NHS: Funding

Baroness Manzoor Excerpts

Monday 17th November 2014 Lords Chamber

[Earl Howe]

My Lords, I cannot speak for a party other than my own, but I can tell the noble Lord firmly that we are averse to any system of charging and wish to keep the NHS free at the point of use, regardless of ability to pay.

[Baroness Manzoor (LD)]

My Lords, the NHS five-year review clearly highlighted that there was a need to upgrade preventive and public health services. Can my noble friend the Minister say how this will be done, particularly when you go back to the 2011 WHO agreement on 25 goals, under which 25% of deaths have to be reduced by 2025?

[Earl Howe]

My noble friend is right to highlight the role of public health. That is why many people are encouraged that health and well-being boards, which now oversee the planning and prioritisation of healthcare in their local areas, are taking those public health goals into account and building them into the strategic health assessments. So the co-ordination of healthcare and public health is in a much better position than it was before the reforms.

Mental Health: Beds

Baroness Manzoor Excerpts

Tuesday 29th July 2014 Lords Chamber

[Earl Howe]

My Lords, if people with a learning disability are detained under the Act, this must be for assessment or treatment of mental illness. The person must satisfy the strict criteria laid down in the 1983 Act. When a learning disability is identified as well as a need for assessment or treatment of a mental disorder, the important thing is that alternatives to the use of the Mental Health Act are considered—for example, use of the provisions of the Mental Capacity Act and whether reasonable adjustments would assist the person with learning disabilities fully to access the assessment and treatment. This is an area we have explicitly covered in the draft code of practice, which is currently out for consultation.

[Baroness Manzoor (LD)]

My Lords, more black and ethnic minority people continue to be detained under the Mental Health Act. Can my noble friend the Minister say what is being done to address that issue?

[Earl Howe]

Yes, my Lords, we know that BME groups are overrepresented in the detained patient population. The reasons for that are quite complex. Research studies indicate that rates of detention reflect the needs of patients at the time of detention. We know that the rates of psychosis, for example, are higher in some BME communities, and they often access mental health services in a crisis. The reasons for that are not entirely clear. We recognise that more work needs to be done to establish the causes of higher rates of mental illness in some communities.

Health: Midwives

Baroness Manzoor Excerpts

Tuesday 22nd July 2014 Lords Chamber

[Earl Howe]

My Lords, we attach great importance to choice in maternity care and, in particular, to each mother having a named midwife throughout the care pathway. That is what we are aiming at and what NHS England and Health Education England are charged with delivering. As regards the age profile of midwives, my advice is that there is not a particular age bulge, although we are keen to ensure that we do not lose qualified midwives who, clearly, we can ill afford to lose. However, we have made a commitment to ensure that the number of midwives in training is matched to the birth rate and, so far at least, we have been successful in that.

[Baroness Manzoor (LD)]

My Lords, continuity in care is very important, particularly when you consider that one in 10 women suffers from postnatal depression, and that number increases to four in 10 for teenage mothers. Can my noble friend reassure the House that, first, there is good identification of health needs for mothers during the prenatal stage; and, secondly, that there is one-to-one care during labour and postnatal so that these women are helped and supported?

[Earl Howe]

My noble friend makes two important points. As I said, we attach great importance to each mother being able to have throughout the care pathway a named midwife. Improving diagnosis and services for women with pregnancy-related mental health problems is one of our objectives for maternity care. The mandate from the Government to NHS England includes an objective for NHS England to work with partner organisations to reduce the incidence and impact of postnatal depression through earlier diagnosis and better intervention and support. We are clear that midwives have a key role to play in that.

NHS: District Nurses

Baroness Manzoor Excerpts

Thursday 10th July 2014 Lords Chamber

[Earl Howe]

I am happy to look into that case, but clearly we need to ensure that there are the right skills for the right patients, and this is what the health service increasingly aims to achieve. The district nursing team has to contain those multidisciplinary skills. If there is a case of someone being inappropriately looked after, then that is certainly a cause for concern.

[Baroness Manzoor (LD)]

My Lords, nearly 50% of district nurses are over the age of 50. I heard what the Minister said regarding the number of nurses in training but perhaps the numbers could be looked at again, because quite a number of district nurses will soon be retiring.

[Earl Howe]

My noble friend makes a good point, and this was highlighted by the royal college. Health Education England was established precisely to ensure a greater connection between the needs and demands of local employers and the education and training commissions which are made. It takes into account all the relevant variables, such as the age profile of the workforce, to ensure that it sets the appropriate number of training places for district nurses to meet future capacity and capability service needs. As I mentioned earlier, Health Education England has in fact increased the number of training places for district nurses by 7% this year, to 431 places.

NHS: Hospital Waiting Times

Baroness Manzoor Excerpts

Thursday 10th July 2014 Lords Chamber

[Baroness Manzoor (LD)]

My Lords, the Government have stated that there is to be parity of esteem between mental health services and acute services. Will my noble friend the Minister state whether this will include waiting times for the provision of mental health services to both adults and children?

[Earl Howe]

Up to now, mental health has been omitted from the waiting time standards. However, we are looking actively at what might be possible within the bounds of affordability.

