NHS Dentistry Services

Baroness Blackwood of North Oxford Excerpts

Thursday 11th July 2019 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what assessment they have made of the availability of National Health Service dentistry services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, nationally, access to NHS dentistry remains high, with 22 million adults and 7 million children seen by a dentist in the 24 and 12-month periods ending 31 December 2018 respectively. However, we know that there are areas of difficulty and more work remains to be done. NHS England, in its role as commissioner, is responsible for commissioning NHS dental services to meet local need and is actively looking into dental access issues.

[Baroness Gardner of Parkes (Con)]

That is rather a disappointing Answer, although it certainly ties in with my experience: it was declared in Manchester that no children could have operations done under general anaesthetic because all slots were taken for the clearance of baby teeth. When I saw that, I wrote to the Mayor of Manchester, who has great experience in the field of health from when he was in the House of Commons. I did not even get an acknowledgement, so after a time I wrote again, saying that perhaps my letter never reached him so I was resending it, but to this day I still have not had an acknowledgement. The press reports get worse and worse about the shortage of these possibilities.

[Baroness Blackwood of North Oxford]

I am very sorry to hear of my noble friend’s experience with the Mayor of Manchester. Children’s oral health is now better than it has ever been, with more than 75% of five year-olds in England being decay-free, which we welcome. However, the number of children requiring tooth extraction remains a concern. It fell slightly between 2016 and 2017-18, which we welcome; however, we recognise that there is much more to do. That is why the NHS outcomes framework is working to ensure that we perform better, with much work being done to target improved oral health of young people, with the Starting Well core framework and Starting Well pilots in the 13 areas of greatest deprivation.

[Baroness Thornton (Lab)]

My Lords, in Portsmouth there are 20,000 patients without a dentist, due to the closure of three practices. In Cornwall, 22,000 people are on the waiting list, having to wait an average of 529 days before they get an NHS dentist. The noble Baroness is quite right that there are some serious problems to address here about access to NHS dentists. I should like to know exactly how those areas in desperate need, such as Portsmouth, will be tackled. Secondly, how many of the babies, children and young people included in those numbers currently have no dental care whatever?

[Baroness Blackwood of North Oxford]

As I said in my previous answer, children’s oral health is better than it has ever been. This is not to say that there is any complacency or acceptance of where we are. We recognise that while access has significantly improved, there are still areas where NHS England needs to do more to meet local need. NHS England is responsible for helping patients who cannot find a local dentist. Those in that situation should contact NHS England’s customer contact centre for assistance. Things that are being done to improve this include the introduction of new nationally flexible commissioning, which can help national commissioners commission a wider range of services from dental practices, and the testing of a new, reformed dental contract, which we think will make the profession more attractive for new dentists.

[Baroness Benjamin (LD)]

My Lords, patients’ dental fees in England have been increasing at an unprecedented rate. These charges are discouraging patients from seeking treatment; they are made to think twice before treatment. Delayed treatment means that they end up seeking free help for dental pain from their GPs and the local A&E, piling huge pressures on other parts of the NHS. Will the Government take urgent action and start proper investment in NHS dentistry to end these extortionate dental fee increases?

[Baroness Blackwood of North Oxford]

The noble Baroness raises an important point. Patient charges are an important contribution to the overall costs of the NHS, and they were driven by some really difficult financial circumstances in the NHS, but she is right that it is critical that no one be deterred from seeking care by the cost. As part of this year’s uplist, the Government and the department have committed to looking further at evidence as to whether patients are being adversely impacted so that this can be taken into account in next year’s—and any future—decisions.

[The Countess of Mar (CB)]

My Lords, the Care Quality Commission recently published a pretty damning report on dental care for people in residential care and nursing homes; most of these people do not have access to a dentist. What are the Government doing to ensure that people in residential or nursing home care get regular dental treatment?

[Baroness Blackwood of North Oxford]

My friend the noble Countess, Lady Mar, raises a vital area. Overall care for those in care homes, whether healthcare, mental health care or dental care, must be provided in a suitable manner. This is being considered in the social care Green Paper.

[Lord Tomlinson (Lab)]

My Lords, I declare an interest as a former chairman of the British Fluoridation Society. Does the Minister agree that prevention is much better than cure, and that you can prevent the need for dentists through a substantial increase in the use of fluoride in our water supplies? Is she satisfied with the progress being made on fluoridation of water? If not, what plans does she have to encourage it?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right: prevention is always better than cure. That is why the programme for oral health improvement in both the NHS long-term plan and the dental contract being tested focuses on a more preventive approach to oral care. Water fluoridation is obviously a very effective way of improving oral health, particularly for children. According to the 2012 Act, it must be a local decision supported by Public Health England in the lead. We want to see more decisions. PHE’s guidance on delivering better oral health sets out clear expectations on this, but there are also other ways in which fluoride can get to children. One is through fluoride in toothpaste, which is now at effective concentrations; the other is that all dentists are expected to deliver fluoride to teeth directly, at clinically appropriate intervals, to all children in their care.

[Lord Clark of Windermere (Lab)]

Is it true that more than a million people were unable to get a dentist under the health service last year?

[Baroness Blackwood of North Oxford]

I do not have that figure in my briefing pack, but I am very happy to write to the noble Lord to confirm or deny whether that is the case.

NHS Pensions: Taxation

Baroness Blackwood of North Oxford Excerpts

Tuesday 9th July 2019 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I beg leave to ask a Question of which I have given private notice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we will be consulting shortly on proposals to make NHS pensions more flexible for senior clinicians in response to evidence that shows that pension tax charges as a result of the tapered annual allowance are having a direct impact on retention and front-line service delivery. These proposals aim to maximise the contribution of our highly skilled workforce, who are crucial to delivering the NHS long- term plan.

[Baroness Finlay of Llandaff]

My Lords, I declare my interest as a past president of the BMA. Can the Government state exactly when the consultation will begin, how long it will run for, how it will be organised and when it will report? Do they recognise that, of 4,000 consultants recently surveyed, 60% said that they would retire at or before 60 years of age, and over half of those cite the sudden unexpected tax bills as a reason? This is particularly urgent because in August we have new graduates starting, who need additional supervision as they begin to get used to working in the clinical arena, yet we are already seeing consultants dropping sessions, which will adversely impact on clinical services. Doctors seem to have only two options now: to retire or to leave the NHS pension scheme, and until they can do that, they are financially penalised for working. One paediatric intensivist I was talking to said that he is £300-plus out of pocket by working a weekend.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important Question, which she has asked before. Retaining and maximising the contribution of our highly skilled clinical workforce is crucial to the delivery of patient care. We are preparing to provide pension flexibility that appropriately balances the benefit of new flexibilities with their affordability. We have listened, and we are discussing the issue with the Treasury. As a first proposal, the consultation will set out a potential 50:50 option, offering 50% pension accrual and halved contributions. The BMA requested this as an option earlier this year and has welcomed it as a step in the right direction. The consultation will be an opportunity to listen to a range of views and will be genuinely flexible and open; we will bring it forward as a matter of urgency. I hope that that is a reassuring answer for the noble Baroness.

[Baroness Thornton (Lab)]

The briefings that I have received from the BMA and other places say that the 50:50 solution may not prevent the problem. How many people will have to wait longer for their operations before the Minister’s colleagues, the Chief Secretary to the Treasury and the Secretary of State for Health and Social Care, concentrate on their day jobs—that is, getting together and talking about how to solve this problem instead of campaigning for whoever they are campaigning for to be the leader of her party? Surely their time could be better spent sorting this problem out.

[Baroness Blackwood of North Oxford]

The noble Baroness knows that I cannot answer for the Chief Secretary to the Treasury, although I know that this issue has been raised with the candidates as part of the leadership campaign and that they see it as a priority. As I said in my Answer to the noble Baroness, Lady Finlay, we recognise that the 50:50 flexibility option does not provide unlimited flexibility for clinicians to target their own personalised level of pension growth. Other options, such as additional pension accruals to purchase individual units alongside a pension, may be considered as part of the consultation. The message going out to the sector is that we want as much flexibility as possible to try to find the right solution to meet the complex needs of the system.

[Lord Naseby (Con)]

My Lords, is my noble friend aware that this issue was raised on the Floor of the House? I was one of those who contributed; I hastily declare an interest as a trustee of the Parliamentary Contributory Pension Fund. Against the background of what was raised some three weeks ago and the evidence that was already in the field, I do not blame any particular Minister, but is there not a pensions section in Her Majesty’s Treasury that must know what options are available to Her Majesty’s Government in coming to a decision that will ensure that the consultants affected will not be forced to retire when they reach 60? That evidence must be there by now; surely, we can have some fast decisions on this major issue.

