Health and Social Care Committee
Wednesday 11th November 2026
Skip to latest contribution
This debate has concluded
(began 4 hours, 35 minutes ago)
Watch LiveSkip to latest contribution
This debate has concluded
09:30
Layla Moran
-
-
Layla Moran
Order, order! Welcome to this one off session of the Health and Social Care Select Committee, where we will be examining winter pressures, although they are now all year round, and I'm sure that will be reflected in the answers and the questions. Can we start, please, by our panellists introducing ourselves and telling us a little bit about what they do? Can we start with Ian, please?
09:31
Gregory Stafford
-
-
Gregory Stafford
Thank you. So I'm Doctor Ian Higginson. I'm a consultant in emergency medicine and paediatric emergency medicine working in Plymouth. But I'm here in my role as the president of the Royal College of Emergency Medicine. So we represent now 16,000 experts in emergency care, both doctors and advanced practitioners. And we're the basically the experts in emergency care for the UK.
09:31
09:31
Andrew George
-
-
Andrew George
Matthew Hopkins, I'm the acute and ambulance network director at the NHS Alliance. For those that are less familiar, the. The NHS Alliance has recently formed from the merger of NHS providers and NHS Confederation. We're a membership organisation. We represent the majority of trusts and icbs across the NHS and the intention is to. Through working with our members to improve the delivery of care for the people that we serve across England.
09:32
Layla Moran
-
-
Layla Moran
Thank you. Well, I mean, this is an issue that MPs inboxes get full up with every year, and we thought it was timely to have the session now because rather than examine the problem from after the fact, let's look at how well the planning has gone for this year. We had a session on corridor care with the minister back in the spring, and had very warm words from the department about how they are much more on it this year that they are wanting to bear down on this. I've had this said privately actually a number of times.
From your perspective, Ian, could you just tell us how has winter planning gone this year? Is it any different? Is it better?
From your perspective, Ian, could you just tell us how has winter planning gone this year? Is it any different? Is it better?
09:32
09:32
09:32
Gregory Stafford
-
-
Gregory Stafford
I think a plan implies a concrete plan, whereas I think what we're seeing is preparations which are perhaps potentially more diffuse. Okay. I think just to give you some background, we are going into winter with our departments in big trouble already and many on their knees. Why do I say that? Well, something like 67% of departments in a survey last month said that they were either fairly or very unsafe already, and we're in worse shape than in previous years. And, and 80, 88% of our clinical leads told us that in in the same survey, our patients are still in corridors.
You'll be aware, I would think that earlier in the week, we did a spot survey, a spot prevalence survey. And from that survey, something like 1 in 5 patients in emergency departments at the time of the survey were in inappropriate areas. And we know that some about 16,000 of our patients in England are are dying in excess of that expected, linked to long waits in our departments. And we also know that our teams are exhausted. They're burnt out, psychologically distressed, and many are leaving. And recently it's also become apparent that increasing violence and aggression, often related to long waits, is a particularly acute problem at the moment.
And then when you put that in the context of the preparations, what regrettably, I think what we're saying is much of the same old, same old stuff. And we know that.
You'll be aware, I would think that earlier in the week, we did a spot survey, a spot prevalence survey. And from that survey, something like 1 in 5 patients in emergency departments at the time of the survey were in inappropriate areas. And we know that some about 16,000 of our patients in England are are dying in excess of that expected, linked to long waits in our departments. And we also know that our teams are exhausted. They're burnt out, psychologically distressed, and many are leaving. And recently it's also become apparent that increasing violence and aggression, often related to long waits, is a particularly acute problem at the moment.
And then when you put that in the context of the preparations, what regrettably, I think what we're saying is much of the same old, same old stuff. And we know that.
09:34
Gregory Stafford
-
-
Gregory Stafford
Some of it is what's different. So there's some nuances about it. So what's different? I think for me, there is much there is much more agreement now when you when you hear ministers talking, when you hear various system leaders talking that the problem is a system problem, and there's much more agreement now that this is about the whole patient pathway before. But I don't think that has yet translated into concrete action. And. And so whilst we're seeing the words start to come out, the the concrete preparations that underpin that aren't there, if I'm honest, when I look at what I'm seeing, I'm not seeing much that I think will make a difference.
There is there are some some announcements around money. I think it that is possibly being directed at things which might make a difference. And much of. Much of what we need is actually long term and too late to make an impact on this winter. And I think worryingly, I think we're all seeing also seeing strong suggestions that money is king at the moment, and that's getting in the way of what we would regard as some potential mitigations, which.
There is there are some some announcements around money. I think it that is possibly being directed at things which might make a difference. And much of. Much of what we need is actually long term and too late to make an impact on this winter. And I think worryingly, I think we're all seeing also seeing strong suggestions that money is king at the moment, and that's getting in the way of what we would regard as some potential mitigations, which.
09:35
09:35
Gregory Stafford
-
-
Gregory Stafford
So I think there's a lot of financial pressure on leadership teams within hospitals. And I would imagine within the wider systems. And I think they're trying to balance priorities. So when when you're, for instance, something like 60% of our clinical leads were suggesting that recruitment freezes were affecting nursing staff, 40% affecting consultants. That's in departments, which I've always already described as being actively unsafe with staff that are pretty broken. And so I think there's a lot of balancing of financial priorities versus operational priorities going on. But it feels like money is a it to me, it feels like money is the key financial driver with performance a either equal or a close second.
09:36
09:36
Andrew George
-
-
Andrew George
I mean, I think I think Ian's right. I think the the picture is, is, is better in the context of the recognition that it's not just the A and E departments in each hospital that are responsible for flow, for making sure waiting times are not not excessive. So I think there's, there's been a step change in that.
09:37
Layla Moran
-
-
Layla Moran
If everyone agrees on what you need to do to fix the problem, what, what what's going why didn't they have time to plan ahead for something that would change this winter? I mean, it might just be incremental, but but, you know, the picture we've just had is that it's probably not going to make much difference. In fact, we're starting from a worse basis is kind of what you're you're describing. So what's your sense of that?
09:37
Andrew George
-
-
Andrew George
Yeah. I mean, I think our members are, are our members as well as obviously the membership for Ian's organization are very much saying that given the challenges during summer, given the demand increase, there is now no longer a kind of summer lull across the NHS that people are working flat out. And of course, this is in the context of changes to the way in which integrated care boards operate. The changes.
09:38
Layla Moran
-
-
Layla Moran
Is it your view that's having an impact so that the changes that are happening to Icbs and the board that is negatively affecting our ability to win? Absolutely. That's very clear. Yeah. And in terms of the guidance that NHS. I mean, so in our previous, you know, sparring sessions with whichever secretary of state we might have in front of us, hopefully we've got a period of stability. Now. They they will tell us that they've got guidance, that they're planning better. They've started earlier. Just looking at the guidance notwithstanding, we've we've had a very difficult year.
Is there anything in the guidance that that could be better?
Is there anything in the guidance that that could be better?
09:38
Andrew George
-
-
Andrew George
So I think our our view, given the reality of an emergency pathway, flows from the work that GPS do to, to, to deal with urgent issues through to the work that the ambulance service does in, in not conveying people that don't need to go to a hospital. And the work that is done within hospitals, there are elements of improvement required in all of those areas. And that that requires the system. So all of those partners being focused on, on the importance of getting good, urgent and emergency care provision. And the guidance, I think, sets out what each part needs to do.
But we know across the country there is unwarranted variation in the way in which leadership prioritise the way in which people work effectively together, both at senior leadership but also at, at, at local operational leadership. And that I think.
But we know across the country there is unwarranted variation in the way in which leadership prioritise the way in which people work effectively together, both at senior leadership but also at, at, at local operational leadership. And that I think.
09:39
09:39
09:39
Andrew George
-
-
Andrew George
So so the reality for the ambulance service is that they're they're measured in minutes in terms of their performance category two performance. The the emergency department is also, if you like, measured in minutes in relation to four hour wait minutes. The clock is ticking. But as you move further out through the process of discharging patients out of hospital , again, you see that that organisations don't operate to the same drumbeat.
09:40
09:40
Andrew George
-
-
Andrew George
Yeah. And therefore, the leadership challenge in each system is to make sure that that risk is managed and shared across emergency pathway. And we see that, for example, in places like Airedale in West Yorkshire, where they have been able to come together as a system to to manage effectively, make sure that people in, for example, in nursing homes don't get moved into an A&E department, they get properly triaged. So there are really good examples across the country. But the variation I think is, is the element that we're working with our membership to try to, to address.
09:41
Allison Gardner
-
-
Allison Gardner
Thank you. I think you've touched quite a lot on some of my subject areas, and I'm really interested in and I'm very pleased that you said whole patient pathway approach, because I do think the focus sometimes is heavily on ambulance delivery and heavily on the performance of the emergency departments. But but often and certainly within my own local hospital, the block is actually the flow out of E.D.. And then you have that that backlog. So I'm trying to jump the gun a little bit here, but I was very concerned about the survey, Ian, where 60% of clinical leads in emergency departments describe their ID as actively unsafe.
Could you just expand on what that might mean and the risks involved and what is particularly driving this, and if it is worse than previous years, why?
Could you just expand on what that might mean and the risks involved and what is particularly driving this, and if it is worse than previous years, why?
09:41
Gregory Stafford
-
-
Gregory Stafford
Sure. So I'll explain how the survey works. So the survey is run through a college communication channels directly to clinical leads. This particular survey we ran on October the 1st, and we had 163 responses. So that's a really, really high response rate to this sort of survey. And this is, if you like, directly from the mouths of clinical leaders, it's it's deliberately pitched as a sentiment survey. So the language used is the sort of language you've used rather than drilling right down into it, because we're conscious of survey fatigue. So to enable us to come to you with up to date evidence, we need to be able to do it quick, quick and fast, but that we lose some of the granularity.
So that's just be aware of that. So basically the question was, do your departments feel safe with a Likert scale ranging from very to perfectly safe. And so 67% rated their EDS as fairly unsafe or very unsafe. Importantly, only 15% actually said their departments were safe. What do we mean by that? Usually what we mean is our patients do we feel actively coming to harm? And the driver for that is going to be almost in in almost every case, overcrowding. So what makes emergency departments unsafe is where you you have patients absolutely everywhere and you cannot do your job properly.
So if you if you describe a typical shift for a consultant in charge of an emergency department. In the old days, my job was to answer questions from less experienced practitioners, go and see patients with and teach, support and supervise my job now. And the job of virtually all of my colleagues is essentially traffic control and risk management. So we're trying to find spaces for the next patient. We're we're trying to find a resuscitation bed for that next red phone call because our resuscitation room might be full. We're trying to work out which patients we need to prioritise.
If we've got very long waits, I might be going to the waiting room to apologize to our poor patients who have been waiting there for hours and explain.
So that's just be aware of that. So basically the question was, do your departments feel safe with a Likert scale ranging from very to perfectly safe. And so 67% rated their EDS as fairly unsafe or very unsafe. Importantly, only 15% actually said their departments were safe. What do we mean by that? Usually what we mean is our patients do we feel actively coming to harm? And the driver for that is going to be almost in in almost every case, overcrowding. So what makes emergency departments unsafe is where you you have patients absolutely everywhere and you cannot do your job properly.
