0:00:41 > 0:00:44My lords, I will repeat the statement that is a response to an
0:00:44 > 0:00:48urgent question given by my friend the Minister of State for health and
0:00:48 > 0:00:51the Other Place. The statement is as follows, winter is challenging for
0:00:51 > 0:00:55health services worldwide. With a high number of flu cases this year
0:00:55 > 0:01:01we have seen an increase in anti-attendances from flu, triple
0:01:01 > 0:01:07from last year with a high number of hospital beds occupied as a result
0:01:07 > 0:01:12and a further 700 with the norovirus. The NHS saw many more
0:01:12 > 0:01:15patients in AMD compared to this time last year. The guidance issued
0:01:15 > 0:01:21by the preparedness panel to free up capacity for emergencies given the
0:01:21 > 0:01:25high number of new cases including two dominant strains of flu could
0:01:25 > 0:01:29circulate in this year. It is important to remind the House and
0:01:29 > 0:01:31the deferment of operations referred to in that guidance applied to
0:01:31 > 0:01:37around 13% of hospital beds dealing with alleged patients around half of
0:01:37 > 0:01:42which were protected with respect to cancer and other urgent treatments.
0:01:42 > 0:01:47The guidance was up aided on the 26th of January to confirm that the
0:01:47 > 0:01:50deferment of hospital operations is no longer needed and in terms of the
0:01:50 > 0:01:54impact of this guidance has had on operations, we will not notice on
0:01:54 > 0:01:58either side of house until mid-March when that data will be published in
0:01:58 > 0:02:01paste -- and placed in the library for the benefit of both sides of the
0:02:01 > 0:02:09House.I thank the Minister for that statement and can I also, before I
0:02:09 > 0:02:14ask my questions, thank the Secretary of State and the Prime
0:02:14 > 0:02:18Minister for their response to the United States president, for his
0:02:18 > 0:02:24bizarre attack on our NHS. My lords, over 95% of hospital beds were full
0:02:24 > 0:02:29last week, leaving just one bed in 20 available. We saw the highest
0:02:29 > 0:02:39number of AMD favourites -- accident and emergency favourites. A pager
0:02:39 > 0:02:43beeped to our NHS staff who have gone the extra mile in challenging
0:02:43 > 0:02:48circumstances. We know that many elective operations were planned to
0:02:48 > 0:02:51be cancelled but it would seem that some urgent operations have also
0:02:51 > 0:02:56been cancelled as well so would the Minister explained to the has what
0:02:56 > 0:03:03is operations having cancel despite NHS England's advice to the country?
0:03:03 > 0:03:09The accident and emergency targets which are enshrined in the
0:03:09 > 0:03:14legislation and the Constitution which are... Will the Government be
0:03:14 > 0:03:18bringing forward legislation to amend the Constitution? Will be
0:03:18 > 0:03:23accept that don't be winter plans have been outlined, that these are
0:03:23 > 0:03:30now being compromised in the light of at least 23 trusts, who are now
0:03:30 > 0:03:36on black alert which means that they are under severe pressure.My lords,
0:03:36 > 0:03:40I think the noble lady for her question. I agree with her that we
0:03:40 > 0:03:44are all proud of our NHS on all sides of this has and I am sure we
0:03:44 > 0:03:47had great pleasure in stating that in which ever means we were required
0:03:47 > 0:03:53to. I would also like to join her in paying tribute to the staff who do
0:03:53 > 0:03:56such great work in challenging circumstances. On the two questions,
0:03:56 > 0:03:59first about urgent operations. It was clear in the guidance that they
0:03:59 > 0:04:03should not be cancelled when it affected patient outcomes. If that
0:04:03 > 0:04:08has happened then NHS England is investigating and reinstating this
0:04:08 > 0:04:12operations and the guidance is quite clear and NHS England has followed
0:04:12 > 0:04:18that. In terms of A&E targets being achieved, we noted the targets have
0:04:18 > 0:04:21not been achieved recently and it is important and instructive I think to
0:04:21 > 0:04:26look at the extraordinary increase not just a mentor but overall in the
0:04:26 > 0:04:28number of episodes that are happening, they are really going up
0:04:28 > 0:04:32at a very high level, demand is higher than I think could have been
0:04:32 > 0:04:37anticipated and it is a credit to the NHS that is per free sing --
0:04:37 > 0:04:49producing the performance that it has.My lords, this morning I
0:04:49 > 0:04:56visited a suburban lot -- suburban Hospital in London with an almost
0:04:56 > 0:05:02brand-new A&E unit but despite all of that they were still facing 97%
0:05:02 > 0:05:15bed occupancy on Sundays which is really stretching
0:05:16 > 0:05:20the patients to actually make this work. Money was clearly an issue.
0:05:20 > 0:05:23They were really quite anxious about the end of year and what their
0:05:23 > 0:05:32accounts might look like. Today, the Liberal Democrats launched a report
0:05:32 > 0:05:39looking again at a different way of funding the NHS, the creation of an
0:05:39 > 0:05:43Office for Budget Responsibility for health and care, long-term health
0:05:43 > 0:05:47and care funding, a ring fenced tax placing national insurance, but also
0:05:47 > 0:05:51in the short-term, and there is a clear need for some sort of
0:05:51 > 0:05:57short-term fix, £2 billion to paid for from income tax by adding a
0:05:57 > 0:06:02penny to our income tax and I wonder whether the Minister has actually
0:06:02 > 0:06:10look at this report and whether he would actually agree to discuss it.
