Ambulance and Emergency Department Waiting Times

Debate between Margaret Greenwood and Edward Argar

Wednesday 6th July 2022 Westminster Hall

[Edward Argar]

I am grateful to the hon. Lady, but when hon. Members raise party political points, it is incumbent on me as Minister to respond and to put the facts on the record. I will turn to the specific points she has raised. I will also turn, in that context, to the various points that she and the hon. Member for North Shropshire (Helen Morgan) made about various tangible suggestions from the Liberals on the issue.

The hon. Member for Bath is right to have secured and introduced the debate, because this issue is one of growing concern, understandably, and not just for all our constituents but for those who work on the frontline of our NHS. I think it was the hon. Member for Weaver Vale who highlighted the challenges faced by those staff, who want to be there and want to help. When someone rings for an ambulance, it is not a case of making an appointment with their GP; they are deeply concerned for their health, or the health of someone else, in an emergency. All those staff want to do—I have met many of them—is be there for those people, and the hon. Gentleman was right to highlight that issue.

As the hon. Member for Bath will be aware, the pandemic has caused significant strain across the NHS and the social care sector, and emergency care performance, as hon. Members have been open in acknowledging, is recognised as a whole-system issue. The challenges in performance can be traced along the entire patient pathway. Indeed, as I think the hon. Lady acknowledged in her Adjournment debate in the main Chamber on 31 March, although there are elements of that that we need to look at, we also need to look at the issue as a whole. She was right to say that.

For example, as hon. Members have said, the problems and delays in discharging patients home or to community services once they have recovered have a genuine impact on hospital bed occupancy—taking up beds that could otherwise be used by patients who need them. I want to give my hon. Friend the Member for Broadland a slightly more optimistic picture, which is in no way to diminish the challenge that remains. The number of beds taken up by people who are clinically fit to be discharged is not 20,000; it hovers at around 10,000. We have set up a national discharge taskforce, which is working actively with trusts and across local systems, particularly those that are most challenged, to support that discharge work. The situation is not as acute as he suggested, but it remains challenging because every one of those beds could be used to admit patients from an urgent and emergency care setting, or indeed to tackle elective backlogs and waiting lists.

[Margaret Greenwood]

Will the Minister give way?

--- Later in debate ---

[Edward Argar]

I would like to make a little progress before giving way again. I am conscious that I need to leave enough time for the hon. Member for Bath to respond.

That affects how quickly patients can be admitted from A&E, and such delays increase waiting times, as has been said, and lead to that crowding in departments, which has an impact on how quickly new patients arriving in A&E can be seen and treated, including those arriving by ambulance. When this causes ambulance queues to form, the local ambulance resource available to be dispatched to incoming 999 calls is reduced. It is fair to say that although the ambulance queues and delays are often the most visible manifestation of challenge, they are in many ways a symptom of that broader patient flow and the systemic challenge we face.

The root cause of these issues is hospital bed occupancy. That has consistently remained nationally at around 93%—a level usually seen only during winter pressures, as hon. Members have said. The pandemic has played a significant part in driving those pressures, and there are nearly 9,500 in-patients either with covid or for covid in clinical settings, as of 1 July. That is about 10% of all general and acute beds in the NHS.

[Margaret Greenwood]

rose—

[Edward Argar]

I will give way to the hon. Lady, but I want to make a little progress. There are points I want to make before I run out of time, but then I will give way.

That number, as we know, has frequently been higher during the pandemic, and there is the challenge of staff absences during waves.

[Margaret Greenwood]

rose—

[Edward Argar]

If the hon. Lady is brief, I will of course give way.

[Margaret Greenwood]

The Minister will be aware that I have expressed extreme concern and tabled written questions about what happens to those people who are discharged under what was known as discharge to assess and their clinical outcomes. Will he commit to carrying out a review of the patient outcomes of all the patients discharged in that way, to see how many were readmitted to hospital within 30 days of discharge?