So if you if you describe a typical shift for a consultant in charge of an emergency department. In the old days, my job was to answer questions from less experienced practitioners, go and see patients with and teach, support and supervise my job now. And the job of virtually all of my colleagues is essentially traffic control and risk management. So we're trying to find spaces for the next patient. We're we're trying to find a resuscitation bed for that next red phone call because our resuscitation room might be full. We're trying to work out which patients we need to prioritise.
If we've got very long waits, I might be going to the waiting room to apologize to our poor patients who have been waiting there for hours and explain.
09:44
Allison Gardner
-
-
Allison Gardner
09:44
Gregory Stafford
-
-
Gregory Stafford
So it's not particularly now. It's the problem. This has been an emerging crisis for many years. And there's a bit of Groundhog Day, isn't there, as before you in March, essentially saying the same story. And if you brought me in in a few years time and you did my predecessor, he would be telling you the same story. So this isn't a right now problem. This is a getting worse and worse and worse problem. Okay, so the why is because we are not adequately dealing with the root causes of the problem. So the main problem in safety is overcrowding.
Overcrowding is caused because we can either not find alternatives to admission for our patients, or we can't find them a bed when they need it. Okay. The reason we can't find them a bed when they need it is because our hospitals do not work effectively across the working week. They are essentially week day and a bit of evening services. So patients stay too long in hospital. And then when hospitals, when patients are ready to leave, a large number of them aren't able to do so. So something like 10% of a hospital bed base, about 13,000 beds are occupied by patients who don't need to be there.
Overcrowding is caused because we can either not find alternatives to admission for our patients, or we can't find them a bed when they need it. Okay. The reason we can't find them a bed when they need it is because our hospitals do not work effectively across the working week. They are essentially week day and a bit of evening services. So patients stay too long in hospital. And then when hospitals, when patients are ready to leave, a large number of them aren't able to do so. So something like 10% of a hospital bed base, about 13,000 beds are occupied by patients who don't need to be there.
09:45
Allison Gardner
-
-
Allison Gardner
So you're now said thank you for that. So now you're referencing the flow issue. Yes. And and I do worry that we focus at discharge and we focus at admission. And we don't focus at that, that middle pathway. That's really, really important. You in the report, there were some actions to mitigate the impact of overcrowding. And I read in somewhere in here in horrible statistics, and somebody might have to correct me that if a patient stays over a certain length of time in Ed, it doubles their risk of dying within 30 days. It was quite shocking.
Was it 4 hours or 12 hours?
Was it 4 hours or 12 hours?
09:46
09:46
Allison Gardner
-
-
Allison Gardner
That that really concerns me. So you did suggest some mitigations requiring. And so one of them is required trust in hospitals with overcrowded Ed to open and staff every available bed in acute community and intermediate care settings. So I'd like to explore that. But also, you know, looking at flow critical services and making sure that they're open 24, 12 hours a day, seven days a week. So these were some of the suggestions that you made. So could you just expand on these suggestions and how do you feel if if money is a critical factor, how could we deliver these?
09:47
Gregory Stafford
-
-
Gregory Stafford
Yes, sure. So the one bit of my previous answer that we didn't get to is. So I described the pathway and you asked what had. Why has it got worse? It's basically because the focus has been predominantly on the front. So trying to persuade patients not to come to us rather than fixing those problems with the flow. So then when you come to, okay, now we're so we're now approaching winter, those problems aren't fixed. What can we as a Royal College suggest that could be done now to, to try and make things a little bit better, given that our membership is telling us it's pretty rubbish out there and we're really worried about how it's going, the sort of changes that are needed to fix what I've described to you are not quick fixes.
So so we when we propose the mitigations, what we were trying to look at is stuff that could be done right now that might have an impact right now. And so this is what you're drawing from is, is in a letter that we wrote to the Secretary of State and also in a bit more detail to the leaders of the NHS. And this letter actually went out to secretaries of state across four nations. But we're England focused here. And there were five things that we suggested. So number one was we're going into winter. I believe we're still a thousand beds down compared to last year, yet in a worsening situation.
So our request was that we we require organisations and trust to open every and staff, every available bed in, in hospitals that are experiencing overcrowding because we know that the major problem is flow. And we know, for instance, that some hospitals may still not have opened up spare capacity that they might be saving for winter and that'll Matthew will be able to win. But I'd imagine that would largely be due to financial reasons. So that was one. Number two is that there's a tension between the ambulance handover target, which says we must we must hand over quickly.
And are we just essentially dumping patients into already overcrowded emergency departments in order to fix that target? And so our suggestion on that was that you shouldn't be able to implement what's called a rapid drop off policy unless the hospital is in the highest state of escalation, because to be generating that risk, things must be bad if you are implementing that protocol. Number three was to ahead of ahead of the game, require icbs and trusts to ensure that flow critical services were open not 24 hours a day. But we went for 12 hours a day, seven days a week.
And the reason, the reason we do that is because I'm about to get a whole bunch of letters from departments, and it'll say pharmacy is open these hours over Christmas. And what it's really telling me is when pharmacy is shut and we get whole loads of these letters telling us when services are open that are really saying we're not open here. So and over the Christmas period, we know that things drop off. So we're saying plan ahead. When we wrote it, there was time to plan rotas, to plan, plan resources to get those services open.
Number four was to end recruitment freezes across in services that are critical to flow where they exist. And then number five was actually to prioritise local measures to support emergency departments, teams. So psychological and physical security measures , given we know the stress runs, those are the five things we could think of that could be done. Right now, the only barrier would be either will or money, and we think they would be a bit of a mitigation. So that I think is what you were driving.
So so we when we propose the mitigations, what we were trying to look at is stuff that could be done right now that might have an impact right now. And so this is what you're drawing from is, is in a letter that we wrote to the Secretary of State and also in a bit more detail to the leaders of the NHS. And this letter actually went out to secretaries of state across four nations. But we're England focused here. And there were five things that we suggested. So number one was we're going into winter. I believe we're still a thousand beds down compared to last year, yet in a worsening situation.
So our request was that we we require organisations and trust to open every and staff, every available bed in, in hospitals that are experiencing overcrowding because we know that the major problem is flow. And we know, for instance, that some hospitals may still not have opened up spare capacity that they might be saving for winter and that'll Matthew will be able to win. But I'd imagine that would largely be due to financial reasons. So that was one. Number two is that there's a tension between the ambulance handover target, which says we must we must hand over quickly.
And are we just essentially dumping patients into already overcrowded emergency departments in order to fix that target? And so our suggestion on that was that you shouldn't be able to implement what's called a rapid drop off policy unless the hospital is in the highest state of escalation, because to be generating that risk, things must be bad if you are implementing that protocol. Number three was to ahead of ahead of the game, require icbs and trusts to ensure that flow critical services were open not 24 hours a day. But we went for 12 hours a day, seven days a week.
And the reason, the reason we do that is because I'm about to get a whole bunch of letters from departments, and it'll say pharmacy is open these hours over Christmas. And what it's really telling me is when pharmacy is shut and we get whole loads of these letters telling us when services are open that are really saying we're not open here. So and over the Christmas period, we know that things drop off. So we're saying plan ahead. When we wrote it, there was time to plan rotas, to plan, plan resources to get those services open.
Number four was to end recruitment freezes across in services that are critical to flow where they exist. And then number five was actually to prioritise local measures to support emergency departments, teams. So psychological and physical security measures , given we know the stress runs, those are the five things we could think of that could be done. Right now, the only barrier would be either will or money, and we think they would be a bit of a mitigation. So that I think is what you were driving.
09:53
Allison Gardner
-
-
Allison Gardner
I hear what you're saying, Matthew. I'll come to you, but I will just just quickly close this. This is a frustrating frustration because we've been reducing bed numbers with with the laudable aim to do people being cared for in their homes. But I think maybe the balance has tipped, and I've got a whole load of empty community hospitals that have wards just stood there, and it's very frustrating. And they've been very useful in the past. So, you know, the role of community hospitals will be very useful. Matthew, I'm going to come on to you because I'm interested in in in time.
We've been dealing with quite a complex set of mergers and changes within the whole health ecosystem. So we've got the NHS England merger with, you know, and the modernisation of that. We have the ICB reorganisation, which is currently on hold because we're just trying to find ourselves and and a lot of expected financial savings. And does this will impact on NHS capacity to prepare for and navigate the pressures. Has this caused problems for trusts to deal with this?
We've been dealing with quite a complex set of mergers and changes within the whole health ecosystem. So we've got the NHS England merger with, you know, and the modernisation of that. We have the ICB reorganisation, which is currently on hold because we're just trying to find ourselves and and a lot of expected financial savings. And does this will impact on NHS capacity to prepare for and navigate the pressures. Has this caused problems for trusts to deal with this?
09:55
Andrew George
-
-
Andrew George
Yes. I mean, I think the the specific element of the the changes around Icbs is that previously Icbs had a convener role. They would bring the elements of the ambulance service, the acute trust, the community trusts, mental health trusts, all key partners, local authorities together to say, how do we make sure that we're working properly, optimally and in a way that enables urgent and emergency care patient flow to work effectively? And part of the challenge for Icbs is obviously they've had their capacity cut by 50%. They are unclear at the moment really about their role in relation to performance management and convening.
Is that the regions responsibility, or is that the ICB? And there's been significant leadership churn, which in a number of systems has led to some of the loss of skills and capacity around convening urgent emergency care. So now that's that's the the reality now across the country, as I said, there are places that are that are effectively working together. But as Ian said, there is a significant trade off at the moment where money and hitting financial targets is impacting on the ability to do what Ian's described would be short term measures that could help, which is the the focus on reducing staffing numbers, the focus on where you can make appropriate savings, and to close a Ward 30 bed ward probably saves you about two, 2.5 million recurrently.
These are those are big numbers. And and obviously the opposite is true of reopening award for winter pressures, particularly if you're going to need to use temporary staff, which again, is another measure that the NHS is being pushed to reduce the dependence on bank and agency staff. So, so so the trade offs, I think, are part of the picture.
Is that the regions responsibility, or is that the ICB? And there's been significant leadership churn, which in a number of systems has led to some of the loss of skills and capacity around convening urgent emergency care. So now that's that's the the reality now across the country, as I said, there are places that are that are effectively working together. But as Ian said, there is a significant trade off at the moment where money and hitting financial targets is impacting on the ability to do what Ian's described would be short term measures that could help, which is the the focus on reducing staffing numbers, the focus on where you can make appropriate savings, and to close a Ward 30 bed ward probably saves you about two, 2.5 million recurrently.
These are those are big numbers. And and obviously the opposite is true of reopening award for winter pressures, particularly if you're going to need to use temporary staff, which again, is another measure that the NHS is being pushed to reduce the dependence on bank and agency staff. So, so so the trade offs, I think, are part of the picture.
10:00
Andrew George
-
-
Andrew George
So we we from looking right across our membership, there are a number of things that we, that we think alongside the things that Ian has described could help. So for example, the , the ambulance service are doing a lot of really good work around making sure that they're only taking people in that need to be taken. But there is also further work that the ambulance service could be doing, and in some cases is by innovating going into people's homes earlier, if you like, in, in, in, in the pathway so that you're, you know, for example, one ambulance service has got a van that does on site blood tests where previously they'd have been brought into a, to a hospital to do that.
There are, there are innovations that could be put in place pretty quickly if the resources were made available to prioritise.
There are, there are innovations that could be put in place pretty quickly if the resources were made available to prioritise.
