NHS: Waiting Lists

Baroness Finlay of Llandaff Excerpts

Monday 26th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I think we all know what happened in 2010, but it might be worth pointing out that 10 years ago, half of patients waited more than 18 weeks for referral to treatment and that is now only about 10%.

[Baroness Finlay of Llandaff (CB)]

My Lords, given that many consultants report feeling demoralised and worn down by constant pressure from the number of clinical problems they are dealing with and the administrative pressures that they find themselves under, what discussions have the Government had with NHS England, and what discussions has NHS England had with trusts, on ways that consultants and their teams could have better administrative support and better ways to achieve upgrades in equipment that they may need to undertake specialised procedures? At the moment, they are having to apply and reapply for funding, which wears them down and takes away from clinical time.

[Lord O'Shaughnessy]

I shall write to the noble Baroness on what NHS England is doing about the specific issue. I think her real point is about morale. We know that NHS staff do an incredible job under a great deal of pressure, dealing with that rising demand. We are doing two things to try to alleviate that situation. One, which we have talked about, is increased numbers coming through training so that we can increase staffing. The other is pay. Getting rid of the pay cap and allowing for an Agenda for Change pay increase is a good way of saying thank you to those staff.

NHS: Winter Crisis

Baroness Finlay of Llandaff Excerpts

Wednesday 7th February 2018 Lords Chamber

[Lord O'Shaughnessy]

As the noble Baroness knows, last year we had two significant spending announcements —there were two Budgets—in the March Budget on social care and in the November Budget for NHS funding, with billions extra being put into the service to meet very quickly rising demand. The review that will come out in summer will be a retrospective review of planning and the success of planning for winter. There will also be important lessons to be learned from it I am sure.

[Baroness Finlay of Llandaff (CB)]

Are the Government planning to ask NHS England to review the number of beds available, given that staff at the moment are starting shift after shift with no beds available and having patients who need IV therapy or even ventilation in their departments who cannot possibly be sent home? Staff morale is inevitably being undermined because they just do not know where they can put these patients.

[Lord O’Shaughnessy]

The noble Baroness is quite right to highlight the issue of bed occupancy; it is very high. The service managed to get it down below 85% before Christmas but inevitably it has risen since then. There is a big improvement in delayed transfers of care; we need that to continue to happen, and it was welcome that the Secretary of State for local government announced more funding for social care so that we can increase those transfers into social care and free up space in hospitals.

NHS Winter Crisis

Baroness Finlay of Llandaff Excerpts

Monday 5th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her questions. I am glad she had a positive experience this morning at the hospital she mentioned. She is quite right that bed occupancy is very high at the moment. A good job was done in getting it down below 85% across the system in the run-up to Christmas, but of course it has filled up subsequently. An important part of dealing with this is the social care side, as we know, and the extra funding that has gone in is having some impact on these so-called DToCs—delayed transfers of care—and freeing up a number of beds.

The noble Baroness is right of course that money is important, particularly as we have the demands of a growing and ageing population. More money was of course announced in the November Budget for the short term. As for the long term, there is obviously a very informed and lively discussion going on not just among the Liberal Democrats but across the system and across politics about what is the right long-term solution. Obviously, as I have said before, issues of taxation are for the Chancellor and not for me, but I would be delighted to meet her to discuss those plans. What I can say, on behalf of the Secretary of State, is that we understand that there needs to be sustainable, long-term increases in NHS funding. We have to find the right way to do that.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise the concern of the Royal College of Emergency Medicine that the revised way of collecting data by NHS England does not allow meaningful comparisons because it includes walk-in and minor injury units, some of which are off site from the level 1 major emergency departments? Its concern is that this may be giving an overoptimistic impression of throughput and does not reflect the huge pressures on level 1 units. Will the Minister undertake to meet the president of the Royal College of Emergency Medicine with me to discuss some of its concerns?

[Lord O’Shaughnessy]

This is an afternoon of agreeing to meetings—but, yes, I would be delighted to do so. I am not knowledgeable enough about the issue that the noble Baroness mentioned but, while of course there is a huge difference in the kinds of workloads of those different types of A&E, the target incorporates all of them. They all have the obligation to reach the four-hour waiting time standard and we want to make sure that, whatever the situation and whatever the venue, we can do that.

Public Health: Strength and Balance Programme

Baroness Finlay of Llandaff Excerpts

Thursday 18th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I have not seen an extrapolation of the benefits the noble Baroness talks about but they would clearly be significant. There are a number of schemes going on at a local level, which it is important to point out. One of them, which we have discussed before, is the “Dance to Health” programme that started with six pilots two years ago. That is now a nationwide scheme across England and Wales. Local authorities should look at precisely that kind of activity. Public Health England is committed to making sure that local authorities understand the Chief Medical Officer’s targets, so that we see more of these programmes taking place.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest as president of the Chartered Society of Physiotherapy. There is evidence that every £1 spent on physiotherapy can save £1.50 on the cost of a fall along the whole trajectory. There is also evidence that targeted, multifactorial risk assessment of people at particular risk can decrease falls by 60%. Therefore, will the Minister make sure that falls prevention is viewed across the whole of the NHS and not only delegated to local authorities and programmes outside, because that would miss some of the people who are at the highest risk of falls?