National Health Service: Nursing Staff

Baroness Manzoor Excerpts

Monday 16th June 2014 Lords Chamber

[Earl Howe]

My Lords, I do not agree with that because nursing numbers are now at a record high, which cannot indicate that hospitals are being starved of resources for their nurses. I do not see it as ironic that some senior posts have been reduced, bearing in mind the effect of Robert Francis’s report which has caused hospitals to increase the number of nurses on the wards. By and large, nurses at grades 7, 8 and 9 are in managerial positions and not in front-line posts.

[Baroness Manzoor (LD)]

My Lords, can the Minister say if an impact assessment has been undertaken on losing senior nurses from the NHS and the impact it has on service standards? The noble Lord, Lord Hunt, has already made the connection with the Francis report. Can the Minister also say whether an exit strategy has been undertaken to see why senior nurses are leaving?

[Earl Howe]

My general answer to my noble friend is that it is not for the Government to decide how many nurses hospitals should employ. We have not done an impact assessment. That is a matter for local hospitals to judge. They are in the best position to do that, based on the needs of their patients and local communities. What the Government should do, and are doing, is to ensure that staffing levels are available for public scrutiny and comparison on a patient safety website. That work is currently in train. It will now be much more evident to patients and the public what their local hospital is doing in terms of safe staffing ratios.

National Health Service: Nursing Staff

Baroness Manzoor Excerpts

Monday 12th May 2014 Lords Chamber

[Earl Howe]

The guidance issued today by NICE on staffing ratios, to which I think the right reverend Prelate is specifically referring, is in draft, but the deputy chief executive of NICE has stressed that there are no floor or ceiling numbers on the required number of nursing staff that can be applied either across the whole of the NHS or in a particular ward setting. What the profession is seeking, and what NICE is looking to give it, is a reference tool or guideline that will enable it to judge correct staffing levels in accordance with the particular circumstances of a ward and the skill mix of the staff on that ward. It is a guideline rather than a mandatory prescription.

[Baroness Manzoor (LD)]

My Lords, my question relates to specialist nurses. NICE has issued guidelines in relation to TB, and I am delighted to see that Public Health England has also issued a strategy on TB, making it a key component. However, there are variations in the number of TB nurses within trusts. How are the Government and NHS England going to adhere to the ratios that have been advocated by NICE?

[Earl Howe]

My Lords, as regards specialist nurses, the Government have supported the development of a range of specialist roles within the profession. In the end it is for local NHS organisations, with their knowledge of the needs of the local population, to invest in training for specialist skills and to deploy specialist nurses. We recognise that more could be done by some local healthcare organisations in this area, and Health Education England is able to support employers with continuing personal and professional development—but within clear limits. The planning process has created an opportunity for employers, through the LETBs—local education and training boards—to prioritise investment in this area.

Health: Liver Disease

Baroness Manzoor Excerpts

Tuesday 6th May 2014 Lords Chamber

[Noble Lords]

My Lords—

[Baroness Manzoor (LD)]

My Lords, the incidence of liver cancer and liver disease is increasing significantly in young people, and it is the only cancer that continues to increase. Can my noble friend state whether there is a high-profile health education strategy that will help to tackle alcohol abuse and raise awareness among young people, who now talk about getting “preloaded” before they go out to drink alcohol, and which will highlight the issue of obesity? We need a high-profile health education campaign in that area.

[Earl Howe]

My Lords, as my noble friend knows, there is of course scope to include alcohol awareness in relevant lessons in secondary schools. However, I take my noble friend’s point. I am encouraged by recent figures which show a drop in binge drinking, but that is no cause for complacency. It still takes place, and too many young people end up in specialist care and sometimes lose their lives. That is very much on Public Health England’s radar.

NHS: Midwives

Baroness Manzoor Excerpts

Monday 17th March 2014 Lords Chamber

[Earl Howe]

I thank the noble Earl for bringing the example of the Chelsea and Westminster to my attention. I am sure it is a model of good practice, as I know how good that hospital is. With regard to supervision, the noble Earl is right. This bears upon the whole question of midwife numbers, to ensure that we have enough midwives not only looking after women about to give birth and giving birth, but also to ensure good practice in our hospitals and midwifery units.

[Baroness Manzoor (LD)]

My Lords, I congratulate the coalition Government on two facts. One is that there are many more midwives than there were in 2010. The second, as my noble friend says, is that there are 6,000 more student midwives in training. There is, however, an issue regarding the attrition rates of student midwives leaving before the end of their three-year training. Can my noble friend state what the Government are doing to understand why the attrition rate is as high as one in four students leaving, and whether this information is being collected by exit surveys?

[Earl Howe]

My noble friend is right to draw attention to the attrition rate. NHS England is focusing on this very closely. It is not always possible to predict the attrition rate because midwives leave practice for varying reasons—for instance, to take a career break. It is, however, very important that the motivation of midwives should be maintained. There is a great deal of work going on to ensure that we do not lose highly qualified and skilled midwives from the NHS.

Health: Midwives

Baroness Manzoor Excerpts

Wednesday 5th March 2014 Lords Chamber

[Earl Howe]

Yes, my Lords, that would be a very simple solution but it was rejected by Independent Midwives UK when it was put to it.

[Baroness Manzoor (LD)]

My Lords, the Royal College of Midwives says that there is a shortage of 4,800 midwives —a welcome drop from the 6,000 in recent times. However, this shortage and the shortage of obstetricians are resulting in variations in maternity services and in standards of care among trusts. What is the Government’s strategy to address these concerns?