10:02
Allison Gardner
-
-
Allison Gardner
To collate those innovations. One thing that I know is, is it's mentioned now the difference between summer planning and winter planning, and there is no lull now, and we're due to have a very hot summer next year. And I know that impacts very much, particularly on people with neurological conditions epilepsy, Alzheimer's, neurology. So, you know, again, often the elderly, but change in demographic really that might be in practice. So do you know when summer planning and not preparation planning would be expected to start. And would that overlap with the winter pressure periods? And then given that this seems to be the trend going forward, do you think it makes sense to still plan for specific seasonal pressures as winter versus summer in the way the NHS does?
And is there an alternative approach? Oh, right. I was going to go to Matthew, but Ian looked keen.
And is there an alternative approach? Oh, right. I was going to go to Matthew, but Ian looked keen.
10:04
Gregory Stafford
-
-
Gregory Stafford
So again, I think if you look at the the the real basics of planning are you look at the demand you're likely to face on your service. You predict it and then you plan for it. If you look at the basic attendance figures for emergency departments over the last ten years, apart from an anomaly over the Covid period, those attendances have consistently risen year on year. So it should not be a surprise when every year more patients pitch up in urgent and emergency care services, because that's what happens and that is what is continuing to happen.
And if you look at the demographics, it's going to continue to happen. And so I guess part of the failure of planning is, is, is simply not recognising the data that is in front of us that says, this is what is happening out there. Let's prepare for it. If we were any other industry, we'd be saying, look at this demand. Let's prepare for it. Let's build the capacity, let's build the skills so that we can see ahead. Why is that? I think I ponder on this a lot. I think a lot of the. So I think it is partly recognised, but a lot of NHS planning is a triumph of optimism over reality.
So there's a. There's a tendency to put a lot of stock in, in the demand management side. So let's, let's look at that demand. Let's try and keep it under control. But but planning to keep patients with a sore throat and help them see their GPS will not help. An 83 year old lady who's fallen over has a broken hip who needs a bed. And so the investment and the attention has been on the wrong thing. And when I wonder why, as I say, the language is much more now everybody seems to agree that's the problem and it's really welcome.
I heard the Secretary of State say this in at your committee very recently, but we're not putting in the planning to back up those words. We're still relying on the wrong things. So then when you come to summer, summer was the summer demand is was going to be up. It's no point calling it unprecedented. It's going to be unprecedented almost every day because it's just going up. There was a heat wave, which definitely made things worse. But that will happen again. You could predict for it this winter. More patients will get respiratory illnesses. There will be flu, there will be RSV, there will be norovirus.
We know that's going to happen. All we need to do is accept that and plan for it. And I think that's the basic failure is, is, is, is a failure to accept that demand is doing what it's doing. And we have to actually invest in our health and social care service to deal with the demographic and health realities. And I think what we've done is avoided looking at those really big questions, because when you get to the numbers, that can be quite scary. They are certainly expensive, and it requires long term planning, which doesn't necessarily fit with short term political or leadership cycles.
And if you look at the demographics, it's going to continue to happen. And so I guess part of the failure of planning is, is, is simply not recognising the data that is in front of us that says, this is what is happening out there. Let's prepare for it. If we were any other industry, we'd be saying, look at this demand. Let's prepare for it. Let's build the capacity, let's build the skills so that we can see ahead. Why is that? I think I ponder on this a lot. I think a lot of the. So I think it is partly recognised, but a lot of NHS planning is a triumph of optimism over reality.
So there's a. There's a tendency to put a lot of stock in, in the demand management side. So let's, let's look at that demand. Let's try and keep it under control. But but planning to keep patients with a sore throat and help them see their GPS will not help. An 83 year old lady who's fallen over has a broken hip who needs a bed. And so the investment and the attention has been on the wrong thing. And when I wonder why, as I say, the language is much more now everybody seems to agree that's the problem and it's really welcome.
I heard the Secretary of State say this in at your committee very recently, but we're not putting in the planning to back up those words. We're still relying on the wrong things. So then when you come to summer, summer was the summer demand is was going to be up. It's no point calling it unprecedented. It's going to be unprecedented almost every day because it's just going up. There was a heat wave, which definitely made things worse. But that will happen again. You could predict for it this winter. More patients will get respiratory illnesses. There will be flu, there will be RSV, there will be norovirus.
We know that's going to happen. All we need to do is accept that and plan for it. And I think that's the basic failure is, is, is, is a failure to accept that demand is doing what it's doing. And we have to actually invest in our health and social care service to deal with the demographic and health realities. And I think what we've done is avoided looking at those really big questions, because when you get to the numbers, that can be quite scary. They are certainly expensive, and it requires long term planning, which doesn't necessarily fit with short term political or leadership cycles.
10:10
Andrew George
-
-
Andrew George
Yeah, I mean, I think the, the, the challenge for many organisations during the heat waves was the building stock and the ageing, the aged buildings, the requirement to, to keep data centres, to keep MRI scanners, to keep operating theatres cool. When most organisations, hospitals have got cooling systems in daylight, in sunlight all day and significant pressure. So we've called consistently for capital allocations to be to be there to help organisations to address this. Given the scale of the of the NHS backlog maintenance sitting at about 18 billion, there needs to be targeted capital investment into into helping right across GP surgeries, community hospitals, mental health and acute hospitals to be more resilient from a building stock perspective.
10:11
10:12
Paulette Hamilton
-
-
Paulette Hamilton
Good morning. Thank you. My questions are going to be directed towards yourself, Matthew. And it's around the ambulance service. Also some of the challenges so that you know where we're going with this. And my first question, my first question is you've sort of answered this, if I'm being honest, what factors are driving the challenges that you're currently facing in the ambulance service?
10:12
Andrew George
-
-
Andrew George
Yes. So I think the well, there are multiple I think there's a there's that the question of that rising demand that Ian talked about and how best to for, for ambulance services to, to respond to that. They they're most of the ten organisations across the across the country now have pretty good see and treat here and treat mechanism. So basically when people are ringing up for an ambulance, they're talking to a clinician. There is clinical advice being given and the ambulance services are moving away from, if you like, being seen as a, an organisation that only conveys somebody from A to B, but actually really focuses on treatment in over the phone or in people's homes and directing them so that.
10:14
10:15
Andrew George
-
-
Andrew George
Yes. I mean, I think I think the performance question is an interesting one because only about 10% of ambulance activity is going to accidents and life and death situations. The big performance measure that the ambulance trusts are measured on is called category two, which is, yes, people are experiencing, you know, severe, urgent and emergent emergency situations. But the data suggests that only 50% of people that have an ambulance sent out under category two actually need it. So the real question is , what are the right performance measures for ambulance services that they should be measured on, rather than just a time limited, you know, time, time from A to B?
10:16
10:17
10:17
10:17
10:17
10:18
10:18
Andrew George
-
-
Andrew George
Agreement that waiting related targets are important, but there's also there's also a sense that actually, what are the quality outcomes that are important from a patient perspective, alongside how long people are having to wait for, for an ambulance to arrive. So we're in early, early stages of that, that that review, but that's part of the NHS Alliance's sort of stepping back and saying, really, are the constitutional standards the right ones now in the modern day NHS for organisations to be measured against?
10:19
10:19
Andrew George
-
-
Andrew George
So as as I said, I think the the parts of the country that are doing well around emergency care, urgent emergency care are those that work really effectively together where there is good leadership, good clinical engagement, and there is a consistency around risk sharing across the organisations, and the ambulance service has obviously got a part to play. So we know that the the consequence of the cause of corridor care and ambulances waiting outside A&E departments is multi-factorial.
But it's a system wide challenge. But there are things.
But it's a system wide challenge. But there are things.
10:21
Paulette Hamilton
-
-
Paulette Hamilton
I'm going to be a little bit challenging. I'm fed up with people telling me it's system wide. I am not, I am a health professional, so I understand that term. Explain to me, when you say system wide, where do you feel the blockages? Are we going into? Eddie? It's a nightmare. Ambulances can't get in. They're waiting longer than they should. So come on now.
We're in this system. Do you think we may have issues?
We're in this system. Do you think we may have issues?
10:22
10:22
10:22
Andrew George
-
-
Andrew George
It, there will be areas for improvement. But we do know that since Covid, the number of patients that are in acute hospital beds and mental health hospital beds that that are that are that should be discharged has risen. And so a number of our acute trust members are describing perhaps between 20 and 30% of their bed base with patients that don't meet the criteria to be in that bed. So if I was to say the the one key area that are parts of the country is focusing on is that bit around delayed discharges. Because as we've heard already from Ian, you know, this point about flow backing up into EDS and in waiting rooms is where there is significant risk.
But the ambulance service would also say ambulances waiting outside of an Ed department to hand over is creating risk for people that are waiting in their homes for an ambulance, which is why I'm describing the fact that this is this is multi-factorial and it is across the system. But I think if we were able, if our membership right across the board, along with community and social care services, reduce that delayed discharge percentage in hospitals, that would make a difference.
But the ambulance service would also say ambulances waiting outside of an Ed department to hand over is creating risk for people that are waiting in their homes for an ambulance, which is why I'm describing the fact that this is this is multi-factorial and it is across the system. But I think if we were able, if our membership right across the board, along with community and social care services, reduce that delayed discharge percentage in hospitals, that would make a difference.
10:25
Paulette Hamilton
-
-
Paulette Hamilton
Thank you. Starting to warm me up now. So my next point, which is leads on from what you've just said, if you had a crystal ball throughout this system where you say it's multifaceted, where in the system would you like to see some real improvements? So it would help to release the issues you're currently facing.
10:25
Andrew George
-
-
Andrew George
So so I go back to the point about the, the real challenge in acute and mental health trusts is that delayed transfers of care, people that are in beds that that no longer need it. And if we were to see everybody working more effectively together on that, we've. Healthwatch has recently. Healthwatch England has recently published some members survey that shows that patient experience is really poor when waiting unnecessarily long for discharge. So there's there's also a flow challenge, but there's also a patient experience challenge. And that's the area, I think, of all of the elements of improvement that's required would be, I think would make a difference.
10:27
10:28
10:28
10:28
10:28
10:28
10:28
10:28
Speaker 1
-
Speaker 1
Yeah, it's really, really important question. And I think the what we hear from our ambulance trust members is that across a year in the past, they've they've been able to, if you like, bank some good. performance during the summer period, that would then be offset by the challenges that we've heard already around winter, so that across the year they were able to meet the the waiting time targets that were set. And because of the now. consistent challenge right through the year. including the likelihood of. continuing heat waves, that is is creating a real performance challenge that, as you quoted, that that data tells you.
So this year, I think it's going to be very, very difficult, in fact. unlikely that the NHS meets its category two target to because of the difficult. period that we've had during the summer and the heatwave. So the. question that ambulance trusts are asking themselves and we're supporting them with is, how do we get those. innovations that are happening in each of the ambulance.
So this year, I think it's going to be very, very difficult, in fact. unlikely that the NHS meets its category two target to because of the difficult. period that we've had during the summer and the heatwave. So the. question that ambulance trusts are asking themselves and we're supporting them with is, how do we get those. innovations that are happening in each of the ambulance.
10:31
10:31
10:31
10:31
10:32
10:32
10:32
Andrew George
-
-
Andrew George
You for that. And at that point, I'll hand back to the chair. Thank you very much. Andrew. George, please. Thank you very much. On on the issue of delayed discharge, which you were referring to in just a moment ago. I mean, this has been an issue which has been endemic in the service for the last 30, 40 years. I suppose you one of your predecessor organisations, I think the the NHS Confederation produced a report in 2004, which I know I made lots of comments on at the time, which is entitled Why we Need Fewer Hospital Beds.
