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Urgent and Emergency Care Recovery Plan
30 January 2023
Lead MP
Steve Barclay
Debate Type
Ministerial Statement
Tags
NHSEducationTaxationEmploymentForeign AffairsStandards & EthicsMental Health
Other Contributors: 39
At a Glance
Steve Barclay raised concerns about urgent and emergency care recovery plan in the House of Commons. A government minister responded. Other MPs also contributed.
How the Debate Unfolded
MPs spoke in turn to share their views and ask questions. Here's what each person said:
Government Statement
NHSEducationTaxationEmploymentForeign AffairsStandards & EthicsMental Health
Government Statement
Today, the UK government has published a new delivery plan to recover urgent and emergency care services amid the pandemic pressures. The plan includes a £14.1 billion funding boost for health and social care as part of the autumn statement. This is the second of three plans to cut waiting times in the NHS, focusing on reducing waiting times for urgent and emergency care through demand management before hospital admissions and supporting quicker discharges with care at home or in the community. The plan also aims to improve ambulance response times for category 2 calls (heart attacks and strokes) to an average of 30 minutes by March next year and increase A&E patient throughput rates, targeting a 76% compliance rate within four hours by March. Key commitments include backing up these improvements with better data management and transparency, including publishing the number of 12-hour waits from arrival in A&E starting April onwards. The plan includes £800 million for new ambulances (including 100 specialised mental health ambulances), over £5 billion for hospital beds, a workforce growth initiative to recruit more than 50,000 nurses, and boosting social care capacity with up to £2.8 billion in the next year.
Wes Streeting
Lab
Ilford North
Question
The Secretary of State says that this plan will see patients waiting longer for GP appointments, with no restoration of district nursing or expansion of medical staff numbers. Does the shadow believe the targets set by the government are credible and achievable?
Minister reply
The minister emphasises that the recovery plan is based on evidence and experience from best practices across trusts, backed by significant investment in new ways of working. He commits to year-on-year improvement in A&E waiting times and ambulance response times for emergency calls, with transparency in data publication starting April. He also notes positive reactions from NHS Providers and the Royal College of Emergency Medicine.
Wes Streeting
Lab
Ilford North
Question
The MP criticises the Health Secretary's plan for failing to address critical issues such as GP appointment shortages, insufficient community care, and lack of negotiations with healthcare workers. He also questions the ambition and validity of the new waiting times targets.
Minister reply
The Minister responds that the Opposition's approach is inconsistent, ignoring operational improvements in England compared to Wales. He highlights additional funding for NHS staff, noting an increase of 10,500 nurses this year over last. The Minister also emphasises the need for realism alongside ambition and outlines plans for scaling up virtual wards.
Question
The MP inquires about the plan's ambition regarding a two-hour response to falls at home for frail elderly patients, which was committed to in the long-term plan.
Minister reply
The Minister states that funding has been earmarked from £2.8 billion next year and highlights the need for accurate data on community response gaps. He notes that integrated care boards will play a key role with control centres enabling better visibility of service delivery.
Rachael Maskell
Lab Co-op
York Central
Question
The 300,000 vacancies in health and social care mean that, whatever the Secretary of State puts on the table, his plans will never be delivered. What is he doing to retain the burned-out, traumatised staff who currently work in the NHS, to resolve their pay dispute and to put enough money on the table to pay social care staff enough to come and work in the service?
Minister reply
We recognise the huge pressure on social care; that is why, at the autumn statement, the Chancellor set out the biggest-ever increase in funding into social care of any Government, £7.5 billion over two years. We are putting more funding in. On the workforce more generally, the Prime Minister and Chancellor have committed themselves to bringing forward the workforce plan, which will set out the longer-term ambition on workforce and will be independently verified.
Question
I warmly welcome the plans set out by my right hon. Friend today, but he will know that one reason emergency care faces so much pressure is that successive Governments have not focused enough on the prevention agenda. Indeed, last week’s news that the Government will not go ahead with individual focused plans on cancer, dementia and mental health has concerned many. Can he assure this House that the Government’s new major conditions strategy will be published promptly and will be comprehensive and significant?
Minister reply
I am happy to give my right hon. Friend that assurance. I assure the House that our commitment to the cancer mission and the dementia mission through the Office for Life Sciences is absolutely there. He is right that we are bringing that together in one paper—I think we should take a holistic approach—but I share his ambition on prevention.
