Adult Social Care

Debate between Baroness Brinton and Lord Prior of Brampton

Tuesday 15th November 2016 Lords Chamber

[Baroness Brinton (LD)]

My Lords, it is good that extra money is coming into the NHS, even if it is loaded in the wrong direction at the moment. However, this Question is much more about care. The real problem at the moment is that social care is significantly starved of funding. What will the Government be doing to ensure that real cash goes into social care to help to alleviate the problems that the NHS is facing due to people remaining in hospital because there just are not the places for them to go nor the assessments for them in social care at the moment?

[Lord Prior of Brampton]

My Lords, the squeeze in social care started in 2010. Between 2010 and 2015, spending on social care declined in real terms by 12.8%. That was a significant reduction in spending when the noble Baroness’s party was in power in the coalition Government. Since then, it remains very tight in social care. As I said, we are putting more money into the NHS at the front end of this Parliament. We have introduced the 2% precept for local authorities to raise money for social care and we have put £1.5 billion into the better care fund, starting from 2017-18, which will provide more money for social care at the end of this Parliament.

NHS: Primary and Community Services

Debate between Baroness Brinton and Lord Prior of Brampton

Monday 7th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I acknowledge that there is tremendous pressure in the social care system. Looking back over the last 20 years, not enough support has gone into primary, community and social care relative to what has gone into acute care. The sustainability and transformation plans are designed to bring together social care and healthcare. They are being published intermittently as I speak.

[Baroness Brinton (LD)]

My Lords, the country owes so many carers an enormous debt of gratitude for what amounts to unpaid work they are doing on behalf of the state. The NHS website says to carers:

“If someone you know is in hospital and about to be discharged, you should not be put under pressure to accept a caring role”,

or to take one if you are already doing this as their carer. It continues:

“You should be given adequate time to consider whether or not this is what you want … to do”.

The carers report has found that three out of five carers say they felt they had no choice, and of those not consulted four out of five carers said it was way too early and that there were readmissions as a result. What will the Government do to ensure effective communication between hospitals and carers truly happens, so that there are no more unprepared discharges and carers get the support they need?

[Lord Prior of Brampton]

My Lords, delayed and inappropriate discharges are clearly a huge issue for the whole health and care system. Again, this is something the STPs are designed to address. The five-year forward view is explicit in saying that there are 5.5 million carers in England and their continuation goes to the very sustainability of the NHS. The importance of care is not in dispute. The Care Act, which the noble Baroness’s party and mine put through in the last Government, recognised that so as to give them parity of esteem with those they care for. There is no question but that better communication with carers would go a long way to improving the problems we have with inappropriate discharges.

Carers over 80: Support

Debate between Baroness Brinton and Lord Prior of Brampton

Monday 13th June 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is absolutely right. Nearly half a million people over 80 are providing more than 35 hours a week of care to their partner or loved one, which is a huge commitment and often has profound implications for their own health and well-being. We are all singing from the same hymn sheet on this and I am sure that the carers strategy coming out at the end of the year will address the particular requirements of that age group. The Government will continue to support carers’ rights. I mentioned the £186 million being given to local authorities to do that.

[Baroness Brinton (LD)]

My Lords, the Building Carer Friendly Communities research report for Carers Week last week reported that approaching half of older carers had not been offered an annual health check by their GP practices, and about half of older carers said that their GP practice had not told them where they could find help. What are the Government doing to encourage primary care to make sure that older carers get access to annual health checks and support?

[Lord Prior of Brampton]

My Lords, clearly it is essential that older people have access to at least annual check-ups from their GPs. A large part of the review that is being undertaken will be about how we signpost and inform people of the need to have these health check-ups. I am sure that will be a part of the strategy announced at the end of the year.

Learning Disabilities: Transforming Care

Debate between Baroness Brinton and Lord Prior of Brampton

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

This is an area of healthcare about which I am least informed, so I would very much like to do that.