[Edward Argar]

I will not commit myself to what the hon. Lady specifically asks for because of the challenge of data collection, but I will say that I see where she is coming from and appreciate the underlying point, which is about understanding the impact of the policy. It has been in use since 2020 as a pandemic measure and is now in statute. The NHS will be monitoring it carefully. We do not agree on everything, but I am always happy to talk to her about these matters because she takes a close interest in them.

With regard to local actions in the patch covered by the hon. Member for Bath, as an illustration of the sorts of measures being put in place across the country, the local integrated care system is working to improve patient flow and reduce handover delays at acute trusts, including the Royal United Hospital in Bath. I join her in paying tribute to the work that her local team there are doing. That hospital is working well with community partners to help patients to return home as soon as they are well. That includes work with the hon. Lady’s local council to develop its domiciliary care provider, which will provide an additional 1,000 hours of domiciliary care a week. A £2 million investment will also be made in the Home First programme, whereby experts from across health and care help patients to get safely back home as soon as possible. The system is also working on opening an additional 20 beds at St Martin’s Community Hospital, while also developing same-day emergency care for frailty to avoid unnecessary admissions to hospital and to care for patients safely in the community.

There is of course nationally a wide range of support in place to improve urgent and emergency care more widely. That includes growing the number of call handlers for 999 and 111, and the investment that we have seen going into our ambulance services and A&Es. It is the case that £450 million of capital investment has already gone into increasing capacity in urgent and emergency care departments. In addition, we have kept, I think, over 155 more ambulances on the road over winter with our investment of £55 million more going into ambulance services. We are investing those resources in the frontline. If I recall my statistics correctly, there has been a 38% increase in the paramedic and ambulance workforce since 2010. The hon. Lady and her party can rightly claim a degree of credit for that, because a degree of that took place between 2010 and 2015. We do continue to grow the workforce.

Turning to workforce issues more broadly, it is absolutely right that, as well as providing the support to which the hon. Member for York Central (Rachael Maskell) alluded—mental health and physical support for the workforce—we continue to grow the workforce in order to ease the workload pressures. We have already witnessed over 30,000 more nurses in the NHS since that pledge was made in 2019. We continue to grow all workforces. In section 41 of the Health and Care Act 2022 we set out a very clear duty on the Secretary of State in relation to workforce planning, and that work is already under way.

I will turn to a couple of further points very briefly, because I want to give the hon. Member for Bath her two minutes at the end. She raised a number of specific points. She called for greater resources to be put in. That has been done. She called for an increase to be made in paramedics and ambulance staff. That has been and continues to be done. None of these are completed works, but they continue to be done. She called for action to stop ambulance station closures or community ambulance station closures. I have to say that those decisions are made clinically by local trusts; the power was not there for the Secretary of State to intervene. In fact, it was the Labour party that argued against giving the Secretary of State and Ministers the power to take action on those things when it voted against and spoke against that measure during the passage of the Health and Care Bill. It is right that clinicians determine what is the best set-up for clinical services in their area. I just gently make that point.

In summary, I think that both sides of the House recognise fully the challenges faced in these unprecedented times by our urgent and emergency care sector, and particularly by patients and those who work in the sector. We have a plan to fix it. We continue to invest in that plan and to support our workforce, and we will continue to do that for the benefit of patients.

Integration White Paper

Debate between Margaret Greenwood and Edward Argar

Wednesday 9th February 2022 Commons Chamber

[Edward Argar]

My hon. Friend is absolutely right. He is, I think, alluding to the fact that quite considerable inputs in the form of taxpayers’ money and resources go into the system. Members sometimes fall into the trap of talking about inputs as the ultimate result, whereas my hon. Friend quite rightly talks about outcomes for patients and ensuring that money is well spent and delivers reform and improved outcomes. That is exactly what this paper is determined to achieve.

