Paramedic Services
Baroness Brinton Excerpts(3 years ago)
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The Lord Speaker (Lord McFall of Alcluith)
My Lords, we have a virtual contribution.
Baroness Brinton (LD) [V]
My Lords, when Sandra Francis of Oswestry had a cardiac arrest a few months ago, her son had to do 35 minutes of CPR waiting for an ambulance delayed in handovers at A&E. Sadly, she died. Her son said:
“An ambulance should be a way of getting someone to hospital. It shouldn’t be a waiting room sat at the hospital.”
He is right. Ambulance delays are the very visible part of the A&E crisis and the wider shortage of hospital beds, doctors and other healthcare professionals. Again, I ask the Minister: what are the Government doing to remedy this much wider emergency that is causing preventable deaths right now?
Lord Kamall (Con)
The noble Baroness will be aware that there are a number of things going on with the 10-point plan. Maybe I will go through some of the points now. We are supporting 999 and 111 services, making sure that the appropriate person answers the call; supporting primary care and community health services to manage those services; making more use of urgent treatment centres; and providing more support for children and young people. Sometimes people ring 999 but do not need emergency treatment and they can be redirected to another clinician, who can speak to them and that takes pressure off. We are recruiting more staff and looking at more prevention and looking at different rules which prevent the appropriate workflow through the system.
Mental Health: Advertising and Body Image
Baroness Brinton Excerpts(3 years ago)
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The Lord Speaker (Lord McFall of Alcluith)
We have a remote contribution from the noble Baroness, Lady Brinton.
Baroness Brinton (LD) [V]
My Lords, the Children’s Society’s Good Childhood Report 2021 shows that one in seven girls and one in eight boys is particularly unhappy about their appearance. Young people who are not happy with their lives at 14 are more likely than others to have symptoms of mental health issues by 17, including instances of self-harm and suicide attempts. Despite the Government’s promises of future funding for mental health support for schools and CAMHS, it is clear that young people are not getting that initial front-line support that they need now. How soon will there be mental health counsellors in every secondary school?
Lord Kamall (Con)
When we look at mental health in children and body image, we see that it varies not only among age groups but within age groups. We have identified concerns about poor body image as a risk factor that leads to mental health conditions, but it is not necessarily a mental health condition in itself. We have to look at how much of this was already present in the playground before the age of social media, with people being called nicknames for their appearance. However, that has been amplified by social media. We are working with social media companies and others to find the most effective solution.
Draft Mental Health Bill
Baroness Brinton Excerpts(3 years ago)
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The Deputy Speaker (Lord Duncan of Springbank) (Con)
My Lords, the noble Baroness, Lady Brinton, is taking part remotely.
Baroness Brinton (LD) [V]
My Lords, from these Benches we would also like to thank Sir Simon Wessely for his report. We welcome reform to the outdated Mental Health Act and we are pleased to see that the Wessely review is finally being implemented by the Government, even if they are not accepting all the recommendations. The Liberal Democrats pledged in 2019 to implement all the recommendations of Sir Simon’s review, including bringing forward the necessary investment to modernise and improve patient settings and ambulances. We will apply the principle of “care, not containment” to mental health, while ensuring an emergency bed is always available if needed. Sadly, that has not been the case in recent years.
The Statement talks of the Mental Health Act 1983 and how it was designed to protect those who presented a risk to themselves or to others, but it has long been unfit for purpose, with some practices adding more distress to those already struggling with mental health conditions. I am sure most of us have seen that with our families and friends, because everybody knows somebody who has had mental health problems. For too long, people from ethnic minority groups, as well as autistic people and those with learning disabilities, have been unfairly detained under this Act and it has caused huge distress and damage, not only to the individuals themselves but to their families too.
Shockingly, black people are more than four times more likely to be detained under the Act and more than 10 times more likely to be subject to a community treatment order. The noble Baroness, Lady Merron, said it is important to eliminate racism in mental health and criminal justice system interventions for those with mental health problems. This is long overdue. It is or has been, frankly, institutional racism, and it is time that it is dealt with very quickly.
