NHS Dentistry

Baroness Jolly Excerpts

Monday 19th February 2024 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely. That goes back to my noble friend’s point about outcomes. I know that a lot of places, if they are fortunate enough to have an NHS dentist, give you check-ups every six months as a matter of course. In fact, NICE says that if you are in good oral health you will need that only every 24 months, with the idea being that you can create more space for other people to come in, because prevention and screening are vital in all this as well.

[Baroness Jolly (LD)]

My Lords, I live in Cornwall, where there are now very few NHS dentists and many people are resorting to do-it-yourself. What plan does the Department of Health have to ensure that all in Cornwall have access to a dentist as and when needed? A kit is available from the high street for less than £10, but this does not buy any expertise or guarantee of success.

[Lord Markham (Con)]

The noble Baroness is quite correct. Cornwall is one of the areas where we piloted the mobile services. It is probably not the number one area, but it is fair to say that it is one of the main areas where we are putting in more resources for precisely that reason.

In-patient Mental Health Care: Learning Disabilities and Autism

Baroness Jolly Excerpts

Wednesday 13th December 2023 Lords Chamber

[Baroness Jolly (LD)]

My Lords, we have heard two quite outstanding speeches, and I am fairly anxious about putting my toe in the water. Some years ago, I had the privilege to chair a national charity called Hft, founded in 1962 by a group of families with a vision for creating a better life for their relatives who had learning disabilities. They pioneered the idea that everyone could have choices about how they live. They called it Home Farm Trust, and it became known as Hft. This role changed my perspective and understanding of learning disability.

At present, there are around 2,000 learning-disabled adults being held in mental health in-patient units. These individuals are detained under the Mental Health Act, even though they do not have a mental health condition, in a secure hospital setting, often far from their community, and they can be subject to restraint and overmedication. Today, Hft supports more than 2,000 people across England and Wales, from those living independently in their own homes to day-care opportunities from a few hours a week right up to 24 hours a day. For every person it supports, it is committed to working with them to realise their best life possible.

Despite repeated commitments from the Government to transform care and end this practice, they have repeatedly missed their targets over the past 12 years. The latest commitment set out in the NHS long-term plan—to reduce the number of people with learning disabilities and autism in in-patient mental health care by 50% by March 2024—is likely to be missed again. The Government must bring forward a mental health Bill which prevents the inappropriate detention of learning-disabled adults under the Mental Health Act. It was highly distressing that this was not included in the King’s Speech and is not on the Government’s legislative agenda, despite a 2019 manifesto commitment to

“make it easier for people with learning disabilities and autism to be discharged from hospital and improve how they are treated in law”.

Ensuring social care is funded properly, so that everyone can receive the right care, is also critical. This will ensure that everyone who needs social care can receive the right support at the right time, and should prevent admissions to in-patient units.

Social care faces financial challenges, from poor quality and unmet need to low pay and high turnover. Central government grants to local authorities fell by 37% in real terms between 2009-10 and 2019-20, from £41 billion to £26 billion in 2019-20 prices. This results in local authorities with less to spend on adult social care despite demand, and therefore costs remain high. In 2019-20, local authorities had to meet a funding gap of £6.1 billion to meet the cost of care, resulting in £4.1 billion of cuts to adult social care at local authority level.

Ultimately, the impact of financial pressure is felt by those who draw upon and work in the sector. The consequences of this are numerous. It causes unmet need: with funding squeezed, social care is more often being commissioned only for those with the highest needs, leaving those with lower needs without essential support. The number of adults waiting for social care is still incredibly high, estimated at 400,000 people.

There is an impact on the NHS: a lack of suitable social care can affect health services, for example, by delaying discharging people from hospital or not having suitable or any care in the first place leading to admission. According to the Care and Support Alliance, one in seven people have needed hospital treatment due to a lack of care.

The financial pressure also contributes to workforce pressures: 81% of providers reported that local authority fee increases did not cover the rising cost of the national living wage, let alone a higher, more competitive wage. Pay of social care providers is uncompetitive. This is largely due to the fact that, in general, the amount local authorities pay providers to deliver care does not allow for substantial pay increases.

The knock-on impact of this is high vacancy rates, due to the necessary use of expensive agency staff and turning away of admissions due to insufficient staffing. We are aware that the twin impact of funding cuts and the pandemic has had an impact on commissioning trends. We have seen instances where commissioners are using the closure or reduction of day services as a reason not to recommission, consequently saving money.