Question
I want to raise the case of a constituent who described to me the state of Salford Royal’s A&E earlier in January, saying: “My partner was taken by ambulance yesterday at about 11am. He has a severe chest infection and breathing problems. He was left sitting in a chair on oxygen until 10pm when a trolley was found for him to sleep on. There are no beds available.” My constituent said that patients and staff feel that no one cares. After such a long wait, my constituent’s partner was found to have pneumonia and he has been very poorly. Now the Secretary of State is talking about a target of 76% of A&E patients being seen within four hours by next March. Will he tell me and my constituent why he thinks it is acceptable for patients to wait longer than is safe?
Minister reply
We are bringing times down; I think the current mean response for C2s is much more in the region of 25 or 26 minutes than it was in late December-early January, because across the UK there was a massive spike in flu. The hon. Lady will have seen exactly the same in the Labour-run NHS in Wales.
Question
I strongly support the £1 billion for 5,000 additional beds and 800 more ambulances. I have long argued that, with a growing population and a growing elderly population, we need more capacity. Is it also possible to take some of the £14 billion of additional money to provide even more capacity? I think we are going to need it.
Minister reply
Within my right hon. Friend’s question is, I think, how we get more flow into hospital: once bed occupancy goes above a certain threshold, lack of flow is the key interaction that drives inefficiency within hospitals. That is why we are putting in the extra capacity.
Daisy Cooper
Lib Dem
St Albans
Question
I welcome the additional transparency on data for 12-hour wait times, because it is only by shining a light on the problem that we can see just how bad it is, but the targets set out in the plan today are utterly woeful. The Royal College of Emergency Medicine says that we need 13,000 beds; the Government are offering 5,000. The percentage of patients who are seen within four hours should be 95%; the Government are aiming for 76%. Heart-attack and stroke victims should be seen within 18 minutes; the Government are aiming for only 30 minutes.
Minister reply
First, I thank the hon. Lady for recognising the steps that we have taken on transparency. That has been an area of challenge and it is part of my wider commitment to transparency.
Question
I welcome my right hon. Friend’s statement. In the pandemic, the use of local private hospitals by the NHS, particularly in places such as Basingstoke, kept services such as cancer care going uninterrupted. Could the NHS be using more private facilities more widely to relieve some of the pressures that he so eloquently outlined in his statement?
Minister reply
My right hon. Friend makes an important point. Again, within that is patient choice and how we empower more patient choice—providing services that are free at the point of use—to use what capacity there is within the system, including in the independent sector.
Derek Twigg
Lab
Widnes and Halewood
Question
I saw for myself only a few weeks ago the real crisis in our hospitals when I accompanied a close relative to Whiston Hospital, where I saw every single space in the corridors taken up by a bed, a trolley or a chair. Quite frankly, what the staff—doctors, nurses and support staff—were doing was amazing, and they deserve all our praise for the hard work that they are putting in.
Minister reply
First, the hon. Gentleman is right to recognise the work that the staff have been doing. He mentioned a family member; when I made a statement earlier in January, I recognised that there has been huge pressure on the system.
Question
There is no doubt that the 5,000 extra beds will help the NHS to provide the best possible patient care. Community hospitals across East Devon and NHS Nightingale Hospital Exeter can play their part, too. Does my right hon. Friend agree that community hospitals can play a key role in helping to cut waiting lists?
Minister reply
Community hospitals are key to tackling the issue of delayed discharge. Community settings have been a bit of a Cinderella in the past.
Jeremy Corbyn
Ind
Islington North
Question
The social care sector is dominated by dedicated staff who are paid low wages. High profits are made from it and there is an insufficiency of spaces. Will the money that the Secretary of State has announced go to local authorities? Can it be spent on public provision?
Minister reply
One area where I agree with the right hon. Gentleman is the importance of local authorities, which will receive £2.8 billion and £4.7 billion in funding from the Chancellor over two years. The money is targeted at local authorities as part of a wider discharge package to improve data transparency and address blockages.
Question
Does my right hon. Friend agree that speeding up discharge from hospital and freeing up beds for patients needing urgent and emergency care is necessary, but there must also be an expansion of new services in the community?