[Lord O'Shaughnessy]

I am grateful to the noble Baroness for pointing out the benefits of physiotherapy. She might be aware of a scheme in Middlesbrough that is providing for people who have fallen a precise pathway from physio into community activities involving strength and balance work. As ever, one of the challenges is to make sure that all local authorities know about such programmes and put them in place. They are not necessarily expensive, but they take a bit of time. I will make sure that Public Health England is taking that attitude of spreading good practice across the country.

NHS Winter Crisis

Baroness Finlay of Llandaff Excerpts

Monday 8th January 2018 Lords Chamber

[Lord O’Shaughnessy]

My Lords, I am happy to endorse calls for more funding for the National Health Service. That is precisely what the Chancellor provided in the Budget.

[Baroness Finlay of Llandaff (CB)]

My Lords—

Health: Atrial Fibrillation and Stroke

Baroness Finlay of Llandaff Excerpts

Tuesday 12th December 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is quite right that this is a very easily diagnosable condition through checking pulses. The device that he described and other ones are doing that. They are in every GP surgery and form part of the health checks that the noble Baroness talked about. As I said, I do not have the figures for just how many of those are taking place, but we know that 300,000 people are undiagnosed with this condition. Many of them will be in regular contact with the health service, and this is about making sure that GPs use the opportunity to carry out those tests, which will inform the treatment that follows.

[Baroness Finlay of Llandaff (CB)]

My Lords, could the Government undertake to ascertain from NHS England why the commissioning of day-case ablation for the treatment of atrial fibrillation is way below the European average, given that it is shown to be safe and effective, and to improve symptoms and the rate of return to work? It also almost certainly, although this is not yet completely proven, decreases the incidence of strokes, so it can be a preventive measure.

[Lord O'Shaughnessy]

Yes, I shall certainly write to NHS England to find that out, and I will write to the noble Baroness with that information.

NHS: EEA Doctors

Baroness Finlay of Llandaff Excerpts

Tuesday 12th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I point the noble Lord to the Prime Minister’s letter, in which she talks about the fact that the rights will be written into law as we leave the EU. He is right to point out the position of nurses and midwives; that is the only category where fewer EU staff are working in the National Health Service year on year. However, as we have talked about many times in the House, new language tests may have had a critical role in that and that is something we are reviewing it to make sure that we can continue to welcome nurses from abroad.

[Baroness Finlay of Llandaff (CB)]

Given the current vacancy factor, and the fact that we have some refugees who are doctors and some who are nurses with an enormous amount of clinical experience but whose English language skills need to be improved, what are the Government doing to provide targeted English language training and apprenticeship attachments so that these refugees can enter the workforce and become economic contributors?

[Lord O'Shaughnessy]

This is an excellent idea that the noble Baroness has shared it with me before. We are looking at it and we have a workforce strategy coming out, so I will do my best to ensure that it includes something on this.

Social Care

Baroness Finlay of Llandaff Excerpts

Thursday 7th December 2017 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interests as vice-president of Hospice UK and my role with the Royal College of Emergency Medicine. I will ask the Minister three short questions. Will the voluntary sector be closely involved, given that there is a £1 billion contribution to care from hospices and the voluntary sector, which looked after 212,000 patients last year, providing health and social care that otherwise would have fallen to statutory funders? Secondly, given that falls are the major cause of deterioration in the health of older people, and the lack of social care in preventing falls and in being able to take people out of hospital afterwards, will the Minister assure me that this will look at the flow through hospitals and the requirements of social care provision in an integrated way? Thirdly, while the Minister has mentioned young carers, will he specifically provide assurance that this will also look at child carers, some of whom might be at primary school age? They are often forgotten when people look at the burden on carers because they are, in a way, invisible apart from in the school sector.

[Lord O'Shaughnessy]

I can absolutely provide that reassurance on the voluntary sector. The noble Baroness is quite right to highlight the vital role it plays—it is essential and critical to this sector. On falls, she will know just how important reducing falls is. The disabled facilities grant is increasing. It is not a well-known bit of government spending and not talked about much, but it amounts to about half a billion pounds a year. It can have a really big impact by keeping people in their homes for up to four years longer, reducing falls by 40%. It is something we have had the opportunity to discuss in this House recently. It is critical. She is quite right to focus on the frontier between health and social care and making sure that it flows and works well.

On child carers, I will write with more details about what the action plan covers, but clearly we will make sure that it looks at all carers, because a carer could be of almost any age. As she pointed out, it includes very young children as well as people in their 80s and 90s. A true carers approach would encompass all of them.