That people with learning disabilities and those who are autistic are being detained under the Act even when they do not suffer from any mental health conditions is appalling. The Statement says that the Bill will change this, but can the Minister assure us that the Government are serious about tackling these issues and will have no cause to delay this Bill again? While pre-legislative scrutiny is important, it should not lead to further delays in getting the Bill on the statute book next year.
It is good that the Statement announces £150 million over the next three years to bolster mental health services, especially to support people in crisis and avoid their having to attend A&E, which is not good for them and not good for A&E either, but I ask the Minister, since it is not clear from the Statement: is this entirely new money, or is it coming out of the mental health budget that was announced?
It is good that patient safety will be enhanced, but what is being proposed to bring much of the elderly and decrepit mental health building stock up to date and suitable for the 21st century? Some of the buildings are not just unsafe; they are actually not very pleasant places to be either.
The cost of living crisis continues to have a significant impact on families and the demand for mental health services for parents with young families is increasing, but the support to deliver these services is simply not keeping pace with demand, with nurses reporting cuts to funding and staff shortages. What plans does the Minister have in place to improve access to mental health services for new parents?
The Statement mentions the important proposals to give patients more control over their care and treatment. This is vital. We in the disabled community say that there should be nothing about us without us, and that is true too for those with mental health issues. The proposal for the nominated person to be chosen by the patient is a great step forward too, but that may well be hard for family members not selected as the nominated person, who may be excluded from any information about their family member’s mental health or progress, or as my honourable friend Daisy Cooper MP said yesterday, may not even know which part of the country their family member is staying in. This is part of the navigation of a future which is important to get right for the patient, while making sure that close family members who are worried about their loved ones are not cut out of the information loop entirely. Perhaps the Minister can give us some indication of how this trickly situation could be navigated.
The Government have said that they are accepting most of the recommendations of the Wessely review, but I add my concern to that expressed by the noble Baroness, Lady Merron: why have some not been accepted? Having said that, we accept the Wessely review and look forward to the pre-legislative scrutiny and the opportunity to discuss this Bill in detail when it comes into Parliament.
Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022
Baroness Brinton Excerpts(3 years ago)
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The Deputy Speaker (Lord Brougham and Vaux) (Con)
The noble Baroness, Lady Brinton, will be taking part remotely and I call her now.
Baroness Brinton (LD) [V]
My Lords, I thank the Minister for his introduction to this Order and the noble Lord, Lord Hunt of Kings Heath, for explaining his amendment. First, as others have said, it is important to recognise the contribution pharmacists in our health service have made for many years—long before the NHS was created. Too often we talk about clinical and health care professionals and do not raise the vital contribution made by pharmacists. Covid-19 has really demonstrated in a number of ways that they are not only a cornerstone of the NHS and our healthcare system. In the pandemic, and lockdown especially, they also stepped up, took on extra responsibilities and became a new frontline service for people concerned about minor symptoms that they would normally have taken to their GPs, while their GPs were overrun with many more serious cases, including Covid cases.
I too thank the PSNC for the pharmacy advice audit it sent through earlier this week. We now know that nearly a quarter of a million consultations a week—that is 65 million informal healthcare consultations a year—are still being carried out in community pharmacy because patients are unable to access another part of the healthcare system. We should not forget, either, that the pharmacy database was used as the basis for the NHS app because it already had direct links with GP records, prescriptions and vaccinations that were delivered by pharmacists in their pharmacies.
