Health: Treatment Rationing

Baroness Finlay of Llandaff Excerpts

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

Before long, my Lords.

[Baroness Finlay of Llandaff (CB)]

What action does the Minister intend to take against clinical commissioning groups which are commissioning services based on arbitrary, discriminatory decisions rather than on evidence?

[Lord Prior of Brampton]

My Lords, the whole purpose of local commissioning groups was that they would be guided and directed by local clinicians. They must be allowed to set their own local priorities. It would not be right for me to direct local commissioning groups how to behave.

Accident and Emergency Services: Staffing

Baroness Finlay of Llandaff Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

The right reverend Prelate is right that reliance on agency and non-permanent staff has become far too high. It is something we must reduce, not just because it is very expensive to use agency staff, but because the continuity and quality of care suffers. We are taking strong action to reduce the role of agency staffing in the NHS.

[Baroness Finlay of Llandaff (CB)]

Do the Government accept that demand on services is now outstripping the increasing workforce that they have tried to invest in? The workforce crisis is made worse because of the brain drain, with emergency medicine trainees being attracted to other parts of the world that often have very good working conditions. The Government therefore need to take an urgent look at the whole pinch point of emergency departments, given the increased number of patients who go to where the lights are on all the time and where they know they will be seen properly by someone who is properly trained. The crisis means that they now will often be seen by a locum and the staff are on their knees.

[Lord Prior of Brampton]

My Lords, the noble Baroness raises an important point, but it is not new: 24% of all doctors who work in the NHS have been trained overseas. This problem goes back over 20 to 30 years. We must train more of our own doctors. On the specific point on emergency medicine, I was surprised that, over the last 10 years, there has been an increase in emergency doctors—A&E doctors in the main—of 9% per annum, against growth in demand of between 2% and 3%. That does not fully answer the noble Baroness’s point, but, compared with other parts of the NHS, there has been greater investment in doctors and other staff in emergency medicine.

Mental Health Taskforce

Baroness Finlay of Llandaff Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is right: psychiatry is one of the shortage areas, along with general practice and a few other specialties. Premia will be available in the new junior doctor’s contract to encourage people to do psychiatry. That does not answer the noble Baroness’s question all that fully; this is something I should like to look into more myself. However, within the extra spending that has been announced, there will be money for, I think, 1,700 therapists who are experienced in IAPT—cognitive behavioural therapy and the like—which should also help.

[Baroness Finlay of Llandaff (CB)]

Given the problems experienced by emergency departments when they have an acutely distressed and ill mental health patient who cannot be cared for in the community and who needs to have a bed found for them, do the Government recognise that, at the moment, beds in the emergency department have to be blocked off—sometimes for hours, occasionally for days—while a bed is sought for this person, who could not possibly be cared for in the community because they are so acutely disturbed? Will the task force be asked to look specifically at that area of acute provision, separately from some of the other areas of more chronic mental health provision?

[Lord Prior of Brampton]

My Lords, it is very serious when someone going through a severe psychotic episode ends up in an A&E department, there is no local bed available in a mental health hospital, and they therefore spend time being specially guarded by two or three people, often in wholly inappropriate surroundings. This is the issue that the noble Lord, Lord Crisp, addressed in his report which came out a week earlier than the task force’s: people are moved, often many hundreds of miles away, out of their area, to find a bed. Sometimes they get there and the bed is full and they are a long way from their family. It is a highly unsatisfactory, often very dangerous, situation. The approach of the task force is to try to ensure that more money goes into the home treatment and home resolution area, to free up beds in the acute sector. By providing more care in the community, more beds are freed up in acute hospitals, increasing capacity and enabling people who are in A&E departments to be transferred more quickly to the right place. This is clearly a very serious issue.

Health: Adult Psychiatric Care

Baroness Finlay of Llandaff Excerpts

Monday 22nd February 2016 Lords Chamber

[Lord Prior of Brampton]

No, it is not very simple, or at least it is not simple to me; but then I perhaps have a smaller brain than the noble Lord opposite. It is certainly additional to the £1.5 billion for children and young people. I cannot tell the noble Lord now, without fear of making a mistake, whether it will be £1 billion every year from 2016-17 to 2021. It is certainly £1 billion in 2021. If it is all right, I will write to the noble Lord to confirm and clarify that.

