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?

NHS: General Practitioners

Baroness Manzoor Excerpts

Wednesday 26th February 2014 Lords Chamber

[Earl Howe]

My Lords, the current Government have maintained funding for the National Health Service; that is contrary to the Labour Party manifesto of 2010, which promised to cut funding to the National Health Service.

[Baroness Manzoor (LD)]

My Lords, I am fortunate that I am registered with an excellent GP practice which is well run, accessible and innovative. Over the last 30 years, I have seen significant improvements, and not only in the range of services that the practice provides. Who is responsible for ensuring that GPs are learning from other GPs the excellent practices which are available across the country?

[Earl Howe]

My Lords, there is a variety of means to ensure that GPs have continuous professional development. It is partly up to Health Education England to see that that happens and that there is peer-to-peer learning and review. Clinical commissioning groups also have an interest in ensuring that the quality of service provided by every member practice is of an equally high standard.

NHS: Black and Minority Ethnic Nursing Directors

Baroness Manzoor Excerpts

Monday 10th February 2014 Lords Chamber

[Earl Howe]

My Lords, I have already mentioned some of the initiatives that are in train. However, I can tell my noble friend that, within the NHS Leadership Academy, there are two programmes specifically for nurses and midwives that map to foundation, mid and executive level leadership development. There is the front-line leadership programme which is for staff who have leadership responsibilities—for example, ward sisters and nurses working in primary care. We expect 6,000 nurses and midwives to participate in that programme in the first year. There is also the senior operational leaders programme which provides senior nursing clinicians with an opportunity to enhance their leadership skills.

[Baroness Manzoor (LD)]

My Lords, a web audit found that only 80 NHS trusts publish annual staff data broken down by ethnicity. Will the Minister reassure the House that all NHS trusts meet their legal obligations under the Race Relations Act and that all workforce issues faced by black and minority ethnic staff are identified?

[Earl Howe]

My noble friend raises a crucial issue about transparency. I can assure her that this is squarely within the sights of the Chief Nursing Officer and her advisory group.

NHS: Seven-day Working

Baroness Manzoor Excerpts

Thursday 6th February 2014 Lords Chamber

[Baroness Manzoor (LD)]

My Lords, I, too, thank the noble Lord, Lord Ribeiro, for securing this debate. As other noble Lords have stated, the variation in outcomes and patient experience for patients admitted as emergencies at the weekend is evidenced in higher readmission rates, higher mortality rates, poorer patient experience and an increased length of hospital stays, while the availability of diagnostics such as imaging can be 40% lower. These facts are, on the whole, not in dispute so it is not my intention to mention the many excellent surveys and reports which evidence them. However, it would be remiss of me not to restate the importance of the report commissioned by NHS London in 2011, which concluded that increasing consultant cover in acute medical and surgical units at the weekends could prevent more than 500 deaths a year in London alone. The evidence clearly demonstrates the need for the NHS to take action.

Like other noble Lords, I applaud Sir Bruce Keogh’s report and its conclusions, except that it is rather disappointing that it took nearly a year to produce. I would like to hear what the Government are doing to ensure that the pace of change is rapid and that the report’s implementation programme is given greater priority. Quite rightly, there is much emphasis by the Government and NHS England on clinical outcomes and reducing inequalities in care, but NHS England will not deliver on its mandate should the current status of health services prevail at weekends.

While the £3.8 billion Better Care Fund which the Government have made available, pooled with local government, is also welcome, NHS England has yet to demonstrate how clinical commissioning groups are addressing the need for services at weekends and what support CCGs are giving to local authorities which support patients being discharged from hospitals and prevent unnecessary admission to hospitals, particularly as CCGs spend three-quarters of the £98 billion NHS budget. Indeed, I find it difficult to understand how the regulator, the Care Quality Commission, could have judged any hospital to be outstanding when such inequalities in care and service have existed in the NHS and been evidenced as such for at least the past 12 years. Perhaps the Minister can reassure the House that regulators will not be awarding outstanding status until a hospital is deemed to have improved its record of safety and patient care for patients at the weekend.

NHS England should also demonstrate how, as the commissioner of primary services, it is ensuring that it addresses and improves the variable quality offered by general practitioners. Although an optimist, I remain concerned by the slow pace of change. On the current evidence, NHS England cannot deliver on its mandate, and Public Health England will fail to close the inequality gap in social provision for some of the most vulnerable in our society, such as the elderly and people who need access to mental health services at the weekend. This is mainly because there is an absence or limited availability of consistent support services such as diagnostics, and a lack of community and primary care services which, if available, could prevent some unnecessary admissions and support the timely discharge of patients. It remains, as has been said, difficult to get routine blood tests, X-rays, MRI scans, pharmacy, physiotherapy and social services at weekends. Of course, I have already mentioned the variable out-of-hours primary care.

Sir Bruce is quite right when he advocates a whole-system approach to improve the current, unacceptable standards being offered in the NHS at the weekends. However, although I do not support yet another reorganisation of the NHS, with tight finance restraints, the Government may need to think further about simplifying the current and complex NHS system. They will also need to consider how budgets are shared and pooled between organisations, including with local authorities, and who will lead on this. The NHS is a great institution, and it is our duty to make it fit for the 21st century.