Health and Social Care: Falls Prevention

Baroness Brinton Excerpts

Thursday 30th November 2017 Lords Chamber

[Lord O’Shaughnessy]

I will happily do so. Dance is very popular in my household, with “Strictly Come Dancing” on the television at the moment. Debbie McGee might not be quite over 65 but she is a great advert for older people dancing. I absolutely support what the noble Lord says. I have seen the evidence on the impact that was published as part of the APPG’s work on this; it is very convincing and we will certainly let health and well-being boards know that this is exactly the kind of thing—social prescribing, if you like—that they should be looking at to prevent falls.

[Baroness Brinton (LD)]

My Lords, the Royal College of Physicians estimates that between one-quarter and one-third of falls could be prevented through assessment and intervention. NHS Improvement ran 19 projects with volunteer trusts. There is not much evidence of those pilots working closely with local authorities, which is the nature of the Question of the noble Lord, Lord Jordan. What were the results of the pilots that started in January? One of the key findings of NHS Improvement was that two-thirds of trusts were still using outdated predictor equipment which NICE has recommended against. Can the noble Lord let me know, either now or later, whether he can confirm that those predictor instruments that NICE is now saying should not be used have been withdrawn, particularly from hospitals and general practice?

[Lord O’Shaughnessy]

I do not have the specific details that the noble Baroness has asked for; I will write to her. The figures are not good; there are still around a quarter of a million falls in hospitals and mental health trusts each year, which is equivalent to the emergency admissions, so it is still a significant problem. NHS Improvement is working with the poorest-performing trusts and is reporting that those interventions have seen improvements, but we clearly need to phase out some of the poor practice that exists in order to reach higher standards.

Nurses: Tuition Fees

Baroness Brinton Excerpts

Wednesday 29th November 2017 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right to point out that student debt is forgiven after 30 years. The point of that is to ensure there is an equitable system, where those who earn more pay back more over the course of their working lives. It is important to point out that, with the new threshold moving up to £25,000, a nurse earning £26,000 in band 5 of the Agenda for Change pay scale would pay back £7.50 of that loan per calendar month.

[Baroness Brinton (LD)]

My Lords, with the NHS reporting that 96% of hospitals are currently failing to meet their planned number of registered nurses, and UCAS reporting a decline in student nurse applications, as the noble Lord mentioned, as well as the further news that one in four post-qualifying nurses leave in their first year, what are the Government proposing to do to change the problem of recruiting new nurses, including returning to bursaries and abolishing tuition fees altogether? Specifically, what are the Government doing right now to attract nurses into our hospitals?

[Lord O'Shaughnessy]

It is important to point out that there are 10,000 more nurses on wards than there were seven years ago. One of the things that we are trying to do is encourage nurses to return to practice—3,000 of those nurses have been on the return to practice programme. In regard to attracting them to hospitals, the main thing is that we need to train more nurses to fill those places so that we fill the demand that we know that we have from a growing and ageing population. That is why there are going to be 5,000 more funded nursing training places from 2018 onwards.

Veterans: Mental Health

Baroness Brinton Excerpts

Tuesday 7th November 2017 Lords Chamber

[Lord O'Shaughnessy]

On the first point, there have been reviews at European level to improve the packaging and the patient information leaflets about any risk that might attend taking this drug or indeed any others. Status as a veteran is now recorded in the NHS and goes into the patient record.

[Baroness Brinton (LD)]

My Lords, the mefloquine help page for veterans and current serving officers is very good at explaining the signposting, but there is no mention in Meeting the Healthcare Needs of Veterans, which has not been updated since 2011. Only 2,000 GPs out of more than 50,000 have attended the day training course on working with veterans. Can the Minister ensure that at least one GP from every surgery has training, so that he or she can advise other GPs when they are helping to serve our veterans once they are back in the civilian workforce?