The importance of the social care workforce cannot be underestimated. For many of the 1.5 million people in the UK with a learning disability, it provides support to ensure they remain healthy, can remain in employment and be an active member of their community. Tackling longstanding recruitment and retention issues within the social care workforce is one of the most fundamental challenges for the sector. It impinges on both the viability of services from a health and safety perspective and can have a huge impact upon the care received by people with a learning disability.

During 2022, the adult social care sector saw an average vacancy rate of 21%. Some 42% of providers saw a decline in the number of applications for care staff in 2022, which saw an average turnover rate for the sector of 25%. The Government have taken several steps to address this, including pledging £500 million to support and develop the social care workforce. While this will fund positive initiatives such as a new knowledge and skills framework and a portable health certificate, it will not address the most pervasive cause of high turnover and vacancy rates, which is uncompetitive pay. When surveyed, providers told us increases in pay would make the biggest difference to workforce challenges. Invaluable social care staff should be paid a wage which remunerates them for their skill and recognises inflationary costs. The increase in the national living wage is therefore a welcome step.

Yet, too often, this is not sufficiently reflected in local authority funding, with 80% of learning disability care providers stating that the fees they receive to deliver care do not cover the increased cost of wages. This requires providers to make up the shortfall, adding to existing financial pressures—such as energy and agency costs—and precluding any ability to pay a higher wage to alleviate the recruitment and retention crisis.

What changes are needed? First, we need a reform package for the social care system to deliver high-quality, person-centred care but which also supports and appropriately remunerates those who work within it. It must provide long-term and sustainable funding for social care. This must factor in a fully funded minimum pay rate for social care to reflect the complex and demanding role the workforce plays, as well as the increased cost of living. The Government must publish a comprehensive social care workforce strategy akin to the NHS workforce plan, co-produced with people who use the service and those who work in social care. The Chancellor is aware of the chronic underinvestment in the social care sector and the required national action to prevent further pressures on the NHS. To support the sector, we should see the introduction of a fully funded minimum pay rate for social care, as recommended by the Migration Advisory Committee and which is already in place in Scotland and Wales. Can the Minister confirm that this is on his wish list too?

NHS: Staff Numbers

Baroness Jolly Excerpts

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is absolutely correct: a workforce plan needs to be backed up with the physical real estate to deliver it. As noble Lords are aware, I am responsible for the new hospitals programme, which is part of that. In primary care, much of the long-term workforce plan is all about getting upstream of the problem in terms of prevention, and clearly we need to make sure that the physical real estate is there to support that. So the next steps will be to make sure that the capital meets the long-term workforce plan.

[Baroness Jolly (LD)]

My Lords, the NHS needs more recruits, but can the Minister tell the House where there are pressing shortages that adversely affect patient care and when he anticipates that the problem will be sorted?

[Lord Markham (Con)]

As I say, the long-term workforce plan puts this on the right footing, going forward. There are big increases in the number of staff, so it is not like we have not been working hard on this area already. By any definition, 63,000 more staff over the last year is a prime example of that. So we are addressing this, but I am not going to pretend to the House that this can be done once, lightly and quickly; it is part of a long-term programme, which the long-term workforce plan is all about.

NHS: Allocation of Financial Resources

Baroness Jolly Excerpts

Thursday 11th May 2023 Lords Chamber

[Lord Markham (Con)]

Numbers out just this morning show that we are now at 75% of people being seen within four hours, so we are close to the 76% target. That is the best since September 2021. I am the first to admit that we want to go further, as the noble Baroness states. It is about making sure we have got the care in the right places. We are triaging to make sure that the most important cases are seen first and, as I mentioned in a previous answer, we have things such as fall services, which can avoid trips to A&E in the first place, and more primary care in place to avoid visits in the first place. That is what the primary care recovery plan is all about.

[Baroness Jolly (LD)]

My Lords, sometimes the NHS is a bit like a greedy child, always needing more. In his Question, my noble friend mentioned additional beds, extra ambulances, and recruitment and training. Will the Minister tell us what budget each of these items comes from? Will the Minister enlighten the House about this issue?

[Lord Markham (Con)]

The budgets are in the allocations for each ICB and each hospital, and within them there are specific allocations to make sure that these fundings are rooted in the place where they have the most effect. As for making sure that really does happen, it is the responsibility of each ICB to make sure it is doing that. Ministers hold them to account by each having seven ICBs to take care of and make sure that they are hitting those targets.

Social Care

Baroness Jolly Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I considered myself fortunate to sit on the Select Committee, most able chaired by the noble Baroness, Lady Andrews, and joined by experts and enthusiasts for the subject, along with brilliant witnesses. A few years ago, I would have had to declare my interest as the chair of a national charity providing services across England for adults with a learning disability. That is where my heart is. I echo the question posed by the noble Baroness, Lady Andrews, to the Minister about the national care plan.