Minister reply
My right hon. Friend hits the nail on the head regarding the need to manage demand better before people get to the emergency department. The frail elderly are a key focus area for action, alongside enabling discharges where patients are fit to leave hospital.
Karin Smyth
Lab
Bristol South
Question
Will the Secretary of State ensure that demand and capacity are matched in his own ICB? How will I know this is true for my own ICB?
Minister reply
ICBs need to understand virtual ward capacity, physio wraparound services, residential care versus community care, and other domiciliary care packages. Control centres will be set up to make data more transparent so that ICBs can be better held to account.
Question
I welcome the fact that Barnet Hospital’s emergency department will be expanding and improving its facilities, but how soon must this plan be delivered on the ground?
Minister reply
This morning the Prime Minister and I were at University Hospital of North Tees where such measures are having an effect on the ground. Innovations from hospitals like North Tees and Maidstone will be scaled up across the NHS.
Valerie Vaz
Lab
Walsall and Bloxwich
Question
There are 165,000 vacancies in social care. How will this statement address them?
Minister reply
We are dealing with the issue through additional funding of £500 million for this winter to be spent on workforce issues including in social care.
Question
The Secretary of State is aware of Torbay’s demographics, particularly the growth in the number of people aged over 85. How will he engage with local ICBs that cover areas where demographic pressure means they are at the leading edge and driving innovation?
Minister reply
We met almost all the ICBs before Christmas to discuss these issues. We want to bring greater transparency so that solutions for emergency departments can keep pace with demand.
Janet Daby
Lab
Lewisham East
Question
Last night, my constituent’s 11-month-old son had to wait in A&E for eight hours. Will there be a plan to return to the standard of 95% of patients who come to A&E being seen within four hours?
Minister reply
We are not setting out that ambition because the impact of the pandemic has been severe, but we are putting in extra funding and taking best practice from areas working effectively.
Julian Lewis
Con
New Forest East
Question
From 2005 to 2006, there was a campaign within the NHS to close many in-patient beds in community hospitals. Will he reconsider the future of the site of Fenwick Hospital in Lyndhurst where in-patient beds were closed?
Minister reply
ICBs are encouraged to take ownership of individual decisions rather than trying to make all the decisions centrally from Westminster.
Luke Pollard
Lab Co-op
Plymouth Sutton and Devonport
Question
The additional capacity for beds is welcome, especially because of structural under-funding and lack of beds in the south-west. Can he look again at the mothballed Cavell Centre programme which would have done much to slow the flow?
Minister reply
Schemes such as the community response service and the falls service are being looked at along with models like North Tees to get more staff into community support, thereby integrating health and social care.
Greg Smith
Con
Mid Buckinghamshire
Question
I warmly welcome my right hon. Friend’s clear and credible plan, but on the uplift of 800 ambulances, which is good news, I urge him when it comes to their deployment to look at rural areas first. In these areas, ambulances by definition spend much longer per patient on the road going in between much more diversely spread out hospitals.
Minister reply
I recognise my hon. Friend’s point, not least as a rural constituency MP myself. I have talked to paramedics, as I am sure he has, and the principal cause of frustration of late has not been the issue of pay—important though that is. It has been frustration over long handover times, which has had a particularly damaging impact. I am happy to look at any specific issues in his area but he is right on the wider point about the pressures in rural areas.
Question
When can the people of Warrington, and indeed Halton, expect to hear about the new hospital campuses, which are much needed by both communities—with sufficient staff to resource them?
Minister reply
This statement is focused on urgent and emergency care. At Health oral questions and on other occasions, we often discuss the wider capital programme and the increased funding we are putting into that programme. Part of that is about outcomes and how we get more from that investment in capital. That is why through the NHS estate we are starting to standardise our builds, starting with the Hospital 2.0 programme. We will be rolling that out more widely through the estate. I am not familiar with the specific issues at the hon. Member’s local site, but I am happy to look at them after the statement.
Question
I welcome this recovery plan and my right hon. Friend’s comments on the role community hospitals have to play in future. The 16-bed Hopewell ward at Ilkeston Community Hospital was re-opened ahead of this season to ease pressures, but it is due to be decommissioned in the spring. To aid with more efficient planning, will he work with my local community health trust and ICB to ensure that these beds form part of the extra beds for next winter and, more importantly, become permanent—rather than this ad hoc approach we have had until now?