On my hon. Friend’s final two points, I will certainly consider taskforces. We have used one on tackling delayed discharge, so I know their value. I also take his point about data, and underpinning that is something that underpins all our work: co-design and doing things with patients, not to them. We must recognise that it is their data and that they should have control of it.

[Margaret Greenwood (Wirral West) (Lab)]

The Minister talks about ICBs, but he knows full well that they are able, under his Bill, to delegate functions and budgets to private providers, which represents a clear Government privatisation agenda.

The Minister talks about transferring skills and knowledge across the NHS, public health and social care, but how will that work in practice? Will the NHS be running training courses for private sector care organisations? If so, why should the NHS hand over valuable intellectual property and spend time gifting it to big business? Will he explain what that will mean for NHS staff?

[Edward Argar]

We have had these debates before. The hon. Lady knows that the pace of privatisation was fastest under the last Labour Government, when the increase in spend on the private sector was much steeper. We have always been clear in our belief in the founding principles of our NHS, which is free at the point of need, but we have also been clear, as have every other Government since the foundation of the NHS, that there continues to be a role for voluntary sector organisations and private sector providers in that context.

On the hon. Lady’s final point, it is important, as in this White Paper, that we bring out the opportunity to help increase knowledge and share skills across the NHS, local authorities and the voluntary sector.

Future of the NHS

Debate between Margaret Greenwood and Edward Argar

Monday 31st January 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to my hon. Friend the Member for Stockton South (Matt Vickers) for leading this debate on behalf of the Petitions Committee. I am pleased we were able to find time to hear from the hon. Member for Middlesbrough (Andy McDonald); I offered to take an intervention from him, which I suspect was a brave offer on my part given the intervention that might have come my way. I am pleased he got to give his speech.

I am grateful to the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). I think this is the first time we have properly been opposite one another since his appointment to this role on the Opposition Front Bench. Although I did not agree with everything he said, he made a typically well-informed and well-argued speech. He is right to pay tribute to all hon. Members who have spoken today, regardless of whether one agrees with the positions advanced. This has been a passionate debate. At its heart is, perhaps, the most precious of our country’s institutions; understandably, right hon. and hon. Members and our constituents have very strong views on the subject.

Before turning to the substance of the debate, and although I may not agree with their position, I pay tribute in a broader context to the work of Unite, Unison and other trade unions. I do not always agree with the stance they adopt, but they play a hugely important role in our democracy and society. It is right to put that on the record. As always in these debates, and as the shadow Minister has done very clearly, I also put on the record our gratitude—from both sides of the Chamber equally—to all NHS staff and those working in social care, local government and other key workers across the country for what they have done across the past two years and, indeed, what they do every year, day in, day out.

As I have said before, the Health and Care Bill reflects evolution, not revolution. It supports improvements already under way in the NHS and, crucially, builds on what the NHS recommended and consulted on back in 2019.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will make a little progress before giving way; I will always give way to the hon. Lady. The Bill is backed by not only the NHS but many others working across health and social care. In a joint statement, the NHS Confederation, NHS providers and the Local Government Association state that they

“believe that the direction of travel set by the bill is the right one”,

noting that local level partnership is the only way we can address the challenges of our time.

[Margaret Greenwood]

The Minister is talking about a consultation that, as I recall, took place over the Christmas period, when NHS staff are absolutely exhausted. He talks about these changes being requested by the NHS, but what percentage of NHS staff does he actually think took part in the consultation?

[Edward Argar]

As the hon. Lady will know, the former chief executive of the NHS, Lord Stephens, was clearing in saying that the

“overwhelming majority of these proposals are changes that the health service has asked for.”

We should do the right thing by them and by patients. It is the right time for the Bill: it is the right prescription at the right time.

The substance of the petition, which has framed many speeches by hon. Members today, calls for the Government to renationalise the NHS. I have to say that it has never been denationalised. The NHS is and always will be free at the point of use. The Government are committed to safeguarding the principles on which the NHS was created. The hon. Member for Denton and Reddish set that out very clearly. We have no plans for privatisation.