[Baroness Finlay of Llandaff (CB)]

How do the Government intend to monitor the efficacy of this investment, and against what performance indicators will this investment be audited?

[Lord Prior of Brampton]

My Lords, that is a very hard question to answer. The talking therapies, for example, seem to be effective in about 50% of the cases, and whether they are effective is clearly a clinical decision. As for other standards, we tend to rely, as the noble Baroness will know, on proxies such as waiting times and the four-hour standard, which the noble Lord recommended in his report. We are considering the introduction of a four-hour waiting-time standard for people suffering from psychotic problems, in the same way as we have for physical health.

Allied Health Professionals: Training

Baroness Finlay of Llandaff Excerpts

Monday 8th February 2016 Lords Chamber

Asked by

[Baroness Finlay of Llandaff]

To ask Her Majesty’s Government what discussions they have had with Health Education England to ensure that the number of student commissions for 2016–17 supports the goal of increasing the number of student places for allied health professionals set out in the comprehensive spending review, and ensures stability in allied health professionals’ education provision and workforce supply.

[Baroness Finlay of Llandaff (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and I declare an interest as the honorary president of the Chartered Society of Physiotherapy.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, Health Education England plans to commission, overall, 7,554 AHP training places in 2016-17—an increase of 344, or 4.8%, compared to 2015-16. The announcement in the 2015 spending review to move nursing, midwifery and AHP students on to the standard student loan system is for new students commencing their courses from 2017 only and therefore does not affect students commencing their courses in 2016-17.

--- Later in debate ---

[Baroness Finlay of Llandaff]

Do the Government recognise that 500 more physiotherapy places will be needed in training each year until 2020 just to meet current needs? With Health Education England proposing cuts in training places in six out of 10 of the allied health professions—cuts ranging from 3.4% to 9.7%—how will the new models of care in prevention, patient treatment and reablement be met, given that they depend on these professionals taking on extended roles? This goes across sectors commissioned by the NHS and by other departments, including the Department for Education, the Home Office and the Ministry of Defence.

[Lord Prior of Brampton]

My Lords, Health Education England is proposing a net increase of 334 places in 2016-17 and we expect a growth in overall numbers of nurses and AHPs from 2017 onwards as a result of moving on to the standard student loan system.

NHS: Trust Finances

Baroness Finlay of Llandaff Excerpts

Monday 1st February 2016 Lords Chamber

[Lord Prior of Brampton]

The cap on agency staffing rates and on agency staff has really started to apply only in the past six weeks. So far, it looks as if we are making significant progress there. As I said in answer to the Question, the NHS is receiving £3.8 billion of extra funding in the forthcoming year. We believe that that will enable it to restore its finances to a proper balance by April 2017.

[Baroness Finlay of Llandaff (CB)]

What are the Government going to do about the haemorrhage of finances into the PFI deals, given that £11.8 billion of buildings will have cost the country £79 billion by the time 31 years comes round? By then those buildings might very often not be fit for purpose because things have moved on so fast. Year on year there is a haemorrhage of money from the NHS to finance these deals. Last year, £2 billion went in that direction.

[Lord Prior of Brampton]

It is clear that a number of these PFI deals were massively expensive and have put huge pressure on a relatively small number of trusts. However, the fact is that we have entered into these long-term contracts and there is no way of getting out of them. I am afraid that it is a cost that the NHS will have to continue to bear.

National Health Service: Nurses

Baroness Finlay of Llandaff Excerpts

Tuesday 26th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think the noble Lord is wrong in what he says, but I will double check. I believe that there will be an additional 10,000 placements per year, but I will check that afterwards. That is not until 2021 because the new scheme will not come into place until August 2017, which means that the first students will come out of the new scheme in 2020. We are estimating that there will be 10,000 in that year.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise that the retention of nurses is also extremely important and that the loss from the profession later in life may reflect difficult working conditions and lack of support? Will the Government also note that nurses in the hospice world and specialists in palliative nursing tend to be older nurses who have left NHS employment and gone to the charitable sector precisely because they feel that they can work as they want to, fully and professionally, and have a supported working environment?

