Tag: Edward Argar

The speech made by Edward Argar, the Minister for Health, in the House of Commons on 10 February 2022.

Reflecting the rest of the week, Mr Deputy Speaker.

I am grateful to the hon. Member for Ellesmere Port and Neston (Justin Madders) for securing this important debate. In the same spirit, this is rather nice; it is like déjà vu: he used to shadow me at that Dispatch Box and in Committee. It is a pleasure to respond to his debate on this occasion.

However, I must say that responding to the hon. Gentleman is a pleasure slightly tempered by caution on my part, because I know the depths of his expertise on this subject after his many years shadowing the Minister for Health—I think he shadowed my predecessors as well. He has great depth of knowledge in this space. He is and has been a notable advocate for our ambulance service and what it needs, and he looks forensically into those issues. I also know that he is a diligent reader of The BMJ, the Health Service Journal and various other excellent trade and specialist publications. It is a genuine pleasure to respond to him on this extremely important issue. It is a shame that the way in which the House allocates debates means that this is the last debate of the day, so there are few Members in the Chamber for it, because it is important. However, those we have in the Chamber are quality, and I look both at the shadow Minister—sorry, the former shadow Minister—and the hon. Member for City of Chester (Christian Matheson).

As the hon. Member for Ellesmere Port and Neston highlighted, ambulance services have faced extraordinary pressures during the pandemic. I am sure that the House will join me and the shadow Minister—the former shadow Minister; by force of habit, I keep calling him the shadow Minister. The hon. Gentleman and I have not always agreed, but we have been as one in paying tribute to all those who work in our ambulance services up and down the country. They have done an amazing job over the past two years, during the pandemic, to the very best of their ability. Of course, they do that amazing job day in, day out; irrespective of pandemics, they always do everything they can to support those who need them.

The hon. Gentleman rightly highlights that the pandemic has placed significant demands on the service. In January 2022, it answered more than 800,000 calls. That is an increase of 11% on January 2020 and is one of the factors placing significant pressures on ambulance services, the wider NHS and the A&E departments to which they will take people when they feel that there is a clinical need. Although 999 calls tend to highlight the demand related to more serious medical conditions, many ambulance services are also responsible for 111 calls, which, in December last year, saw an increase of 15.5% compared with December 2019.

I use those statistics to illustrate the demand pressures, but I understand that behind those numbers, in every case, lies a human story—someone in need of care, someone worried and anxious, with friends and family anxious for them—so before I seek to go into the reasons, statistics and our plans and support, I want to say that I am sorry for patients who have suffered the impact of those service pressures. I want to be very clear that patients should expect and receive the highest standards of service and care.

The hon. Gentleman highlighted some specific examples, including the case of Bina Patel. He is right that the right hon. Member for Ashton-under-Lyne (Angela Rayner) has raised that with me. I have asked for full information because I want to get back to her with as full an answer as I can, and I hope that he can convey that to her, if he speaks to her before I do. I am fully aware of her correspondence raising this on behalf of the family.

Let me turn to ambulance response times and the reasons sitting behind some of the pressures. The ambulance service is facing a range of challenges that are impacting on its performance. The hon. Gentleman will be familiar with many of them, including the impact, still, of infection prevention and control measures not only in the ambulance service but particularly in A&E departments and wider acute clinical settings. Higher instances of delays in the handover of ambulance patients into A&E as a result of some of those factors, which I will turn to, are therefore leading to ambulances waiting for longer in queues and not being as swiftly out and about on the road and able to respond to calls. So there are knock-on effects there.

One of the key challenges, which the hon. Gentleman will be very familiar with, remains the question of flow through an A&E and through a hospital. I am referring to the flow of patients out of ambulances into the A&E, who are then able to be treated in the A&E and discharged, hopefully, or who are then, in some cases, able to be admitted to a bed in a hospital ward. To do that, we have to see discharges continue of patients who no longer meet the criteria to reside because they have recovered sufficiently, and the national discharge taskforce has done a huge amount of work on addressing that challenge.

In recent months, we have seen the combined pressures of winter—the hon. Gentleman and I are familiar with those on an annual basis—and the impact of the omicron variant on the number of hospitalisations, which have not been as high as many feared and predicted, thankfully, but which have still had a significant impact on hospital beds. The combination of those factors, coupled with a high level of workforce sickness absence rates, including through positive covid tests—particularly over recent months with omicron—has created pressures that we would not expect to be systemic or built into the system. That partly reflects longer term pressures, and I will move on to what we are doing to address those, but a large element of it is down to the specific circumstances of the past winter.