And since that time. And that was really reflecting what what NHS managers were, were, were pushing for that that stage and indeed had been going on in any case for some time and indeed has happened and been delivered, perhaps surreptitiously. I haven't got the figures in front of me, but something like sort of 10 to 15% of beds have been cut since that time. And we obviously delayed discharges are still are still with us. I don't know whether is there is there such thing as a golden bullet? Do you do you think is there something that that that successive governments and and, and health care managers have simply failed to to do.
Is there is there something that can be .
And since that time. And that was really reflecting what what NHS managers were, were, were pushing for that that stage and indeed had been going on in any case for some time and indeed has happened and been delivered, perhaps surreptitiously. I haven't got the figures in front of me, but something like sort of 10 to 15% of beds have been cut since that time. And we obviously delayed discharges are still are still with us. I don't know whether is there is there such thing as a golden bullet? Do you do you think is there something that that that successive governments and and, and health care managers have simply failed to to do.
Is there is there something that can be .
10:34
Speaker 1
-
Speaker 1
Done to address this? So not to repeat myself, but I do think there, there are there are there are opportunities. And we do see examples of this across the country where there are really effective ways of working with partners, with health and social care that that. enables beds to be freed up. The question, though, is in in a number of acute trusts. particularly when beds become.
10:36
10:36
10:36
10:36
10:37
10:37
10:37
10:37
Speaker 1
-
Speaker 1
Organisation to, to, you know, to people get stuck overnight who shouldn't. So it creates a bit of movement and then bed availability for those patients that might then need to be admitted. So there's, there's definitely room for. improvement in, in many. organisations in that regard. So, so there's lots of things, lots of things that, that, that are being focused on, but .
10:38
10:39
10:39
10:40
10:40
10:40
10:40
Speaker 3
-
Speaker 3
If you like, the problem and the search for the magic bullet has, has led to focus on the wrong. things with an expectation it will solve things. It won't. But if you like the the, the. My wish, my single wish as an emergency physician is if you say, what's the problem? The the word that just comes in there is beds. The, the, the root cause for us is if you say to me on the shop floor, what do you need? I need enough staff to see the patients. They're brilliant in the right place. Once we've got that, I either need an alternative to admission or a bed for a patient who needs it.
Now the bed for a patient who needs it. There are probably three key drivers for that. One is getting hospitals working effectively so patients don't stay in longer than they need to, and everything works smoothly. Two is a focus on delayed.
Now the bed for a patient who needs it. There are probably three key drivers for that. One is getting hospitals working effectively so patients don't stay in longer than they need to, and everything works smoothly. Two is a focus on delayed.
10:42
10:42
Speaker 3
-
Speaker 3
As you said, and three actually is the number of beds we have in the system. We are probably when all that's done haven't got enough beds. And that's when you get to the bits that haven't been fixed. So the search for the magic bullet, combined with having collective heads stuck in sand and not not acting on what has been happening progressively over years is the root of the problem. The solutions are all at the back door.
If our emergency departments weren't.
If our emergency departments weren't.
10:43
10:43
Speaker 3
-
Speaker 3
We'd free up ambulances. They'd be back on the road like they were in the old days. Before you know it and performance would improve. And probably the last thing just to say on the points Matthew has raised is there's loads and loads of innovation going with ambulance services, trying to avoid admission as really they're brilliant. They they hate bringing patients to hospital who don't need it as much as the patients hate it. But if services aren't there when they need them. So if on a Saturday they've got a patient who needs a frailty intervention or.
investigations that can be done at home, and because it's Saturday, it's not happening. They all end up at our door anyway, and the emergency department becomes the default for when the system fails, because it's not operating when it needs to. And that comes back if you like, to. The same thing of systems working. operationally seven days a week and over extended hours, that'll. support the ambulance services, it'll support us. It would support.
hospitals and that would be part of this picture. So those .
investigations that can be done at home, and because it's Saturday, it's not happening. They all end up at our door anyway, and the emergency department becomes the default for when the system fails, because it's not operating when it needs to. And that comes back if you like, to. The same thing of systems working. operationally seven days a week and over extended hours, that'll. support the ambulance services, it'll support us. It would support.
hospitals and that would be part of this picture. So those .
10:45
Layla Moran
-
-
Layla Moran
Would be the one thing would be beds. And I think there are four things that drive it. Sorry to interject, but you know, we're always looking for what is the, the, the thing to suggest to the department that would actually be the right measure at the moment. They put a lot of stock in the four hour wait and all of that stuff. But actually is the better .
10:45
Speaker 3
-
Speaker 3
Measure, the number of beds available at 1 p.m.. So the, the four hour standard is a single measure of a whole system is, is actually it's, it's unmatched. And we can't think of anything better because it's what the patients want to be seen quickly and efficiently. It's what we as clinicians want. It's directly linked to.
10:46
10:46
10:46
10:46
10:46
10:46
10:46
Speaker 3
-
Speaker 3
Occupancy is the next thing to go. So that's number two, not number one. Well, no hospital occupancy would drive if you've got hospital occupancy, right? Along with staffing to see patients who don't need to come in. You would do what we used to do, which is achieve the four hour standard. So the key driver of failure of the .
10:47
10:47
10:48
Speaker 3
-
Speaker 3
So that you think that it should be, what, 85%? Yes, there's a bit of debate, but we currently recommend. 85% on the best available evidence. It may actually need to be lower, because the modelling that that was based on was based on single hospital systems without single sex accommodation, without infection control, but. 85% is a reasonable starting point. And other emergency medicine societies internationally have landed on the same answer. Yeah. Currently the NHS runs at about 93%. As it's measured, it's probably occupancy is probably higher than that when you actually need the beds. Because that measure, I think the reported one is, is there's two measures, but the one commonly reported is midnight.
We need the beds during the day and particularly in the evenings. Yeah, yeah. And so there's nothing more frustrating for us to hear, you know, 10:00 at night. There are ten beds coming up overnight. We needed them 12 hours ago. So but hospital. occupancy absolutely has to be, if you like, high. A high impact target.
We need the beds during the day and particularly in the evenings. Yeah, yeah. And so there's nothing more frustrating for us to hear, you know, 10:00 at night. There are ten beds coming up overnight. We needed them 12 hours ago. So but hospital. occupancy absolutely has to be, if you like, high. A high impact target.
10:50
10:50
10:50
10:50
10:50
10:51
Speaker 1
-
Speaker 1
That that. enables those beds Ian's describing to be. available when they're needed from usually. mid-afternoon onwards through the day, is the reason why there is a lot of focus on trying to make sure your normal discharged patients go home early in the day, but also. discharged into social care, into community beds and into homes with social care packages. Those elements for everybody working .
10:51
Andrew George
-
-
Andrew George
Locally in that local area are important to get right. The the the fairly lazy amongst politicians assumption is that it's all down to social care. If we sort social care out, then we can all I mean, my my study of what's going on in my own area. Cornwall, suggests that about a quarter of patients require a social care package , and that would resolve the issue. The remainder, it's more complex and it involves sort of primary primary care involvement, etc., other, other parts of the package, which.
So I mean, in your experience.
So I mean, in your experience.
10:53
Speaker 1
-
Speaker 1
I mean, is that reflective of the national picture? Yes. I mean, it's not just a social care challenge. There's there's also the timing and availability of. community beds as well. So community , community hospital beds and. services are working hard to make sure that their length of stay in their community beds is, is reduced to the lowest that it can be in order to make sure that their capacity is used effectively. But it's also making sure that those. community teams are. responding quickly in order to make sure that that patients can be discharged into the care of a community nurse in the right way and in a timely fashion.
So it's back to that.
So it's back to that.
10:55
Andrew George
-
-
Andrew George
All parts of the local health and care system working effectively together. Yeah. I mean, the, the since May 24th, the reasons for delay have been have been reclassified into five categories. And most of them are kind of administrative issues as well as a capacity one. The fifth, I mean, it seems to me that there's quite a lot of administration which needs to be in place, a lot of form filling, a lot of, you know, communication, which which perhaps is falling down as a result of so, so it may be the competence of the systems rather than necessarily capacity to be able to .
10:56
10:57
10:57
Speaker 1
-
Speaker 1
It usually does create delay. So where. organisations are able to work in a really integrated way, where they have trusted assessors that their, their, their judgement is trusted by their local organisation they're working with, or whether it's a community trust or whoever the these things definitely do create a delay wherever there's a handoff between organisations. So again, working in an integrated way will help to .
10:58
10:58
Speaker 1
-
Speaker 1
Service that need to enable that, that discharge to take place. I mean, clearly there's the social care budgets are under significant pressure. I mean, local authority budgets are. increasingly spent on social care. So there are I wouldn't I wouldn't say there isn't a budgetary challenge. but where you have. systems where. leadership at all levels are working to a common purpose, to a common goal of making sure that health and wellbeing of the.
population is managed as effectively as possible, where leadership is actually really focusing in the right way.
population is managed as effectively as possible, where leadership is actually really focusing in the right way.
10:59
Andrew George
-
-
Andrew George
You do start to address some of those administrative and other delays. Okay, because of time, I'll just move on to, to, to corridor care. If I, if I may just come back back to you to Ian a moment. I mean, NHS England set out a definition of corridor care and a series of actions to virtually eliminate its use. What, what what impact of these of these measures has .
11:00
Speaker 3
-
Speaker 3
Been been having having since they were first introduced. So first thing to say is that it's it's really welcome that the previous Secretary of State and the current Secretary of State have maintained a commitment to eliminate corridor care. Also worth mentioning that corridor care is a very useful way of thinking about the problem. It's a great brand if you like, but it's only part of the problem of.
11:01
11:01
11:02
11:02
11:03
Speaker 3
-
Speaker 3
Flawed and potentially open to gaming. Is this the 45 minute? So there are there are several reasons why we say that. One is the threshold within it of. 45 minutes is is hard to justify or explain, and potentially does lead to gaming. Two is it does not count patients who are in. ambulances or waiting to come into hospital. And those can be used by some. organisations as pseudo cubicles. And that's where you start to get the tension between releasing ambulances and putting patients into corridors. Three it does not count patients who are potentially in waiting rooms waiting on hard plastic chairs or in off what are called off the clock units, waiting in hard plastic chairs for admission.
And there are some anecdotal reports to suggest that counting corridor care is driving an increase in the number of patients who are being tucked away in that sort of .
And there are some anecdotal reports to suggest that counting corridor care is driving an increase in the number of patients who are being tucked away in that sort of .
11:04
11:04
11:05
11:05
11:05
11:05
11:05
11:05
Speaker 3
-
Speaker 3
Once it's in a state where I think we all agree on it and trust it, I think it has great. potential for the reason I've. described to help focus on the problem , where perhaps the four hour standard had lost its impact. Although I would come back to the fact that if we if we if we treated every patient within four hours, we would not have corridor care and we would .
11:06
Andrew George
-
-
Andrew George
Not have increased mortality associated with long waits in emergency departments. I mean, you say that it's not necessarily the location, but it's the it's the the amount of time, which is more critical. But of course, presumably patients are at a greater risk, aren't they? Because there is no oxygen, there's no monitoring equipment. There's no there's none of the facilities that are .