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Gentleman. Although we occasionally cross swords in the main Chamber or here, he knows I have a great deal of respect for him. All I would say gently on the point about the 2004 changes is that they came seven years into a Labour Government, so I do not know the reason why they had not been able to make progress before then.

We continue to work closely with the NHS to implement the changes that it has asked for, so that we can build back better and secure our NHS for future generations. As the shadow Minister, the hon. Member for Denton and Reddish, rightly said, the covid-19 pandemic has tested our NHS like never before, and all our NHS staff have risen to meet these tests in extraordinary new ways.

Hon. Members on both sides have rightly raised the point about the pressure that NHS staff have been under. Those who have been under pressure dealing with this pandemic are the people who will also be working flat out to deal with waiting lists and backlogs. We need to ensure that we are honest with the British people and that those staff have the time and space to recover, emotionally and physically, from the pressures they have been under. That is hugely important and we acknowledge the workforce.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not give way to the hon. Lady now. I have given way to her before. I will try to make progress, but if there is time I will try to give way to her.

We have seen innovative new ways of working: new teams forged, new technologies adopted and new approaches found to some old problems. There is no greater example of that than the phenomenal success of our vaccine roll-out. That would not have been possible without the staff, who are the golden thread that runs through our NHS. As we look to the future and a post-pandemic world, we know that, as the shadow Minister said, there is no shortage of challenges ahead of us: an ageing population, an increase in people with multiple health conditions and, as he rightly says, the challenge of deep-rooted inequalities in health outcomes and the need to look at the broader context. I do not know the shadow Minister as well as I knew his predecessor, but both his predecessor and I had a career in local government as councillors. I suspect that the shadow Minister may have had one too, so he may well know that I understand his point about the broader context.

--- Later in debate ---

[Edward Argar]

As the hon. Gentleman will know, there are 1.2 million full-time equivalents in the NHS—a record number of staff. Take one example: our pledge for 50,000 more nurses by the time of the next scheduled general election in 2024. Last year alone, we saw the number of nurses in our NHS increase by 10,900. We have a plan in place, and we are recruiting and training more staff through increased numbers of places—at medical schools, for example.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will not, because I have only two or three minutes left. If I make sufficient progress, I will try to give way, but I cannot promise the hon. Lady.

We know that different parts of the system want to work together and deliver joined-up services, and we know that when they do, it works; we have seen that with non-statutory integrated care systems over the past few years. The petition calls for the Government to “scrap integrated care systems”, but to do so would be to let down our NHS. The reforms have been developed by the NHS, and integrated care systems are already in place. The Health and Care Bill places them on a statutory footing to allow for that integration and joined-up working to continue.

In the minute or two I have left before I hand back to my hon. Friend the Member for Stockton South, I will touch on PFI contracts, which is an issue that he and other hon. Members have raised. In 2018, the Government announced that PFI and PF2 will not be used for any future public sector projects, including those in the NHS. The Government will honour existing PFI contracts, as wholesale termination would not necessarily represent good value for money. We need to look at each on its merits; many have clauses for early termination, which would cost a lot more than the life of the contract.

However, we have committed to undo the worst of the contracts inherited from the previous Government. The hon. Member for City of Chester (Christian Matheson)—I hope he will let me tweak his tail a little on this—chided my hon. Friend the Member for Stockton South by saying he should be careful about references to PFIs. Of the 124 significant PFIs currently in place, 122 were signed between 1997 and 2010.

Mr Gray, I think you want me to give my hon. Friend the Member for Stockton South some time to sum up, so I will conclude. We believe that this Government are doing everything necessary to ensure that the NHS remains free at the point of use. We are working with the NHS to deliver what it has asked for through the Health and Care Bill. There is huge support from those working in the system for the direction of travel. The Bill will create a more efficient and integrated healthcare system that is less bureaucratic, and allegations that this is privatisation by the back door are simply misleading. Through the legislation, we will ensure better and more joined-up services, improving health and care outcomes for all.