Turning to the SI, which clarifies the governance of, and sets out the roles of, responsible pharmacists and superintendent pharmacists, the brief summary by the Secondary Legislation Scrutiny Committee raises some key issues. The Minister is right: although there are only three paragraphs, its report is certainly worth reading. It says in paragraph 14:
“several proposals were not popular with respondents to the consultation exercise on the grounds that they may reduce patient safety, particularly provisions allowing Superintendent Pharmacists to cover more than one firm and Responsible Pharmacists to cover more than one pharmacy or to operate remotely. We also note significant levels of distrust from the profession that the regulator, the General Pharmaceutical Council … would be able to set standards and rules appropriately.”
Worryingly, the committee goes on to say:
“We found the response of the Department of Health and Social Care … to these concerns, as set out in the Explanatory Memorandum, unconvincing.”
In the next paragraph, it says:
“In supplementary material, DHSC told us that to counter the concerns the GPhC will be required to consult on any proposed rules, which will provide the profession with an opportunity for scrutiny and comment. In addition, any changes to professional rules made … would need to be made by a statutory instrument following the negative resolution procedure in Parliament.”
Although this extra information to the Secondary Legislation Scrutiny Committee is reassuring, I still want to ask the Minister what the timescale is likely to be before such an instrument is laid before Parliament for scrutiny, explaining those concerns outlined by the committee and how they will be alleviated.
I thank the General Pharmaceutical Council for its briefing, which sets out the safeguards in the draft order to consult on the rules and report back. I know we look forward to seeing the detailed responses to the consultation and how they might affect the resulting resolution. With any change in responsibility, trust is absolutely critical, and this is on top of the increase in community consultations and referrals to other parts of the healthcare system that pharmacists throughout the UK are now carrying out. This is the real change already happening in our primary care system that Ministers say we should be looking for, and the public have taken to it.
The All-Party Pharmacy Group notes that the new demands on pharmacists have been coupled with a real-terms decrease in funding over the last eight years. Despite their desire to help, many pharmacies have had to limit or reduce their offerings and, as the noble Lord, Lord Hunt, has said, some pharmacies are closing. It is in this context that the noble Lord has brought forward his amendment, asking your Lordships’ House to consider that
“the Order does not make provision about the wider workforce challenges facing the community pharmacy sector”.
Diabetic Prevention Programme
Baroness Brinton Excerpts(3 years ago)
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The Lord Speaker (Lord McFall of Alcluith)
The noble Baroness, Lady Brinton, is contributing remotely.
Baroness Brinton (LD) [V]
My Lords, the observational study by academics of the 2018-19 wave of the NHS diabetes prevention programme, published by BMC Health Services Research, observed disengagement within sessions when patients reported that information was difficult to understand, and when there were very large group sizes and problems with session scheduling. This is all before Covid. Problems with the course will inevitably make patients more likely to drop out but 50% is shocking. Now that this diabetes prevention programme has been rolled out across England, have these specific problems been addressed?
Lord Kamall (Con)
The noble Baroness makes an important point about what we have to learn from these programmes. In many of these programmes we are in a process of discovery. You try things—some will work and some will not. Those which do not work, we want to learn the lessons from. Clearly, the length of the programme, nine months, has put some people off and led to the dropout rate. We are looking at shorter programmes, digital access and self-assessment, and at community-led initiatives rather than top-down government initiatives. To give another example, I met someone at a meeting yesterday who told me that his mosque in Accrington was running healthier-diet programmes for worshippers. We need to see a lot more of those programmes as well.
Social Care: Adults
Baroness Brinton Excerpts(3 years ago)
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The Lord Speaker (Lord McFall of Alcluith)
My Lords, the noble Baroness, Lady Brinton, is participating remotely.
Baroness Brinton (LD) [V]
My Lords, I go back to the previous question: this ADASS survey shows that almost 170,000 hours of homecare a week could not be delivered for the first three months of this year, because of a shortage of care workers. This is a sevenfold increase on the previous year. The changes proposed to the social care system will not increase the rates of pay for social care workers, at the moment, to make it attractive to others, who can work in hospitality. But there is a dire need for people now. What will the Government do right now to help solve this crisis?