11:07
Speaker 3
-
Speaker 3
Available within within the Ed itself. So therefore it is a more risky environment. Hence my choice of words. Almost certainly there is no, if you like, defined evidence base that has examined that particular group per se. But it's just awful, is. absolutely awful. It's it's so undignified. I've had to as as will have almost every emergency doctor in the country examined. patients in. corridors the best I could because I had no option. I've had to talk to patients and take history from them. When you're. literally trying to work out how to get in between the spaces to to reach them.
Procedures are sometimes undertaken in corridors, such as simple things like bloods or putting in drips, because there's no other options. That's dreadful for everybody. Imagine if you're if you're elderly, you're visually impaired, auditory impaired.
Procedures are sometimes undertaken in corridors, such as simple things like bloods or putting in drips, because there's no other options. That's dreadful for everybody. Imagine if you're if you're elderly, you're visually impaired, auditory impaired.
11:09
11:09
11:09
11:09
11:10
11:10
11:10
Speaker 3
-
Speaker 3
There are there are islands of. excellence in in in the midst of a sea of doom. And we can learn from those islands of excellence. One of the frustrating things, I think, for everybody is, well, if it can be done in one place, why can't it be done everywhere? There will be reasons for that. So yes, it has. When we I tried a quick opinion about this just to help me inform you. And basically about 10% of departments said, yeah, we're on our way. It's it's looking it's looking great. But when the first thing, the first messages I got back when I asked my members, that was you didn't put a box in for corridor care is getting worse.
And so there's , there's now a split. It's a smaller number of departments who are doing well.
And so there's , there's now a split. It's a smaller number of departments who are doing well.
11:12
Andrew George
-
-
Andrew George
The vast majority are in trouble, as I described. Yes, yes. And of course, I mean, things change and averages mean that things are better in places and worse than in others. And there are circumstances which are outside the control of the health systems, which might have factors. But I mean, in other words, are you saying that in those areas which have managed to resolve or not resolve but improve the situation that that that that .
11:13
Speaker 3
-
Speaker 3
Lessons are being gathered and, and being shared within the system? Yes. So the predominant lesson is actually lessons which have been known about for an awful long time. I used to work with an organisation called SAS, which was in existence before and before the, the current things. And it's essentially the same, the same lessons. So what it takes is really good, committed.
11:14
11:14
Speaker 3
-
Speaker 3
Whole hospital and whole system ownership of the problem. So it's not just seen as an emergency department problem and absolute focus on the things that are going to make a difference. And underpinning all that, a commitment to say, we're not going to put up with this. Now, if it was just that simple, everyone would do it. So there's much more to it clearly.
11:14
11:14
11:15
Layla Moran
-
-
Layla Moran
Will be on the radar for dropping off because now they've done absolutely everything. We did our session on this, we heard some very good examples. Thank you very much. Thank you. The minister is in the room, so I'm going to allow you a wish list of one that you want her to hear publicly. We've heard that it's a long term problem. It's getting worse over time. You've painted a fairly pessimistic picture.
If she could grant something to you beyond what's already .
If she could grant something to you beyond what's already .
11:15
11:16
11:16
11:16
11:16
11:16
11:17
11:17
11:17
11:17
11:17
11:17
11:17
11:17
11:17
11:17
11:18
Speaker 3
-
Speaker 3
Echoing recommendations we've made. So thank you for that, Ian. So emergency physicians are brilliant, but we're not we're not magicians. So we're really good at running our departments. We're really good at working out how to fix patient who needs to fix them, etc. what we need is one enough staff for us to do our jobs. And then.
11:19
11:19
Speaker 3
-
Speaker 3
We need either. alternatives to. admission to keep patients out of hospital, or we need beds when we need them for our patients. And that is about, as I've described to you before, hospitals working more effectively across the working week. It's about. Really dealing with the problem of patients who no longer need to be in hospital. And fundamentally, it's about. re-examining the bed stock that we have.
So I think it's grasping the metal stop going with all the.
So I think it's grasping the metal stop going with all the.
11:19
11:19
11:20
11:20
11:20
11:20
11:20
11:20
11:21
11:21
11:21
11:21
11:21
11:21
11:22
Layla Moran
-
-
Layla Moran
We welcome back, Minister. Lovely to see you very much. A follow on session from our session in March on corridor care, but looking slightly more widely this time. If it's all right, do you mind if we just get into it? And then when you decide to go to your officials, if at that point they might introduce themselves. But I'm keen for us to get cracking. I think we are all. alarmed by the fact that there are deaths caused by a lack of grasping of this problem. In the Public Accounts Committee session just the other week, the department.
recognised the. numbers that the Royal College of Emergency Medicine have said that something like. 16,000 excess deaths caused by people waiting longer than. 12 hours in emergency departments. Minister, do you do you agree with that assessment by not grasping this?
recognised the. numbers that the Royal College of Emergency Medicine have said that something like. 16,000 excess deaths caused by people waiting longer than. 12 hours in emergency departments. Minister, do you do you agree with that assessment by not grasping this?
11:24
11:24
Speaker 6
-
Speaker 6
This point, winter and summer, and there's no lull. So make of that what you will. Yeah. Well, that is true. And particularly for the staff facing that pressure I'm happy to come on to that. But if I may take issue with your first comment about not grasping this, we've been very clear that, for example, your conversations on corridor care is completely unacceptable. That's why we're the first government to say that we will eradicate that by the end of this Parliament and to put those measurements in place, and I'm very happy to pick up on some of the comments.
I was here briefly towards the end of your session,
I was here briefly towards the end of your session,
11:25
11:25
11:26
11:26
Layla Moran
-
-
Layla Moran
We recognise in doubt that you want to, but the fact of the matter is it's worse rather than better, isn't it? And what we're hearing from panel one, and I appreciate you weren't there for the whole time, although they started to summarise it a bit at the end, is that the real things that are going to make a.
11:26
11:26
Layla Moran
-
-
Layla Moran
Rather than pots of money to keep, you know, the busy parts of the system busy. But that long term thing that deals with the root cause is currently not being dealt with. So no one, no one at all from that last session we did with you and no one today is starting by assuming that you don't want to deal with this. In fact, it's very clear that for the first time, everyone's now .
11:27
11:27
11:27
11:27
11:27
11:27
Speaker 6
-
Speaker 6
Year going into winter is worse. Thank you. I mean, can I just have a baseline? The question about how we grasp that, have we done planning in advance of that? Absolutely. No one expected six heat waves in the summer, but the planning for this winter started in the system. In May, I had my first. meeting with the teams in June. It was 32 degrees outside the office when we had that meeting. And I think it's important to. recognise for the system and the measures that we have put in place, not only accepting that corridor care is.
unacceptable and that we want to eradicate that, putting in measures to do that, but also. recognising that coming into the into this summer that ambulance times, for example, had improved. They are under more pressure now, and that system had started to improve by some of the measures we've put in previously. Recognising, and as your panel previously have just said, looking at the wider system, making boards and leadership accountable and. responsible for, for for what they what they need to do, model editor model pathways. The announcement along some of the lines that I did on Monday around.
supporting GP practices, primary care to support people at home, those are all measures that have been put in place in order to grasp this wider problem, which is a very. pressurised system. And as you know, chair, and the committee knows that some of that pressure pops up in different sorts of places. And of course, people, especially very frail people on trolleys,
unacceptable and that we want to eradicate that, putting in measures to do that, but also. recognising that coming into the into this summer that ambulance times, for example, had improved. They are under more pressure now, and that system had started to improve by some of the measures we've put in previously. Recognising, and as your panel previously have just said, looking at the wider system, making boards and leadership accountable and. responsible for, for for what they what they need to do, model editor model pathways. The announcement along some of the lines that I did on Monday around.
supporting GP practices, primary care to support people at home, those are all measures that have been put in place in order to grasp this wider problem, which is a very. pressurised system. And as you know, chair, and the committee knows that some of that pressure pops up in different sorts of places. And of course, people, especially very frail people on trolleys,
11:30
Layla Moran
-
-
Layla Moran
On chairs, in emergency departments, where it happens is completely unacceptable. And just to go back to my very first question, initially, your department, when it was in front of pack, had no issue accepting this to be true. If we don't get a grasp of this, more people will die than would have to. It causes excess deaths. If people are .
11:31
11:31
Layla Moran
-
-
Layla Moran
EDS for longer than 12 hours in particular. Do you accept that fact? Yes. Fine. No thank you. It is important, I think, for for everyone to understand everyone's on the same page with this. You weren't here for this bit of the first panel, but they took issue with it being called a plan. Was that not much is going to change. How do you reconcile what you've just said with what system leaders are telling us? Well, I didn't hear what they said, but I'm going to I'm going to pass to to Emma Rowlands to talk. If the committee wants to go through the plan and what measures we have put in place, is that what you know, I want to understand why they don't think it's much of a plan and why you do.
Doctor Rowland,
Doctor Rowland,
11:33
Speaker 1
-
Speaker 1
Please introduce yourself first, if you don't mind, and then talk us through that. Good morning. Good morning. Also, I'm Emma Rowland, I'm an A&E consultant, so I know that the panel previously very well. And also I'm the NHS exec for performance and delivery. So thank you for inviting me. I can. understand why it doesn't feel on the ground. So certainly as a as a clinician, as a.
11:33
11:33
Speaker 1
-
Speaker 1
I haven't felt that yet. So I can totally understand from the people that are in this all day, every day, they are still faced with the crowding and the exit block that they have alluded to. Having said that, I do feel we've got a plan. I think it has taken time. There's there's lots of different aspects to this. It's a complex system, as I'm sure the panel are well sited on over the last. Particularly the couple of years in the last year particularly, we have looked at that front door, which I know Doctor Higginson probably alluded to.
So it's about controlling some of that demand because we do have to do that. But we absolutely have to look at the back door. And that's what we've started to focus on. significantly in the last couple of months. A couple of things we've done, if I may, whilst I know the panel previously have alluded, it's far from perfect. We have called out corridor care and we now measure it. I completely accept that . There are questions around the definition of how one measures it, but for the first time we are measuring it and we've now got that data from May onwards.
The second thing is we are clearly stating that we wish to eradicate it. That is our intent for exactly the point that everybody's alluded to. It causes increased harm. It causes increased length of stay at hospital, and it has no dignity to it. So that is absolutely our mission statement. The next part of it is for me, which is probably came out in the last panel, is what's the causation of that corridor care. And that is flow. That's flow and overcrowding. Those are the two big problems. Flow is about how patients move through the hospital system and then the greater system around that hospital.
So our.
So it's about controlling some of that demand because we do have to do that. But we absolutely have to look at the back door. And that's what we've started to focus on. significantly in the last couple of months. A couple of things we've done, if I may, whilst I know the panel previously have alluded, it's far from perfect. We have called out corridor care and we now measure it. I completely accept that . There are questions around the definition of how one measures it, but for the first time we are measuring it and we've now got that data from May onwards.
The second thing is we are clearly stating that we wish to eradicate it. That is our intent for exactly the point that everybody's alluded to. It causes increased harm. It causes increased length of stay at hospital, and it has no dignity to it. So that is absolutely our mission statement. The next part of it is for me, which is probably came out in the last panel, is what's the causation of that corridor care. And that is flow. That's flow and overcrowding. Those are the two big problems. Flow is about how patients move through the hospital system and then the greater system around that hospital.
So our.
