Social Care in England

Baroness Hodgson of Abinger Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Hodgson of Abinger (Con)]

My Lords, I thank the noble Baroness, Lady Pitkeathley, for introducing this vital debate today. With people living ever longer, looking after the elderly and infirm well is critical to the individuals, their families and our communities, ensuring that all receive the care they need and have a dignified and secure old age.

At the party conference last week, the Secretary of State urged people in need of social care to turn to families first and not always to look to the state. As has been said, that is already happening. Mothers look after disabled children, often on their own, and many people need care towards the end of their lives. In 2019, it was reported that, on average, women outlive men by about seven years. However, women often shoulder much of the care of their husbands at home, often without enough back-up and support from local services. Society simply does not recognise the contribution that many women already make in this way.

It is often reported that single people have poorer health and higher mortality rates and that, by the age of 85, over 75% of women who were married are widowed. Left on their own when their husbands die, often with no one to look after them, they then need care themselves. Too often, younger members of the family are working, based too far away to help daily, and may not be able to devote the time needed. These women needing care may then find themselves financially unable to stay in their own home, as the costs of full-time live-in care can exceed those of a care home, and they end up having to sell their home to fund their care. Surely people who want to stay in their own home should be able to.

The Secretary of State, in his speech, went on to talk about how we as citizens have to take responsibility for our health, too—all of which I agree with. Thus, having good and regular health checks is essential, leading to earlier identification of conditions and earlier interventions, which may enable people to stay at home and lead a fuller life for longer.

Of course, the role of the GP in all this is absolutely critical. Last week, there was an article in the Times about a study based on Norwegian health records, published in the British Journal of General Practice. This talked about the benefits of having the same GP for years. In Norway, all residents are assigned a named GP. The study found that, compared with a one-year patient/GP relationship, those who had the same doctor for between two and three years were about 13% less likely to need out-of-hours care, 12% less likely to be admitted to hospital and 8% less likely to die that year. After 15 years, the figures were 30%, 28% and 25%. A senior researcher at the National Centre for Emergency Primary Health Care, part of the NORCE research centre in Bergen, added:

“It can be lifesaving to be treated by a doctor who knows you. If you lose a general practitioner you’ve had for more than 15 years, your risk of needing acute admission to hospital or dying increases considerably the following year.”


Yet the model in the UK seems to be moving away from this. This appears to be detrimental not only to patients but to doctors. Most GPs I know found one of the most satisfying aspects of their job was getting to know their patients and looking after them over many years, but practices in the UK are becoming bigger, with more doctors and patients, and less of a relationship between the two.

Patients over 75 in the UK are also given a named GP, and I would like to ask the Minister exactly what their duties towards these patients should be. I hope he agrees with me that medicine should be patient-focused and not administration-focused. While I understand that patients who wish to be seen urgently cannot always see their named GP that day, should the named GP have contact with patients and their families when requested and provide continuity of care? Please can my noble friend be specific about this?

I hope the House will not mind me speaking from personal experience, because my mother suffered from lack of care from her GP at the end of her life. This was just before the pandemic took place. She had had a marvellous, caring GP for 30 years who retired. In the last six months of her life, she was transferred to a larger local practice. The named GP never came to see her or even spoke to us, even when we requested him. There was a lack of continuity of care; she saw a different doctor every time. Visit requests were refused on two occasions, even when she had fallen, hit her head, was badly bruised and her carers were asking for support; and, on another occasion, when the out-of-hours doctor said she urgently needed to be seen. The only way we got the district nurses to come, two weeks before her death, was because one of her marvellous carers actually knew them and rang them, desperate.

If my mother’s experience is the same as that of others in this situation, surely ensuring that named GPs actually attend their patients would be a good place to start, not least because, according to this Norwegian survey, it would ensure that patients stay healthier for longer and would relieve an enormous burden from the care system.