The hon. Gentleman touched on the support in place to improve services, and asked what we are going to do about it, and what is being done to address these issues. He is true to form from when he shadowed me, as he will always set out the challenge and ask me what I am going to do or am doing about it, rightly holding the Government to account. Because of the pressures I mentioned we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to the end of March. All trusts are receiving part of that funding, which will increase call handling and operational response capacity, boosting staff numbers by around 700.

NHS England has strengthened its health and wellbeing support for ambulance trusts, recognising the pressure of the job on those working in the ambulance services, with £1.75 million being invested to support the wellbeing of frontline ambulance staff during the current pressures. NHS England and Improvement is undertaking targeted support for the most challenged hospitals, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That is focused on the most challenged hospital sites where delays are predominantly concentrated, with the 29 acute trusts operating those sites being responsible for more than 60% of the 60 million-plus handover delays nationally. That is targeted support for trusts that have particular challenges, either from the current situation or where there are underlying issues that we need to resolve.

There is capital investment of £4.4 million to keep an additional 154 ambulances on the road this winter, and a £75 million investment in NHS 111 to boost staff numbers by just over 1,000, boosting call taking and clinical advice capacity that will better help patients at home, and better help triage those who genuinely need an ambulance and those who can be treated safely in a different context. There is continuous central monitoring and support for ambulance trusts from NHS England’s national ambulance co-ordination centre, and we have also made significant long-term investments in the ambulance workforce. The number of NHS ambulance staff and support staff has increased by 38% since July 2010.

More broadly, alongside the ambitious plan set out by the Government earlier this week, showing how we will invest the significant additional resources in outcomes for patients, just over a year ago we invested £450 million in A and E departments, to help mitigate the impact through increased capacity of infection prevention and control measures. I have regular direct meetings about discharge rates, and what we can do further to improve the flow of patients through hospital trusts within NHS England, with members of the taskforce on that.

I am pleased to reassure the hon. Gentleman that those measures have had an impact, and we are seeing improvements in response times from the peak of the pressures in December. Performance data for January, published today, shows significant improvement against all response time categories. Performance for category 1 calls—the most serious calls, classified as life-threatening—has largely been maintained at around nine minutes on average over the past several months, and improved to eight minutes and 31 seconds in the latest figures. That is despite a 19% increase in the number of incidents in that category compared with December 2019. Average responses to category 2 calls improved by more than 15 minutes compared with December, and the 90th centile responses to category 3 calls by more than two hours.

We recognise that that is welcome progress, as I am sure the hon. Gentleman would agree, but there is much further to go to recover fully from the pandemic’s impact on response times and to sustain that improvement. We welcome the service’s hard work and dedication and pay tribute to it for making those changes and delivering the significant improvements on which I am updating the hon. Gentleman.

Justin Madders

As always, the Minister is being courteous and comprehensive in his response. Will he comment on the concern expressed earlier about patients being told, when visited by the service, that they needed to go to hospital but should find their own way there? That is extremely worrying, and we should be clear that it is not what we expect to happen.

Edward Argar

I am grateful to the hon. Gentleman—I keep feeling tempted to say shadow Minister; he is a shadow Minister but he is no longer my shadow—for that point. He is right that when people ring 999 they should be given the appropriate clinical advice on whether they need to go to hospital, and if they do, an ambulance should be sent. I suspect that in individual cases a call handler may have made a tough clinical decision about the fastest way to get someone to hospital given the availability of ambulances, but the hon. Gentleman is right that if someone rings 999 and their condition is clinically deemed to require an ambulance and swift transfer to hospital, they should be able to expect an ambulance to come, assist them and take them to hospital.

At a time when the NHS is facing unprecedented demand, ambulance services are absorbing some of the increase in pressure. They are treating more people over the phone and finding other ways to reduce pressure in a clinically safe way. With clinical support in control rooms, the ambulance service is closing around 11% of 999 calls with clinical advice over the phone. That is far more than the 6.5% achieved in January 2020 and saves valuable ambulance resources for response to genuinely more urgent clinical needs.

Let me say a little about North West Ambulance Service, if that is helpful to the hon. Gentleman—I know that he and the hon. Member for City of Chester take a close interest in their local ambulance service. Our support and investment has benefited the North West Ambulance Service. The hon. Member for Ellesmere Port and Neston’s local trust received £6.2 million of funding, which it has used to increase its workforce for operational and contact centre teams. The trust is also engaged with regional NHS England and Improvement and commissioning teams to develop a six-point winter plan that seeks to address six key areas throughout the winter period. As it starts to get a little warmer and the daffodils start to come out, it is tempting for people to think that winter has passed, but winter pressures in the NHS can continue into late February and occasionally a bit beyond. I wanted to add that caveat.