[Baroness Blackwood of North Oxford]

I absolutely share my noble friend’s desire for a speedy response. He is right that the evidence has come forward and that the issue is affecting front-line services, which is why we are keen to bring the consultation forward as quickly as possible and resolve it. He is also right that those in the Treasury will have seen the evidence and it is right for them to consider it. It is important to understand that the consultation is about the implementation of tax policy, not changing it. That would be a separate question for the Treasury team.

[Baroness Jolly (LD)]

My Lords, the Nuffield Trust found that two-thirds of GPs are retiring early for tax reasons, and because of burnout, the level of extra training required and stress. The Secretary of State is reported as saying that this tax issue is the area that concerns him most about the GP workforce—and well he might worry. Given the Minister’s earlier reply to the noble Baroness, Lady Finlay, when will we see the figures on the decline in GP early retirement?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that this is an important aspect of the recruitment and retention of GPs in particular, which is why we are bringing forward the consultation. As I said, we have been working closely with representative bodies, including the BMA and others. When we brought forward the five-year contract for general practice, announced in January, part of that was to provide greater certainty for GPs to plan ahead. Part of the work we have done is looking at other aspects that will ensure recruitment and retention. This includes, as we have discussed before, funding towards 20,000 extra staff working in practices, remaining committed to recruiting an extra 5,000 GPs and looking at targeted enhanced recruitment schemes, which include a £20,000 salary supplement to attract doctors into GP specialty training. The noble Baroness will understand that it takes a little time for these policy changes to be reflected in the data, but she can have no doubt that this is a policy area in respect of which the Government are absolutely determined.

[Lord Patel (CB)]

My Lords, there is currently a disparity in pension arrangements between clinical academics and NHS consultants. Can the Minister confirm that any discussions the Department of Health and the Treasury have will include the university sector? Otherwise, a disparity between pension arrangements will be created, which might affect the recruitment of clinical academics.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

The noble Lord raises an important point. I am afraid I do not have the specific details about NHS clinicians and academics within the university sector. I will ask about this and write to him.

[Baroness Kramer (LD)]

My Lords, the BMA makes it clear that the Defence Medical Services are the most impacted group of medics. Will the Minister confirm that we are today sending medics out to battlefields such as Afghanistan, who work all hours to serve their wounded comrades and are having to call home to tell their families to take out a second mortgage to pay an unexpected £20,000 to £40,000 tax bill, which hits them because of the peculiar pension consequences? Will this be remedied immediately?

[Baroness Blackwood of North Oxford]

I can confirm that it has been made absolutely clear that NHS clinicians have been impacted by these reforms, and front-line care has been impacted. This is unacceptable and that is why we are bringing forward the review to find a solution as quickly as possible. The noble Baroness is right to raise the issue and we are determined to resolve it.

[Baroness Altmann (Con)]

My Lords, I am sure the Minister agrees that this was an unintended consequence of changes to the tax system. The reality is that the cliff edge of the taper is forcing consultants to pay tens of thousands of pounds for doing one small extra shift, sometimes voluntarily. Could she look at offering financial advice to each individual consultant who may be affected? They will not all face this tax charge, but they are all frightened that they might, so they are not undertaking the extra shifts we need them to undertake. Can she also note to her departmental colleagues that high-paid people potentially affected by the taper in other areas of the public sector received some assistance and mitigating measures from their departments, whereas it has been almost impossible for consultants to plan ahead? We are now seeing the problems occurring belatedly.

[Baroness Blackwood of North Oxford]

My noble friend speaks with particular expertise on this issue. As the whole House will appreciate, NHS consultants are often asked to take on additional shifts at short notice and they face peculiar challenges when calculating the consequences for their pensions. This is one of the reasons why the BMA has put up its calculator. However, the pension rules we are discussing today mean that some who take on extra work may find they have inadvertently incurred a substantial tax charge in moving into the taper. This is why we have brought in the consultation. It is obviously important that those facing pension charges should seek advice. NHS England is considering this issue closely at its most senior levels and working with the department to better understand the impact on clinicians, but also on NHS performance, and we are determined to resolve the situation to get it right.

Restaurants: Calorie Labelling

Baroness Blackwood of North Oxford Excerpts

Tuesday 9th July 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we welcome the ongoing commitment of Diabetes UK, including the Food Upfront campaign, which, together with its encouraging support for our proposals, makes a valuable contribution to improving the nation’s diets. The impact assessment published alongside our consultation last year estimates the number of businesses that will be affected under the various policy options considered. An updated impact assessment will be published when the Government publish the outcome of the consultation later this year.

[Baroness Thornton (Lab)]

I thank the noble Baroness for that Answer. It is a shame that the consultation, which ended in December, has yet to be published. Diabetes UK tells us that three out of four people want to see calorie information on restaurant, café and takeaway menus, and that nine out of 10 say that clearer food labelling will help them make healthier food choices. Diabetes UK is worried that the Government intend to limit compulsory calorie labelling to companies with 250 employees. If that is the case—I would like to know whether it is—only 520 businesses would be included out of the 168,000 eligible, rendering this meaningless. What are the Government doing in this regard and when will we see the results of the consultation?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important question. She will know that we remain committed to delivering the actions we set out in chapter 2 of the childhood obesity plan, which included the consultation on calorie labelling in the out-of-home sector. We will publish it shortly. She will also know that our ability to introduce changes to the labelling system depends on EU legislation. We are committed to exploring whatever additional opportunities we can to have food labelling in the UK display world-leading, simple nutritional information, as well as information on origin and welfare standards. We will bring that forward as soon as possible.

[Baroness Walmsley (LD)]

My Lords, I was alarmed to read the Public Health England report about unacceptably high levels of sugar in baby foods, even some labelled as being healthy. What steps are the Government taking to ensure that such products give parents the information they need to make healthy choices for their children?

[Baroness Blackwood of North Oxford]

I know the noble Baroness has raised issues around baby food on several occasions. The reformulation programme taking place under the obesity plan takes account of sugar in a number of different products. So far, I do not think baby food has been one of these, but the Secretary of State has commissioned the CMO to urgently review what can be done to help the Government meet their ambition of halving childhood obesity by 2030. The report is due for publication by September and I will pass on the noble Baroness’s comments.

[Baroness Neville-Rolfe (Con)]

Does my noble friend agree that two other policies on obesity are not adequately focused on? The first is helping parents to teach self-control and good eating habits. The second is increasing physical activity—for example, through the daily mile and school sports. I was horrified to learn from the Diabetes UK briefing that only 18% of children in the UK reach the recommended target for physical activity so vital to lifetime health.

[Baroness Blackwood of North Oxford]

I thank my noble friend for her question; she is absolutely right that increasing physical activity is a key part of the childhood obesity plan. That is exactly why the revenue from the soft drinks industry levy is being invested in improving childhood health and well-being in this way, including doubling the primary PE and sport premium to £320 million a year. This has included a commitment to every school in the country including the daily mile, or something similar. We are particularly pleased about that, but we also believe that work needs to be done in supporting parents, and PHE is working on that.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, parents carry some responsibility. What disturbs me—I would like to know whether the Minister agrees—is that I often see parents with young children who have a scooter. The child will stand on the scooter and the parent pushes the child all the way to school, so the child gets no exercise whatever. It seems to defeat the whole purpose. Are the Government doing anything to remedy this by means of advertising?

[Baroness Blackwood of North Oxford]

The noble Lord has asked a most innovative question, to which I do not have an immediate answer in my notes. I hazard a guess that scooters offer some balance benefits, but I shall get back to him on that.

[Baroness Young of Old Scone (Lab)]

Are the Government losing their grip on this issue? We were promised the Public Health England sugar reduction data in April, when it did not appear, and then “in late summer 2019”. Can the Minister tell us how late summer will be this year?

[Baroness Blackwood of North Oxford]

Based on the weather, I cannot really answer that, but I absolutely reject the premise that the Government are losing their grip on this issue. We have seen some real successes since the publication of the 2016 plan. The soft drinks levy has resulted in the equivalent of 45 million kilograms of sugar being taken out of soft drinks, which is a genuine success. Some products in the sugar reduction programme have exceeded their first-year targets: a 6% reduction in sugar in yoghurts has been achieved. As I mentioned, significant investments are being made in schools to promote physical activity and healthy eating. We accept, however, given the obesity crisis, that much more needs to be done and the noble Baroness will be glad to hear that the Secretary of State has, as I said, commissioned the CMO to urgently review and drive this agenda forward, which is exactly what we intend to do.

[Baroness Boycott (CB)]

My Lords, I urge the Government to follow up on the point of the noble Baroness, Lady Thornton, about how many of these places are small companies. When I ran the London Food Board, we did research in Tower Hamlets and I found one single takeaway where a portion of chips—a large one, admittedly—was 1,800 calories. That is completely insane, and parents and children do not know about it. I would be grateful to hear the Government’s view on how we might publicise that fact.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her point. As I said, we remain committed to exploring what additional opportunities leaving the EU presents for food labelling. At the moment, we have some world-leading simple nutritional information, but we want to work with the devolved nations and Administrations to explore the potential for common approaches. Obviously, the consultation on mandated calorie labelling has received a high level of interest—there were over 1,000 responses—and that is partly why we are in the process of going through that at the moment.

