances on the road this winter. The crux of my hon. Friend’s speech was to acknowledge those pressures and to look to the military, through the MACA system, for further assistance. The scale of the challenge we faced, and continue to face, cannot be overestimated.”
“Despite those pressures, performance for category 1 calls—the most serious calls, classified as life-threatening—has been largely maintained at around nine minutes on average over the last several months, despite a 16% increase in these calls compared with before the pandemic, although we are clear that there has been a significant increase in response times across other categories. It is exactly because of those pressures that we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to March. All trusts will receive part of this funding, which will increase call handling and operational response capacity, boosting staff numbers by 700.”
“In December 2021, it answered almost 1 million calls—a 22% increase on December 2020—placing significant pressures on ambulance services and the wider NHS. We know the background reasons for that: infection prevention and control measures, higher instances of delays in the handover of ambulance patients into A&E and, crucially, the staff absence rate. Flow through our hospitals, which is always the key determinant of the ability of ambulance services to offload patients to the safety of A&E, is about the ability of that A&E to either get those patients discharged safely or admitted to hospital. A combination of those factors has placed unprecedented stress on the service and driven increased response times to patients in the community.”
“It is a pleasure, as ever, to service under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this debate, and I pay tribute to him for the manner in which he conveyed some challenging personal experiences on the part of his constituents and others. I will turn first to the situation faced by ambulance services, before clarifying for my hon. Friend that many of the expectations in terms of specialist posts are not realistically achievable within the constraints on the military’s resources. Ambulance services have faced extraordinary pressures over the past 18 months, and I know that all hon. Members will join me in paying tribute to all the staff for their dedication and hard work. The pandemic placed significant demands on the service.”
“I will address that point and then return to the military point. I had a very productive meeting with St John Ambulance in the past couple of weeks to discuss exactly that. We should not underestimate the huge role it has already played throughout the pandemic in supporting our ambulance and other emergency services.”
“Friend referred is that it was incorporated into the broader request for ambulance drivers between 10 and 31 August last year. The element of that request to be granted was the 28 category C drivers who were provided by the Ministry of Defence. However, I come back to the point that, while he is right that the military are always there to assist us in times of need, we equally need to be realistic about their capacity in specific places.”
“We have to be—realistic is the wrong word—careful in our expectations of the capacity to support specific requests, such as the specific types of support that his ambulance service put in for. More broadly, considerable support has been offered by the military for tasks such as logistics, which my hon. Friend highlighted—for example, in supporting the ambulance service in a range of roles. Currently, the Ministry of Defence provides support to ambulance services in the following ways: 366 personnel in a range of roles, including non-driving roles; 96 personnel continuing non-blue-light ambulance driving support for the Scottish Ambulance Service; and 313 personnel in driver support to the Welsh ambulance service. My understanding of the specific matter to which my hon.”
“It is important that we take advantage of all opportunities in terms of those qualified professionals and their ability to support our more regular frontline services. To pick up on the point raised by my hon. Friend the Member for West Dorset about MACAs and military capacity, a large number of those 20,000 were used for testing and helping to build Nightingale hospitals, and they have recently been helping in vaccine testing centres. However, capacity in terms of, for example, clinically qualified Army medics is limited, and they often already serve in the NHS and in hospitals, so there is not a huge pool to draw on. It is important that we are clear about that. Secondly, I mentioned to my hon. Friend the point about those qualified as blue-light drivers. Again, that is not all the 20,000 or anywhere near.”
“In extremes, they are there to help in very specific and pressured circumstances, but they are not the solution to the problem in the long term or to avoiding the challenges recurring. That is why we have our plan not only for the ambulance service, but for improving urgent and emergency care. We saw £450 million invested in that over the past 18 months or so to improve A&Es across the country, helping them to function more effectively, in particular in the context of IPC—infection prevention and control—measures. More broadly, we are investing in our acute hospitals to allow for the flow of patients out of A&E and into the hospital or, we hope, home. That is the key to solving this.”
“My hon. Friend will have heard me set out exactly how we have done that with the extra investment in our ambulance services. That is the key—to reinforce the strength and resilience of our existing ambulance service provision. He is absolutely right to highlight the impact—the patient and familial impact—of long waits for an ambulance, but the real answer is the measures that we are taking to invest in the ambulance service, with the £55 million more, the investment we put into hospitals to ensure that they were ready for winter, and the broader funding across the piece for our healthcare system to strengthen it further. Today, we saw another element of that package in the announcement of waiting list recovery and how we intend to approach that. My hon. Friend is absolutely right to highlight the military.”
“That is in no way a criticism of the amazing work their staff are doing, but they face significant challenges. We continue to focus on those, and I look forward to working with my hon. Friend and his colleagues in Dorset to meet the challenges in the south-west. Question put and agreed to.”
“I appreciate the particular complexities of the system in the south-west, and we continue to work closely with the local system, but also with the military where appropriate, to see where they can support us and help add additional resilience into the system. However, there is no substitute for the investment we are putting into making those systems more resilient in the long term, the need for which my hon. Friend has highlighted again today. We continue to focus on outcomes for patients—which is, I think, exactly where he is coming from—to avoid or reduce the risk of people having to wait a long time for an ambulance in very challenging circumstances. Tackling and improving the performance of our ambulance trusts remains a high priority in my ministerial inbox.”