Everyone has a right to the best life possible, and that includes people with learning disabilities, but they face obstacles that are hard to imagine. Their challenges can be complex and certainly lifelong. Even so, with the right care, support and encouragement, everyone with a learning disability can find more enjoyment, comfort and satisfaction in their lives. We saw evidence of this on our several visits. I also met pensioner children: children of our age being cared for by their parents. I met 70 year-olds being cared for by 90 year-olds. They would have had it no other way. I just cannot imagine that.

The Care Act 2014 changed the way that adults in England who require care due to old age, illness or disability receive their support. It replaced most existing legislation on this issue. The Guardian called it

“the most significant change in social care law for 60 years.”

I remind noble Lords that it received its Second Reading in the House of Lords when Jeremy Hunt was Secretary of State. Its authors were Health Ministers Paul Burstow MP and Norman Lamb MP. At its heart was the well-being principle, which established local authorities’ responsibility to safeguard and further the well-being of those under their jurisdiction. It introduced new ways of supporting adult social care. A set of national minimum eligibility criteria was introduced to ensure that people across the country received the same care for the same needs. It rather begs the question of whether local authorities and the CQC ensure that these criteria are being delivered now. That would make a good Oral Question to the Minister; I have put a marker down.

The Care Act 2014 is governed by six principles to safeguard vulnerable adults from harm: empowerment, protection, prevention, proportionality, partnership and accountability. They are as important now as they were nearly 10 years ago, and they are all to be found in the Select Committee’s report, A “Gloriously Ordinary Life”.

Looking back, why did we need the Care Act 2014? Previously, there were lots of different laws on care and support in England, and it was difficult to know what support and care one could get. The Act brought them all together under one new law and determined what type of care people should get. The Act also gives guidance and information for authorities on how to use its provisions appropriately. It gives clear and simple rules and advice on care and support for adults. The Act helps to improve people’s independence and well-being. It aims to protect vulnerable adults from any kind of mistreatment, giving people who need support more control over what happens. Consequently, it has improved their quality of life by keeping them safe and protected.

My noble friend Lady Barker brought up the issue of costs. Alongside that Act was a discussion about paying for care, influenced by Andrew Dilnot, now warden of Nuffield College, who was also a witness to our committee. Back then, he was chairman of the UK Statistics Authority and of the Commission on Funding of Care and Support, which reported in 2011.

The six principles I mentioned that govern the Care Act 2014 to safeguard adults were first introduced by the Department of Health in 2011, and they are embedded in the Act to apply to all health and care settings. It is the law that sets out how adult social care in England should be provided. It requires local authorities to make sure that people who live in their areas receive services that prevent their care needs becoming more serious or delay the impact of their needs.

Disabled adults and older people, as well as unpaid carers, frequently pointed to the vision described by Social Care Future. With the right care, support and encouragement, I believe that everyone with a learning disability can find more enjoyment, comfort and satisfaction in their lives—their glorious lives, as the title to the report realised.

GP Appointments

Baroness Jolly Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. One of the things I am very proud to be leading on the NHS side is our whole digital way of addressing access to the health service. This will be fundamental to how people make their hospital appointments and take control of their own health, so it will be the main thing that will help with the 8 am appointments, alongside the increased telephony services and everything else. Just as every walk of life is coming down to being able, at your fingertips, to make appointments and bookings and get your own records, this will also be the case with GP surgeries and I think it will fundamentally change the way that we address our whole health.

[Baroness Jolly (LD)]

My Lords, part of the problem is where there is no mobile phone signal. People who live or who have homes in Cornwall will identify with that. Does the Minister have any idea what proportion of patients find accessing their GP difficult? What advice has been given to practitioners on resolving the issue? In rural areas such as Cornwall and Northumberland, there are poor bus services, if any. Getting home can mean a really long wait—sometimes half a day if there are only two buses a day. What advice would the Minister give to the GP and to the patient?

[Lord Markham (Con)]

First, my understanding is that the vast majority of homes in Cornwall have broadband, to which your mobile phone will of course connect. That is where people will be making appointments from. They can use digital to do that. Secondly, we are rapidly increasing the number of doctors’ appointments. We made a pledge to increase the number of appointments by 50 million. To date, we have increased them by 36 million—11% up since 2019. So we are making more appointments available. Do we want to do more? Absolutely. Are we going to publish a primary care plan shortly to show how we will address those additional needs? Yes.

Bread and Flour Regulations 1988

Baroness Jolly Excerpts

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

Yes, that is my understanding. One of the aspects that has taken time is getting the devolved Administrations on board and the complications of the Northern Ireland situation with the EU.