Asthma

Baroness Blackwood of North Oxford Excerpts

Wednesday 3rd July 2019 Lords Chamber

[The Earl of Clancarty]

To ask Her Majesty's Government what support they are giving to people suffering from asthma, including on access to medicines.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, respiratory disease, including asthma, is a clinical priority in the NHS Long Term Plan, which aims to improve outcomes for patients through earlier diagnosis and increased access to treatments. Pharmacists in primary care networks will undertake medicine reviews for asthma patients. This will include education on inhaler use and uptake of dry powder and smart inhalers where clinically appropriate. Finally, the NHS will build on the RightCare programme to implement respiratory initiatives in 2019-20.

[The Earl of Clancarty (CB)]

My Lords, Asthma UK finds that, of the 2.3 million people with asthma in England who pay for their prescriptions, more than three-quarters struggle to afford them, let alone follow an essential treatment plan. Does the Minister agree that prescription charging sends out entirely the wrong signals to the whole community about the seriousness of the condition which causes the deaths of many young people? The great tragedy is that most of those deaths are avoidable. Should we not as a priority look again at the exemptions list?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question. I have met with Asthma UK on this issue. As an asthmatic myself, I understand the challenges of keeping up with medication, especially when in the middle of an exacerbation. At the moment, we do not intend to review the prescription charges list. However, there are some exemptions in the prescription list, and we have committed to work with Asthma UK to ensure that those who are eligible for low-income exemptions and for the pre-payment charge are accessing them and to look at any other ways in which we can help those who need life-saving medication.

[Baroness Wheeler (Lab)]

My Lords, I am sure that the Minister will know about the recent shocking report from the BMA describing the UK health system as complacent about the risks of asthma. It comments on and documents some of the tragic deaths of young children who would still be alive if their chronic asthma had been properly cared for. It shows a sorry litany of absence of a proper asthma plan across primary and secondary care and failure to refer children suffering repeated attacks to a specialist respiratory team or to optimise medical management of the condition. Some clinicians and staff are unaware of national treatment guidelines, prescribing advice or recommendations from the national review of asthma deaths. What is the Government’s response to this? Why has only one of the NRAD recommendations been implemented since 2014? Why are the remaining 18 still to be acted on to try to stop these unnecessary and untimely deaths?

[Baroness Blackwood of North Oxford]

The noble Baroness will have heard in my opening remarks that we have put treating asthma and respiratory diseases as a key priority within the NHS Long Term Plan precisely because we recognise that we need to improve our performance on respiratory diseases. Working with Asthma UK, we have identified that one of the key challenges in improving performance has been the identification of those with severe asthma and providing them with an appropriate care plan. That is exactly why we are pleased that a new NICE quality standard, QOF and the RightCare programme are in place; these should help to improve referrals and outcomes for patients as is desperately needed.

[Baroness Manzoor (Con)]

My Lords, as the Government roll out the early diagnosis centres, including for lung-health checks, across the country, will they be looking to implement recommendation 1e of the lung task force as part of their strategy, so that air pollution is monitored and the NHS can provide advice when pollution levels are high?

[Baroness Blackwood of North Oxford]

I thank my noble friend. She is right that we need to improve our response to those at high risk of respiratory illness. That is partly why we are improving our offer on mobile lung-health screening, specifically as part of the national targeted lung health checks programme. It is also why we are offering smoking cessation advice and treatment as part of that service. We offer the general population and vulnerable groups advice via the daily air quality index, but she is right: we need to improve our monitoring of air pollution if we are to make progress on this issue. It is something that I will take up with the department.

[Lord Brooke of Alverthorpe (Lab)]

In view of the gravely damaging effect of asthma on children, does the Minister agree that the abolition by the former Mayor of London of the west London zone for congestion charging has increased the amount of air pollution in London over recent years? Many children have died and many people have suffered as a consequence. Will she ask the candidates for the Tory leadership whether they are prepared to reintroduce such a zone in London?

[Baroness Blackwood of North Oxford]

The noble Lord is asking me to step in and comment on matters that are slightly outside my brief. However, I am pleased that we have brought in the clean air strategy, which is a significant step forward. He is also asking me to commit the Mayor of London rather than leadership candidates to a policy area. We do need to move further and faster on air pollution; that is what I expect to see in the prevention Green Paper which will be published shortly.

[The Lord Bishop of Carlisle]

My Lords, given the recent report of an upsurge in acute asthma attacks among schoolchildren at the start of each school year, and given that—as we have already heard—there are three deaths per day from asthma in the UK, many of them preventable, what plans do Her Majesty’s Government have for encouraging better health education regarding the seriousness of this disease?

[Baroness Blackwood of North Oxford]

As ever, the right reverend Prelate is insightful on this matter. Children going into school with identified respiratory illnesses should have care plans to assist the school in caring for them. Asthma UK has indicated that many children are slipping through the net and remaining on long-term oral steroids in primary care. This results in repeated trips to A&E with no referral to specialist centres. We are working with NHS Improvement and others to ensure that we support them with training in the use of medication and improving the use of smart inhalers, which can track the management of their care and reduce referrals to secondary care.

[Lord Rennard (LD)]

My Lords, I am grateful to the NHS for the fact that as a diabetic I do not pay prescription charges, but other people in England with long-term conditions have to pay such charges. In Scotland, Northern Ireland and Wales, all prescription charges have now been scrapped. Is this not somewhat anomalous? Is it not unfair that the 2.3 million adults with asthma have to pay these charges?

[Baroness Blackwood of North Oxford]

The noble Lord will already have heard me answer his question in reply to the opening Question. I have already met Asthma UK on this issue and discussed its concerns about the balance of prescription charges. We are not in a position at the moment to review prescription charges as a whole, but I will be working with that organisation to make sure that the system works as effectively as possible for asthma patients and that they get access to the exemptions that are in place.

National Health Service: Bullying

Baroness Blackwood of North Oxford Excerpts

Wednesday 3rd July 2019 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government what assessment they have made of the level of bullying, harassment and abuse in the National Health Service in England.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the NHS staff survey shows that the level of bullying, harassment and abuse in the NHS is too high, so we are tackling these issues through the national Social Partnership Forum’s collective call to action; the interim people plan, which, through its new offer for our people, will create a healthy, inclusive and compassionate culture where bullying, harassment and abuse will not be tolerated; and our alliance of healthcare organisations, which is promoting civility and respect throughout the NHS.

[Lord Clark of Windermere (Lab)]

I thank the Minister for her Answer. As she said, the latest survey shows that over 25% of NHS staff had personally experienced bullying from fellow employees in the previous 12 months. Does she agree that that is appalling and intolerable, and that in most other organisations it would simply not be tolerated? I accept that the problem is exacerbated by the chronic staff shortages, but bullying can be reduced by firm and proper management practices. That is within the Government’s power, so will they get on with the action of reducing the intolerable level of bullying in the NHS?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question, which is a follow-up to a recent Question on this. This is exactly why the Government have brought out a manifesto commitment to tackle violence and abuse against staff, including legislation that has already brought forward one conviction. NHS Improvement and NHS England have reviewed what central support arrangements should be provided to support NHS organisations in their responsibility to protect staff from unacceptable violence and abuse. In addition, we are bringing forward a plan that will pilot and evaluate the use of body-worn cameras by paramedics, who experience the worst of the violence and abuse, so that we can ensure that they have evidence for prosecutions that is sadly often lacking for convictions where they are appropriate.

[Baroness Jolly (LD)]

My Lords, as we have heard, levels of abuse and bullying are unacceptably high in the NHS, and whistleblowing is not a universally trusted or successful route to resolution. The Scottish Parliament is investigating using the Scottish Public Services Ombudsman to investigate unresolved NHS whistleblowing cases. Does the Minister consider the use of the English Parliamentary and Health Service Ombudsman a sensible route for English NHS whistleblowers? If not, what would she recommend for frustrated NHS whistleblowers?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for that proposal; I shall certainly look into it. A number of measures have been put in place to enable a safe space for whistleblowers to come forward, including a number of regulations ensuring that they are protected and that non-disclosure agreements do not inhibit them from coming forward, but I will certainly consider her proposal.

[Lord Dobbs (Con)]

My Lords, does my noble friend accept that the rights that we all enjoy with the National Health Service also come with commensurate responsibilities: the responsibilities of patients not to abuse staff and to turn up to their appointments, and the responsibilities of staff to ensure that the National Health Service is being used honestly and responsibly? Does she agree that the BMA’s recent announcement that charging health tourists is “fundamentally racist” is not only bonkers but financially disgraceful, and deeply damaging to the people and the patients the National Health Service was set up to protect?

