NHS: Primary and Community Services

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Monday 7th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not sure we could go so far as to say that one should always have their agreement—sometimes, discharges from hospital are incredibly complex and difficult—but there is no doubt, arising from the Carers UK report, that where there is proper communication with carers, the discharge procedure is much better for everyone, from the point of view of the carer, the patient and the hospital. If proper arrangements are not put in place, delays arise long after the patient should have been discharged home. It could be to do, for example, with a care package or altering the patient’s home.

[Baroness Howarth of Breckland (CB)]

My Lords, I have recently become a carer myself and therefore have experience of a number of hospitals. Why is there such a postcode lottery in terms of where one finds oneself? West Suffolk Hospital, where my partner found herself, has given excellent service and—we must not run it all down—we have had fantastic aftercare in that area, whereas the London hospital does not even answer the telephone. Why is there such a difference? She was also in a mixed ward, the use of which I thought had already stopped.

[Lord Prior of Brampton]

My Lords, I am surprised that the noble Baroness’s friend was in a mixed ward because their use is supposed to have stopped unless there is an absolute emergency when only one bed is free. Unless there were exceptional circumstances, it is very disappointing to hear that that happened. Perhaps the noble Baroness would like to write to me about it. On her first point, there is variation in pretty much every aspect of health and social care around the country, which is inevitable. To some extent, it is not a bad thing, because it drives up standards if those who are not delivering great care can see how best it can be done. The STP process is designed to build in best practice, but I am afraid that a degree of variation is inevitable.

Dental Health: Children

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

I am afraid that I cannot answer that question as I simply do not have the knowledge. I will research it and write to my noble friend.

[Baroness Howarth of Breckland (CB)]

My Lords, this used to be picked up through schools and nurseries, where most children are seen. What happens now in education establishments, particularly academies, where children’s teeth are found to be poor and action needs to be taken?

[Lord Prior of Brampton]

Schools clearly have an important role to play. Interestingly, in Bradford the Building Brighter Smiles programme involves not just a community-based fluoride varnishing application but also supervised tooth-brushing in schools and nurseries. I am sure that that has a very important role to play.

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

I do not know how long a judicial review will take. I guess that it will be months rather than years, but I simply cannot answer that question as I do not know the answer to it. Again, this is a legal issue, not an efficacy issue. This is a question not of the Government saying that we do not want to fund this prophylactic, but of NHS England simply saying that it has been advised it does not have the power to do so.

[Baroness Howarth of Breckland (CB)]

My Lords, can I ask a simple social question? If there are to be trials, how will the decision be made as to who gets into a trial and who gets left out, as that could be a matter of life and death for some HIV sufferers?

[Lord Prior of Brampton]

My Lords, NHS England and PHE are consulting on how those trials should be constructed. Clearly, they will be focused on high-risk individuals but choosing who goes on to the trial will be up to PHE and NHS England.

Health: Neural Tube Defects

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Monday 21st March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the evidence given by the SACN is that it affects between 15% and 30%. My honourable friend in the other House, Jane Ellison, is bringing together a round table of all stakeholders interested in preconception health to discuss this matter.

[Baroness Howarth of Breckland (CB)]

My Lords, does the Minister think that the resistance to this is in the general public or among the food producers? My discussions with many young women across the country do not give me the impression that it is among the general public. If it is among the food producers, of course they would be resistant if it does not benefit their profits. Where does the Minister think that attitude is, and can he advise us where we should put our energies in order to change it?

[Lord Prior of Brampton]

My Lords, I am not aware that the food industry is opposing the introduction of folic acid into white bread flour, but I will investigate that and write to the noble Baroness.

Accident and Emergency Services: Staffing

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Lord will know that we are consulting on the proposals to remove bursaries and replace them with student loans. All the indications are that this will enable us to increase the number of nurses because the current system means that many young men and women who wish to become nurses are not able to do so. I think that three out of four people who apply are not able to get on the right courses. We hope that the new system will increase the number of nurses available to the NHS.

[Baroness Howarth of Breckland (CB)]

My Lords, will the Minister tell me why, when they are qualified, it is safe for young nurses to do five 12-hour night shifts on the trot when we would not allow lorry drivers to do five 12-hour nights on the trot?

Social Care and Support: Funding

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

What we are saying is that we have to fundamentally transform the health and social care sector so that it is fit for the kinds of patients living in today’s society, not those living in, frankly, 1948.

[Baroness Howarth of Breckland (CB)]

My Lords, it seems an extraordinarily unreal situation—the present circumstances that people find themselves in. Day after day, as the noble Baroness, Lady Pitkeathley, pointed out, we hear about people having their hours cut, people finding that they no longer have carers and local authorities having huge cuts in their budgets. What is the Government’s plan if we do not get the settlement that we need from the spending review?

[Lord Prior of Brampton]

I am afraid that I can only repeat what I said earlier: our plan is for health and social care to become more integrated and for more budgets to be pooled, and that by doing so we can transform the care we deliver to the very vulnerable people in our society.

NHS: Mental Health Patient Assessment Needs

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Monday 12th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think spreading best practice is a perennial problem in the NHS. The noble Baroness gave an example of that but I could give many, many others: we are not good in the NHS at spreading best practice. I hope that the newly reformed combination of the TDA and Monitor into NHS Improvement will be a very useful repository of good practice, in the same way as the IHI is in the USA.

