Primary and Community Care: Improving Patient Outcomes

Baroness Masham of Ilton Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank my noble friend Lord Patel for this necessary debate, and I declare an interest. In November 1981, I was given an honorary fellowship award by the Royal College of General Practitioners, and I have been and am a user of the NHS, being a high-lesion paraplegic. I ask the Minister: how is the NHS going to be improved without an adequate workforce?

We have a growing elderly population, with many complex conditions, who need treating. I am absolutely perplexed that many well-qualified students with many A and A* exam results, and who would like to study medicine, are being turned away by universities because the universities do not have an adequate number of places or because they are too expensive to train. This seems ludicrous when there is such a shortage of GPs and specialist consultants. This is a frustrating situation. What can the Government do to rectify it? Should we not try to be self-sufficient for the future years by training our enthusiastic young people, not training just half of what we need? We must invest in our future.

I bring to the notice of your Lordships and the Minister the situation of sick notes. It seems to be a difficulty for small businesses when an employee goes off sick and keeps getting repeat sick notes. Because of confidentiality, an employer cannot get advice from the GP. Are these repeat sick notes being given over the telephone, and for how long can they keep coming? Since the coronavirus epidemic, many GPs prefer telephone calls to face-to-face visits to surgeries. Small businesses need advice, as they have to put in staff to cover the absent staff who are off sick. At this difficult time, it may be the last straw which breaks the camel’s back.

Bed-blocking is well known and seems to be getting worse. This is not the fault of patients but it is very serious. Ambulances are being held up by multiple patients needing beds and waiting to get entrance to hospital. One of the main problems is that many elderly people have serious falls and cannot leave hospital until there is a care package in place at home so that it is safe for their return, otherwise they will be back in hospital. There is a desperate need for carers and a community team of physiotherapists, occupational therapists and speech therapists for patients who need to be safe at home. This does not come cheap. More funds are needed in both home care and hospital. It is no good robbing Peter to pay Paul; we need both.

My noble friend Lord Patel is asking for a House of Lords Committee on this important matter. It cannot wait: something should be in place before winter sets in. Whatever is set up needs to start the moment Parliament returns in October.

I end by saying that dentistry in the NHS is in crisis. Something must be done to save many people from agony and frustration. Dentistry has not caught up after the Covid epidemic. I have every sympathy with anyone who has toothache from an abscess, having had one myself last week. The conclusion is that reform of the dysfunctional NHS dental contract is now a matter of urgency. A reformed service will not work if there is no workforce left by the time it is finally introduced.