(1 day, 7 hours ago)
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Lord Lansley
To ask His Majesty’s Government what assessment they have made of the effectiveness of neighbourhood health services in improving patient outcomes and reducing pressure on hospitals.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, the success of neighbourhood health will be measured against the national goals in the neighbourhood health framework, including improved health outcomes and better urgent and emergency care performance. Early local reported evidence from neighbourhood health approaches is encouraging, including reported reductions in emergency department use and in emergency admissions. The learning from the 43-place national neighbourhood health implementation programme is informing wider implementation, alongside an independent national evaluation commissioned through NIHR.
Lord Lansley (Con)
I am grateful for that response from the Minister. Can I ask about the example of heart valve disease, which affects one in 15 people over the age of 75? Of those, half go undiagnosed, which can lead to severe illness, hospitalisation, expensive treatment and, unfortunately, avoidable early mortality. We have digital diagnostics available in the community now which, in the hands of GPs and pharmacists, can enable much of that lack of diagnosis to be met and therefore preventive treatment to be successfully applied. What are the Government doing to enable the spread of diagnostics into the community, which is vital in that transition from hospital to community, from treatment to prevention and from analogue to digital?
Baroness Merron (Lab)
The noble Lord comes forward with a good example; digital diagnosis is a huge support in the improvements that we seek to make for patients, so we are investing in digital diagnostic transformation through NHS England’s diagnostics digital capability programme. That will ensure that networks have that core set of digital capabilities so that care can be improved in quality, safety and productivity. Those are all outcomes that we seek in neighbourhood healthcare.
Lord Hunt of Kings Heath (Lab)
My Lords, the noble Lord, Lord Lansley, has underpinned the importance of general practitioners. My noble friend will be aware that there is a big variation in the number of GPs per patient up and down the country. Can she say a little about what the Government are doing to deal with these under-doctored GP areas?
Baroness Merron (Lab)
It is true that general practice is a cornerstone of neighbourhood health. I am glad that people will now find it easier to access their doctor and have more choice in how and when they book appointments. With reference to digital access, I believe that will greatly help in accessibility to GPs, but we are improving capacity. We are employing more GPs; there are now 2,800 more fully qualified full-time equivalent GPs employed compared with July 2024. That is the highest number since 2015. We have also made changes to the GP contract so that PCNs and practices can hire more GPs and introduced a practice-level GP scheme. We are focusing our efforts on the more under-doctored areas that my noble friend describes.
Baroness Pidgeon (LD)
My Lords, we cannot expect neighbourhood health services to succeed without ensuring that resources shift from hospitals into the community, so can the Minister set out how much additional NHS funding will be directed towards primary and community care, and how this will be monitored?
Baroness Merron (Lab)
My Lords, joined-up care requires changes to funding flows in order that we can shift our resources. That is where the focus will be. I am glad that from next year we will be trialling for neighbourhoods and places payment mechanisms which mean that savings from reduced unplanned hospital care can go into increased investment in community services. That will not only provide extra funding in terms of neighbourhood health but drive change, which is what we are seeking. In addition, we announced in the Budget 250 neighbourhood health centres, with 120 delivered by 2030, and the first wave of 27 sites comes with a commitment of £50 million.
Baroness Finlay of Llandaff (CB)
My Lords, given that 97% of emergency departments feel that the current pressures on them are unsustainable through the winter, when will the Government establish seven-day services in the community so that bed occupancy rates can fall from their current 93.4% to 85%, which is much safer and will allow emergency departments to deal with really major emergencies and trauma?
Baroness Merron (Lab)
By expanding urgent community care, we will reduce avoidable emergency department attendances, hospital admissions and ambulance conveyances. That is why we are engaging not just an urgent community response but virtual ward services. I also point to the fact that we are supporting patients to book the most appropriate urgent care service through NHS 111 or the NHS app before attending emergency departments. There are a number of very good examples around the country of how people are doing that. Winter is going to be hugely challenging, and that is why, for example, we are putting in £190 million to help the NHS manage winter pressures and £140 million for new urgent care schemes.
Lord Kamall (Con)
My Lords, we all agree with the shift from hospital to community but, as we discussed on the Health Bill in Committee last night, we are still waiting for details of how it will all fit together. Can the Minister explain whether existing primary care providers, especially local GP practices, will be expected to rebrand as neighbourhood health centres and maybe offer some additional services, particularly secondary services, or will existing GP practices be told to physically move from their current premises into a neighbourhood health centre, and how will they be consulted?
Baroness Merron (Lab)
We are supporting ICBs, providers and everyone across the NHS to work together differently. That is the main point I want to get across. In March this year, we published Fit for the Future: Towards Population Health Delivery Models, which set out three new population-based contract types. They aim to bring various aspects of services into a single contract, and they will deliver a shift from what is currently fragmented, service-by-service commissioning to end-to-end pathways around the patient. That is where we need to get to. GPs are very much part of that, and we have involved them throughout.
Baroness Barker (LD)
My Lords, we cannot have neighbourhood health without having more community nurses, yet the majority of nurses are in the acute sector, so what are the Government doing to increase the number of community nurses?
Baroness Merron (Lab)
The noble Baroness will be aware that the Secretary of State has confirmed that the workforce plan will be published in the new year. It will take account of that point and the new way of working—how we build the NHS into the future around patients. The point that she makes is quite right. The workforce plan will set out how we will do that.
Lord Kakkar (CB)
My Lords, I draw attention to my declared interest as chairman of King’s Health Partners. Section 131 of the 2006 NHS Act requires NHS England to ensure that it has been properly professionally informed in determining how to provide diagnostic, preventive and treatment health services and public health services. It is proposed that this obligation will no longer apply to the Secretary of State when NHS England is abolished. How do His Majesty’s Government propose to ensure that proper, clinically informed information is available in determining the provision of local health services in the future?
Baroness Merron (Lab)
As I recall, we discussed last night in the Health Bill the establishment of a clinical council which could guide and advise the Secretary of State, who is, of course, ultimately responsible.
Baroness Ritchie of Downpatrick (Lab)
My Lords, community pharmacies are a key pillar of neighbourhood health services, providing treatment for small illnesses and as part of the vaccination programme. Can my noble friend the Minister outline what plans the Government may have to extend and expand the vaccination programme to community pharmacies?
Baroness Merron (Lab)
My noble friend is quite right that expanding the availability of NHS vaccinations through community pharmacy is very much the way forward. That is why in the last flu season we enabled the provision of flu vaccinations through pharmacists to two and three year-olds. It is why in this flu season we are extending that still further, to children and young people in clinical risk groups and for catch-up vaccinations. We have also piloted delivery of the RSV vaccination for older adults and pregnant women, which my noble friend has campaigned on very successfully.