Health and Social Care

Baroness Finlay of Llandaff Excerpts

Thursday 12th October 2017 Lords Chamber

[Lord O'Shaughnessy]

There has been a 20-year search for a solution to this problem. It was not me who said that; it was the chief inspector of hospitals, who said:

“I think the one thing I regret is that 15 or 20 years ago when we could see the change in the population the NHS did not change its model of care”.


This is something we have all grappled with, but we have not yet come up with the solution that we need. That is why, through this consultation, we will be looking not just at finance but at quality of care, variation and sustainable staffing to rebuild the consensus that we need to move forward.

[Baroness Finlay of Llandaff (CB)]

Given that the report has pointed out that staff resilience is not inexhaustible and that services are at breaking point, do the Government recognise the enormous contribution of voluntary sector providers, particularly—I declare my interest in the area—in palliative and end-of-life care and hospice services, which are maintaining patients in the community and taking a great deal of pressure off statutory services? Are the Government giving any consideration to a national funding formula, such as I propose in my Access to Palliative Care Bill, which has had its First Reading?

[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.

National Health Service (Mandate Requirements) Regulations 2017

Baroness Finlay of Llandaff Excerpts

Wednesday 6th September 2017 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare all my interests as a clinician. I worry that, if we keep on changing the way that we collect data, we have no way of monitoring what is happening. One thing about the figures as they are at the moment is that they are monitoring process. In addition to that, there must also be monitoring of outcomes—both clinical outcomes and outcomes in terms of the patient experience.

I worry that, if we start saying that the demography has changed and we have an elderly population, it makes it sound as if we are blaming people for living well and living longer, which we must not do. Actually, if people remain well, they are not a drain on the NHS at all. One of the most important predictors of poor outcomes is loneliness. If we have a population of people who are kept relatively well and mobile, they look after each other in communities. Good work on compassionate communities is happening around the UK already.

When we look at this question of targets and what the Government are doing, a worrying message is being sent. The Royal College of Emergency Medicine contacted me yesterday because its members are worried that they will not be able to cope with winter pressures. They are going into the winter with absolutely no wiggle room at all. They are at capacity. There has also been a change in the way that people behave. For an urgent appointment, they go through A&E, so the number of emergency department attendances has gone up as well.

In that group are those people who have been waiting for a time and during that time they have deteriorated. As they have deteriorated, something else has happened and they collapse—a bit like a stack of cards. Multiple problems arise and then those become more complex for the NHS. So it is not as if people are stable during their 18-week wait. If they have a disease that is progressing, they may well be deteriorating. Even worse for them, if the diagnosis in the original referral was wrong, they may need a complete review of their diagnosis. So simply talking about treating them is not correct.

My other concern is this: at what point does the clock start ticking? In some clinical commissioning groups, we are seeing groups being set up to look at the so-called appropriateness of the referral on paper. As a clinician, that worries me greatly, because I do not see how one can assess on paper. I know from many years of looking at referrals coming through on paper that they are only a very rough guide. Too often, I might see a referral that does not sound urgent and the patient in front of me should have been seen yesterday. Another one might sound urgent but actually is not. There is a real worry that, if we fiddle around with when the clock starts to tick, some people who really need to be seen urgently will be in a no-man’s zone before they are even properly referred because there have been delays. We hear about delays in access to primary care as well. The delay in being seen by a GP must be added on to any delays in being referred.

We also need to remember that, when we talk about 10 years ago, medicine has changed enormously. There are a large number of procedures now that, if they are done early, can be done in out-patients or as day cases. The days of needing to be admitted are not there, so that is all the more reason why we should be able to get more patients through more quickly if they are seen earlier.

I have a real worry that, as has been expressed very well by the noble Baroness, Lady Thornton, this flies in the face of reassurances that we were given during the passage of the Health and Social Care Bill through this House. Also, this sends a message to the service out there that, actually, we cannot cope. I worry that it will also disincentivise finding ways of treating people more speedily—as day cases and so forth—which could, with a little more investment, help to address the problem.

[Lord Beecham (Lab)]

My Lords, the impact of the cuts which are being debated tonight—and here I congratulate my noble friend on bringing forward his Motion—are not confined to the health service. They also stretch to social services departments and social care. The most rewarding period of my fairly lengthy political life was as the chairman of social services in Newcastle from 1973 to 1977 when we transformed social care in that city. Much of what we did in those days is now being undone as the result of pressures on the social care budget and a lack of adequate funding for the problems which many of us are becoming increasingly familiar with. What are the Government going to do about that impact of the decision, as it would appear to be, not to adhere to the 18-week period? What estimate have they made, if any, of the impact on social services and social care in a climate where local government budgets are extremely hard pressed? The two things are inseparable. It was a Health and Social Care Bill, now an Act, and we need to look at the social care implications of this extended period because, undoubtedly, it will put increasingly impossible pressure on local authority social services departments and other organisations involved in supporting people in the community.