11:36
11:36
11:37
11:37
Speaker 1
-
Speaker 1
More about the front door than the back door currently. Is that or is that unfair? Yeah. No, that's absolutely fair. So that's very much about the front door. So that's about the demand management and also. ensuring that when we get. So we have got an increase in demand in urgent and emergency care. We've seen that year on year, but particularly this year, we've seen a. significant increase in demand beyond the plan to the region of 3.4%. And secondly, we've seen an increase in acuity within that demand. So we know the patients coming through the door are more complex and sicker.
That's what we expect. That's what emergency department should be there for. So that is what that investment .
That's what we expect. That's what emergency department should be there for. So that is what that investment .
11:38
Speaker 1
-
Speaker 1
Like urgent treatment centres and same day emergency care. So what are you doing for the back door then. And so for the back door. So flip it around if I may. So then for the back door is very much. focusing on those patients who need a timely discharge to hospital. Leaving hospital. One of the first things we've done is again, looking at some of the data and changing some of that data so that we're all agreeing. Again, you might question what the definitions are, but at least we've got a single point of. definition for different what's called different pathways.
So what does a patient need to leave hospital? And specifically we're looking at patients who what's called no longer meet the criteria to reside. So how can we get patients who are medically fit out of hospital. And they've got different needs there. And some of those are very much in the hospital process. Some of those are very much in social care process, and some of them are across the board. And what we're doing is trying to tackle all those three. So with regards to the hospital processes we're looking at, we've designed model discharge. So what does a good discharge look like.
We've also then collaboratively worked with social care and particularly what can we look like for winter. How can we make those. patients get out of hospital safely.
So what does a patient need to leave hospital? And specifically we're looking at patients who what's called no longer meet the criteria to reside. So how can we get patients who are medically fit out of hospital. And they've got different needs there. And some of those are very much in the hospital process. Some of those are very much in social care process, and some of them are across the board. And what we're doing is trying to tackle all those three. So with regards to the hospital processes we're looking at, we've designed model discharge. So what does a good discharge look like.
We've also then collaboratively worked with social care and particularly what can we look like for winter. How can we make those. patients get out of hospital safely.
11:40
11:40
Speaker 1
-
Speaker 1
Together quicker before winter hits us hard so that we move there because there are frailest patients, and certainly the Secretary of State is very clear and has all of us around the table in a very collaborative fashion about what that's done. We then got some very. specific examples, if I may, where we are looking at what does the improvement? Again, I just came in and there was a mention of ISIS, but we have get it right first time. Yes. We've got very specific providers who have got challenges where that team have gone in and we've agreed 40 specific.
11:42
11:42
11:42
11:42
Speaker 1
-
Speaker 1
Front door, looking at that back door, and finally, sorry, I'm just looking about the system. So it's not just about social care. It's not just about hospitals, but it's about the system in which we all work. So particularly in primary care, is there anything else we can do before the particularly the frail and elderly patients come into .
11:43
11:44
11:44
11:44
Layla Moran
-
-
Layla Moran
Your message to them would be, it's going to work. Stick with the plan that would even if you don't think it's a plan . And can I come to. Culture Minister, and you'll know that this, when we wrote to you, was something that committee was was really struck by, you know, we heard from areas that have done this well. And the one thing that does seem to be the.
11:45
11:45
Layla Moran
-
-
Layla Moran
Well, if there is a secret sauce, it's kind of this. It was also very heartening to hear in the Public Accounts Committee session, people, when they are when the teams offer, if they can have their help, they welcome them with open arms. It isn't a sense of, oh, you're coming to tell us off. Actually, they want that best practice. My question to you, Minister, is, given that teams want this help, they. And the issue seems to be a capacity constraint from within the department rather than people not wanting it. What are you doing to address that capacity constraint?
11:46
Speaker 2
-
Speaker 2
That was made clear in the Public Accounts Committee hearing just a few days ago? Well, if I take take some of that in in turn, I think that that that is right. And I am calling Secretary of state's asked me to talk to various leaders in the system across the piece in the last few weeks about specific issues that we've got, because, as you know, it's different in different places. Some of the problems are different, and the relationships and the culture is different in different places. So working with Doctor Rowlands, we're looking at talking to those colleagues and very much I've had feedback that those calls are welcome.
And actually it's really helpful to hear from frontline leaders. And I agree with your previous panel. Leadership is really key here that, you know, sort of sharing that learning. They welcome the teams, they welcome that that sort of issue coming forward. So I .
And actually it's really helpful to hear from frontline leaders. And I agree with your previous panel. Leadership is really key here that, you know, sort of sharing that learning. They welcome the teams, they welcome that that sort of issue coming forward. So I .
11:48
11:48
11:48
11:49
11:49
11:50
11:50
Speaker 2
-
Speaker 2
Some of these issues about the flow, we eradicated this as a previous government in A&E departments. All of these things were known. And I think we've referred sort of loss of memory loss. So I think we have lost in many places the basic, you know, how to do some things properly and to own this as a system. And so getting that back in, changing the culture to your .
11:50
11:50
Speaker 2
-
Speaker 2
Is, is a tough task. And I just want to specific one of the things that the new Secretary of State has made very clear, and we have a new minister particularly focused on social care, is having that extra. capacity to look at. discharge in the department. So we very much we have focused on getting the best into the NHS part of the system. I think that's true because of the situation we inherited. That's both getting the board ownership of the problem, focusing on the NHS. There is still. And again, Sir Jim McKay said this at committee last week.
There is still a lot to. I think he used the words go for. In terms of how.
There is still a lot to. I think he used the words go for. In terms of how.
11:52
11:52
11:52
11:52
11:52
11:52
11:52
11:52
11:52
Layla Moran
-
-
Layla Moran
Answered the question. I don't think you did. But carry on. Please answer some of the detail on what I want. So I'm clear because maybe you were asking answering a different question that I want, and maybe that's because I haven't been clear. So let me be clear. What's new? What is new this year to change culture? Because that is so. important in .
11:52
11:52
11:53
Speaker 2
-
Speaker 2
Prevention angle and from the wider angle outside of the hospital. I just want you to focus on leadership. Thank you. So in terms of leadership, if you look at the back door coming out of the hospital, Emma can talk about the leadership that happens in the hospital. But outside, I think, you know, two things in this committee. Firstly, you know that there is a long term framework about how we bring together leaders from the NHS and leaders from local government. The Better Care Fund has locked that in for many years, and this year it has a focus on admissions and a focus on discharge.
But in addition, in answer to your question about whether leadership capability is. Our department and NHS are working together with locally stressed systems. So we have a team at the moment who are going in to talk to those areas where we can see the greatest challenge on discharge to social care in particular. And then if you look at another example, as you ask for specifics, I know you're taking a session next week about homelessness and rough sleeping. You will know that we have recently published a new discharge pathway there for rough sleepers. My team are working with MHC, LG, we have a joint action plan together, and we are going into the areas that have the highest level of discharge challenge where it relates to rough sleepers.
So I hope that gives you a sense of how we are engaging with senior leaders this afternoon. Emma and I are, in fact, jointly chairing a session with Icbs and with local .
But in addition, in answer to your question about whether leadership capability is. Our department and NHS are working together with locally stressed systems. So we have a team at the moment who are going in to talk to those areas where we can see the greatest challenge on discharge to social care in particular. And then if you look at another example, as you ask for specifics, I know you're taking a session next week about homelessness and rough sleeping. You will know that we have recently published a new discharge pathway there for rough sleepers. My team are working with MHC, LG, we have a joint action plan together, and we are going into the areas that have the highest level of discharge challenge where it relates to rough sleepers.
So I hope that gives you a sense of how we are engaging with senior leaders this afternoon. Emma and I are, in fact, jointly chairing a session with Icbs and with local .
11:55
11:55
Speaker 2
-
Speaker 2
Looking at those rough sleeper cohorts and people who are at risk of that, we're going to come. Yeah, absolutely. So there's quite a lot of work across the system where we are. connecting with local leaders and creating forums to bring them together where we know that they are stressed. I agree with you that it's a leadership issue. I agree that a lot is local,
11:55
11:55
11:55
Layla Moran
-
-
Layla Moran
Being in the mess that they are, was identified in the last panel as one of the the things that is missing this year compared to last year, you know, where in previous years they were able to be conveners of all sides of the system this year, because, no, all the turmoil that's not happening in the same way. What is the .
11:55
11:55
Speaker 1
-
Speaker 1
Is it just mitigating the gap? I'm trying to understand the levels here. Yeah, please. I come into some of this and I might take it back to your previous question as well, if I may, chair, so very leadership. So we have been very clear specifically on winter and corridor care, that trusts and boards are accountable for that. And likewise, into winter. What we've done is, is ask and expect completion of board assurance statements.
And that has gone through all the system. So that's gone from trusts through icbs, through.
And that has gone through all the system. So that's gone from trusts through icbs, through.
11:55
11:55
Speaker 1
-
Speaker 1
And to try and support and sort of mitigate that gap. We've then tested those plans and that's come through regions initially, and then that's gone to National to check that. So we've tried to sort of wrap as much as we can around that, particularly through the operating model from a national to a regional and an ICB and a provider. And we've had many, many of those leaders in the room, certainly with myself and Sir Jim .
11:55
Paulette Hamilton
-
-
Paulette Hamilton
CEOs of the Icbs. Thank you, Paula Hamilton, please. Thank you, chair. Good morning all. Let me start by talking about data. So my first question is. around a report that was published from the. National Audit Office. And the report. highlighted a lack of national. data on patient flow. Now with that in mind, do you have the. data on pressure flows within. hospitals and not just looking at the front and back door? So you've talked about the front and back door, but do you have the data that you need to do the work that you've just .
11:55
11:55
11:55
11:55
Speaker 1
-
Speaker 1
We have a significant amount of data, but to your point, those are very much on either front door or back door metrics. particularly the the. individual flow metrics are very much a provider. And I can say that having been a chief operating officer, you get down into that nitty gritty because it's that detail that you need. And I think if we got that at aggregate level for National, we would lose a lot of that nuance.
So for us, it's very much about seeing the outcomes of that .
So for us, it's very much about seeing the outcomes of that .
11:55
11:55
11:55
11:55
Speaker 1
-
Speaker 1
You can say, we have clearly got that data. So for me, I come back on that again, if I may. We are seeing the outcomes. So our data shows the. outcomes of our system not working. So that is corridor care. That is the patients with no criteria to reside. Those are the outcomes of of poor flow. And that .
11:55
11:55
Speaker 2
-
Speaker 2
They improve and demonstrate better flow. And we're about if I just add, I think, I mean, for me, this this does come back to this point. And I know we keep reiterating, but it is an important one for the future, that this is the. responsibility of trusts at a local level. You know, we're not just. evolving for the sake of it, but what what has happened. And this is our. assessment coming in as a new government is that the the system is. overcentralised and the. responsibility and the. accountability for performance and what happens and this covers, you know, staffing, all sorts of issues has to be at that local level with boards.
Now, I know that, you know that that's not always they're not always in the right place in the right, but that is part of what the team is doing. We have to have that ownership and that leadership at a local level, and that. includes access to and following that data and how we how we then accumulate that data at a national level. We're open to different ways, and the committee has different ideas of what is useful to look at and so on. And I've shared data with members of Parliament here about their individual trusts and performance data, productivity data, all of that, because I think it's really important for you as members of Parliament, for me, as a member of Parliament, you as a committee, to know exactly what is happening at your .