Three systems-led initiatives focus on the reduction of hospital handover times, the improvement of pathways for patients with mental health presentations and ensuring that alternatives to emergency departments—including access to primary care and other non-emergency-department pathways—are available to North West Ambulance Service in a timely and responsive manner.

Hospital handover delays continue to challenge the North West Ambulance Service footprint. Through its Every Minute Matters collaboration, which began three years ago, the trust has been working with other hospital trusts on improvements by working with senior leadership teams in hospital trusts to ensure there is a shared understanding of the risks of handover delays and a lack of ambulance resources to respond to patients in the community, to revisit action cards for operational commanders and, crucially, to recognise and thank staff for their continued reporting of delays and willingness to highlight problems to their managers or to the trust.

The trust’s strategic winter plan has been activated and includes details of the measures in place to handle winter pressures and mitigate the effects of increased demand and a loss of capacity. The plan is comprehensive and covers a wide range of topics and details on the preparation for various scenarios. It includes several continuous improvement initiatives for support during the winter period.

In summary, North West Ambulance Service is increasing its double-crewed ambulance capacity in line with winter funding arrangements, reducing conveyance to emergency departments and reducing the number of lost operational hours caused by day-to-day operational challenges. The trust has already seen significant improvements in the number of patients managed effectively through telephone advice, which helps free up ambulances to be deployed to where they are most needed. The trust has recruited additional paramedics and emergency medical technicians and upskilled its ambulance care assistants to blue light driving standard, thereby enabling the trust to deploy 269 additional frontline staff by the end of December.

I close by reiterating the Government’s commitment to support the ambulance service. We retain regular contact with ambulance services, trusts and those delivering on the frontline to help to ensure that patients and the ambulance service receive the care and support that they need. I am grateful to the hon. Member for Ellesmere Port and Neston for bringing this matter to the House.

The speech made by Edward Argar, the Minister of State for Health, on 16 March 2021.

Introduction and thanks

Thank you very much, Simon, and good morning everyone.

Thank you also to everyone in NHSE/I and the Institute of Healthcare Engineering and Estate Management for organising today. Organising events like this are always a challenge, even more so in the current circumstances. So thank you very much.

It is an important event, and I’m absolutely delighted to be here as the minister with direct responsibility for both the NHS estate and all of the work you all do with it.

In normal times, I would have of course given multiple speeches in my 18 months in the role, but the challenges of organising such events as this during the pandemic, and the pressure of work we have all faced, have meant that I have generally politely declined invitations that have been extended.

Today’s event is different. As soon as Simon and his team invited me there was no question I would say ‘yes’.

That is because of just how central and vital the work the profession and people represented here today has been to our pandemic response, and how vital your work is to our NHS every day.

Now, I understand attendees cover the full breadth of those working in and around supporting our estates – from NHSE/I, to directors of estates, to finance directors to those working in the facilities space. It really is a great privilege to have the chance to speak to you all today.

So, before I go any further, I want to start by saying a huge ‘thank you’ to all of you.

Thank you to all of those senior estates professionals attending today.

And thank you to every one of the 100,000 people who work in NHS estates and facilities, who you collectively represent.

Now I always remember the quote – quite possibly apocryphal but I hope not because it is a very powerful quote – and it is one which you may have also heard my Secretary of State use in the past, attributed to John F Kennedy when he visited NASA for the first time.

During his tour of the facility, he met a janitor who was carrying a broom down the hallway. Kennedy asked the janitor what he did for NASA, and the janitor replied, “I’m helping put a man on the moon.”

And it is that approach and sentiment which I think should characterise our attitudes towards our amazing NHS workforce. Whether you are a consultant or a cleaner, an emergency department nurse or an estate manager and any and all roles in between – you are all vital to help the NHS do what it does day in and day out – which is to save lives and help patients recover from illness.

Indeed, I often hear those who work in this profession as it is represented today described as the ‘hidden heroes’ of the NHS.

That heroism has never been greater.

My role is to work with you, Simon and his team to do what we can to make sure to ensure that role isn’t quite so ‘hidden’. So that people know what you do everyday to make our NHS function.

You have worked tirelessly during these extremely challenging circumstances.

You and your teams have played a pivotal role in so many of our great achievements.

The shift to telemedicine, which kept so many of our vital services going; the building of the Nightingale hospitals in 9 days to ensure that there was always the surge capacity should the NHS need it; the doubling of ICU capacity in 9 days.