Future of the National Health Service

Debate between Margaret Greenwood and Edward Argar

Wednesday 22nd September 2021 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Ms Bardell; I think that I do so for the first time.

Although I suspect that it is fair to say that the hon. Member for Leeds East (Richard Burgon) and I are not fellow travellers in the same direction on many things politically, I congratulate him on securing this debate on a very important subject. Although his speech was long on opinion and perhaps short on fact, I do not think that anyone could doubt the passion or the sincerity with which he spoke, whether one agrees with everything he says or not. I pay tribute to him in that respect.

I think it is clear to everyone in this Chamber, as I hope it will be to people watching on Parliament TV and those who read the transcript of our debate, the genuine affection and respect that every Member of this House has for our NHS and those who work in it. It is right that I join the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), and others—I often do so on these occasions, because this cannot be said too often—in paying tribute to those who work in our NHS, including the shadow Minister herself. On the occasions when she and I see each other across the Dispatch Box, I always try to make that point.

A number of key themes have emerged today. The legislation is currently in Committee, and I know that a number of Opposition Members have argued that it should be paused or even scrapped. I have to say that the former chief executive of the NHS, Lord Stevens, said that about 85% of the Bill is exactly what the NHS asked for, wanted and wanted done now—ideally, the NHS wanted it done two years ago, before the pandemic.

In the evidence sessions of our Bill Committee, which continues to meet, we heard NHS Providers, the NHS Confederation and the Local Government Association all saying, “This is the right Bill at the right time.” I should acknowledge that some of those witnesses said there were certain elements that they would question or challenge, but they said it was the right time to pass this legislation. In fact, in a joint statement the NHS Confederation, NHS Providers and the LGA said,

“we believe that the direction of travel set by the bill is the right one.”

At the heart of this legislation is the principle of integration underpinned by evolution. Colleagues across the House who have served with me since 2015 will know that I am not by nature revolutionary, so the legislation is evolutionary in what it seeks to achieve, but it seeks to achieve greater integration. I think it was the hon. Member for Liverpool, Wavertree (Paula Barker) who spoke about accountability needing to be upwards, downwards and sideways. With these proposals we seek to do exactly that: to achieve greater integration at a local level within the NHS and, at the ICP level, to achieve greater integration with local authorities.

[Margaret Greenwood]

What would the Minister say to the British Medical Association council, which passed a resolution overwhelmingly

“calling for the Health and Care Bill to be rejected, arguing that it is the wrong time to be reorganising the NHS, fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies in healthcare, and significantly dilutes public accountability”?

[Edward Argar]

I will turn to those key points in a moment, but first I will address the specifics. The point I made to the Chair of the BMA council in Committee was that, if I recall rightly, every single piece of legislation on the NHS, including the National Health Service Act 1946 that brought it into place, has been opposed by the BMA. I challenged him to tell me which pieces of legislation the BMA had supported, and he said he would write to us. I have yet to get that letter; I am sure, knowing Dr Chaand Nagpaul as I do, that he will write to us, but in the Committee he was unable to say which piece of legislation—including Labour legislation in 1999, 2001, 2003 and 2006—the BMA had supported.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will make a little bit of progress, because I want to address the hon. Lady’s allegations about privatisation and workforce. If we have time at the end, I will of course seek to let her come back in.

On allegations or suggestions of furthering privatisation, I know it is tempting for some, even when they know better—and they do—to claim that this is the beginning of the end for public provision. It is not, and Opposition Members know it. There have always been key elements of the NHS that have involved private providers, voluntary sector providers and so on.

What is instructive is the extent to which that was accelerated when the Labour party were in power. The shadow Minister talked about the 2012 legislation and any qualified provider, but that was not brought in by the 2012 legislation; it was brought in by the Gordon Brown Government in 2009-10 under the term “any willing provider”. The name was changed, but nothing substantive changed from what the Labour Government had introduced in terms of the ability to compete for contracts.