[Baroness Jolly (LD)]

My Lords, many countries put folic acid into bread to prevent neural tube defects. When it was added to flours in Australia, the number of these defects reduced by 14%. More folic acid in more bread products could save 800 babies a year in the UK from developing birth defects such as spina bifida. The Minister gave your Lordships positive news, but when can we expect it to bear fruit?

[Lord Markham (Con)]

As mentioned, there is a process that we are going through. As I said in my first Answer, we will be laying the legislation early in 2024, but it is happening. More importantly, in the meantime a lot of the industry are voluntarily adopting it.

NHS Winter Pressures

Baroness Jolly Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

I have said before in this Chamber —and I will say it again—that we should be learning all lessons. I like to think that, three months into my role, I am learning some of those lessons. The noble Baroness will see that we have taken some backwards steps on the use of the independent sector, which, again, was pioneered 15 or 20 years ago, but hopefully we will move forward again. I unashamedly say that we can learn from those things. I have spoken to some colleagues from the noble Baroness’s side of the House, and will continue to, because I will adopt anything that works, and I agree that payment by results is one of those things. We can speak after these questions; my door is definitely open on those matters.

[Baroness Jolly (LD)]

My Lords, I have the privilege to chair the NHS national community nursing plan clinical reference group. We meet on a regular basis and look at how community nurses can keep people out of hospital and get people home from hospital. We have heard very little about that today. Can I have five or 10 minutes with the Minister at some stage to bring him up to speed on the work that is going on?

[Lord Markham (Con)]

As with my answer to the previous question, I look forward to that meeting and learning everything we can. I will repeat the statistics on that subject that struck me most: of those 13,000 people who are fit to be discharged, we think that only 3% need to be in social care in the long term; 97% could be at home, which is the best and most cost-effective place for them. We need to ensure that the support is in place to ensure that that option exists.

NHS Dental Contract

Baroness Jolly Excerpts

Thursday 1st December 2022 Lords Chamber

[Lord Markham (Con)]

I will need to write to give the exact number. From memory, it is not a big number at the moment—less than 10%—but I will confirm that. That is why I was pleased that we agreed the measures the other day, so that we can expand that. Evidence shows that in areas where water is fluoridated—again, I am speaking from memory and I will confirm it in writing—tooth decay declines by as much as 20%, so it does work.

[Baroness Jolly (LD)]

What advice does the Minister give to people in Cornwall for whom the nearest NHS dentist is 50 miles away but there is no public transport from the local town to the practice?

[Lord Markham (Con)]

I am aware of some of the dental deserts. Some 700 urgent care centres have been set up to try to cater for such cases, and they have seen 4 million people. In total, there were about 26 million treatments last year. About 75% of patients who wanted to get an appointment were able to. Clearly, that leaves 25% who were not. We need to work further on that, including in Cornwall.

Polio

Baroness Jolly Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend makes a very important point. Even though a number of countries have been declared polio-free, including the UK because of our high level of polio vaccination, we should be clear that it has been detected and it has derived from someone having had a polio vaccine, probably an oral vaccine—the sugar cube that many of us will remember from our youth, rather than the injection that a person receives now as part of their 6-in-1. That has the potential to spread, and it is why the UKHSA is monitoring it. The important message is to remind everyone: check your red book, check your medical records, check your vaccination record. If you have not been vaccinated against polio or have not had the booster, go to your GP and get it as quickly as possible.

[Baroness Jolly (LD)]

My Lords, what is unusual about these detections is that several positive ones have come from the same sewage facility over a few months. It is worth noting that this kind of polio virus community transmission in London has not been detected since the 1980s. Genomic testing has subsequently revealed that these positive samples are all related, suggesting the virus has been spreading through one or more individuals in London over recent months. Can the Minister give us more detail and tell us what action is being taken by local public health scientists and local authorities? Does the department consider it may be part of a trend? Many noble Lords can remember polio vaccinations—I had a vaccination and then my younger brother had a sugar lump, which I thought was distinctly unfair. Is there a plan to start vaccinations in the area?

[Lord Kamall (Con)]

Vaccination is already part of a national plan. People should be vaccinated at certain ages—I think it is in the first few months, and then in preschool and then at about the age of 14, when they get their booster at school. A couple of things could have happened. Someone may have travelled overseas, had the oral polio vaccine and then excreted it into the system—and it has happened on more than one occasion. On top of that, the important message is: check your records and make sure that you are vaccinated. It is not a matter of trying to get a new vaccine; it is already part of NHS routine. We encourage more people to come forward.