Now, I know that, you know that that's not always they're not always in the right place in the right, but that is part of what the team is doing. We have to have that ownership and that leadership at a local level, and that. includes access to and following that data and how we how we then accumulate that data at a national level. We're open to different ways, and the committee has different ideas of what is useful to look at and so on. And I've shared data with members of Parliament here about their individual trusts and performance data, productivity data, all of that, because I think it's really important for you as members of Parliament, for me, as a member of Parliament, you as a committee, to know exactly what is happening at your .
11:55
11:55
11:55
11:55
11:55
11:55
Paulette Hamilton
-
-
Paulette Hamilton
Even after all this time I was around when Icbs were set up, I was around when SDP. I know they should be doing it at local level, but with 50% cuts going on down there, I am not sure how you're going to get all this data, how you're going to measure it, how you're going to ensure that what you need to get is the right data.
11:55
11:55
11:55
11:55
11:55
Speaker 2
-
Speaker 2
No, no, no, sorry, sorry. If I'm not not being clear and I know you've not been clear. So it is their. responsibility to to manage their local systems and their accountability there. They have a lot, you know, they have that data to, as you know, to manage their systems in the first place. I think the issue is what is helpful to have a national level and what is nationally published and what is.
11:55
11:55
Speaker 2
-
Speaker 2
I think that that is that is that is a that. And I think we need we can I'm very happy. You know, we can always look at that. The data is is largely there how we then put that up to the wider system and how we share that. I'm very happy and open to other suggestions. Or if we if we think there is it is data that we need to mandate differently. We don't want to overburden the system with reporting. That's another sort of issue we have to be mindful of, but very willing. If we think there is information that we don't .
11:55
11:55
11:55
Speaker 1
-
Speaker 1
If you want to add do you want to add? And then we're going to have to stop. No, that's just I guess the question for me is, is about driving change and improvement. That's the ultimate for us, for patients, for staff, etc.. So we have. data in, in my mind that shows it's not where it needs to be. So I'm keen that we don't recount that and that actually our focus is on improving that. And I think therefore the question is what do you need at local level to drive that change? And that might be very.
different for in a hospital in .
different for in a hospital in .
11:55
11:55
11:55
Speaker 2
-
Speaker 2
Example, the patient experience, you know, we've got two minutes. Just add the patient experience stuff which you alluded to. Absolutely. And that is why we have a new patient experience director coming in to the new department. And I absolutely agree. There is a lot of, you know, there's so much data and.
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 2
-
Speaker 2
Director, will you commit? I only need a yes or no. That that will be his job. That is why there is a new patient experience, director and working, you know, with the National Quality Board, which has also been, you know, updated. This is all part of Penny Dash's review in order to exactly capture the data. We know. And we have got much better to drive improvement, that is. And I'm sure that the committee wants to look more closely at that .
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 2
-
Speaker 2
Feel might work better especially. Yeah. So I mean, sometimes they do drive local change. They support local. innovation in different sectors, but largely and it's something that I have striven to do, particularly around capital, is to streamline the. processes between NHS England and the Department and the Treasury, so that we are clear about the pots of money. There's longer term certainty now in the financial settlement, both for revenue over a three year period for capital over a four year, indeed a longer length into a nine year period for exactly that reason, to give local systems more certainty over funding how to access it.
So we don't have all these different pots of money. It was a bit .
So we don't have all these different pots of money. It was a bit .
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 1
-
Speaker 1
The last committee meeting. I'm going to ask Catherine to update on that. Thank you very much. I don't have an update for you today, but I have spoken to the team. We're expecting to issue the next step of the guidance this autumn. So what we've said, as I'm sure you know, so we'll update the committee and make sure that you're sighted on that at the moment it happens. If you've got anything more specific that you want us to take away on that,
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 2
-
Speaker 2
It, however, you know, whatever people might think about it is it is hard to measure. I think previous panel identified some of the issues around measurement. It's not easy to measure, and it did take some time for us to get that to try and get that right. And we'll learn from that as well. By the way, in reference to your previous panel, we we don't want to see gaming. We want to learn from that because ultimately it's about patient safety. You know, we know this summer was tough with those six heat waves. That has not helped.
But also I would say that it is very different in different places. And I think that's important. Again, back to my point about .
But also I would say that it is very different in different places. And I think that's important. Again, back to my point about .
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 2
-
Speaker 2
Terms of eliminating corridor care by 2029? I'll answer that. I think it's relatively early days, if I'm honest, because it's because we're collecting the data relatively new. I think there has definitely been variation how people have been reporting that data. And within it, there is definitely an. interpretation within that data. Despite best efforts of giving a definition in examples, people will always interpret locally. So I think the.
granularity about what the team are feeling on the ground is probably more important. So in.
granularity about what the team are feeling on the ground is probably more important. So in.
11:55
11:55
11:55
Josh Fenton-Glynn
-
-
Josh Fenton-Glynn
People probably reporting it better. But we probably also know it's still an underestimate. I mean, you know, it's good to actually be open about the data. I'd rather that than gaming. Speaking of data. 13,000 hospital beds were occupied by. patients with no capacity to resign last reside last winter. So that's. 1.27 million bed days. How many corridor care incidents do .
11:55
Speaker 2
-
Speaker 2
You think are. attributable to that? I, I don't think you can work out. exactly the mathematical model, but I think you can absolutely say that the causation in my mind of corridor care is poor flow. So if you've got poor exit from the. hospital and it's the number of patients, those patients in the corridor should be in a hospital bed. That's my general consensus, and that's the way I think we should view it.
So there is no doubt that that is a .
So there is no doubt that that is a .
11:55
11:55
Speaker 2
-
Speaker 2
Is down to social care not being where it should be? It's it's a. combination across the patch. As I say, there are again, there are several different ways of cutting this data. And we definitely know there are more patients in hospital with no criteria to reside this year versus last year. And that's why I definitely it's a focus for us. There are again, depending on how you count it, it is. estimated between about.
20 to 23% are about within the hospital's own capability.
20 to 23% are about within the hospital's own capability.
11:55
11:55
11:55
Josh Fenton-Glynn
-
-
Josh Fenton-Glynn
Which is joint, which is the communication and things like the transfer of care hubs where people work together. The Casey Commission isn't coming out until next summer. I'm going to go back to Minister Smith, if that's okay. What are we doing between now and when we actually start implementing the Casey Commission to .
11:55
Speaker 1
-
Speaker 1
Make sure that social care is improving somewhat? Yeah. No, we're not waiting for the Casey Commission to to be addressing this point. And to my my earlier point, and we do have a additional minister in the Department and within the Secretary, the new Secretary of State has been very clear that Department wide looking at discharge and social care as as the Prime Minister, being clear, is absolutely part of that wider, wider remit. And as I said earlier, we have been very focused on the NHS side efficiency, if you like, and getting that right. So, so very much not waiting for Casey on that.
And again, it's very variable. So you cut the average. It's about 15%. In some places that goes up to 27%. And in some of the conversations I'm having with local leaders, it's talking about that. Now, some of those are what I call in my local area geopolitical issues. They are border issues, not only just with our friends in Wales, for example, but also within systems in different counties. So, you .
And again, it's very variable. So you cut the average. It's about 15%. In some places that goes up to 27%. And in some of the conversations I'm having with local leaders, it's talking about that. Now, some of those are what I call in my local area geopolitical issues. They are border issues, not only just with our friends in Wales, for example, but also within systems in different counties. So, you .
11:55
11:55
Speaker 1
-
Speaker 1
Very difficult things for a hospital to manage. I'm aware of I don't want to get into too much geopolitical fighting across the country. We have to change that. That is why looking at that. culturally as a whole system has to be the way forward. Now we know that local authorities are also under a lot of pressure. And again, you know, we need to work with them to manage that.
And so Catherine is working very closely with colleagues over. Mhclg to it's a shared .
And so Catherine is working very closely with colleagues over. Mhclg to it's a shared .
11:55
11:55
11:55
11:55
Speaker 1
-
Speaker 1
Published yet, but it is due to be published very soon. What does very soon mean? I genuinely don't know the answer to that question in terms of days. But it is very, very days, not weeks. Yes, but we can let you know that as soon as possible. But it has it has been brought together. I don't know where. I don't know when we can. It's got to, to get final sign off.
11:55
11:55
11:55
11:55
Speaker 1
-
Speaker 1
Ability to train. So there's kind of long. systemic tale if we don't get this right, but it's to it's to Emma's earlier point, don't underestimate for the staff at the front end dealing with this and in primary care and indeed in discharge, it's very pressured. You know, the demand you know, the numbers are clear that, you know, attendances are up nearly 6%. Ambulance incidents are also up nearly 6%. And that was already a pressurised system at 95% occupancy. We don't shy away from the fact that this is a pressurised system. And to Emma's point, colleagues, clinical colleagues are feeling that very much at the front end.
But I would say that we are grasping it and making those improvements. And a longer term strategy is obviously part of that. But we've put these you know, we've put a lot of guidance out, model ways to .
But I would say that we are grasping it and making those improvements. And a longer term strategy is obviously part of that. But we've put these you know, we've put a lot of guidance out, model ways to .
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 2
-
Speaker 2
Already had? Yeah. So yes, we're currently pulling those together. So it is very clear that we will be. measuring corridor care very specifically for children, which we haven't necessarily done before. So we'll do that by age. So again, that we can see what's going on and then have some specific plans. There are plans being drawn up. I .
11:55
11:55
11:55
Speaker 2
-
Speaker 2
Adult's pathway. Is that the kind of thing you want to see more of? So we do need to look specifically at children because again, there are there are some similarities across the board. There are also some really different nuances. So it's really important that we get specifically into children. And hopefully part of that was we published the pews, the .
11:55
11:55
Josh Fenton-Glynn
-
-
Josh Fenton-Glynn
Warning score about how can we see what's going on for those patients in there as well. I genuinely like the approach that we've taken of measuring things, because I do believe that what gets measured gets mended. One of the things that we've. found is that. 15% of children who experience corridor care have experienced corridor care in some form. Do we have a sense of how many. children have had negative health outcomes in the NHS because of .
11:55
Speaker 2
-
Speaker 2
Experiencing corridor care? Have we measured that? To the best of my knowledge, no, we haven't yet. previously recorded corridor care at all for children, so I'm not cited on some of those statistics and where they've come from, which is why I think it's important that, again, similar to adults, we may differ when we get there on .
11:55
11:55
11:55
11:55
Speaker 1
-
Speaker 1
How many children have negative outcomes because of corridor care? I mean, I would leave that to clinical advice to be honest. You know, we want to know outcomes, obviously, and we want to eradicate. We don't want this to be happening. So we need to know and obviously for. children's difference, I mean, in my own hospital, we have a children's hospital. Different parts of the system obviously can manage that care differently. So I'd be guided by the clinical advice really as to how best obviously, we want to know outcomes for children. And if there's a negative cause anywhere in the system from from primary care through, we'd .
11:55
11:55
Speaker 1
-
Speaker 1
But you might look at that as in future as something that we should. I mean, I think we should look at negative impacts in the whole system for, for children, whether the. specifics as another way of data collection point is the best clinical measure I would. I would wait to be advised, really by by Doctor Rowlands and her clinical colleagues as as the best thing to do, because, as you say, you .