Lord Kamall (Con)
As the noble Baroness will acknowledge, some of the problems have been in evidence for a long time. Sometimes, we are tackling the legacy of this neglect of the social care system. At the same time, we have to remember that many social care providers are not run by the state; they are private providers. Following the People at the Heart of Care White Paper, we want to make sure that, first, we encourage better conditions for workers. We also want to make sure that local authorities determine a fair rate of pay based on local market conditions. We have seen an increase in the national living wage, which means care workers will get an increase. But we are looking at all this as part of the overview of the social care landscape.
Nursing: Staffing
Baroness Brinton Excerpts(3 years ago)
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Baroness Brinton (LD) [V]
My Lords, I congratulate my noble friend Lady Tyler on securing this important and timely debate and her excellent introduction to it. Its content is perhaps no surprise to many of us who have spoken so far. Our nursing workforce continues to face unbelievable pressures in their day-to-day roles. Supported by many other clinical and non-clinical NHS staff, nurses say that the NHS must staff for safety and for effective care.
The right reverend Prelate the Bishop of London spoke movingly from her own experience and deep knowledge of the issues that nurses face. I pay tribute to all of our NHS staff, who face the most severe difficulties at the moment. The Government seem to have glossed over these in their post-pandemic policy of, “Let’s just move on”. I hope that the Minister will respond to the questions raised by other noble Lords.
The RCN report rightly looks at the impact on its members, and it makes harrowing and concerning reading, especially on the lack of enough staff on duty on a regular basis, as well as the personal comments of those who have left through burnout. The Royal College of Emergency Medicine’s Beds in the NHS report shows that the NHS needs 13,000 extra staffed beds—the emphasis on “staffed” is important.
The pandemic was an emergency, but long before 2020 we were well below the OECD average for staffed hospital beds, and some of us have been raising concerns about staffing and beds for well over a decade. The current OECD data, which covers 2017-20, shows that the UK has 2.4 beds per 1,000 inhabitants; France has 5.8 and Germany has 7.8, while Korea and Japan have over 12. To repeat, the UK has 2.4—we have lost 25,000 hospital beds since 2010. Of course, in referring to hospital beds, we mean staff as well.
The pandemic has shown us the consequences of having bed occupancy at 95% early in 2020, but the underlying problems remain. The front line of this crisis in hospitals is the ambulance services and A&E departments, but we delude ourselves if we look at only the data. The workforce is absolutely critical, and many noble Lords have spoken about how important it is to plan properly for our nursing workforce. They have mentioned the Health and Care Act and the Government’s apology for workforce planning, including their assertions that they may not publish the workforce plans in full. I echo the questions seeking to understand why that is the case.
Nurses’ role has changed greatly over the last 40 years, and their high level of education and training means that the skills they offer can help to take the burdens off doctors and other clinicians, who bore them alone in the past. Specialist nurse practitioners have transformed the lives of many with long-term conditions—I include myself in that. Community nurse roles have also changed, but their current workload means that their real benefit of having time to talk to, listen to and understand the needs of their patients at home, and then to be able to signpost extra help or resolution, is under real pressure.
So it is good that the Government have increased the number of nurse training places, but it is less good that it is still not enough, given the number of retirements and staff leaving through burnout. The King’s Fund report on the NHS workforce makes this point very strongly, noting how much the UK will have to rely on international nurses. The noble Lord, Lord Lilley, made some interesting points on international recruitment. He has specific concerns about 4,000 nurses coming from poor countries, and he is absolutely not alone in that. But there are some more ethical overseas arrangements: my local trust, West Hertfordshire Hospitals NHS Trust, had an arrangement with hospitals in the Philippines whereby newly qualified nurses would come for a period, usually of five years, to gain some extra qualifications and then return home highly qualified. Even so, while they are away, their country does not have the skills for which it trained them.