[Baroness Blackwood of North Oxford]

I certainly agree that charging those who come from other countries and use the National Health Service is perfectly sensible and appropriate, and by no means racist. I also believe that, as the call for action on bullying says, it should be perfectly straightforward to get out messages on safety from senior leaders and staff voices. It should be a positive message about how it is a natural extension of the social contract between the NHS and those who use it.

[Baroness Masham of Ilton (CB)]

My Lords, if a member of staff is being bullied by their senior, who should they go to for help?

[Baroness Blackwood of North Oxford]

The noble Baroness asks an important question. There are structures built into the NHS to enable those people to speak up. There is a “freedom to speak up” champion and a system of champions, so that it is perfectly clear to those experiencing bullying by senior managers who they can speak to.

[Lord Hunt of Kings Heath (Lab)]

Does what the Minister suggests apply to the actions of Ministers? She will recall, from when he was Secretary of State, Mr Jeremy Hunt’s practice of insisting on a weekly Monday morning meeting with the key national regulators, at which the sacking of chief executive officers was often discussed. Bullying starts at the top. If Ministers take a bullying attitude towards the NHS, they can hardly be surprised if that behaviour is followed at local level.

[Baroness Blackwood of North Oxford]

I am afraid I do not recognise the characterisation set out by the noble Lord. One of the key characteristics set out by the former Secretary of State in his leadership was that the NHS should be open and not have a culture of blame, and that people should feel free to speak up, so that when mistakes are made they should be corrected.

[Baroness Hussein-Ece (LD)]

My Lords, the NHS is the biggest employer of people from black and minority ethnic backgrounds. They face bullying and harassment from within—from co-workers—but also from members of the public and patients. There is considerable anecdotal evidence that some patients refuse to be treated by a clinician or a nurse from a minority ethnic background. What is being done to protect these workers and ensure that the NHS has a much more inclusive environment and culture?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. Bullying faced by those in the BAME community is more significant, and data supports that. That is why the NHS is implementing the workforce race equality standard, which is a requirement for NHS commissioners and healthcare providers—including independent organisations with an NHS contract —to track and ensure that employees from BAME backgrounds have equal access to career opportunities and receive fair treatment in the workplace, and to ensure that this is properly recorded and published. This will drive through the improvements she seeks.

Academic Health Science Centres

Baroness Blackwood of North Oxford Excerpts

Tuesday 2nd July 2019 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank the noble Lord, Lord Butler, for raising this question on AHSCs. I pay tribute to his work as the former chair and now non-executive director at the King’s Health Partners AHSC and to his speech setting out some of the achievements that have been delivered. This has been a supremely expert debate, so I feel somewhat cautious in summing up. I thank noble Lords who have spoken this afternoon about their work in AHSCs, notably the noble Lords, Lord Kakkar, Lord Patel and Lord Darzi, and my noble friends Lord Prior and Lord O’Shaughnessy, who have been so instrumental in developing the system to where it is today. This is a timely debate because, as many noble Lords said, we are developing policy options for AHSCs going beyond the current designation. As noble Lords know, it is due to end in December this year. I acknowledge that this is a tense time for AHSCs, which will now be thinking about planning their future strategy. I am grateful to the noble Lord, Lord Willis, for making the point that this is a cross-party issue and that there is wide agreement across the Chamber about the importance of AHSCs. I will say at the front that there is also consensus about the need to go forward to designation; the question is how we do that.

First, in response to some of the wider points that were made in the debate, I say that the Government recognise the critical role that health research plays not only in fuelling the life sciences sector, which is one of the most productive within our economy, but in driving up the quality of diagnosis, treatment and care in the NHS. We are committed to creating the best environment for clinical research and to achieving the ambition set out not only in the life sciences strategy but in the sector deals. This is the only sector to have two sector deals, and that is because of the quality of the sector and the relationship between research, industry and the NHS, which has developed into an outstanding ecosystem in the past few years. We have to pay tribute to the role that the NHS long-term plan will play in that, due in no small part to the leadership role of my noble friend Lord Prior.

This country is a world leader in health research, with a world-class science base and three of the top 10 globally ranked universities. As my noble friend Lord Prior said, we have an extraordinary life sciences sector, and we must be as ambitious as we possibly can be in driving it forward. We are investing more than £1 billion per year through the NIHR to fund research, skills and facilities to enable high-quality research. I can answer the noble Baroness, Lady Donaghy: about £100 million of that was invested in a range of training programmes, and we have also created the NIHR training academy so that we can think about how we link that to international training.

We must ensure that we protect the valuable collaborations that we have because that ensures that we have the highest quality clinical research in the world. The commitment to increase our R&D investment from 1.7%, which has quite frankly not been good enough, to 2.4% and beyond that to 3% was hard won from the Treasury. I know that because I was one of the first to campaign on this as chair of the Science and Technology Select Committee some time ago. I will be one of the first to join noble Lords across the Committee in campaigning to drive further and faster, as we must not only have this commitment from our leadership candidates—and I am sure that others will join us in that—but keep driving forward blue-sky investment and further investment through the people, programmes, centres of excellence and the NIHR. That is how we will have an integrated health and research system which is one of the best in the world, designed to transform scientific breakthroughs into life-saving treatments.

The noble Baroness, Lady Donaghy, is right that we should be proud of what we have already achieved. Between them, the existing AHSCs cover health research and education in a wide range of clinical disciplines including mental and physical healthcare, cancer, cardiovascular and inflammatory diseases. It would not be right it we did not pay tribute to some of that today. Noble Lords have already done that. While we do not fund the AHSCs specifically, of the 20 NIHR biomedical research centres, 12 are at the heart of these six AHSCs, representing more than £700 million of NIHR investment over five years from April 2017. This significant NIHR-funded research infrastructure is key to enabling its engines for world-class excellence in early translational biomedical research.

The existing AHSCs were designated based on recommendations made by an independent panel, which we heard about from the noble Lord, Lord Darzi. On the regional spread, I am afraid that the noble Baroness, Lady Masham, will be disappointed that they can be designated only in England, not in Scotland, but it is open to the new designating committee to consider the regional spread as that goes forward.

Over the past 10 years, the six AHSCs have facilitated the strategic alignment of some of our leading NHS providers and their university partners in world-class research and health education, leading to improvements in patient care and playing an important role in driving economic growth through partnerships with industry, including life sciences companies, which is one of our key priorities. It is through this strategic alignment that these partners have secured funding. An example is the £10 million funding from UKRI for a new centre for medical imaging and AI at King’s Health Partners as part of the industrial strategy challenge fund. The noble Lord, Lord Kakkar, spoke about the success of UCL Partners, which has, among many things, been leading on the adoption of a learning health system to standardise data entry. This has allowed seven CCGs to trial and support interventions into early detection of atrial fibrillation, which is a key priority of the long-term plan, and for primary care networks. Specific examples are the ways that we are going to change healthcare for individuals. Imperial AHSC has supported North West London STP’s integrated care record to bring together the health and social care information of 2.3 million patients in the sector, enabling the identification of patient cohorts and the evaluation of service developments.

London’s three AHSCs are collaborating through the MedCity initiative to grow the life sciences cluster of London and the greater south-east, working with the Oxford and Cambridge AHSCs. In Manchester—not in the south-east—the AHSC is working with the AHSN to align research and education into the health and social care priorities of the Greater Manchester population. A single blood test-driven decision aid for patients presenting with chest pain at the emergency department is being rolled out. Since June 2016, more than 7,000 patients have been treated using this tool and the diagnosis of acute myocardial infarction was ruled out in more than 99% of cases, with patients returning home within hours of their arrival in the emergency department. This is evidence of how the AHSCs have changed clinical practice on the ground. Additional data published today by the NHIR clinical research network shows that NHS trusts which are part of the six AHSCs have undertaken more than 3,600 clinical studies and recruited 148,495 participants in 2018-19.We know that other academic health science partnerships have formed, further strengthening the health research and health education interface in London but, as my noble friend Lord O’Shaughnessy said, we must ensure that the deep research base that we have in this country is matched by a health system that embraces innovation and translates research funding into improved patient care, so that innovators can develop, test and deliver those products that patients and clinicians need and so that examples such as those I have just given can be adopted.

We know that in the past the system has been too fragmented, too complex for innovators to navigate and too slow to adopt promising technologies. That is why last summer, at my noble friend’s instigation, the department undertook an innovation landscape review, which identified the need for a system which was more joined up between healthcare partners, and for improved support for late-stage evidence and a better strategic alignment of priorities, such as how we support emerging technologies, including AI, drug discovery, mentioned by the noble Lord, Lord Kakkar, and precision medicine.