[Baroness Brinton (LD)]

My Lords, Sir Stephen Bubb’s update report also said that the review was going forward very slowly. The Minister has also referred to this. What is the new timetable for the full implementation of the Bubb report?

[Lord Prior of Brampton]

It is a three-year timetable. The intention is to reduce the number of in-patient hospital beds by between 35% and 50%, as I said. There will be a review at the end of the three years to see whether that can be taken further. The truth is that progress seems painfully slow until you look back to where we have come from. We have come a long way over the last 20 years, but nothing like far enough or fast enough. An old Chinese proverb says that it is better to light one candle than curse the darkness. We are making progress, but it could be quicker.

Mental Health Services

Debate between Baroness Brinton and Lord Prior of Brampton

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

What I would say to people in the NHS is that the Government are committed to spending a lot more money—more money than has ever been spent before on mental health—so we are putting our money where our mouth is. We are the Government who signed up, with the Liberal Democrats, to putting parity of esteem in law in the 2012 Act, and we are absolutely committed to doing that. There is no ground for thinking that we are deprioritising mental health. The quality premium that NHS England uses to focus the attention of CCGs will change every year. It had mental health in it last year; it had other issues in it this year; and I hope that it will have mental health in it next year.

[Baroness Brinton (LD)]

Parity of esteem has a very specific meaning and it is good news that some extra money has been coming into mental health services but, until mental health is a real priority and there is equal funding, particularly to take pressure off the acute sector, there remains a problem. Can the Minister please confirm that mental health will continue to benefit from additional funding next year, given the priorities set out in the mental health five-year forward view? It would be really reassuring to the House to know that at least there was continuing additional funding available.

[Lord Prior of Brampton]

I assure the House that, on the funding that the Government have agreed for children’s and young people’s mental health and adult mental health—in the light of the Prime Minister’s announcement in January, but particularly in the light of Paul Farmer’s report that came out six weeks ago —we are fully committed to meeting those obligations.

Wheelchair Users

Debate between Baroness Brinton and Lord Prior of Brampton

Thursday 21st April 2016 Lords Chamber

[Lord Prior of Brampton]

I totally agree with my noble friend that there is an absolute need for greater uniformity and standardisation. The level of variation around the country is wholly unacceptable.

[Baroness Brinton (LD)]

My Lords, the NHS guidance on the website to people seeking a powered wheelchair says:

“Each service will have a strict criteria of eligibility. Usually the NHS services do not provide powered wheelchairs … for outdoor use only”.

Some areas, including mine, say that this means you get one only if you need to use it inside your own house. This does not mean independent living. When will the criteria be changed to ensure that if a powered wheelchair is needed for work purposes it will be provided?

[Lord Prior of Brampton]

As the noble Baroness knows, the criteria are local at the moment. The point of collecting the data and developing a tariff, which takes into account assessment, the equipment and repair and maintenance, is to have local commissioning against the national standard.

NHS: Mental Health Services

Debate between Baroness Brinton and Lord Prior of Brampton

Monday 14th March 2016 Lords Chamber

[Baroness Brinton (LD)]

My Lords, last week there was a well-publicised case of a young autistic man being held in secure mental health accommodation because there were no spaces in the appropriate autistic support facility. It transpires that the principal cause was that there was nowhere for the young people in the other unit to move to. Can the Minister explain what is happening with mental health services to avoid bed-blocking, in the same way as is happening with other social care?

[Lord Prior of Brampton]

On the particular case raised by the noble Baroness, the person involved will now come out of that accommodation. I think he has been an in-patient for six months but he is now due to come out of that place fairly soon. This issue is not confined to mental health. There are too many people who, if the right resources were available outside hospital, would be much better off being treated outside an institution than they are at the moment. We are doing our best to address this general concern, raised by Paul Farmer and his task force.