All this alongside your ceaseless work to adapt the estate to meet the demands and clinical needs of this pandemic.

From testing and reworking patient flows, to supporting social distancing – and even more intensive cleaning and infection control.

With the 7 Nightingale hospitals and the National Oxygen Infrastructure Programme alone you have supported essential critical care capacity. Which meant no matter how tough it got, no matter how challenging it got with the number of patients in our hospitals needing care during the pandemic – up to 37,000 at the peak of the second wave – there was always that care available to make sure our NHS was not overwhelmed.

And it is also important that we take a moment to thank all of the partners who make up our NHS supply chain and work alongside you all.

Without your efforts and their efforts, the Nightingales and the National Oxygen Programme would not have delivered the significant increase in additional oxygenated beds.

And you have risen to the occasion in a way that you should all be incredibly proud of, reflecting the way we and the British people are all incredibly proud of you.

And of course, the broader context within which you have achieved these things has never been more challenging. And the human costs have sadly been significant.

I wanted to pause to note how saddened I was to learn of the members of the estates profession, your NHS family, who have lost their lives due to COVID.

May I take this opportunity to express my deepest condolences to their families and friends. Many of these friends and colleagues are listening today. Our thoughts and prayers remain with all of you.

Now I know that the estates community is closely knit, and that sense of community and collaboration will be more vital than ever as we move forward from this pandemic.

Indeed, moving forward will require us all even more so than normal to work as one team. Recognising that every person, every link in that team is vital for its functioning.

Challenges faced

Now the challenges should not be underestimated – and as you all know, many are historic challenges.

Government investment, by governments of all parties over recent decades, has been unpredictable at times.

There has been constant pressure on you to balance competing demands – from the urgent demands of addressing critical infrastructure risks, day-to-day maintenance needs, to raising your eyes to look to the long term, and to develop an estate that is the right size and shape to meet future service needs.

The needs of maintaining an ageing estate has meant that it has often been hard for many of you, the profession, and us to always focus on the long term as much as perhaps we should have.

All too often, the urgency of short-term pressures has won out.

Some specific challenges

As we look forward, the approach we are adopting as a government, championed by the Prime Minister, is to tackle both – investing in meeting immediate needs, but in parallel investing in the long term, with a long-term, predictable pipeline of investment.

The specific challenges we face are significant. Backlog maintenance is a £9 billion challenge that you all grapple with every day.

The day-to-day costs of keeping the estate in working order are huge – and that’s why we’ve allocated £4.2 billion for NHS operational capital investment, supporting NHS trusts to refurbish and maintain their estate. As I say, you grapple with those challenges every day. Every day you ensure that our estates and our hospitals are there, working to deliver that world-class healthcare.

I want to start by looking at some long-term challenges as well.

Climate change is a global challenge, and the NHS must play its part in achieving net-zero carbon emissions – a legal requirement for the whole UK by 2050.

We must create an estate fit for the clinical and patient needs of the 21st century, reflecting the advancements in science and clinical treatments. And the way in which we are able to treat different illnesses and help keep people alive and fit and experiencing a high quality of life for longer.

We must ensure that we build an estate that is capable of incorporating technological advancements as they emerge over the coming years as a standard.

Moreover, the vision set out by this government’s long-term plan for the NHS – a vision built around patient and place and the integration of care – is a vision which simply cannot be achieved unless it is enabled by strategic, sustained investment in our NHS infrastructure and estates.

The approach to strategic investment

That’s why we must deliver that long-term, strategic approach – an approach that enables trusts to look beyond day-to-day demands, and to embrace the vision and intent shown, perhaps encapsulated, by the quote from the janitor at NASA.

I know it is my job to ensure that approach is driven by clear leadership – and delivered at pace.

In that spirit, as Simon in his introduction mentioned, I’d like to talk about the NHS Strategic Infrastructure Board, which I have the honour of chairing.

In this role, I’ve seen first hand the collaboration between NHS staff at all levels.

And we’ve seen how well traditional silos and ways of working can be transformed in a pandemic situation.

My hope is this will continue long beyond the pandemic, and that the positive structural shifts in healthcare that have been accelerated as a result of the pandemic continue to develop at pace.

All NHS trust estates teams are now registered in the NHS Estates Team Collaboration Hub. This is an excellent tool that enables the estates and facilities community to communicate across the system, and crucially share knowledge and experience and share best practice.

This will enable more joined-up, collegiate working on the ground, so we need the same at the centre.

We also need collaborative national leadership to make health infrastructure challenges a priority as we go forward.

We need all the national players in the NHS estate in the same room, albeit at the moment virtually in the same room.