[Baroness Howarth of Breckland (CB)]

My Lords, I find that reply singularly disappointing, as the Minister will know that any child exhibiting the kinds of problems that have been described today could be seriously ill—they could have a brain tumour or hydrocephalus. In addition, he also knows that the availability of good mental health services for young people, adolescents and those in their 20s is in serious difficulty at the moment. What are the Government doing to ensure that NHS England is improving these services and making a real effort so that we do not have cases such as this, for I am sure that it is not an isolated incident?

[Lord Prior of Brampton]

In picking up the general point that the noble Baroness made, the Government have committed a great deal of extra resource to the mental health needs of young people. For example, I cite the NHS mandate and the Health and Social Care Act 2012, in which there is a duty to establish parity of esteem between mental health and physical health. It is also true that one can never do enough, and when one hears about a tragic case such as that described by my noble friend earlier, one has to look very carefully in the mirror and ask whether one could do more. That is why I have offered to meet my noble friend outside this House to discuss the matter in more detail.

Health Funding

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, prevention is very important to the Government and a very important part of the NHS Five Year Forward View. The reduction of £200 million in the grant to local authorities should be seen in the context of a total grant of £3.2 billion; it is a 6% reduction. Public Health England has a campaign to raise awareness of the damage that sugar and salt, as well as smoking and alcohol, can do to people’s lives.

[Baroness Howarth of Breckland (CB)]

My Lords, if the noble Lord takes into consideration not only the cuts to this budget but those to other local authority budgets, he will see that this will mean a reduction in youth services, the closure of young people’s centres and a range of preventive services for children being reduced. Will that not have a cumulative effect on the general health of the nation, and certainly on the protection of children?

[Lord Prior of Brampton]

My Lords, the NHS is facing a challenge over the next five years to achieve productivity savings of some £22 billion. If we wish to have a sustainable, tax-funded health service in the long term, we have to make these savings. I have no doubt that over this time this will cause difficulties, but, again, it has to be seen in the context that we have a national debt of more than £1 trillion and a public sector borrowing requirement that must come down.

NHS: GP Clinics

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Thursday 25th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness makes a good point. The old model, based largely around partners, often in small practices, is the one that I think will evolve over the next five years. We will certainly see many more salaried GPs coming into the workforce. The fact that there are now many more women doctors, who will wish to take time out to look after their children or for maternity leave and the like, means that the structure of general practice will change fundamentally. It may also mean more locums. I do not have a view on that particular aspect of the noble Baroness’s question.

[Baroness Howarth of Breckland (CB)]

My Lords, if the Minister believes that we have had the same model since 1948, what was the House doing taking through during the last Session the health legislation that changed the structure so that the business model was around GP practices? Many GPs find that extremely onerous. They want to be doctors, not business managers. There has been significant change and not necessarily for the better. Would the Minister not agree?

[Lord Prior of Brampton]

The noble Baroness—

Mental Health Services: Young People

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Tuesday 23rd June 2015 Lords Chamber

[Lord Prior of Brampton]

I thank the right reverend Prelate for his question. I am not aware of the Bill to which he refers. I hope he will excuse me for that; I will find out about it after today. The right reverend Prelate asked whether we will work with other parts of the Government, particularly the Department for Education. I assure him that we are doing so.

[Baroness Howarth of Breckland (CB)]

My Lords, I welcome the Government’s prevalence survey. However, does the Minister’s department have any idea at this time of the length of waiting lists and the number of children waiting for very specialist intervention from psychiatrists and psychologists? I hear from groups of people that the waiting lists are growing and the time children spend waiting is getting longer. For a child with a mental health problem, every day makes it worse. What are the Government doing about that? Does the Minister have the numbers?

[Lord Prior of Brampton]

I do not have the numbers to hand, but I can tell the noble Baroness that the number of beds that have been commissioned has increased significantly over the last three years and I think 1,250 tier-1 beds are now available. The noble Baroness puts her finger on it: the way we provide treatment for people suffering from mental health conditions—and have done for many years—falls far short of what we would expect for people suffering from equivalent physical conditions. We often talk about parity of esteem quite glibly, without putting the necessary resources behind it. The Government are determined to do so.

General Practitioners

Debate between Baroness Howarth of Breckland and Lord Prior of Brampton

Monday 22nd June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness speaks a good deal of truth. The model that we have been working with since 1948 in this country is largely broken. We have to deliver more care through vertically integrated units of care, not just independent hospitals. Over the next five to 10 years we will see a huge consolidation of primary care. The old cottage industry model of general practice is probably broken. The Five Year Forward View recognises that and the Government have committed £8 billion to see that forward view put into practice.

[Baroness Howarth of Breckland (CB)]

My Lords, I do not know where the Minister spends his time, but where I come from, in the country, you have to travel 18 miles to a hospital or a GP practice at the weekend. That is very difficult when you have groups of elderly people. In the rest of the country—even in the city where I spend my city time—GPs are now saying that practices are to be closed and people are waiting three weeks for an ordinary assessment. Can the Minister tell us why the Government are not seeing what is happening on the ground and taking more urgent action?

[Lord Prior of Brampton]

The Government are committed to seeing 5,000 new GPs. This is probably the biggest expansion of primary care that we have seen for many years. It is not just 5,000 GPs but a further 5,000 people working in primary care, including physician associates, practice nurses, physiotherapists and other allied health professionals.