Minister reply
Again, decisions on the estate are principally for the ICBs, but I am happy to look at any individual proposals my hon. Friend has on how we get more flow into the system, and that is about putting more capacity into the community.
Kerry McCarthy
Lab
Bristol East
Question
I think I welcome what has been said about mental health ambulances and trying to divert people in mental health crisis from A&E, but I am a little concerned about whether those attending the scene in those ambulances will have access to the past records of people in that situation or be able to carry out a proper risk assessment for them. Will the Secretary of State reassure me on that, and also on whether there will be places other than A&E to take them to? It is one thing to say that we want to divert them, but we need to have other resources in place.
Minister reply
The hon. Lady raises a fair and important point about what is in the wider package, alongside the mental health ambulances, which I think are a positive step. Last week, I met Baroness Buscombe as part of the pre-legislative scrutiny of the proposed mental health legislation, which will pick up some of the points that the hon. Lady raises. Examples of innovation include empowering people before they have a mental health crisis to use one of the apps that have been developed to set out their statement of wishes and other information, which is very helpful for paramedic crews when they have a mental health crisis. We are looking at how we use innovation to better give voice to the patient, and often to do that before they have the mental health incident, rather than when the ambulance arrives.
Question
I welcome the announcement today; I think the key thing is that it makes a difference in the short term. The Secretary of State will be aware of plans to build a new A&E department at Ipswich Hospital. The plan is for it to open in January 2024. What assessment has been made of the difference that that could make in the medium to long term by increasing capacity and improving waiting times? Will he also be prepared to work with me and the hospital’s trust to potentially expedite the plan, so that it might even happen slightly before January 2024?
Minister reply
In a former role, when I was Chief Secretary to the Treasury, I signed off a significant expansion of A&E facilities. I hope that reassures my hon. Friend of my commitment to putting more capacity into emergency departments, not least because they need a certain level of capacity to be able to ensure same-day access, triage and ways of getting flow into the system. As for the wider site proposal, clearly the ICB for his area will want to prioritise that.
Helen Morgan
Lib Dem
North Shropshire
Question
The urgent care and ambulance crisis has been brewing since autumn 2021 in Shropshire, and it has worsened since. Last week, a doctor went on the record to say that the emergency department was “like a war zone” and expressed her fear that, in a fire, not everyone would get out alive. In a six-week period to 12 January, the category 2 response time in the Oswestry area was two hours and 10 minutes. Will the Secretary of State acknowledge that in some areas the crisis is worse than in others? Will he agree to meet me and the other MPs representing Shropshire to discuss how we progress Shropshire further along this track to solve the urgent care crisis that is so serious there?
Minister reply
I am very happy to meet with the hon. Lady and colleagues to discuss this further. I think most people recognise that, since the huge pressures from flu over the Christmas period, the flu numbers have come down, but of course there is continued pressure in the system.
Question
I welcome my right hon. Friend’s statement. In particular, I welcome the announcement today of over £26 million of funding to expand the emergency department at Great Western Hospital in Swindon. He knows from his previous incarnation that we have worked together on this issue. It is particularly important, not just for the integration of emergency services, but for the freeing up of other space in the hospital to allow for further beds or other clinical interventions. Does he agree that it is this sort of long-term measure that will guarantee progress in our much pressed national health service?
Minister reply
My right hon. and learned Friend has been key to securing the funding. He has assiduously lobbied me and ministerial colleagues to make a powerful case on behalf of his constituents, and I think he should be proud of the outcome, which reflects his and his parliamentary colleagues’ work on this issue. He is right; indeed, the case he made was around how this frees up capacity in the system, which will result in much better care for patients in Swindon.
Tim Farron
Lib Dem
Westmorland and Lonsdale
Question
There is nothing in this plan to address the fact that thousands of people are now turning up at A&E as a direct result of being unable to get regular access to an NHS dentist. Last week, another Cumbrian dental practice, in Grange-over-Sands, wrote to all of its 5,800 patients, as it had been forced to quit the NHS too. There is now not a single NHS dental place available anywhere in Cumbria. What will the Secretary of State do to fix an NHS dentistry crisis that leaves a family of four having to cough up an extra £1,000 a year during a cost of living crisis to get access to dental care that they have already paid for through their taxes?