The Strategic Infrastructure Board is the place for national partners to work collaboratively to guide the future vision of the NHS Estate – as I alluded to before, to raise our eyes beyond the horizon of the day-to-day challenges, to look a decade or more in to the future.

And Simon and others with us today are also members of the board.

Now many of the issues that you’ve been discussing today are the same ones that we’ve been grappling with.

We’ve also carried out a lessons-learned exercise on the COVID-19 pandemic.

We wanted to understand the impact of COVID-19 on our priorities for estates and capital.

And to use these reflections to consider what’s on the horizon for health and social care infrastructure over the coming decades.

This exercise clearly highlighted the opportunity to refresh our strategic approach to NHS infrastructure.

When the board met in February, we set out what more we can do. How we can maximise opportunities for integration to deliver better value for money and more personalised care. How we can make better use of data to remodel the estate and drive efficiency. And how we can champion the unsung heroes, each and every one of you in your estates and facilities teams, who have performed with such distinction throughout this crisis.

Thanking Sir Robert Naylor

On the topic of leadership, I would like to take this opportunity to thank another champion of the NHS Estate and a champion of taking the strategic view – Sir Robert Naylor.

Sir Robert’s landmark review originally led to the formation of the NHS Property Board. This was a critical first step in ensuring that the estate receives the attention it deserves as an enabler of care.

Sir Robert has led the estates agenda with skill, diligence and an unmatched level of expertise – challenging us where necessary, and tirelessly championing both the estate and its workforce, and, crucially, driving that long-term view.

As Sir Robert steps down from his official role with the department, I am sure you will all join me in expressing deep gratitude for all that he has done to lay such firm foundations. Such firm foundations that allow us to move into an exciting new phase for the NHS estate.

Strategic approach

That new phase is focused on a coherent strategy for how we can invest in our infrastructure in the most effective, joined-up way.

In 2019 we set out our new, strategic approach to improving our hospitals and health infrastructure with the publication of the Health Infrastructure Plan (HIP).

You will all be familiar with the historic challenge – a burst of activity and investment, for example the early 2000s hospital-building programme, then, an easing off – the stop-start historically which mitigates against a long-term view, and which can see the expertise people have gained in building new hospitals lost in our NHS, as during a paused phase they leave for new challenges.

Our HIP seeks to remedy this, setting out a long-term plan of investment over many years, allowing the NHS to plan for the future and to predict and see that pipeline of investment.

The last few years have already seen significant investment – from allocating £600 million through a Critical Infrastructure Fund to resolve the most urgent estates issues in the NHS, to the Prime Minister’s announcement of £850 million to upgrade 20 hospitals, and of course £3.7 billion to help deliver 40 new hospitals by 2030.

We’ve also provided funding to eradicate mental health dormitories, and to upgrade A&Es to expand capacity and improve infection control.

These have all made a huge difference to the NHS, and with many of these projects invested in and delivered in winter at pace, each and every one of the estates teams working on them in the trusts has risen to the challenge to see that investment get to the frontline and deliver benefits for patients.

And we must now look to refresh our strategy to set an even clearer direction that reflects the lessons we have learned from COVID-19.

It’s vitally important we get this right. In the Victorian era, town halls and civic buildings were symbols of civic pride, of the pride our communities had in themselves and in their country. In many ways, our hospitals fulfil a similar place in our pride today. The pride in our NHS is reflected in the respect and in which we hold those who work in it and the respect and value we attribute to the buildings out of which it operates.

Before COVID, we knew the elements that would make our strategy successful: standardised design through modern methods of construction, listening to clinicians and designing clinical spaces, reflecting what we know they need to do their job. Effective use of technology hardwired in as standard, and an unwavering commitment to achieving net-zero carbon across the whole NHS.

But recent months have also brought into clear focus critical issues like agility and flexibility in controlling infections.

So we must work together to pull this into a coherent framework that balances all these critical elements as we move forward. Working at pace, setting clear standards, and embracing the vital role that health infrastructure plays more broadly in our communities.

Because it is not just acute settings in this context, but the opportunities presented by our primary care facilities – our primary care infrastructure and buildings in the community – to play a key role with councils and others delivering regeneration in our town, high streets and cities to work together to play a key part in that. Not only in delivering vital services, but in helping drive that regeneration.

Getting this right will ensure the NHS estate enables world-class care on the inside, whilst reflecting civic pride on the outside.

That’s why later this year we will publish a refreshed version of the Health Infrastructure Plan.

Setting the strategic direction for all aspects of the department’s capital and infrastructure, and of course the NHS is at the heart of this.