Have the Government achieved their targets, set out in their elective recovery plan, which pledged to recruit 10,000 international nurses by April 2022, and are they encouraging the type of partnership that I just described? As my noble friend Lady Tyler said, retention is absolutely vital too. What plans do the Government have to tackle retention? This is about pay, the work environment, bullying, discrimination, more leadership and support for ethnic-minority staff facing discrimination and bias, all of which we have had reports on in recent months.
The noble Baroness, Lady Bennett, made an important point about the gender construction of nursing and, indeed, care. She is right that we undervalue and underpay those in caring nursing roles. That too needs to be re-evaluated, not just by government but by society. We should not have health staff caring for people’s personal needs while on the minimum wage. There is also pressure on nurses with a lack of doctors, so we need to note that the Secretary of State for Health and Social Care has acknowledged that the manifesto pledge to have 6,000 more GPs in England by 2024-25 is not on track. Similarly, the NHS target to fund 26,000 additional roles to ease the pressure on general practice is unlikely to be achieved by that same date. That pressure causes further pressure on our nurses.
Cancer targets are still being missed every month, and waiting times remain sky high. The NHS does not think that it can get them down in the next year, despite the Government promising performance returning to pre-pandemic levels by spring 2023.
Finally—news hot off the press—today there is monthly data for May on trusts achieving the target of waiting four hours or less in A&E. The average for achieving four hours or less is now 60%. The worst three are my own local hospital, West Herts; Barking, Havering and Redbridge; and Torbay and south Devon, which achieved between only 31% and 37%. Those figures alone are shocking, but what sits behind them is a shortage of nurses, doctors and other healthcare staff writ large. I hope that the Minister can respond to these concerns and ensures that we will have a nursing profession that is fully staffed, fully trained and fully supported, as they do their absolutely vital job in our NHS.
Defibrillators
Baroness Brinton Excerpts(3 years ago)
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The Lord Speaker (Lord McFall of Alcluith)
My Lords, I call the noble Baroness, Lady Brinton.
Baroness Brinton (LD) [V]
My Lords, 12-year-old Oliver King died suddenly of sudden arrhythmic death syndrome, a condition that kills 12 young people under 35 every week. The Oliver King Foundation has been campaigning for a defibrillator in every school. Last September, the Secretary of State for Education said this should happen. The DfE has been working with the NHS to make this possible, but the NHS Supply Chain website says that, in December last year, only 3,200 were advantageously procured for schools to then purchase. Can I ask the Minister: is the NHS expanding its procurement to enable all 22,000 schools to be able to purchase defibrillators now and not just when the school is rebuilt?
Lord Kamall (Con)
The noble Baroness raises an important point: while we require defibrillators to be purchased when a school is refurbished or built, one of the things we are looking at is how we can retrofit this policy. We are talking to different charity partners about the most appropriate way to do this. What we have to recognise is that it is not just the state that can do this; there are many civil society organisations and local charities that are willing to step up and be partners with us, and we are talking to all of them.
Vaccinations
Baroness Brinton Excerpts(3 years ago)
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The Lord Speaker (Lord McFall of Alcluith)
My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.
Baroness Brinton (LD) [V]
My Lords, the shingles vaccine is available in the UK only to those aged between 70 and 79, whereas in the USA it is automatically available to everyone over 50. NICE data says that shingles is much more prevalent in those with a weakened immune system, yet they are not offered it until they are 70, resulting in severe cases of shingles, possible sight loss and other serious consequences which could have been mitigated by an early vaccine. Can the Minister say when Shingrix, the shingles vaccine suitable for the immunocompromised will be automatically offered to this group of patients?
Lord Kamall (Con)
I thank the noble Baroness for that question. I am afraid I will have to write to her with the details.
Neurological Conditions
Baroness Brinton Excerpts(3 years, 1 month ago)
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Baroness Brinton (LD) [V]
My Lords, I, too, thank the noble Lord, Lord Dubs, for securing this important debate. I also thank the Neurological Alliance, the Chartered Society of Physiotherapy, the Royal College of Occupational Therapists, Parkinson’s UK, the MS Society and Merck for their helpful briefings. I declare my interest as a vice-president of the Local Government Association.