11:55
11:55
Allison Gardner
-
-
Allison Gardner
Very much. Quick intervention by Alison Gardner, please. Doctor Gardner. Oh, sorry. Thank you. I'm just doing a couple of. It's not linked with that. It's to do with number of beds. It keeps coming back. NHS beds available. My chief exec at the Royal Stoke and I know Minister is aware of the challenges there. Says they need beds. In the previous panel they said look, we need more beds and I'm just interested if there's been a culture over the last 15 years to reduce the number of NHS beds with concerns that, you know, that that that, you know, patients are better off treated at home, which is understandable.
But our OECD average is two point is 4.6. Our number of beds per 1000 capita is 2.4. Just looking at the population increase and the increase to numbers of Ed, our population since. 2011 has increased by 6 million. Arrivals at Ed has increased by. 6.5 million since 2011. So, you know, this is where the pressures are. And we've also seen a significant increase in over.
But our OECD average is two point is 4.6. Our number of beds per 1000 capita is 2.4. Just looking at the population increase and the increase to numbers of Ed, our population since. 2011 has increased by 6 million. Arrivals at Ed has increased by. 6.5 million since 2011. So, you know, this is where the pressures are. And we've also seen a significant increase in over.
11:55
11:55
Allison Gardner
-
-
Allison Gardner
You know, up to 2.5. So 5 million increase on average. So we've been reducing beds. We've been trying to number crunch this, but we have been reducing beds. And I know, for example, in North Staffordshire, we closed intermediate care beds in community hospitals. We're short of. 183 that step up and step down and reablement care. So my simple question is, as we are reducing our number of NHS beds with all laudable.
11:55
11:55
11:55
11:55
11:55
Speaker 2
-
Speaker 2
Telling us they need beds. Do you want to start? I don't mind, so there are. There's no doubt we have less beds open this year versus last year. And as you alluded to , that there's for a variety of reasons, including the. intention to try and move patients closer to home and get the care. However, the. counter-argument for that is exactly as you've alluded to, that we've got increased attendances in A&E with increased complexity and an increased frail population. So there is a risk that we potentially could and should have more beds. From a financial.
11:55
11:55
Speaker 2
-
Speaker 2
That is that is very difficult. That would cause increased cost. And even if there was an increased cost in beds, that would have to be staffed. So there is definitely I think already we have to do that balance that there is definitely. efficiencies still to be had. If we come back to those no criteria to reside. patients .
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 1
-
Speaker 1
Etc. does help keep people locally. But I think you you quite rightly highlighted the complexity in this when you talked obviously very knowledgeable about step up, step down beds, what sort of beds you've got and what sort of communities. I know when I was involved in commission in this area, you know, people think we know what a bed is and you know what it's for. That's not that's not as straightforward as it was. And as Emma says, in some places where you've got. 27% occupancy by no criteria to reside, then it's absolutely right to resolve that issue primarily for the.
patient who wants to be at home with their families or their loved ones. And so, you know, adding beds into that system would not be a good use of taxpayers money or efficiency. So we do need to, and I make no apologies for the government making sure that we get the best value and the right clinical care for for the patient and for the taxpayer. So to drive those efficiencies. But that also means that that's why we need to work with our colleagues in Mhclg and local government, because very often those patients will need, we can call them step up or step down.
patient who wants to be at home with their families or their loved ones. And so, you know, adding beds into that system would not be a good use of taxpayers money or efficiency. So we do need to, and I make no apologies for the government making sure that we get the best value and the right clinical care for for the patient and for the taxpayer. So to drive those efficiencies. But that also means that that's why we need to work with our colleagues in Mhclg and local government, because very often those patients will need, we can call them step up or step down.
11:55
11:55
Speaker 1
-
Speaker 1
We want to shorten the pathway so that people are kept at home in primary and community care more clearly. That's what the announcement, for example, on stratification on Monday was about. So we pick up those people who are likely to to go in who we do know a lot about in the system, so that they don't end up going into EDS. And because it is harder to get out and manage the whole system. Now, in the short term, obviously we need to keep looking at flexing local systems, and that's what the local. oversight that Emma and her team are doing in each individual system, as she's as she's.
11:55
11:55
11:55
11:55
Speaker 4
-
Speaker 4
Thank you. I'm afraid we need to move on. Sorry, Carl Hassan. Thank you. Thank you, chair, and good morning all. So I have a reasonable amount of practical. experience in vaccination. And in fact, I had my flu vaccination in a fantastic. pharmacy in Clevedon only a couple of weeks ago. And I believe flu is a major driver of winter pressures. So as it's a vaccination is a. significant lever for mitigation. What should we expect from this year's flu season, given what the UK Health Security Agency has said , specifically, around. 18 to 24 year old. circulation rates through their international surveillance?
And are we seeing signs .
And are we seeing signs .
11:55
11:55
Speaker 3
-
Speaker 3
Okay, I've had mine too. I hope you all have. I can perhaps come in on that. So colleagues in. Ukhsa have, when they processed the data on flu this year, we can see, of course, there was a little bit of an early uptick, but it's now looking much more sort of. standardized compared with other years. Of course, that can always change over time, but we're in that sort of point of the cycle in terms of the efficacy of vaccination, as I'm sure you will know, it will sort of vary year to year. In a sense.
We will only know later in the year when. Ukhsa will do that analysis. But our advice remains to everybody.
We will only know later in the year when. Ukhsa will do that analysis. But our advice remains to everybody.
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 3
-
Speaker 3
Avoided from vaccination for flu in previous years, but that will vary year to year. If I may, I would just draw the committee's attention to one other thing, which is that we have a relatively new RSV offer over the last couple of years, and we're seeing quite a significant effect from RSV, both on the impact of very young children under the age of six months, their. hospitalisation and their need for intensive care, and also for older people as well.
So those are things to keep an eye on. Too early to .
So those are things to keep an eye on. Too early to .
11:55
11:55
Speaker 3
-
Speaker 3
Are you on. progress to meet that? Yeah. So flu vaccines this year. I mean it's worth saying I think to this committee and I thank you. You've discussed this with our teams before. We've taken. unusual position where we've set a multi-year set of targets for flu vaccines out to the NHS to sort of try and build the attainment over the course of the year and over a course of a few years, to renormalize up to higher levels.
So far this year, we have delivered on.
So far this year, we have delivered on.
11:55
11:55
11:55
Speaker 3
-
Speaker 3
That's up a little from last year. It's up 300,000. If you break down into that, what you can see is in different cohorts, there's a slightly different picture. So we have done a lot of work this year, as you know, on schools, vaccination and focusing on children. Coming back to the point about children because of their role actually, as they can infect their grandchildren, their grandparents as well, as well as being unwell themselves. Schools look to be. significantly ahead of where they were last year. We think that that is a product both of a significant digital investment, which helps people consent when they want to, but we think it's also a product of some joint work between us .
11:55
11:55
Speaker 3
-
Speaker 3
You mean ahead of their planned vaccination, not vaccinating more people, correct? I mean, I mean ahead of where they were at this point last year. We can't tell at this stage just because it's impossible to tell whether that means that ultimately we'll end up with a higher. vaccination rate, or whether that means that they're simply doing it early. What I can tell you in schools is that we issued the guidance pre summer this year. We asked them to start very early, and we've asked. immunisation providers to make sure they've done their first visit to every single school in November.
There are other cohorts as well as you know. So for 2 to 3 year old children that's delivered this year through a. combination of GPS and community. pharmacies that is following where it was last year, a few days lag. So we've got a slightly different picture. And if we look at other cohorts, it's slightly different through the different cohorts. But the emphasis this year is on pace.
particularly in children.
There are other cohorts as well as you know. So for 2 to 3 year old children that's delivered this year through a. combination of GPS and community. pharmacies that is following where it was last year, a few days lag. So we've got a slightly different picture. And if we look at other cohorts, it's slightly different through the different cohorts. But the emphasis this year is on pace.
particularly in children.
11:55
11:55
Speaker 4
-
Speaker 4
Out there early with pregnant women and children at the start of the season. Thank you for that. Now you've just said that the focus is on pace and that you've put out a. multi-year plan for. vaccination and and you used the word higher for flu. And I'm looking at the multi-year plan. And, you know, for me, going from, what. 46% to 50% for 2 to 3 year olds, that's still leaving.
11:55
11:55
11:55
11:55
11:55
Speaker 3
-
Speaker 3
This is a really good question for the over. 65 cohort, which of course, is the largest cohort of people that we vaccinate. Our target there at. 75% is the World Health Organisation target. And actually we are at or near it for the sorry for the other cohorts where you're absolutely right, the rates are .
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 3
-
Speaker 3
Level then given the mitigation effect that that would have on the system? I think because what we are focusing on is looking at building up the other rates. So, for example, your question about the. 2 to 3 and the schools rates, what we're trying to do this year is to come back to the. pre-pandemic high point rate. And then we're trying to move beyond that over the next few years. If we look at some other groups, I'm sure the committee might want to come onto this. Healthcare workers is at a it has been at a very low rate indeed.
Last year we pulled that up by 7%. That's great progress, but we've set a much higher rate this year. So we are aiming for. 60% this year. And so far we have seen an uptick. It's about 4% higher than this time last year.
Last year we pulled that up by 7%. That's great progress, but we've set a much higher rate this year. So we are aiming for. 60% this year. And so far we have seen an uptick. It's about 4% higher than this time last year.
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 3
-
Speaker 3
Behind that increase? Is it just the target or has there been more? We think it's a few different things. So the first thing is that we've actually helped trusts in terms of putting in better digital and data collection so that they can see what they're doing. And that's rolled out everywhere this year. And the second thing, and it does come back to the point that you were making about.
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
11:55
Speaker 1
-
Speaker 1
You know. fantastic out in their open space nurse centre there, available through the day and through shifts, making it easier, all trusts encouraging, as Catherine has said, encouraging people to have that on site, making that more easy. And I would also commend, if I can, it's not always the case that committees can look at cross-government working, but I would commend the officials at the Department of Education and our own officials at Department of Health and Social Care for really working very hard after last winter to say, no, we need to sort out this issue of consent in schools to get to.
children and to. support people locally about getting the vaccination. I also spoke to chief executive at Barts Trust yesterday about what they're doing across their sites. So, you know, and you'll be well versed as a.
children and to. support people locally about getting the vaccination. I also spoke to chief executive at Barts Trust yesterday about what they're doing across their sites. So, you know, and you'll be well versed as a.
11:55
11:55
11:55
Speaker 3
-
Speaker 3
Cause harm to the. population and support people through this. Perhaps I could come back. Quantifying this, we think is different in the different groups involved. I think there are four big strands. So the first is digital. This rollout into schools that we have seen, it's too early to say what will happen later in the season. I mean, I hope the committee understands that. We just don't know if we've brought it forward or if we've increased overall, but our learning from that is really important. 14,000 schools are now on that new system. That's a huge portion of the system, and there's learning for elsewhere.
The second thing I think is about access. So as you all know, although there are issues, people may have concerns about vaccination or not, but access is really important. We are still learning about access. So for example, for children aged.
The second thing I think is about access. So as you all know, although there are issues, people may have concerns about vaccination or not, but access is really important. We are still learning about access. So for example, for children aged.
11:55
11:55
Speaker 3
-
Speaker 3
We have we have community, we have community. pharmacies also offering 2 to 3 vaccination. This year. We are not yet sure how far that is. increasing the. efficiency and the offer for the public or how far it's going to drive up rates. So are people going to channel switch? We're not sure. And then we think, as the minister has said. communication and role modelling is .
11:55
11:55
11:55
Layla Moran
-
-
Layla Moran