I’m keen that this strategy does not re-invent the wheel, and instead builds on the great work already done, while taking into account what we have learnt over the past year.

So, we will bring together our existing commitments and strategies to give the sector – including all of you as estates, facilities and finance professionals – a clear vision and set of priorities to work towards over the next 10 years.

This updated HIP will set the direction in a wide range of areas, such as:

the strategy for new hospitals and hospital upgrades, including the standards we expect in these projects

the direction of travel in the primary care estate, including getting the most out of primary care hubs

how technology should be most effectively deployed in the NHS

the strategy to deliver on that shared objective of the sustainability agenda and net zero

This strategy will bring together our investment, maximise value for money and ensure we’re all pulling in the same direction towards the same goal.

And we want to support the development of a sustainable health and social care system that is the right size and shape for our future needs. The refreshed HIP will drive the transformation of healthcare to a 21st century model, using the latest technologies.

It will give STPs, ICSs and others what they need to design the estate that best meets the need of their local area while reflecting the learning from the national standards.

The new version of the HIP is currently in the early phases of development, but officials are already working closely with partners across the system. Because partnership with each and every one of you with your trusts and communities is vital as we seek to translate this vision from our hearts and heads into a reality on our streets.

Let there be no doubt – making this plan a reality will require us all to work at pace. We’re already doing this on the New Hospital Programme, under the leadership of SRO Natalie Forrest. This programme is an absolute priority for the Prime Minister.

Six projects are already in construction, with one further scheme awaiting final approvals. We will be bringing forward the criteria for the next 8 projects in the coming months.

We will review the designs of the earliest 8 projects in the programme pipeline, with a view to bringing increased consistency and again driving that pace throughout the programme, informing work on standardised designs which can then be applied across the programme, but crucially working together – hand in hand – in partnership with trusts to help them deliver in their vision for their communities.

But, of course, we should never forget the NHS estate stretches far beyond new hospitals – covering tens of millions of square metres in primary and community care. And, in that regard, we should also be mindful of the huge opportunities that exist for regenerating our communities and high streets while improving the facilities available for our community settings.

Conclusion

Colleagues, in closing, it is also worth reminding ourselves that for 1.5 million people, NHS buildings and spaces are places of work and learning.

For many more the NHS estate offers a vital service every day.

That is why this government’s manifesto commitment is so important.

And that is why it is so important that the HIP refresh delivers a shared vision by providing a clear strategic direction for capital investment over the next decade.

As Chair of the Strategic Infrastructure Board I will continue to champion the NHS estate and all of you who work in it.

This is a once in a lifetime opportunity – what you are doing is genuinely a matter of success or failure for healthcare in the 21st century. There can be few greater callings than the work you are doing.

And I am honoured to have the chance to work with you on making our vision a reality – and I am privileged to have been given the chance to talk to you today and to conclude by offering you my thanks, with those of the Secretary of State and Prime Minister.

Thank you.

The statement made by Edward Argar, the Minister for Health, in the House of Commons on 25 March 2021.

The Prime Minister paid tribute to the extraordinary success of the UK’s covid-19 vaccination programme when setting out on 22 February 2021 his road map for easing lockdown restrictions in England. This vaccination programme would not be possible without the dedication and commitment of many thousands of NHS staff who have already worked tirelessly for many months to support the covid response while doing their utmost to reduce the impact on wider NHS services.

I am today laying before Parliament the Government’s 2021-22 mandate for NHS England and NHS Improvement. It will make clear that covid-19—including further roll-out of the vaccination programme to ensure that every adult in England will be offered a first vaccination by 31 July—remains the NHS’s top priority in 2021-22. At the same time, and taking account of the pandemic’s impact, the NHS will return to implementation of the important transformative ambitions set out in its long-term plan and our 2019 manifesto. These will underpin recovery, and support the NHS’s longer-term resilience and sustainability. There will be a renewed focus on prevention to empower people to live as healthily as possible, and on tackling those health challenges which have been highlighted by the pandemic. The NHS will also work to recover performance of non-covid services that were unavoidably impacted by the pandemic—including elective care.

The new mandate is underpinned by our further funding commitments to the NHS. In addition to the substantial support made available for the pandemic response in 2020-21, and the further £6.3 billion increase in NHS funding already confirmed as part of its funding settlement to 2023-24, we are providing a further £3 billion in 2021-22 to support NHS recovery. This includes £1.5 billion for indirect covid pressures in 2021-22 as well as £1 billion for tackling backlogs in elective activity, and £500 million for mental health and the NHS workforce, for which operational delivery will be agreed in due course. This is in addition to the £6.6 billion announced last week for operationally necessary costs arising from the pandemic in the first half of 2021-22.