[Lord Prior of Brampton]

My Lords, retention and return to practice are crucial. The noble Baroness may be interested to know that Health Education England has up to 90, I think, courses that have so far attracted just under 1,000 nurses back to practice. The cost of attracting someone back to practice is some £2,000 each compared with some £50,000 for a new nurse.

NHS: Preventive Medicine

Baroness Finlay of Llandaff Excerpts

Wednesday 20th January 2016 Lords Chamber

[Lord Prior of Brampton]

I thank the noble Lord for raising this issue today. We discussed it yesterday and the Government will give him a full response to the issue of fortifying bread with folic acid in the very near future.

[Baroness Finlay of Llandaff (CB)]

Does the Minister recognise in his answer that people should be responsible for their own health and the health of their families that there is a responsibility on the NHS to ensure that there is adequate support before, during and after bereavement of children? The preventive effect on mental health problems later in life is very clearly shown. Those who are unsupported do less well in the whole life course in mental health, and in social and educational outcomes.

[Lord Prior of Brampton]

My Lords, clearly, the state has a huge role to play in prevention; I was certainly not questioning that for one moment. I was just saying that I believe that individuals and families have responsibilities as well.

Children: Obesity

Baroness Finlay of Llandaff Excerpts

Tuesday 12th January 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords—

[Baroness Finlay of Llandaff (CB)]

Can the Minister outline what is being done specifically in relation to women in pregnancy, given that excessive weight gained in pregnancy, which is often linked to the phrase “eating for two”, is very difficult to lose afterwards, particularly if women do not breastfeed? Moreover, postnatal depression can itself be a cause of excessive eating after delivery of the baby, causing the maintenance or even aggravation of obesity. That requires specific services to target these women.

[Lord Prior of Brampton]

The noble Baroness will know that the report of the Chief Medical Officer which came out two or three weeks ago laid particular stress on the importance of women who are pregnant because of the impact of obesity not just on themselves but on their children as well. Advice is available through NHS Choices, Start4Life and Healthy Start; we have various schemes that are focused on pregnant women. I am sure that we can do more, and perhaps when the government strategy on obesity is announced in the near future, it will address that issue as well.

Health: Liver Disease

Baroness Finlay of Llandaff Excerpts

Wednesday 9th December 2015 Lords Chamber

Asked by

[Baroness Finlay of Llandaff]

To ask Her Majesty’s Government what progress has been made to implement the recommendations of the Lancet Commission on liver disease, to address the incidence of liver disease in the United Kingdom.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

Since the publication of the report of the Lancet commission, the Government have continued to address the incidence of liver disease through a number of measures which focus on both the prevention of liver disease, and improved care for those with liver disease. Public Health England has a programme of public health action to tackle liver disease and is working with key stakeholders, including the Lancet commission, to produce a framework for liver disease next year.

[Baroness Finlay of Llandaff (CB)]

As we enter the festive binge drinking season, do the Government recognise that 28% of deaths in 16 to 24 year-old males are alcohol-related and that 85% to 90% of the cost of in-patient liver disease is due to alcohol? By raising the floor cost of alcohol by 10%, we may be able to reproduce the Canadian evidence of a 30% fall in deaths attributable to alcohol. Do the Government also recognise that we have a responsibility to the next generation because in pregnant women hepatitis, obesity and alcohol are each risk factors, each compounding the other? If we implement a six-in-one vaccine programme for hepatitis B in neonates, we may prevent the next generation suffering from hepatitis B as well as decrease the incidence of foetal alcohol syndrome by tackling alcohol abuse in pregnancy.

[Lord Prior of Brampton]

My Lords, there was quite a lot in that question. Some 6,000 babies suffer from foetal alcohol syndrome and it is a shocking and appalling by-product of alcohol. Canada has increased the floor price of alcohol and I understand it has seen some reduction in alcohol-driven disease as a result of that. We are watching what happens in Canada carefully. Of course, Scotland is considering a similar move although it is awaiting the outcome of a court case in the European Union. I gather that Wales will possibly follow suit if that court case goes accordingly. We will watch what happens in those other countries, study it and then make up our minds accordingly.