As my noble friend Lord Prior pointed out, it is also important to recognise the role of collaboration between NHS, industry and academia. During the landscape review, we found huge appetite for change and more ambition within the healthcare stakeholders who need to implement it. That is why the sector deals, the NHS long-term plan and the tech vision have all begun the process of transforming a significant part of strategy within government policy. Through the establishment of the accelerated access review and NHSX, as has been mentioned, we have started to build the necessary infrastructure effectively to support health innovation in this country. Under the expert leadership of the noble Lord, Lord Darzi, the AAC brings together senior leaders from the key government, NHS and industry partners with patient and clinician representatives to promote innovation within the NHS. Already, the AAC has made significant progress in supporting uptake.

We must agree that AHSCs and other structures must work hand in hand with AHSMs and wider innovation infrastructure to ensure that this is wired into the ARCs and will be in AHSCs. This is why I have asked the AAC to consider AHSCs, to ensure that the whole system is joined up, because that is what it is leading on. It is important that we give the AAC and the noble Lord the opportunity to build a cohesive health, research and innovation ecosystem that meets the challenges that we have set and the ambitions that we need our life sciences sector to deliver. That is why I have asked the AAC to consider AHSCs’ role within the health system as part of the boost agreement. That will ensure that the future designation of AHSCs complements the innovation support landscape, rather than adding further complexity. The AHSCs will therefore support the AAC in achieving its new objectives, including commitments to establish globally leading testing infrastructure, improving the system’s capacity to adopt innovation.

We plan to extend the existing DHSC AHSC designation until March 2020 to enable that new designation process to be held. We will announce the timescales soon. I appreciate that is not necessarily the answer that noble Lords want, but I hope that the strategic vision, the need for ambition and the purpose, which is to deliver innovation for patients which changes their quality of care and the ambition of our life sciences ecosystem is understood as the reason for that change.

GP Services in Rural Areas

Baroness Blackwood of North Oxford Excerpts

Tuesday 2nd July 2019 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

I beg leave to ask the Question standing in my name on the Order Paper and in doing so refer to my interests declared in the register.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, primary and community care will receive at least £4.5 billion more a year by 2023-24. Incentives have been in place since 2016 to attract GP training to hard-to-recruit areas, including rural areas. NHS England is consulting on allowing digital-first practices to be set up in under-doctored areas and everyone will have the right to digital-first primary care by April 2021, which will provide another way for patients in rural areas to access services.

[Baroness McIntosh of Pickering]

I thank my noble friend for that Answer. She might be aware of last week’s Telegraph report, which shows that almost 2,000 villages are at least three miles from their nearest GP practice. That figure would be higher were it not for the fact that rural practices can dispense medicine where community pharmacies are inviable. Will my noble friend take this opportunity to commit today to specific support for rural general practices over and above what is already in the NHS long-term plan, which has a particularly urban-centric focus? I remind my noble friend that we in rural areas are struggling to get 4G, let alone access to digital medicine.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I know that my noble friend, who comes from a family of GPs, has personal experience of this. She raises an important point. We are encouraged that, in the last year, 300 more doctors, 300 more nurses and 700 more staff with direct patient care responsibilities working in general practice have been recruited. HEE has recruited record numbers of doctors into GP training, but we recognise the challenge of recruiting in hard-to-reach areas. That is why we have put in place the targeted enhanced recruitment scheme and we are identifying ways to improve this, such as the under-doctored digital-first practice. We recognise that we need to do more, however, and I would be very happy to meet my noble friend to discuss ways in which we can do that.

[Lord Clark of Windermere (Lab)]

My Lords, the noble Baroness is aware that Cumbria is one of the blackspots for recruitment of GPs, with, in many cases, surgeries completely dependent on the odd locum and the good will of the general nursing practitioners. Bearing in mind that there are 19 million visitors a year to the Lake District and the national park, as well as the resident population, this is not a satisfactory situation. Is she prepared to look into the particular problems of GPs in Cumbria?

[Baroness Blackwood of North Oxford]

I am definitely happy to look into the situation in Cumbria, but this is one reason we have increased the funding specifically to primary and community care above the rate of the general increase to the NHS. It is also why we are bringing in incentives for GPs to work together at scale through the primary care networks and why there will be seven new service specifications for this. They will include enhanced healthcare in care homes, personalised care and supporting early care diagnosis, but also local action to tackle inequalities. This will be one of the specific areas for ICSs, which will lead the way we improve social care, as my noble friend Lord Young pointed out in his earlier answer.

[Baroness Meacher (CB)]

My Lords, does the Minister expect there to be at least one doctor in each digital-first centre? If not, how do the Government expect patients to be examined when they need an examination? I do not think a machine will be able to do that.

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. The digital-first proposals have been launched as a consultation so that we can work out the funding and contract changes to ensure that we get digital-first primary care right. It can mean telephone as well as video consultations, but there would also have to be physical premises in the area to provide face-to-face consultations where necessary.

[The Lord Bishop of London]

My Lords, I speak as a co-chair of the All-Party Parliamentary Group on Rural Health and Social Care. Living now in a city, I know the challenge of rural health provision, but GP services are not just about doctors. They are also about nurses and community workers. Can the Minister comment on the possibility of developing direct access training for district nurses and health visitors?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

The right reverend Prelate is quite right. We need to expand the wider workforce to support GPs. One reason this has been such a challenge is the shortage of the wider workforce. That is why there was a commitment in the people plan to recruit 20,000 extra staff—such as physiotherapists, pharmacists and nurses—for GP practices, to ensure that we can provide the support staff for sustainable community services. There is an emphasis on moving towards more community care. That is why the funding has been provided, and why there is such an emphasis on that part of the service.

[Baroness Jolly (LD)]

My Lords, I live in a very rural part of Cornwall. My GP practice is 18 miles away. It struggles to recruit GPs and then to keep them. The proportion of the English population who live in rural areas is 19%—the equivalent of the population of London. Can the Minister explain why very few NHS plans consider rurality, with its high levels of deprivation and loneliness and their associated diseases? Might that be one reason why GPs choose not to work there, or why they do not stay for long?

[Baroness Blackwood of North Oxford]

The noble Baroness is very lucky to live in such a beautiful part of the country, but she is right that rurality has a significant impact on health outcomes. It is considered as part of a number of plans. As for recruitment and retention, these have been part of the plans that the NHS has brought in, particularly for GPs. That is why we have had the recruitment and retention plan for hard-to-reach areas for GPs since 2016. We are evaluating that programme and are still considering it.

[Baroness Byford (Con)]

May I press the Minister, following the earlier Question on housing, on the need for her department to talk to the MHCLG, to ensure that when new-build housing developments come in, there is enough tie-in between health provision and housing? My understanding is that unless the number of houses is more than a certain amount, there will not be any new GP practices, thereby putting much more pressure on existing ones.

[Baroness Blackwood of North Oxford]

My noble friend is right; infrastructure must be in place before there is an expansion of development. NHS England is accountable for ensuring that patients have access to a GP practice, although the commissioning of general practices is delegated to local CCGs. It is an important planning consideration, and must be taken into account when new developments occur.

Lung Health

Baroness Blackwood of North Oxford Excerpts

Monday 1st July 2019 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what steps they will take to implement the recommendations of the Taskforce for Lung Health’s five year plan for improving lung health in England.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the NHS has worked closely with the Taskforce for Lung Health and the British Lung Foundation to develop a national programme for respiratory and cardiovascular disease. This will improve lung health by piloting a lung health check programme, expanding quality-assured spirometry, undertaking pharmacy medicine reviews in primary care networks and improving self-management support. In addition, access to smoking cessation interventions will be increased and a national workforce group will be established. Finally, the Government have committed to improving choice and ending variation in end-of-life care services.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister for that response. She will be aware that lung disease is often underestimated as a problem; one in five of us is likely to be affected in our lifetime and priority has not really been given to it over the past few decades. Given that outcomes have hardly improved either, will she look again at the response and commit the Government to implementing the task force report in full?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for that question. He is absolutely right that respiratory illness can be extremely serious. The UK has a higher rate of respiratory deaths than any other country in the OECD; this is a clinical priority for the NHS and the Government are committed to driving it forward. We are working with the British Lung Foundation and the NHS to deliver the co-designed lung foundation’s plan and I am happy to give him that commitment now.

[The Earl of Listowel (CB)]

My Lords, the report highlights the need for prevention, including among children and young people. Will the Government look at the funding of health visitors, who can speak to mothers about smoking, and recognise that a quarter of health visitor numbers have been cut because of their dependence on local authority funding? Will they also look at school funding to ensure that all schools can make the maximum effort to protect schoolchildren from air pollution?