As in previous years, I will also today lay a revised 2020-21 mandate. As required by the NHS Act 2006, this revision is to reflect changes to the capital and revenue resource limits included in it that result from in-year funding decisions.

Comments made by Edward Argar, the Health Minister, on 11 August 2020.

Our NHS did an amazing job to ensure emergency care continued to be available for everyone who needed it during the peak of this pandemic.

Today, we are announcing the details of the Trusts across the country who will receive a share of £300 million to upgrade their A&Es and support emergency care to help them to continue to deliver safe and accessible services throughout the normally busy winter period.

This funding is part of our record investment in NHS infrastructure to ensure our health services continue to meet the needs of the present and to be fit for future demands placed upon it.

Below is the text of the speech made by Edward Argar, the Minister for Health, in the House of Commons on 7 July 2020.

I thank my hon. Friend the Member for Ipswich (Tom Hunt) for securing a debate on the important topic of orthopaedic services at Ipswich Hospital. His commitment to his constituency is commendable and well known. He raised this issue with me when we met very recently, and in his recent letter. I pay tribute to the persistence that he has shown in ensuring that his constituents’ voices are heard on this topic, as on all others.

If I recall correctly, when my hon. Friend last spoke in the House on this matter and I responded, he secured my commitment to visit, which I had the pleasure of doing, with him, in February, and it was a visit that I greatly enjoyed. He is undoubtedly a strong voice for his constituents. Of course, when circumstances allow it, I will be very happy to visit Ipswich once again. I also had the opportunity, that same day, to visit Colchester with my hon. Friend the Member for Colchester (Will Quince), who is a similarly strong voice for the interests of his constituents, his local hospital and the needs of his county, and I pay tribute to him.

James Cartlidge

Many of my constituents use both Ipswich Hospital and Colchester Hospital, and I pay tribute to their staff for the incredible effort they have ​put in throughout the pandemic to look after my constituents, and those of my hon. Friend the Member for Ipswich, to ensure that we get through this keeping our NHS intact. We should be proud of that.

Edward Argar

I am grateful to my hon. Friend, whom I have known for many years. As ever, he puts his finger on exactly the right point. I join with him in paying tribute to all the staff at Ipswich Hospital, Colchester Hospital and across our NHS for the amazing work they do day in, day out, particularly at this time.

My hon. Friend the Member for Ipswich set out his case very clearly. I would say that his hospital has no greater friend than him. I reassure him that there is no question of Ipswich Hospital continuing to be anything other than the first-class hospital it is today. He highlighted in outline a little of the background on this issue. In 2015, Suffolk and North East Essex sustainability and transformation partnership concluded that change in the organisation of services was needed, particularly in orthopaedic planned surgery. Since then, East Suffolk and North Essex NHS Foundation Trust has been developing a proposal for an orthopaedic elective surgery centre. As he touched on, the proposal outlines that the centre would see a roughly £35 million investment in orthopaedic surgery services for the population, offering at least 48 new beds and up to six state-of-the-art ultra-clean operating theatres, providing additional capacity for emergency patients across the area. The NHS in Suffolk and Essex ran a consultation, between 11 February and 1 April 2020, on the specifics of the proposal to create an elective orthopaedic care centre in Colchester, but, as I have set out, those plans have been in genesis for many years and have been extensively and widely consulted on.

I note the points raised by my hon. Friend in his speech and, indeed, those raised in his letter to the chief officer of Ipswich and East Suffolk clinical commissioning group recently. I encourage the clinical commissioning group to take that letter seriously and to respond fully to my hon. Friend, as part of the local accountability which is so important to all our public services. Let me be clear—I will emphasise this again later—that this is a process and a proposal that is rightly driven by the NHS at a local level in his and my hon. Friends’ constituencies. He is right to commend the performance of Ipswich hospital over recent years. I appreciate that he wants to ensure that for his constituents, and, indeed, for all those who use the hospital, the reconfiguration does not in any way diminish the achievement of his hospital and its staff, or have any impact on its other services.