Minister reply
I have addressed that point, in that we are bringing forward the third component of our three plans. I spoke earlier about the elective recovery plan; today’s announcement is on the urgent and emergency care recovery plan; and the third element will be the primary care recovery plan. Of course, alongside the work we are doing on dentistry it is also about access to services, both dentistry and A&E. That comes together in things such as the 111 service and how we review that, as well as the NHS app. It is about looking at how we better manage demand at the front door, and the demand for dentistry is not only through NHS dentistry but often manifests itself through a lot of patients coming forward for dentistry at A&E.
Question
I warmly welcome my right hon. Friend’s plan, particularly his focus on increasing capacity in urgent and emergency departments. I welcome the Government’s recent investment of £8 million to reconfigure the A&E at my local hospital in Southend. Does my right hon. Friend agree that this will increase not just the capacity but the quality of the urgent and emergency care on offer in Southend?
Minister reply
I commend my hon. Friend for her assiduous campaigning on behalf of her constituents in Southend, through which she played a key role in securing the extra £8 million of funding. She is right that that will make a material difference not only to flow and capacity within the hospital but through that to the overall standard of patient care.
Jim Shannon
DUP
Strangford
Question
I thank the Secretary of State for his clear commitment to extra funding for the urgent and emergency care recovery plan. Will he outline whether he is prepared to make additional funding available to meet the needs on maternity wards, which midwives feel are teetering on the brink? In reality, that means it is an issue of life and death, due to staffing levels. Will the Secretary of State ensure that additional funding makes its way to each devolved nation under the Barnett consequentials, to be used before the scheduled new financial year ends?
Minister reply
As the hon. Gentleman will know, the additional funding that the Chancellor announced in the autumn statement will lead to an uplift in health funding for Northern Ireland through the Barnett consequentials. On the flexibility within that, the hon. Gentleman will know that I agreed flexibility when I was Chief Secretary; it will of course be for Treasury colleagues to look at the requirements for ongoing flexibility within Barnett consequentials.
Question
I warmly welcome what my right hon. Friend has said. He is right to recognise that one of the long-term impediments to discharge is the disconnect between the NHS and social care and local authorities. Will he confirm that, to ensure that the additional money is well spent, the integrated care boards will be not only responsible for the establishment of the hubs and extra care packages but properly monitored and held responsible for their performance and for generating value for the extra money that is being put in?
Minister reply
As a former Minister in the Department, my hon. Friend speaks with great experience on these matters. He is right that the crux of the plan is now in its delivery. As I alluded to in my statement, a key component of that is more transparency in the data so that he and colleagues throughout the House can hold to account not only the ICBs but the local authorities. We need to bring those two datasets more closely into alignment.
Selaine Saxby
Lab
North Devon
Question
I warmly welcome today’s announcement, but will my right hon. Friend explain how for remote rural hospitals, such as the fantastic North Devon District Hospital, the workforce challenges that were present pre-pandemic might be addressed post pandemic, when we are now also dealing with a housing crisis? Might there be an opportunity to expedite the next phase of the redevelopment programme, which includes key worker housing?
Minister reply
I am keen to explore with colleagues how we can put more key worker accommodation on to the NHS estate, particularly by making use of modern methods of construction to expedite that. On the workforce plan, Devon is an area that has seen particular growth, given its older population, and greater pressure as a consequence. Those pressures will be worked through in the workforce plan that we will bring forward shortly.
Tobias Ellwood
Con
Bournemouth East
Question
I welcome the statement and the extra investment in the NHS. It was a privilege to visit Bournemouth Hospital recently and meet the dedicated staff, and as the Secretary of State will know, it is expanding with a new A&E facility. Will he visit Bournemouth, meet the staff, and see the progress taking place?
Minister reply
I would be very keen to visit, subject to my diary. If it is not me, I am sure a ministerial colleague will do so.
Ruth Edwards
Con
Clacton
Question
I welcome the £1 billion funding announced today, and it is good that hospitals have benefited from innovations such as patient flow control centres, care transfer hubs, and virtual wards. When will hospitals and ICBs such as Nottingham and Nottinghamshire ICB, which has not been part of the pilot, be able to access those innovations, so that my constituents can start to access the benefits?