The other point I would make is that one of the key changes allowing private sector organisations to compete for and run frontline health services came in 2004, under the Labour Government, when the tendering for provision of out-of-hours services by private companies was allowed.

--- Later in debate ---

[Edward Argar]

My hon. Friend makes a fair point about the need for us to create the conditions—the physical spaces with the technology—in which the workforce, which is the heart of our NHS, can work. He makes a subtle—or not so subtle—plea for his own local hospital. He will not be surprised that I will not comment on the detail of that.

To finish my response to the hon. Member for Strangford, the Command Paper recognises the challenges posed by the current arrangements in the Northern Ireland protocol around the supply of medicines and other goods, for example. The approach that the hon. Member set out, of removing medicines and medical devices from the orbit of the protocol, is reasonable. I hope that discussions between the European Commission and Lord Frost are productive, and that a consensus can be reached on the way forward.

I have to take issue slightly with the hon. Members who raised the role of Sam Jones, one of the Prime Minister’s advisers. They focused on one particular aspect—that for a brief period she worked for an independent provider. What they did not do, which is extremely unfair to a dedicated public servant, is highlight that she worked for NHS England, running new care models; that she has been an NHS paediatric and general nurse; that she was the chief executive of Epsom and St Helier University Hospitals NHS Trust; that she was the chief executive of West Hertfordshire Hospitals NHS Trust; and that she was the Health Service Journal chief executive of the year for 2014 and was highly commended for her work in driving forward patient safety. I gently say that it ill behoves Members of the House to attack public servants, who cannot answer for themselves in this Chamber, with partial references to their careers rather than recognising that they have contributed a huge amount in the past.

The hon. Member for York Central was absolutely right to highlight health inequalities as one of the greatest challenges—not the only challenge—that we face as a society and as a health system. The measures on integration and change in the Bill will help us tackle those health inequalities. I suspect that on Report and Third Reading she may test and challenge me on those assertions and assumptions, but she is absolutely right to highlight the centrality of health inequalities.

The hon. Member for Liverpool, Wavertree (Paula Barker) spoke about residential care and the link to social care. While I am not the social care Minister, everything that I do in my role as Health Minister must have an eye to social care. I was a cabinet member for adult social care in the dim and distant past, when I had rather more hair, and I also sat on the primary care trust, as it then was, at that time. I recognise the need for those two parts of the system to work together to achieve the best outcomes for our constituents. She makes a valid and important point.

I found what the hon. Member for Wirral West (Margaret Greenwood) said about the US experience of great interest and instructive, but it is utterly divorced from what the Bill and the Government are doing in respect of our NHS. It was an interesting reflection on what is going on in America, but it certainly does not bear any resemblance to what is happening or will happen in this country.

[Margaret Greenwood]

Does the Minister not recognise that, where we have a postcode lottery and the increased rationing of care—my constituents are very aware of the rationing of care, and a number of Members have spoken about what happens when people cannot get the treatment that they need on the NHS—there is the spectre of an individual, private insurance-based system? Members of his own party have in fact argued for such a system. People need to be mindful of just how dangerous for us all it would be to introduce a private insurance-based system.

[Edward Argar]

Will the hon. Lady forgive me? I was not questioning the integrity of what she said, but I was suggesting that there was no risk of that system as she described it developing in this country.

I will sum up, because I want to give the hon. Member for Leeds East a little more than two minutes, if I can. We are determined to continue supporting our NHS; this Bill, this legislation, the funding announcements we have made and the reforms we are putting in place do just that. We want to create an NHS that is fit for the future, renewing the gift left to us by previous generations, building on that gift and strengthening our NHS as it evolves to meet the challenges of the future. We remain the party of our NHS; we will give it the support it needs—as we always have done.