My hon. Friend will appreciate that in winter the number of emergency admissions is much higher than it is during the summer. One aspect of this consultation is that it seeks to address planning for that by enabling more beds across the hospitals to be used to meet that demand. I would not seek, and nor should I seek, to prejudge the decision that will be reached next week by the CCG on this matter—it is rightly its decision—but I will set out its rationale in putting the proposals forward. It states that, in practice, if the orthopaedic centre were built at Colchester, it would release 24 in-patient beds at Ipswich, where they are indeed needed. The new orthopaedic centre would be adjacent to the main Colchester Hospital, but away from the emergency department.​

I greatly appreciate the insight my hon. Friend has shared from his constituents in Ipswich, who are thankful for the brilliant surgeries they have been able to access in the NHS. Indeed, that was something he highlighted again when I went to wonderful Ipswich with him. When the CCG considers this matter, I would of course expect it very carefully and respectfully to reflect on the points that he and his constituents have made. The proposals reflect the importance of the surgeries. I hope he and his constituents will welcome the fact that the proposals will not remove access to orthopaedic services at Ipswich Hospital. Of nearly 46,000 in-patient day cases and out-patient appointments completed for orthopaedic patients at Ipswich last year, only about 3% would move to the new centre at Colchester under what the trust is proposing. In its proposal, the trust sets out that day surgery, including shoulder and elbow joint replacements, would remain at Ipswich Hospital, as would services for emergency patients, such as joint replacement after a hip fracture.

As I just mentioned, my hon. Friend described the life-changing impact such surgeries have had on constituents who have been treated at his hospital. This proposal, as the trust sets out, seeks to achieve shorter waiting times for surgery and shorter stays in hospital, so that patients can seek the comfort of home more quickly, and to minimise the risk of cancellation of surgery, as the proposed centre will be built safely away from the emergency department and the knock-on impacts that a busy emergency department can have. It also seeks to achieve improved clinical outcomes in terms of reliability from the standardisation of care and provide training, education and research opportunities for clinicians. The trust maintains that it is on that clinical basis that it is putting forward the proposals, which, it states, seek to support the excellent performance of hospitals in the area by organising services in a sensible way so that necessary elective operations can take place while the system supports patients admitted in an emergency.

My hon. Friend also mentioned the merger of Ipswich and Colchester in June 2018. At the time, NHS England outlined several service improvements that the merger would bring about. As well as improvements in various services from paediatrics to emergency ambulatory care, the enlarged organisation would also have an expanded catchment area, leading to improved opportunities for training, providing a more attractive option for clinicians, resolving a number of historical recruitment and retention issues at both trusts and improving finances. It is important, however, as my hon. Friend alluded to, that the trust is held to account for those promises and that it ensures, by the merger, that both hospitals continue to improve.

I briefly touched on the consultation earlier in my remarks, and my hon. Friend raised several points about the process. He is absolutely right to say that important decisions are made with the best interests of patients from across the area in mind, and that the views of local clinicians should not be diminished. There has been much lengthy consultation. As well as the formal process, my hon. Friend highlights the petition, which has been signed by many of his constituents and, I suspect, more widely. It is absolutely right that everyone has their say, and I commend him for what he is doing to ensure that they have their say. Again, such views should be considered with respect and care when decisions are reached.​

My hon. Friend also rightly raised the issue of patients and transport, and that they must be supported to travel should the plans go ahead. He has raised the need for a comprehensive plan, both locally and with Ministers, to ensure that all patients can be supported to access the right care. Access to the current patient transport scheme will, the trust states, be available for those unable to make the journey themselves. Under the proposals, pre-surgery and post-surgery appointments would still take place at the patient’s normal point of care at Ipswich or Colchester. Indeed, I pay tribute to my hon. Friend for fighting his constituents’ corner, should the decision not turn out the way he wishes, and for playing an important part in highlighting that issue as well. The only change for patients would be the actual site travelled to for the planned surgical procedure, which would involve a lengthy stay of three days in hospital. I have also been reassured that local partners completely recognise that, alongside these provisions, additional support will be needed for some patients and, should the proposal be approved, further work is already under way to address that.

Being conscious of the time, I reassure my hon. Friend that the Department of Health and Social Care recognises how important these decisions are and recognises ​that the right accountability, consultations and people must be included in the process of discussing proposals to change services. This is, of course, not a decision for me or, indeed, for the Secretary of State. The next step, as my hon. Friend said, is the final decision, which will be made locally by the CCG on 14 July, but the proposal is not to downgrade or diminish Ipswich, but to promote an alternative way of delivering clinical services. I have no doubt that the CCG will have heard my hon. Friend’s case today, as will his constituents, in whose interests he has spoken so eloquently. I again encourage the CCG to ensure that it carefully considers his words and the representations in making its decision.

I conclude by thanking my hon. Friend and congratulate him on securing this debate. I also thank those other Members who have intervened. My hon. Friend has set out his case powerfully and his constituents are lucky to have him as their Member of Parliament.