[Baroness Blackwood of North Oxford]

The noble Earl is absolutely right. Prevention is a core part of the plan and as well as smoking, the clean air strategy and flu vaccinations, health visitors are a crucial part of it, and will be looked at as part of the forthcoming prevention Green Paper.

[Lord Borwick (Con)]

My Lords, I declare my interest as in the register. Does my noble friend agree that air quality is vital for lung health and will she comment on the distressing fact that lung diseases are strongly correlated with poverty, and that air quality is worst in poor areas?

[Baroness Blackwood of North Oxford]

My noble friend is right that poor air quality is one of the largest environmental risks to public health in the UK. That is exactly why we brought forward the air quality strategy, which has been identified by the WHO as an example for the rest of the world to follow. But he is right that it will not work if we do not also tackle variation across the country. That is exactly what we intend to do and why we will also look at air pollution as part of the Green Paper, which is due imminently.

[Lord Rennard (LD)]

My Lords, 6.1 million people in this country still smoke. The NHS long-term plan is good at encouraging further measures to reduce the prevalence of smoking. At the same time, 50% of local authorities have had to reduce funding for smoking-cessation services, even though smokers trying to quit are four times more likely to succeed if they can benefit from such services. Is it not essential to reverse cuts in funding to Public Health England and spend money cost effectively on further advertising campaigns to reduce the prevalence of smoking among adults in this country?

[Baroness Blackwood of North Oxford]

The noble Lord is right to praise the success that we have had in smoking cessation in this country. We now have the lowest rates of smoking that we have ever had, some of which is because of the work of local authorities and PHE. He is right to identify the need to target the variation and inequalities. We are targeting this through the prevention Green Paper and we identify the need for a sustainable funding settlement through the spending review allocation.

[Baroness Thornton (Lab)]

A study of over 38,000 people with chronic obstructive pulmonary disease found that opportunities to diagnose were missed in 85% of patients in the five years before their diagnosis. My mother was probably included in that number. Will the Minister commit to introduce target case findings in general practice for people who have symptoms suggestive of COPD with follow-up care and services? How do the Government intend to eliminate the postcode lottery that exists in the quality of and access to COPD treatment?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: COPD is the second most common lung disease in the UK. It is disturbing that around a third of people, in their first hospital admission for COPD, had not been previously diagnosed. NHS RightCare is developing a COPD pathway, which is being rolled out nationally through clinical commissioning groups, to identify the core components of an optimal service for people with COPD to ensure earlier diagnosis and better management, so that they do not experience the concerns that she has identified.

[The Lord Bishop of Carlisle]

My Lords, further to the Minister’s helpful comments about air quality, can she tell us to what extent Her Majesty’s Government are monitoring the existence of microparticles of plastic in the air, especially in our cities, and the impact they are having on lung health?

[Baroness Blackwood of North Oxford]

The right reverend Prelate raises an extremely important point on air health. While we have long-term commitments in the clean air strategy, and the other measures that have been put forward in the Green Paper and net-zero commitments, NICE has published guidance on the effect of air pollution on people with chronic respiratory and cardiovascular conditions. We also have the Committee on the Medical Effects of Air Pollutants, which advises the Government on many matters, including those the right reverend Prelate raised.

[Lord Kakkar (CB)]

My Lords, I remind noble Lords of my registered interests. Are Her Majesty’s Government satisfied that the research strategy between UKRI and the National Institute for Health Research is sufficiently well co-ordinated to ensure discovery, as well as early evaluation and adoption, of novel therapies that could manage chronic lung disease more effectively?

[Baroness Blackwood of North Oxford]

The noble Lord has raised a crucial point, which is not a surprise given his expertise in this area. We have been working with him and others to ensure that the most innovative medicines are getting to patients as quickly as possible. We announced the Accelerated Access Collaborative to identify those innovative medicines and ensure that we speed up the rate of ideation to uptake in the NHS, particularly for illnesses such as asthma. For example, smart inhalers and integrated connected devices could dramatically improve the management of that condition.

NHS Long-term Plan

Baroness Blackwood of North Oxford Excerpts

Monday 1st July 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, with permission, I will now read a Statement made by my right honourable friend the Secretary of State for Health and Social Care in the other place on the implementation of the NHS long-term plan. The Statement is as follows:

“Mr Speaker, I would like to update the House on the implementation of the NHS long-term plan and the delivery of improvements to the health service. Today marks the 100th anniversary of the Ministry of Health under the Liberal and Conservative coalition of Lloyd George. I can tell the House that on Thursday, the boards of NHS England and NHS Improvement agreed the long-term plan implementation framework.

Alongside the clinical review of standards, and the interim workforce plan, published last month, this framework is a critical step in delivering on our 10-year vision for the NHS and in transforming our health service with the record funding the Government are putting in. The document sets out the framework in which each of the 300 commitments in the long-term plan will be delivered, the 20 headline commitments and how we will monitor delivery of the plan. In the past, there have been criticisms that NHS plans have not led to full delivery, and we are determined to ensure that the LTP fulfils its potential to transform the health service. I am placing a copy of the implementation framework in the House Libraries.

I would like to draw attention to three areas, the first of which is cancer care. I would like to thank my honourable friend the Member for Basildon for his efforts in ensuring our focus on the vital indicator of cancer survival. The Prime Minister set out the ambition that three-quarters of all stageable cancers are detected at stage one or two by 2028. Early detection and diagnosis are essential to enhancing people’s chance of survival. Since 2010, rates of cancer survival have increased year on year. However, historically our survival rates have lagged behind the best-performing countries in Europe.

The implementation framework sets out our goal of measuring the one-year cancer survival rates as one of the core metrics. The one-year survival rate is how we measure our progress in achieving the ambitions set out in the NHS Long Term Plan. To realise these ambitions and ensure that we do everything we can to give people diagnosed with cancer the best chance of survival, these are the steps that the framework sets out: first, a radical overhaul of screening programmes; secondly, new state-of-the-art technology to make diagnosis faster and more accurate; thirdly, more investment in research and innovation.

From this year, we will start the rollout of new rapid diagnostic centres across the country, building on the success of a pilot scheme with Cancer Research UK, so that we can catch cancer much earlier. NHS England is further extending lung health checks, targeting areas with the lowest survival rates. Health Education England is increasing the cancer workforce, which will lead to 400 more clinical endoscopists and 300 more reporting radiographers by 2021. Because of these steps, our ambition is that 55,000 more people will survive cancer for five years, each year, from 2028. Improving the one-year survival rate is how we ensure that the NHS remains at the forefront of cancer diagnosis and treatment and continues to deliver world-class care.

The next area is mental health. The Prime Minister and her predecessor have rightly prioritised the treatment of mental health so that we can ensure that it finally gets parity with physical health. The £33.9 billion cash-terms settlement—the longest and largest cash settlement in the history of the NHS—includes a record £2.3 billion extra for the expansion of mental health services. The framework sets out how 380,000 more adults and 345,000 more children and young people will get access to mental health support. We are also introducing four-week waiting-time targets for children and young people, and testing four-week community mental health targets for adults.

The implementation framework specifically references the vital improvements to community mental health services that we all know are needed. These are adults living with serious mental disorders, including eating disorders, and those coping with substance misuse. The framework sets out how we will create a new workforce of mental health support teams to work with schools and colleges to help identify young people who need help and reach them faster. In all, it is a fundamental shift in how we treat mental illness and how the NHS will prioritise mental health services.

The third area I want to draw out is people. Three-quarters of the NHS budget goes on staff because people are the most valuable resource that we have in the NHS. We need not only the right numbers but to ensure that we have the right support for our staff. The long-term plan sets out our ambition to recruit, train and retain the right numbers of staff over the next decade. Last month, Baroness Dido Harding published her interim people plan, setting out how we will build the workforce we need and create the right culture so that doctors, nurses and other NHS staff have the time to care for patients and for themselves.

Last week, the BMA accepted, in a referendum, the new agreement with junior doctors that will improve both pay and working conditions. Thanks to the hard work of my predecessor, we are already taking steps to increase the number of clinical training places by opening five new medical schools and increasing the number of routes into nursing through apprenticeships and nursing associates. Last year, more than 5,000 nursing associates started training through apprenticeships, and this year the figure will be up to 7,500.

Those are just three of the most vital areas from a 10-year vision for the NHS. Across England, based on the implementation framework, local strategic plans are now being developed and will be brought together as part of a national implementation plan by the end of the year. All of this will be underpinned by technology.

Today sees the official opening of NHSX, the new part of the NHS which will drive digital transformation to give citizens and clinicians the technology that they need. I am delighted that NHSX has received such a warm welcome across the NHS, because it has so much potential to transform every part of health and social care for patients and for staff.

The forthcoming government spending review will settle the budgets for health education, public health and NHS capital investment, and these settlements will feed into the final implementation of this plan. As part of the SR, we will also review the current functioning and structure of the better care fund, which is rising in line with NHS revenue growth.