“I am grateful to my hon. Friend. He is right to highlight that, not least because of his role in continuing to argue for it and in supporting Dorset hospitals in that context. The military have done, and continue to do, a fantastic job in the context of this pandemic. However, as I say, the key to this issue is long-term investment, which is exactly what we are putting in place. I am very conscious of the challenges faced by all ambulance services over the winter, but I know that my hon. Friend’s local ambulance trust faces specific challenges of geography, distance and location of hospitals, which can be difficult for it on occasion.”
“We know that we must get this right. We are working with the NHS and across Government to deliver a targeted and far-reaching plan for elective recovery, and we will update the House at the earliest possible opportunity.”
“We want to ensure that 75% of patients are diagnosed or have cancer ruled out within 28 days of a GP referral, and to return the backlog of people waiting more than two months for their cancer treatment to pre-pandemic levels by March 2023. Today the NHS has also announced the launch of a new platform, My Planned Care, which will provide patients and their carers with relevant and up-to-date information ahead of planned treatment, including information on waiting times for their provider. I am under no illusions about the fact that our health system is facing an enormous and unprecedented challenge. That is why we are doing everything in our power to support the NHS and its patients, recovering services to reduce waiting times and deliver more checks, operations and treatments. We are faced with a once-in-a-generation challenge.”
“However, we are pulling out all the stops to help the NHS recover and ensure that patients are receiving the right care at the right time. Hon. Members will be aware that the Government will have invested more than £8 billion in the NHS in the three years from 2022-23 to 2024-25. As part of the new health and social care levy, we will be putting huge levels of investment into health and social care over the coming three years, and all the time we are announcing new solutions to the problem of how we can ensure that the NHS is on the firmest possible footing for the future. On Friday we launched a call for evidence that will inform an ambitious new vision for how we lead the world in cancer care. As the Prime Minister announced earlier today, we are setting out some tough targets for the NHS on cancer.”
“The covid-19 pandemic has had a huge impact on healthcare systems everywhere. The NHS has performed incredibly, caring for covid and non-covid patients alike and delivering the vaccination programme that has helped us to open up this country once again. Throughout the pandemic, we had to take steps to ensure that we could treat those with the greatest clinical need and that we provided a safe environment for those who needed covid care. As a result, there is undeniably a huge covid backlog that needs urgent attention. The number of people waiting for care in England now stands at about 6 million, and we know that that figure will get worse before it gets better. Furthermore, our best current estimate is that about 8.5 million people who would normally come forward for treatment have not done so during the pandemic.”
“Even before the pandemic, when the current Secretary of State for Health was Chancellor, this Government had already put in place a £33.9 billion increase in funding, enshrined in law. It was one of the first pieces of legislation passed by this Government after the election. We have also set out our long-term funding plans through the health and care levy, which I recall the hon. Gentleman’s party did not support.”
“Gentleman mentioned delays, and I have to say that this plan is delayed. This is a plan we anticipated publishing in December. The reason that we did not do that was because of the omicron variant and the impact it has had on our health services over the winter. We have made sure that we get this plan right. The hon. Gentleman also mentioned Her Majesty’s Treasury. I have to say, speaking as a Minister in the Department of Health and Social Care, that we could not wish for better partners than Her Majesty’s Treasury and this Chancellor. They have shown strong support to our health and care system throughout the pandemic, with record levels of funding to support it through the pandemic and to help performance to recover subsequently.”
“I am grateful to the shadow Secretary of State. As he said, 2 million of those on the waiting list have entered that waiting list since the pandemic began. There is undoubtedly a huge covid backlog, as we had to put in place infection prevention and control measures and ensure the availability of beds for those with covid. I am with him, I suspect, on at least one point, which is that I, like him, entirely understand the impact that this has on people’s lives, their anxiety and their health outcomes. That is why this Government are determined to tackle that waiting list. As I said, this is a once-in-a-generation challenge and it is absolutely right that we make sure we get the plan right. We need to ensure that we have the right plan, delivering the right outcomes. The hon.”
“I am grateful to the Father of the House, who once again brings his typical wisdom and experience in this House to our deliberations in the final point that he makes. He is absolutely right. I am happy to join him and his constituents in expressing gratitude to all those who work in the NHS for the work they have been doing throughout the pandemic and that they do every day, irrespective of the pandemic. I know that those on both sides of the House will share in that. The term “elective” is a technical term used within the NHS, but I take his point that it is easy for us in this House to use the technical terms used within our Departments or in the system, but that it is often helpful if we talk in rather more simple terms that mean something to all our constituents.”
“The plan is important for mapping out the future direction of care, but we are not waiting for the plan to improve services, to build back better and to tackle the waiting lists.”
“The hon. Lady and I often exchange views across the Dispatch Box, and she always asks sensible and reasonable questions. She is right to highlight the importance of cancer care, and that there are some illnesses and diseases like cancer where delay can have a significantly detrimental impact on the outcomes experienced by patients. Between March 2020 and November 2021, more than 4 million urgent referrals were made for cancer, and over 960,000 people received cancer treatment. Thanks to the amazing work of NHS staff, we maintained cancer treatment at 99.7% of pre-pandemic levels in the latest month for which I have statistics, which is November 2021. As well as looking to the future with the announcement of community diagnostic hubs and a range of other measures, the plan is not necessary for us to do the work, as we are already doing it.”
“I am grateful, I think, to my right hon. Friend for his question. As I set out, it is important that this is the right plan and that it does the job for which it is intended. We are working closely with other Departments to make sure the plan, when it is published, does the job for which it is intended, and I look forward to its imminent publication.”
“The hon. Gentleman and I have previously met to discuss this issue, and I share his view on the value of radiotherapy in helping to tackle the cancer backlog, and more broadly as a treatment. Ministers and I are always happy to meet him.”