[Lord O'Shaughnessy]

The noble Baroness makes a good point. As I mentioned, that training is now in the curriculum, but of course that deals with the flow of new GPs as opposed to the stock of existing GPs. I shall certainly look at that and see what more can be done to make sure that GPs have up-to-date training.

Care Homes: Hospital Discharges

Baroness Brinton Excerpts

Monday 16th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The point about integration is critical. The CQC’s report from last week, which we were discussing, is all about collaboration and integration. Someone in their 80s who is experiencing care does not distinguish between different bits of it as we do bureaucratically. They want to know that there is seamless care. That is what the sustainability and transformation process is attempting to do.

[Baroness Brinton (LD)]

My Lords, I am grateful for the right reverend Prelate’s comment about the National Audit Office’s report from February, which makes it clear that 43% of the multidisciplinary team meetings in acute hospitals began immediately, which is to be encouraged, but only 20% of local authorities were invited to those early meetings. What are the Government doing to ensure that the advice from NHS Improvement about getting that earliest intervention will actually happen?

[Lord O'Shaughnessy]

The noble Baroness raises an excellent point. She may know that the better care fund—the route by which the additional money goes into social care—reviews and holds accountable local authorities and the NHS for interacting with one another to deal with delayed transfers of care. There is something called the high-impact change model, which is designed precisely to bring people together to ensure that the number of delayed transfers in care are reduced. That is compulsory as part of the funding provided.

Health and Social Care

Baroness Brinton Excerpts

Thursday 12th October 2017 Lords Chamber

[Lord O'Shaughnessy]

I join the noble Baroness in paying tribute to voluntary sector providers and volunteers, whether family members or others, who support care throughout the NHS and social care. There need to be more paid staff to meet the needs of our growing and ageing population, which is why the Secretary of State announced a 25% increase in the number of training places and more nursing associates. That is being put in place to make sure that the system, which is described in the report as stretched, has the capacity it needs to meet patients’ needs.

[Baroness Brinton (LD)]

My Lords—

[Lord Davies of Stamford (Lab)]

I shall give the Minister another chance. He did not even begin to answer the question from my noble friend Lord Hunt. Why did the Government drop Dilnot?

--- Later in debate ---

[Baroness Brinton]

My Lords, the CQC report has shown that over the past two years there has been a reduction in beds in nursing and care homes, while the Lancet published the results of a research project in the summer showing that we will need an extra 9,000 beds per annum by 2025—that is more than 70,000 beds. What are the Government proposing to do to make it easier for more homes to be set up and run and to fund the beds we clearly need urgently, not just in 2025 but from now on?

[Lord O'Shaughnessy]

The noble Baroness will know that there has been a small reduction in the total number of residential nursing home beds, although it is a fairly flat picture over a long period of time. We have also seen an increase in the amount of domiciliary care. One of the things we need to get to the bottom of, and this is what the consultation will look at, is the imbalances that exist between the funding regimes for residential and domiciliary care. We have to get to the bottom of it, because it creates an imbalance on the provider side as well, so that we can have proper funding for the kind of care that people need regardless of whether it is in a residential nursing setting or at home.

Queen’s Speech

Baroness Brinton Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Brinton (LD)]

My Lords, in my contribution to the humble Address to the gracious Speech I will focus on health and social care, mainly the latter, and some of the overlapping and invisible problems facing the most vulnerable.

There was much debate during the general election about the funding of our NHS. The Government’s additional funding, announced earlier in the spring, is vital but, as many people, not just politicians, have expressed, it is just not enough. I am proud that my party was brave enough to suggest we should have one penny on income tax for health and social care. I also applaud Labour’s very specific proposals to provide the necessary funding for health and social care. Over recent weeks, with some of the crises and emergencies that we have faced, we have rightly praised the response by the emergency NHS workers, but I praise in particular the invisible unsung heroes who make the NHS, our social care and many people’s lives work without our being aware of it.