On this the 100th anniversary of the foundation of the Ministry of Health, this framework sets out how we will go about securing the foundations of the National Health Service into the next century and the creation of an NHS that delivers world-class care for generations to come. I commend this Statement to the House”.

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[Baroness Jolly (LD)]

My Lords, I too thank the Minister for reading the Statement. I feel I should get out an orange flag—I am probably wearing the right colour—because, in the 1940s, Liberals were orange, not a yellowish colour. Beveridge, whose paper proposed the National Health Service, was indeed a Liberal and his proposal was for a service,

“free at the point of need”.

Anyway, I will get back to the Statement. I welcome the Secretary of State’s commitment to cancer and mental health services and workforce growth—who would not? But the Statement does not refer to the local five-year strategic plans to be completed by mid-November and rolled out thereafter. These will involve local consultation and incorporate performance trajectories and milestones across health and social care; they are truly the plans to implement the Secretary of State’s plan. The Statement mentions funding but is quiet about how much. I guess that is quite understandable given the position of the Government, who do not know who the new leader will be let alone his priorities.

The NHS is crying out for more capital: diagnostic and treatment equipment these days is big and very expensive; those of us who have been into English hospitals recently will notice that the buildings are looking sadder than they did 10, 15 or 20 years ago; and workforce shortages are mentioned. Will the Minister tell us when we can expect the NHS to be fully staffed and appropriately equipped? There is no mention of widespread regional variation in outcomes: by when will these be no more? Can the Minister explain how the areas for concentration will be managed? Will management be top-down or bottom-up, reflecting local needs?

Will the Minister also tell the House about any conversations regarding more funding for adult social care? I shall not say any more about the Green Paper. Public health services are critical to help people deal with obesity, stop smoking and become fit, so living longer, healthier lives. All these are critical matters for local authorities. The Statement barely mentions social care but, without an injection of staff and funding, it will fall, and with it the Secretary of State’s laudable visions for cancer treatment and mental health.

[Baroness Blackwood of North Oxford]

I thank the noble Baronesses for their contributions. I think the most helpful thing would be for me to talk a little about the next steps in the development of the local plans, which answer a lot of the points that have been raised.

A significant engagement exercise went into the development of the implementation framework as it stands. It identified a real desire to deliver on the total breadth of the long-term plan rather than to pick and choose, a request for systems to take into account local needs and the different starting points in order to deal with variability, and a request for help on sequencing: what they should prioritise and where they should start from.

The framework seeks to address these issues and asks the systems to develop the five-year plans, which they will implement over this period. It also sets out the approach to STPs and ICSs, which are asked to develop their strategic plans by November, covering the period from now until 2023. By the end of the year they will be aggregated as part of the national implementation plan. As has been noted, that will take into account the Government’s spending review decisions on workforce education training. Social care will be part of it, and it will also play into the upcoming publication of the prevention Green Paper and the social care Green Paper. Relevant decisions will also need to be made about public health and capital investment, as set out in the Statement.

There are key points that need to be taken into account. The NHS has been asked to ensure that these are clinically-led plans and that they are locally owned, so that communities can have meaningful input; that there is realistic workforce planning—the people plan will be part of that process; and that the plans are financially balanced, because that is the only way we can ensure genuine delivery of the long-term plan and that the concerns raised by both noble Baronesses are taken into account.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest as a past president of the BMA. It will take some years for the new workforce plan to come through. Given that the current NHS medical workforce crisis involves consultant and GP staff having to drop clinical sessions to avoid huge tax bills, what consideration is being given to abandoning the concept of annual allowance in relation to defined benefit pension schemes, and allowing tax relief to be limited by the lifetime allowance? The current situation means that people are dropping sessions. Combined with the GMC regulations around retirement and revalidation, this is forcing clinicians into permanent retirement, rather than coming back to work additional sessions, which would relieve the pressure on waiting lists in clinics, would help with teaching and supervision, and would offer experienced surgical hands in operating theatres to assist in complex operations.

[Baroness Blackwood of North Oxford]

The noble Baroness, as ever, asks a very perspicacious question. She will know that as part of the GP contract negotiations, pensions and other issues were raised, and are still under discussion. Similarly, issues around secondary care doctors are in discussions with the Treasury. These discussions are quite technical but the issues are under consideration. I am unable to give her a complete answer now, only to tell her that we are very alive to the issue and trying to find a way through.

[Lord Clark of Windermere (Lab)]

We are very keen that the Government’s attempt to have a proper plan should work. The Minister knows that the staff are working under shortages of numbers and terrible shortages of finance. The Government go on and on about promised increased finance. According to the Health Foundation, funding for the wider health budget, which includes public health, will in real terms be £1 billion less in the next financial year. Are they right?

[Baroness Blackwood of North Oxford]

It is very important to pay tribute to the extraordinary work that NHS staff are doing across the system and in the wider healthcare system—we should thank them for that. The noble Lord is right that there is great financial stress in the system. A lot of work has gone into trying to alleviate it. That is why the NHS is one of the few parts of the public health system which received a significant increase in the £22 billion increase.

As for the public health system, training and the capital and social care investment, this will be part of the SR negotiations. I am sure the noble Lord will be aware that the Department of Health and Social Care will be making a strong case for increasing those parts of the system, because we believe it needs to increase just as much as he does.

[Baroness Neville-Rolfe (Con)]

My Lords, I have two questions for my noble friend. First, I very much welcome the inclusion in the plan of a section on improving productivity. My experience is that the best way to improve productivity is the intelligent application of additional capital, and not just, to quote from page 29, “its better use”. Picking up on some of the comments already made, may I ask the Minister how the NHS will make a step change in providing or attracting, and using, capital within the system?

Secondly, a huge medium-term threat is antibiotic resistance, which gets the briefest mention on page 15. Is there a plan to nail this as part of the approach to improving the NHS?

[Baroness Blackwood of North Oxford]

I thank my noble friend for a very important question. We have just published our new plan to tackle antibiotic resistance; it is an incredibly sophisticated proposal. We have already had some success in bringing down antibiotic use in humans and animals, but there is still a significant way to go, as antibiotic-resistant infections within the system are still rising. That is why we cannot relent in our ambitions, and why it is so important that the commitment to implement that strategy is in the long-term plan and the implementation plan. Although it has a brief mention, there is a whole strategy that it refers to, and it is comprehensive, so I am optimistic about that part.

On intelligent application of capital and ensuring that it increases productivity, my noble friend is right. That is partly why there is such a focus on ensuring that there is a radical reshaping of how the NHS delivers health and care using technology: so that services and users can benefit from the advances, and so that we can have a democratisation of information, which will be one of the key ways that we will manage demand and ensure that the NHS is sustainable.

[The Lord Bishop of Carlisle]

My Lords, as a former member of the Long-Term Sustainability of the NHS Committee, I welcome the long-term plan and the Government’s response to it. I am especially glad that mental health issues will achieve financial parity with physical health issues. Does the Minister agree that research into and attention to the causes of these ever-increasing issues is as important as more spending on their treatment?

[Baroness Blackwood of North Oxford]

As ever, the right reverend Prelate is insightful in his question. He is right that although we have made a lot of progress in improving services, we were coming from a low base. One of the challenges is not understanding why there is such an increase in the challenges we face. This is why the NIHR has dramatically increased the amount of funding it provides to mental health research, and why other important organisations, such as the Wellcome Trust, are prioritising mental health research as a matter of urgency.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, does the Minister recognise that while welcoming the emphasis on mental health—as the right reverend Prelate did—the Women’s Mental Health Taskforce, which reported in December 2018, recognised that more women are becoming the real issue in mental health work, that many more women are presenting, and that many of them, particularly those who have suffered abuse and trauma, require a gendered approached? The Women’s Mental Health Taskforce recognised this as an issue for the workforce and the way women engaged with treatment, particularly that group of women. I recognise that not everything can be reflected in plans, but it would be a tragedy if that message was not communicated to localities and to those providing mental health services. Unless that happens, many women will simply be let down.

[Baroness Blackwood of North Oxford]

The noble Baroness has communicated an important message and it is one reason why we have prioritised perinatal mental healthcare. Specifically, services for young girls, who are particularly at risk of self-harm and suicide, recognise this risk. I would be interested to see the findings of the task force she mentions to ensure that those concerns are communicated.

[Baroness Masham of Ilton (CB)]

My Lords, the Statement puts importance on technology. Will the Government speed up NICE in its assessments of technology? I hear that it is taking too long.

[Baroness Blackwood of North Oxford]

The noble Baroness, Lady Masham, is right to raise the importance of this. If we want to get innovative technologies and treatments to patients as soon as possible, we must ensure that we are one of the fastest in the world at regulating and assessing those technologies. However, it is also a matter of uptake. We have dramatically improved that process but we can and must always strive to do better. This is part of my job and I will make sure that I keep working harder at it.