Minister reply
They can start to access them now. We announced £250 million at the start of the month, as part of the £500 million that was announced in the autumn statement, and hospitals know that funding of up to £8 billion is coming in the new fiscal year, so this is an opportunity for them to move at pace.
Andrew Bridgen
Con
Hinckley and Bosworth
Question
The Secretary of State told the House that the NHS was put under pressure with a spike in influenza cases in December. Will he say where he thinks that influenza virus has been hiding for two and a half years?
Minister reply
I do not think it has been hiding. Flu seasons are not uncommon in the NHS and come round on a periodic basis, and that is why we anticipated it through the flu vaccine. On the hon. Gentleman’s wider point, it is also recognised that as a consequence of covid some resistance to flu may have been lowered, but we have had flu pressures on the NHS in past years.
Mark Pawsey
Con
Rugby
Question
Would the Secretary of State consider more use of existing urgent care centres, such as that at St Cross in Rugby? Our nearest full A&E is 12 miles away at University Hospitals Coventry and Warwickshire NHS Trust, in Coventry, which means that 83% of my constituents are more than 15 minutes’ drive from an A&E. The hospital at Coventry serves a population of 600,000, which is twice the national average. Does he agree that extending provision at St Cross would go a long way towards reducing pressure at the hospital in Coventry?
Minister reply
My hon. Friend is right that not every patient accessing an emergency department needs a tier 1 A&E facility. This is about right place, right treatment for the patient, and making better use of urgent care centres. How those centres can better triage patients who can be treated there is a key part of the plan we have set out.
Matt Vickers
Con
Stockton South
Question
In Stockton South we are incredibly grateful for the Government’s commitment to build a new diagnostic hospital so that local people can get access to lifesaving scans, tests and checks. We are also grateful for the £3 million announced to establish a new mental health crisis hub, so that people can get support in their hour of need. What is my right hon. Friend doing to ensure that we have the right people with the right skills in the right place to deliver great service at those facilities?
Minister reply
I am delighted that, thanks to my hon. Friend’s assiduous campaigning, he has secured his diagnostic centre, and that he assures me he will get it operational in one of the fastest times seen by any area. We are bringing forward our workforce plan, and as I set out, we have 2,500 more nurses this year compared with last year. We are on track for our manifesto commitment of an extra 50,000 nurses, with more than 30,000 recruited already.
Andy Carter
Lab
Croydon North
Question
May I take my right hon. Friend back to the response he gave to the hon. Member for Weaver Vale (Mike Amesbury) about Warrington Hospital? That A&E unit is incredibly under pressure. Over the weekend nurses talked to me about the 120 patients currently waiting to be discharged, which is putting intolerable pressure on that unit. My right hon. Friend said that he was not particularly familiar with those issues, but perhaps I can invite him to Warrington to see the pressure. While he is there, perhaps he will also look at the Health and Social Care Academy, which was set up by the local college to try to address the shortage in social care. A great level of innovation seems to be happening there, and I am sure he would like to see Warrington for himself.
Minister reply
That last question gives me a beautiful opportunity to correct an earlier answer regarding the constituency of my hon. Friend. He knows I am familiar with this issue, because I remember calling him at about half past 10 one evening to discuss his A&E when some particular issues had come to the attention of the media. I am familiar with the pressures on his hospital—[Interruption.] I was just placing the constituency of the hon. Member for Weaver Vale (Mike Amesbury) vis-à-vis that of my hon. Friend. Now clarified on place, I am familiar with the fact that that hospital is under pressure. I know the Minister of State is due to visit, and I am sure she will look forward to meeting both the hon. Gentleman and my hon. Friend.
Shadow Comment
Wes Streeting
Shadow Comment
The Labour party's shadow health secretary criticises the government's plan as inadequate and unrealistic given current NHS conditions. He highlights that the front door of primary care is broken, leading to excessive A&E visits due to lack of GP appointments, while the exit door is also problematic because community care is insufficient, causing patients to stay in hospitals longer than necessary. The Labour party argues for restoring district nursing services, engaging with striking workers like nurses and paramedics, expanding medical staff numbers, and addressing workforce shortages through additional training placements. They challenge the government's ambition of improving waiting times without addressing critical staffing issues and propose more radical solutions such as doubling the number of district nurses qualifying annually and increasing medical school places to tackle understaffing.
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