0:06:10 > 0:06:14I think the noble lady for questions and I'm glad she had a possible --
0:06:14 > 0:06:19positive experience at the hospital this morning. Bed occupancy is this
0:06:19 > 0:06:26moment in time but a good job was done to get it now below 80% -- 85%
0:06:26 > 0:06:30in the run-up to Christmas. Part of dealing with that is actually the
0:06:30 > 0:06:37social care Saitama as we know. The extra funding is having some impact
0:06:37 > 0:06:40on these delayed transfers of care and bring up the number of beds. She
0:06:40 > 0:06:43is right of course that money is important, to Tovey as we have the
0:06:43 > 0:06:48demands of the growing and ageing population. We did have more money
0:06:48 > 0:06:52in November in the budget for the short term. In the long-term, there
0:06:52 > 0:06:54is in and formed an lively discussion going on across Knost
0:06:54 > 0:07:05just a liberal -- the Liberal Democrats... I would be delighted to
0:07:05 > 0:07:10meet with her to discuss her plans and what I can say is that there
0:07:10 > 0:07:14needs to be a sustainable long-term increase in NHS funding and we need
0:07:14 > 0:07:20to find the right way to do that. Does the Government recognise the
0:07:20 > 0:07:23concerns of the Royal College of the emergency medicine at the revised
0:07:23 > 0:07:34map collecting data by NHS England does not allow meaningful
0:07:34 > 0:07:40comparisons? Their concern is that this may be giving an overoptimistic
0:07:40 > 0:07:43impression of throughput and does not reflect the huge pressures on
0:07:43 > 0:07:47level one units and I wonder whether the Minister would undertake to meet
0:07:47 > 0:07:50with the resident of the Royal College of emergency medicine with
0:07:50 > 0:07:56me to discuss some of their concerns.It is an afternoon of
0:07:56 > 0:08:00agreeing to meetings. I would be delighted to although I am not
0:08:00 > 0:08:05knowledgeable enough about the particular issues you mentioned. Of
0:08:05 > 0:08:11course, they all have the obligation to reach the four hour waiting time
0:08:11 > 0:08:14standard everyone to make sure that whatever the situation, whatever the
0:08:14 > 0:08:22venue, that we can do that.Could the noble lord the Minister
0:08:22 > 0:08:29explained how five years after France's inquiry, the lack of
0:08:29 > 0:08:34investment in health care in England, as outlined in the report
0:08:34 > 0:08:38published today, left to chance, shows that even if we had more beds,
0:08:38 > 0:08:44we would not be able to staff them? In comparison, Wales has invested
0:08:44 > 0:08:52heavily in new nurses, and continued professional development, and is
0:08:52 > 0:08:54doubling the amount of district nurses it intends to train this
0:08:54 > 0:09:02year. While in England, we currently have 4400 qualified district nurses
0:09:02 > 0:09:09went in 2010, we had 7500. How can we resolve this quickly and ensure
0:09:09 > 0:09:14that we have more district nurses in training by this up Amber? -- by
0:09:14 > 0:09:22this September.This is an important point about nursing numbers and the
0:09:22 > 0:09:26particular accusation was about the follow-up to the Francis Report. Of
0:09:26 > 0:09:30course, a lot of that was about staff on awards and their the
0:09:30 > 0:09:37picture shows and delays figures from October, when compared to May
0:09:37 > 0:09:46of 2010 -- October 20 17th -- 2017. Some other areas of nursing have
0:09:46 > 0:09:49been affected, we talked about mental health and district nursing.
0:09:49 > 0:09:53What I would say is that the increase in nurses training places I
0:09:53 > 0:09:59do mean that there are more nurses going into mental health and
0:09:59 > 0:10:06community nursing as well.The increase in population over the last
0:10:06 > 0:10:0930 years, the number of beds in the National Health Service is half what
0:10:09 > 0:10:20it was 30 years ago. In Germany, they have eight beds per thousand.
0:10:20 > 0:10:27In France, it is six, and in the UK, it is two and a half. Is it not time
0:10:27 > 0:10:30we revisited the whole question of the number of beds available at our
0:10:30 > 0:10:35national concerns?The noble lord raises an interesting issue and is
0:10:35 > 0:10:38he quite rightly pointed out that number has been dropping over a long
0:10:38 > 0:10:41time and indeed it has actually plateaued in recent years but it has
0:10:41 > 0:10:46been following. It is a difficult situation. We all agree that more
0:10:46 > 0:10:49care should be delivered in the community but we also understand at
0:10:49 > 0:10:55certain times of year you do need beds in hospitals. I think I would
0:10:55 > 0:10:59point to two things. Firstly, freeing up, making sure that that
0:10:59 > 0:11:03capacity is more efficient so that people can stay safely for less time
0:11:03 > 0:11:05and can spend more time being treated in their homes, often where
0:11:05 > 0:11:09they want to be and that is why funding for social care is
0:11:09 > 0:11:12important. The other thing I would point out is that there was a
0:11:12 > 0:11:15reconfiguration test that has been introduced by NHS England which is
0:11:15 > 0:11:20about stopping reductions in bed numbers, which the noble lord has
0:11:20 > 0:11:22said has happened over successive governments, where it cannot be
0:11:22 > 0:11:25proven that any reduction is for the benefit of patients overall in terms
0:11:25 > 0:11:32of their overall care.My lords, I declare an interest as president of
0:11:32 > 0:11:40this Association. Is the Minister aware that ID national spinal
0:11:40 > 0:11:44centre, one ward was absolutely necessary, has been taken away from
0:11:44 > 0:11:51the spinal unit and used for general patients? And all over the country,
0:11:51 > 0:11:54in the spinal units, there are waiting lists, and these are very
0:11:54 > 0:11:59seriously ill patients who need specialised treatment. Would the
0:11:59 > 0:12:06Minister look into the situation?I was not aware of that but I shall
0:12:06 > 0:12:16certainly investigate.