NHS: Junior Doctors’ Pay

Debate between Baroness Brinton and Lord Prior of Brampton

Wednesday 27th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think the whole House will agree with the noble Lord that we all very much hope to avoid another strike. The Secretary of State has asked David Dalton, the very distinguished chief executive of Salford Royal—the noble Lord, Lord Turnberg, will know him extremely well—to head up those negotiations with the BMA, and we are very hopeful that a conclusion to this dispute will be reached before there is any more strike action.

[Baroness Brinton (LD)]

My Lords—

--- Later in debate ---

[Baroness Brinton]

I am very grateful to the noble Lord for giving way. Pay is only part of the problem for our doctors in this country at the moment. The NHS is increasingly kept afloat by overseas-trained doctors and over 40% of our hospital doctors are now from overseas. In certain specialities such as obstetrics and gynaecology the number is currently over 56%. Can the Minister say what the Government are doing to understand why some specialities struggle to attract enough UK-trained doctors, and, further, what they are doing to increase the number of medical training places for UK-based students?

[Lord Prior of Brampton]

The noble Baroness raises a very important point that we are highly dependent in a whole range of medical specialties on overseas doctors and of course overseas nurses as well. Health Education England is expanding the number of training places, in particular for GPs; we hope to have an extra 5,000 GPs in place by the end of this Parliament.

Health and Social Care: State Pension

Debate between Baroness Brinton and Lord Prior of Brampton

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the NHS produced its five-year forward view 18 months ago, which called for additional spending in real terms from the Government over the five-year period of £8 billion. The Government have met that in full and are front-loading that investment, as the noble Lord knows, spending £3.8 billion in the forthcoming year. So the Government are fully supporting the NHS’s plan.

[Baroness Brinton (LD)]

My Lords, there are two issues here. One is the short-term funding issue, and the noble Lord, Lord Hunt, is absolutely right to say that there is a crisis. Simon Stevens’s reference was about much more than just the pension; there are intergenerational fairness issues and a whole string of other things. My honourable friend in another place, Norman Lamb, suggested that there should be a cross-party commission to look at these issues, which cannot be resolved overnight. Is there progress on the Government accepting the principle of this cross-party commission and, if so, when might an announcement be made?

Four Seasons Group

Debate between Baroness Brinton and Lord Prior of Brampton

Monday 11th January 2016 Lords Chamber

[Lord Prior of Brampton]

I fully agree. Our interest is in the residents in the homes. The CQC’s oversight regime is not intended to prop up a provider—that is an entirely different matter. My noble friend is absolutely right that when Southern Cross went into insolvency, very few homes—in fact, I do not think that any homes—closed as a direct result at the time; most of them carried on as going concerns.

[Baroness Brinton (LD)]

My Lords, is the Minister working with the Department of Health, the CQC and BIS to ensure that the new financial instrument, whereby an individual can invest in a single room in a care home for a guaranteed rent, protects the user of that room as much as it provides any yield for the investor? Evidence in the student sector has shown very mixed results. Students can move on elsewhere, but elderly care residents have nowhere else to go and their protection, and indeed the trading viability of a care home, could be affected if investors had to move out quickly.

[Lord Prior of Brampton]

My Lords, I could not see where the question was coming from. I am not fully briefed on the financial instrument that my noble friend—I am sorry; the noble Baroness—referred to. I will have to research it and get back to her.

Health: Parity of Esteem

Debate between Baroness Brinton and Lord Prior of Brampton

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

My noble friend makes a very good point: reaching for medication is often not the right way forward. I am not sure how much time in the undergraduate syllabus is reserved for mental health training. However, I know that a considerable amount of time is set aside for it, so that people who decide to become GPs will have had some training in mental health before they qualify. Only last week, I was talking to Clare Gerada, who was the president of the Royal College of General Practitioners. She said that she thought the best combination of all was for a GP to have studied psychiatry as well.

[Baroness Brinton (LD)]

My Lords, it is encouraging to hear the new Government continue the priority that the coalition Government gave to improving mental health access for everyone, and specifically for children. I am also encouraged to hear the Minister talk about waiting time targets. However, surely true parity of esteem will be reached when we have targets for CCGs and, if they miss them due to lack of funding and the appointment targets are missed, that is publicised in the same way as missed A&E targets.