Reforming the NHS is vital, but to do so at a time when funding is not just scarce but in some areas—mental health, primary care and for those with long-term conditions—in total crisis sets up these reforms to fail. I congratulate the 50 charities that have recently come together to form the Disabled Children’s Partnership. It has just launched its thought-provoking campaign, the Secret Life of Us. It is those disabled children on whom I want to focus my remarks. Nine out of 10 of the parents surveyed by those charities say that the needs of their disabled children would not be met if they, the parents, could not care for them, and only 10% of the families believe that health and social care services in their area meet the needs of their disabled child. More than four in five of parents of a disabled child face problems accessing the services they need, and over half of them see that this has a negative impact on their child’s health, well-being and ability to make friends. Three-quarters of parents with a disabled child have personally experienced mental health issues, compared with just one in five in the general population.

One example very close to my heart at the moment illustrates all these points and more. I live on the same road as Nascot Lawn, an outstanding facility run by the NHS for disabled children with extremely complex needs. It is in Hertfordshire but it is so good that it is used by other areas as well. Friends of ours have survived—I choose my words carefully—because of the respite care offered by Nascot Lawn. You can get help there only if your child requires hourly attention night and day and their medical needs are complex. They may have tracheotomies, colostomies or regular seizures, or may require feeding by IV tube directly into their stomachs. These children are so sick that they cannot even go to children’s hospices for care. One mum said on television the other day that she could not leave her child on the ward at Great Ormond Street Hospital because that specialist hospital does not have the staffing levels needed to look after her child.

The local CCG has just announced that it will close Nascot Lawn because its work is discretionary. Given that respite and other care provided by Nascot Lawn is specified in most of the children’s education and healthcare plans, and their continuing care plans, some of us think that the CCG has got that wrong. Accountants have decided this without any reference to any of the children’s individual cases.

I am in awe of the commitment, love and dedication of the parents and families of these children. Unless you have seen it first-hand, you cannot understand what living with children this sick and disabled is like. Now imagine if that occasional lifeline is arbitrarily removed by the NHS. Parents say, and I am sure they are right, that it is likely to cost the NHS much more money in the longer run. I also believe that it breaches their child’s rights and, what is more, their rights as carers, working all day and all night, and nursing their children all their lives.

There is something else here, too. A nation’s commitment to its people should be judged by the way it treats its most vulnerable. These children represent the most vulnerable and they are easy targets because they are invisible. My question to the Minister is: will he please meet me and some of the parents involved to discuss why on earth this sort of care could be deemed discretionary?

My noble friend Lady Jolly raised the crisis in social care as a result of employment tribunals and sleep-in shifts. I echo her concerns and agree that that funding must be found to help this problem, but I also want to highlight a further problem. There are now more than 108,000 disabled people with care needs who receive no social care support at all. This is just not acceptable, and the practical problem seems to be that the better care fund is for those who are in hospital and come out, and completely misses out those people living in the community who require long-term continuing care. I ask the Minister: when will there be extra funds for this group?

In conclusion, the Government propose a new consultation on social care. We do not need a new consultation on social care; we need an update on the Dilnot commission and for that to be introduced as soon as possible.

Healthcare: Spending

Baroness Brinton Excerpts

Tuesday 4th April 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord makes the point that the NHS is operating in challenging conditions, not least because of rising demand and expectations. Notwithstanding that, there is a huge improvement in performance. More operations are being performed, there are more diagnostic tests, more people are starting cancer treatment, and people say that they have never been more satisfied with the quality and dignity of care that they are receiving. Those are the points that we need to bear in mind when we talk about the fantastic work that NHS staff do.

[Baroness Brinton (LD)]

My Lords, perhaps we can push the Minister for a clear answer on this. The average spend of G7 economies is 10.4% of their GDP in comparison with the UK’s 9.8%—a gap of £10.3 billion. The Government are proudly saying that they are putting in just under £0.5 billion this spring, with a bit more capital to follow, but what are they going to do to address that shortage, given that £10 billion could provide 10,000 extra GPs and other help in primary care?

