Healthcare Services: Acute, Primary and Community

Baroness Brinton Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank my noble friend Lady Janke for calling for this important debate, and it is a pleasure to follow my noble friend Lady Leaman, who spoke movingly of services for children with ADHD. I support everything that the noble Baroness, Lady Lane-Fox, said earlier. The 10-year NHS Fit for the Future plan aspires to change the NHS to make it work better in the mid-21st century. Science, medicine, demography and lifestyles have changed so much since the NHS was founded that radical change must happen. But it must be patient-centred, not organisation-convenient.

My chronic illness means that I have more interaction with the NHS than the average patient, and recently that has escalated with new auto-immune problems, so I have seen at first hand what is happening in too many different hospitals in recent months. Good A&Es, including at my local Watford General Hospital, have in place not just an effective triage system but a 72-hour emergency admissions unit to which GPs can refer patients who do not need A&E but need very short-term hospital care—perhaps to get an infection under control. This latter system has worked well for a decade.

I have experienced two emergency eye clinics in the last three months. The first, in London, was a complete nightmare to navigate. The staff were wonderful, from the receptionist to the nurses and doctors, but the building was completely inadequate and hampered an effective service for people who may not be able to see where they are going. A&E was on the first floor, with a narrow waiting room with about 60 seats and at least another 20 people standing. It was barely wheelchair accessible, noisy and chaotic.

I contrast that with Addenbrooke’s Hospital’s emergency eye clinic in Cambridge, where I still saw at least three different professionals on each of my visits. It had four different smaller and quieter waiting areas, so a patient progressed through the system, being informed at each stage about the likely wait time. That was a calming and effective process.

The pressure on GP and community services with the move to reducing pressure on acute services has considerable unintended consequences. The time many GPs have with each patient can be as short as five minutes, so a GP who does not know the patient well just cannot read the longer history. I am at high risk of serious infection, but a locum GP told me that they did not just hand out antibiotics for minor infections. I was in A&E 24 hours later on an antibiotic drip. This is not about the locum; this is about the pressure that our GP services are under. This needs to be remedied.

The Government want to divert patients in surgeries to non-GPs, so, recently, my surgery system automatically got the pharmacist to call me to discuss my medication. I asked him how my hospital medication would interact with what he was proposing. He had not read my notes, either, and he realised that I must see a doctor instead of him. It was a waste of his time and a waste of mine.

Do not get me started on the barriers to accessing community physiotherapy if you have a chronic illness. Five years ago, my local physio community trust sacked all its specialist physios to save money. If you need help, you have to navigate two 20-minute automated triage assessments, but they only triage patients on one injury. When I finally got to talk to a human on the phone, I was then given interim exercises, which caused serious pain to my other joints. I cannot get past the gatekeepers to look at me as a whole person—and there is a national shortage of physios, without whom Fit for the Future will not work.

But there is excellence happening. Last October, my sister was diagnosed at William Harvey A&E in Ashford with terminal and untreatable cancer. The one thing she wanted was to be back in her own flat with her cat. Madeleine was put on the end-of-life discharge to assess pathway, run by the Kent Community Health Foundation Trust. My other sister and I were with her for those last two months, and we saw at first hand how an excellent and complex system can work well. They helped us with the expert end-of-life care at home company, the GP and nurses at her surgery, the Pilgrims Hospice and the community nursing team. We were told by the brilliant GP surgery nurse who visited often that, if we had to call 999, we should tell them her wishes from the start, on the phone, so that, when the paramedics arrived, it was all about getting her back into bed after a fall, not into hospital.

Managing all of this were exceptionally well-trained administrators, who understood their role and how to make things happen. She was able to be at home until the last 24 hours, but there was also a reduction in need for A&E space, acute bed space, and advice on tap when needed. This service should be universal, but it is not.

To conclude, as with many of the other wonderful parts of the NHS and care sector, there is real excellence, value for money and social care. The difficulty remains that it is not consistent. As long as acute, primary and community healthcare are not focused on the patient, services will be inconsistent and probably more expensive, to the detriment of patients in the community. A plan alone will not change things, but putting the patient journey truly at the heart of these changes can and does work.