[Lord Prior of Brampton]

That is a very interesting point. We have three principal targets for mental health: two relate to IAPT and the other to access for those who have their first psychotic episode. Clearly, we do not yet have the range of targets for mental health that we have for physical health, although the introduction of those three targets this year is a big step forward. It is important that the targets should be based around outcomes rather than funding.

Social Care and Support: Funding

Debate between Baroness Brinton and Lord Prior of Brampton

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

As regards the position of the social care sector, “fragile” is putting it kindly. It is very difficult; there is no point making any bones about that. The increase in the living wage, which is long overdue and very welcome, will add to pressures on the sector. It was made very clear in the Five Year Forward View that the future of the healthcare system is very much tied up with the future of the social care sector. The noble Baroness can be assured that we have brought that to the attention of the Treasury and we are waiting for a favourable result in November.

[Baroness Brinton (LD)]

My Lords, the social care sector is in a perfect storm, with councils having faced a 30% cut in their social care budgets as well as the increase in the national living wage which—much as it is welcomed—it is estimated will cost an extra £1 billion. I ask the Minister once again: will the Government commit to spending the extra £6 billion that they are saving by not implementing Dilnot and ring-fence that money to support the social care sector through this very difficult time?

Social Care

Debate between Baroness Brinton and Lord Prior of Brampton

Thursday 15th October 2015 Lords Chamber

[Lord Prior of Brampton]

I thank my noble friend for that important observation, with which I agree completely.

[Baroness Brinton (LD)]

My Lords, the better care fund was a good starting point for the integration of health and social care, but the Government deferring the integration of the spending limits in the Dilnot review means, we are told, that there are £6 billion of savings. Will the Government ensure that that saving of £6 billion from not fully implementing the integration of health and social care is put towards the new minimum wage and the new contracts ensuring that staff are paid for travel between appointments?

[Lord Prior of Brampton]

The position on the savings from deferring the introduction of the Dilnot proposals is that they are being taken into account under the spending round and I cannot comment further today.

National Institute for Health and Care Excellence

Debate between Baroness Brinton and Lord Prior of Brampton

Monday 13th July 2015 Lords Chamber

[Lord Prior of Brampton]

I am not entirely convinced by the argument about regulation when it comes to managing wards. My own observation is that when you have strong leadership from strong ward sisters, ward managers or charge nurses, many of the problems that we identify seem to disappear and there is very high staff morale, low absenteeism and little use of agency staffing. So much comes down to local leadership, and sometimes regulation is used as a scapegoat.

[Baroness Brinton (LD)]

My Lords, given that everyone accepts that the new safer staffing guidelines will require more nurses, what will the Government and Health Education England do to reduce the number of nurses who do not qualify from their training, which is currently running at about 20%?

[Lord Prior of Brampton]

That is a very high figure. It is quite revealing that most of the people drop out in their first placement, and it behoves universities and Health Education England to ensure that they are recruiting new nurses who have done some work in a care home or hospital so that they know what the realities and practicalities of being a nurse are.

NHS: Whistleblowing

Debate between Baroness Brinton and Lord Prior of Brampton

Tuesday 30th June 2015 Lords Chamber

[Lord Prior of Brampton]

There are a number of organisations that the noble Baroness might wish to contact, but most important is to raise the matter first in the local organisation. All organisations should have their own whistleblowing procedures, and that is the right way to raise concerns. If any individual finds that not to be satisfactory, the right way to proceed is through the Care Quality Commission, which has a dedicated hotline in its service centre in Newcastle.

[Baroness Brinton (LD)]

My Lords, which takes priority: duty of candour or an employee’s contract with their NHS trust where they are gagged?

[Lord Prior of Brampton]

The duty of candour should clearly take precedence. It should be seen in the context of an agenda to improve patient safety in hospitals; if we are not open about our mistakes, we will not learn from them.