[Lord Ribeiro (Con)]

My Lords, I welcome the development of the five new medical schools that are going onstream. Two weeks ago, I was fortunate to be at Chelmsford when the Duke of Kent opened the Anglia Ruskin University medical school. But it is quite clear that a lot of medical graduates are leaving the profession, for whatever reason. There is also good evidence that those who come in at graduate entry last the distance a lot better than those who perhaps come in much younger. Your Lordships may ask, “Where is the evidence for that?” What efforts are being made to look into why people are giving up medicine early, and what is the possibility of increasing the number of graduate entries?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. The core of the work my noble friend Lady Harding is doing is to analyse recruitment and retention patterns in the health service, obviously not just among core clinicians but across the whole system, to identify best practice for improving the workplace environment to recruit and retain. I am not sure whether she has done specific work on the difference between direct entry and graduate entry but I will be happy to find out for my noble friend.

[Lord Judd (Lab)]

My Lords, with longevity still at record levels, is the Minister satisfied that in the plan for the future new doctors coming into the service get sufficient support in their training on dealing with the dying and their families, or is it often just left to them to pick it up in their professional work? The same sorts of issues arise in mental health. If you are treating mental health, of course there is often a great deal of stress within families. How far do these plans take into account family support, at the same time as the treatment of those with mental illness?

[Baroness Blackwood of North Oxford]

The noble Lord raises two hugely significant issues, which probably deserve a full debate. On clinicians and NHS systems being prepared to respond most effectively to those facing terminal illness, and their families, we have improved but there is much more to do—not just for the health service but for us all as a society. We need to become more open and comfortable with discussing that; some work has been done but more is needed. On mental health services providing support for families as well as individuals, we are still some way from where we would like to be but it is recognised as something that needs to be done.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I want to ask my noble friend the Minister about GPs’ training in mental health. I think it has been acknowledged that when parents take their children to the GP, quite often that is for a physical ailment but it turns out that the child could have a mental problem. It is difficult for GPs to pick that up, perhaps partly because of a lack of training and partly because they have only 10 minutes to see the child.

[Baroness Blackwood of North Oxford]

My noble friend raises a hugely important issue. We are seeing an improvement in the quality of training for GPs; the RCGP has been playing an important role in this, especially in raising specialist areas such as perinatal mental healthcare through the champions that it spreads through its system. We are seeing the impact on the ground, with CCGs meeting the mental health investment standard and rolling out specific access waiting times, so it is having an impact. But there is always more to do and the royal colleges have a specific role to play in raising awareness and the quality of training.

[Lord Smith of Leigh (Lab)]

My Lords, I declare an interest as chairman of the Greater Manchester Health and Social Care Partnership. There is much to welcome in this White Paper’s implementation—after all, a lot of the ideas were taken from Greater Manchester in the first place so we are pleased about that. We are particularly pleased about population health being a major factor now within government. I want to raise again two of the main issues that noble Lords have already raised. First, in deciding on local needs, if we think about only health we are missing a lot. Many times when people present with health symptoms, other social and economic issues are causing them to present. It could be loneliness or unemployment, but all these things create ill health in people and we need to think of things in the round rather than just about health. Secondly, I have a local government background, as Members know, but I must emphasise that unless we get social care right the NHS will grind to a halt. There is a real crisis in social care at the moment; it needs more money and there is no flexibility. We cannot solve the issues in the NHS unless we resolve care as well.

[Baroness Blackwood of North Oxford]

I thank the noble Lord and he is absolutely right, which is exactly why one of the core priorities in the long-term plan is the creation of integrated care systems, so that there can be a holistic approach to health while recognising that a lot of ill health is driven by social determinants. If we do not address what are often perverse incentives within healthcare systems, we will not be able to address the problems that we all know have been experienced through multiple Governments and generations. In addition, in the prevention Green Paper we have already announced a desire to bring in much more social prescribing, making it much easier for general practitioners and others within the system to address some of those wider challenges that lead to ill health and transform the system. We have already seen some fantastic pioneers of social prescribing transform the healthcare in their area, such as those in Tower Hamlets, and we want to see that thriving across the country.

Social Care: Free Personal Care

Baroness Blackwood of North Oxford Excerpts

Wednesday 26th June 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the Institute for Public Policy Research’s report Social care: Free at the point of need—the case for free personal care in England, published on 23 May, and whether this matter will be addressed in the forthcoming Social Care Green Paper.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we welcome the contributions made by recent reports on how social care should be funded in future, including the report by the IPPR. The Green Paper will bring forward ideas for including an element of risk pooling to help protect people from high and unpredictable costs. This Government are committed to ensuring that everyone has access to the care and support they need, and we are clear that people should continue to expect to contribute to their care.

[Baroness Wheeler (Lab)]

I thank the Minister. Age UK estimates that more than 1 million older people have died in the past two years either waiting for a care package or having been turned down and that nearly 1.3 million people have an unmet need for basic care support, such as washing, dressing and going to the toilet. Macmillan research shows that 8% of people living with cancer who have critical or substantial needs and who should qualify for council support receive no practical help at all and that 60% of their carers experience stress, anxiety and depression. I hope that when she responds the Minister will not just repeat the Government’s stock answer on so-called extra funding. The King’s Fund, the Nuffield Trust and the Health Foundation have independently identified the huge scale of government local authority social care cuts and the £2.5 billion investment needed just to keep the current system going. May I once again ask the Minister for news of the Green Paper? When is it going to be published? What is holding it up? The IPPR shows that free personal care would treble the number of older people with access to state-funded care, improve their health and well-being and save billions of pounds in hospital costs. Surely it is one of the key options for solving the current care crisis.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for an important question. She is absolutely right that the Green Paper must be a priority. It will set out our sustainable plans for reform. We have welcomed the contributions that have been made by a number of recent reports. The noble Baroness rightly pointed to the IPPR, the Joint Select Committees, the Health Foundation, the King’s Fund and the Resolution Foundation. They have made some important proposals which are being considered as part of the Green Paper’s work going forward. The noble Baroness is right that we cannot wait for that, because there are people who need improvements in care now, and that is part of what the better care fund has been set up to do—to improve the spreading of best practice and the new models of care work which have been put front and centre for the long-term plan improvements. That was introduced in 2015, and has brought in the funds required, taking the total of increased funding to £7.7 billion by 2018-19. We are looking at how we can make sure that that improves. It has brought changes across the system.

[Baroness Campbell of Surbiton (CB)]

My Lords, research carried out by the Independent Living Strategy Group, which I chair, concluded very recently that charging for the support disabled people need to go about their daily lives is unfair and counterproductive and undermines the primary purpose of the Care Act. Will the Minister tell me whether the Government have considered implementing the recommendations of the Darzi report, which called for extending the NHS’s “need, not ability to pay” principle to social care, especially for younger disabled people who have no savings and who want to save, to get a life, to get a house, to go to university and so on?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for the important point she has raised. The Government have established an interministerial group for disability chaired by the Secretary of State for DWP on exactly this point to identify barriers for those with disabilities and to drive forward co-ordinated action across government to try to address this. We are identifying organisations required to provide quality and comprehensive services based on clinical need which do not discriminate between patients on the basis of disability. I will take away the points the noble Baroness has raised because they are hugely important.

[Baroness Manzoor (Con)]

My Lords, there are examples of good social care packages across the country, but these are patchy. Can the Minister say exactly how the Government are currently disseminating good practice so that the elderly and young people who need social care packages get them now rather than in the future?

[Baroness Blackwood of North Oxford]

I thank my noble friend for her question. We should pay tribute to those who work very hard in the social care system under very challenging circumstances. Swindon, for example, has brought in a co-designed service with users and an increase in reablement of 150%, bringing an annual saving of £1.9 million to the health and care economy, while also reducing DTOC. Services and improvements such as these should be spread across the system. That is exactly what the better care fund is designed to do, and it is what the new models of care commitment within the NHS long-term plan will spread across the system so that we can improve social care for all.

[Baroness Pitkeathley (Lab)]

My Lords—

--- Later in debate ---

[Baroness Brinton]

My Lords, the IPPR report also notes that, if health and social care were truly integrated, the NHS could save £1.2 billion a year, rising to £4.5 billion by 2030, by reducing the number of admissions to hospitals and delayed transfers, as well as placing a real focus on funding care in the community. Will the new Green Paper ensure that true integration is fully addressed and that it is not just a case of adding “Social Care” to the title of the department?

[Baroness Blackwood of North Oxford]

The noble Baroness, Lady Brinton, is absolutely right. Integrating social care funding is the key priority of the social care Green Paper. It is part of the work that we are prioritising through the better care fund, but it is also part of the ICS work.