[Lord O'Shaughnessy]

As I referred to in my previous answer, the Government have provided additional funding to the NHS—£10 billion more by 2020. It is also worth noting that since the 2015 election over £9 billion of additional funding has been found for social care, which of course has huge strains upon it, and that makes a big difference.

Social Care in England: Older People

Baroness Brinton Excerpts

Monday 20th March 2017 Lords Chamber

[Lord O'Shaughnessy]

Much more funding is now going into the social care system to reflect the additional needs of the ageing population. I am looking forwards in thinking about the extra £9 billion that will be provided. We also have over 150,000 more care workers helping people in the system, whether in residential care homes and nursing homes or at home through domiciliary care.

[Baroness Brinton (LD)]

My Lords, after the publication of the Dilnot commission report nearly six years ago, the noble Lord, Lord Lansley, in another role, and the then Chancellor congratulated the commission on its report being a valuable contribution to meeting the long-term challenge of an ageing population. A Green Paper being seen as the beginning of this process six years on is way too late. I repeat the question that I asked the noble Lord last week: can he confirm that the Treasury will specifically be involved in looking at the funding of social care in the future?

[Lord O'Shaughnessy]

The noble Baroness is quite right to point out that Dilnot was an important move. It is also fair to say that several Governments, including 13 years of a Labour Government, failed to make any significant progress on this issue. We now have a Green Paper coming forward that is, of course, looking at a sustainable and fair care system, and that must also include looking at funding.

Adult Social Care: Funding

Baroness Brinton Excerpts

Thursday 16th March 2017 Lords Chamber

[Lord O'Shaughnessy]

I will speak to the Chief Whip about taking a few days off. I thank the noble Lord for bringing that point to my attention. As he says, there are examples in the UK—in Scotland, England and Wales, and of course Northern Ireland has a joined-up system too—so clearly there are lessons to be learned from home.

[Baroness Brinton (LD)]

My Lords, following the push by Norman Lamb MP for this review that the Government have been talking about and putting into the long grass, the independent specialist group that he convened gave its interim report this morning. It makes it absolutely clear that we have to look at how the NHS and social care are paid for. Can the Minister give an assurance that the Green Paper will address those Treasury issues, as well as the issues of care and the relationship between the NHS and social care?

[Lord O'Shaughnessy]

As I have said to several noble Lords, the intention of the review is to put the adult social care system on a sustainable and long-term basis and to make sure that it is fair and transparent and that it delivers high-quality care. It will address all the issues required to do that.

Tobacco Control Plan

Baroness Brinton Excerpts

Thursday 23rd February 2017 Lords Chamber

[Lord O'Shaughnessy]

I understand the frustration at the delay in publishing the plan. That does not mean that action has not been taking place: all the action set in train under the previous plan has been taking place throughout that period. As I said, the new plan will be published shortly. I look to my noble friend Lord Ahmad, who has given several master classes in the use of words to describe “shortly” in different ways. I will save a few of those for any future Questions and stick with “shortly” for now.

[Baroness Brinton (LD)]

My Lords, the most recent report on child uptake of smoking by area shows some alarming figures of how many children start smoking every day. Given that it has been 100 days since the Government said that they would publish a new report, 67 children a day in London have taken up smoking, which makes 6,700 children in London alone. Do the Government not recognise the urgency of the plan’s publication, not just for the wider protection of our country but specifically for the most vulnerable of our children?

[Lord O'Shaughnessy]

I agree with the noble Baroness. It is worth pointing out that 8% of 15 year-olds smoke, which is obviously eight percentage points too high, but it is down from 15% in 2009, so things are moving in the right direction, although we are absolutely not complacent about it. We have taken action that is reducing the number of children who smoke. In particular, we have banned displays in small shops, which normalise that activity for children, who might be with their parents and see them—marketing is very clever at catching the eye. That is happening. As I said, we will be publishing the plan shortly and it will have reducing smoking among children as a key part.