The noble Lord, Lord Monks, spoke movingly of his son’s personal experience: that, despite the excellent treatment, the service feels in constant crisis, not least because of staff shortages—not just clinicians. As the noble Baroness, Lady Fraser, outlined, the Neurological Alliance surveyed more than 8,500 people with neurological conditions, including Parkinson’s, about their experiences. It found a shortage of neurology specialists, as outlined by other noble Lords. It is shocking that the UK was ranked 44 out of 45 European countries for the number of neurologists. The Royal College of Physicians found that 48% of consultant geriatricians in England are set to retire within the next 10 years.
Mental health services, which we have debated quite a lot in your Lordships’ House recently, are an absolutely integral aspect of care for people with neurological conditions, but a Written Answer to a Parliamentary Question two years ago revealed that the Government were on course to miss the recruitment target for expanding the mental health workforce by 50%. I do not think the last two years have helped that.
Delays to treatment and care can change your life for ever. More than half of adults, children and young people living with a neurological condition experienced delays to routine appointments with specialists last year. The Neurological Alliance is calling on the UK Governments to establish a neurology task force to get to the bottom of these problems and create real change.
Along with the noble Baroness, Lady Murphy, I am particularly interested in wider healthcare support, including rehabilitation, and was delighted to receive the briefings from physiotherapists and occupational therapists because, with my own long-term condition, I am very reliant on their expertise. The Royal College of Occupational Therapists surveyed staff working in rehab multidisciplinary teams, including physios, speech and language therapists, nurse specialists, dieticians and many more. Its survey found that 82% had seen an increase in demand for rehab support in the past six months. It is vital to those with chronic and deteriorating long-term conditions to have access to rehabilitation, so the ability for patients to access rehab is a lifeline, frankly. If it is not there, deterioration can speed up.
This is an area that cannot continue to work in constant crisis. One of the main problems in the short staffing in the MDTs is the load on clinicians. This is not just the allied healthcare professionals but those invisible administrators, who have a key role in smoothing access to the full range of services for patients. That is why the alliance is seeking a fully funded national two-year rehab strategy to ensure that people who have seen significant deterioration in their condition have the therapeutic support they need.
Too often, one key part of public services is involved too late. It is one that society—particularly the health sector, I am afraid—just does not plan for. I am referring to housing. Research over many years by Habinteg, a housing association that campaigns for the raising of accessibility standards in new homes, shows that for a small amount extra to pay at the time of a new build or major renovation, adaptations for patients with mobility problems can be overcome cheaply and easily. One thing that many patients with neurological conditions say is that the adaptions to their home are difficult and expensive.
Finally, one expert is too often overlooked. The expert patient programme is for people with long-term conditions, where patients take a six-week course and are trained and supported, often by tutors who have a long-term condition themselves. The course aims to give patients the confidence to self-manage their health and be active participants in the care of their condition. The course looks at general topics, including healthy eating, dealing with pain, relaxation techniques and coping with negative feelings, along with very specific advice on their condition. I know of it from the rheumatology sector, but I know friends who are expert patients in the MS community. Multidisciplinary teams welcome their expert patients. A patient’s understanding of when to seek help means more timely interventions and, often, improved outcomes. It is not just beneficial for the patients, it is cost-effective.
Is there specific support to spread the expert patient programmes to more neurological conditions? Will the Minister respond to the Neurological Alliance’s recommendation of a neurology task force? When do the Government plan to publish a workforce strategy for the neurology workforce? As we discussed a lot in debate on the then Health and Care Bill, this is one element of wider workforce planning that really needs to happen now and be visible. Therefore, how will the Government ensure that any such strategy delivers a sufficient number of health professionals to fill the gaps in staffing for neurological conditions?