Health and Social Care

Baroness Masham of Ilton Excerpts

Thursday 24th November 2016 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank and congratulate my noble friend Lady Finlay of Llandaff on securing this very important debate. I hope it will highlight the essential need to be able to fill some of the gaps in our NHS and social care workforce with people who come from Europe and elsewhere. There are gaps too in the private sector, and disabled and elderly people living in the community in their own homes are also having difficulties. As it is now, with the extreme demands on the services to fill the gaps, if we are more restricted, it will be a total disaster.

Nobody knows when they or their families will need the NHS. It can be the vital lifeline in an accident or serious illness. Since the campaign and the referendum, there has been an increase in horrible incidents involving people who seem not to be British or who support the EU. The tragic murder of Jo Cox MP has shocked the world, as has the murder of a Polish man. Given the uncertainty of what will happen when we leave the EU, recruitment has already become more difficult for the health and social care workforce. If people who want to come to work in the UK feel they are not wanted and are not safe, they will go elsewhere. There are plenty of other countries in Europe which need them apart from us. It is of great concern to hear that the Commons Health Select Committee has criticised some hospital trusts for allowing poor performance to “become the norm” in A&E departments because of the lack of staff. The NHS faces a winter predicted to be more difficult than the last. What preparations are being made for this crisis?

More than 55,000 EU nationals work as doctors and nurses in the health service, which would collapse without them. Companies that recruit abroad on behalf of NHS trusts are full of anxiety. TFS Healthcare, which recruits nurses for UK hospitals from Spain, Portugal, Romania, Poland and Italy, is already seeing the impact of the Brexit vote. A lot of nurses from these countries have now been put off coming to the UK. The managing director says that even more concerning is that nurses already placed in UK hospitals are seriously considering leaving as they no longer feel wanted or welcomed. The BMA has warned that the boost in home-grown doctor numbers will go only part of the way to addressing the NHS recruitment crisis.

I cannot stress enough how serious the problem is becoming because of the escalating costs of agencies. Those who work for agencies charge so much that people with disabilities living in the community find it difficult to fund their care, and local authorities find it difficult to fund care for the people they support. As a result of cuts and growing costs, social services have reached crisis point. With society getting older, people having complex conditions, and NHS and care staff also getting older and retiring, we need young, fit, honest people, and we should welcome them coming from abroad to fill shortages in our NHS workforce.

There are exciting advances in personalised treatment across the world. The UK is among the leaders in the field in Europe, and it is important that people in Europe do research work together and share data. If we lose our place in Europe, it would be everyone’s loss. In research, everyone should work in co-operation with the universities to drive innovation forward. What will happen when we lose the grants from the EU? Will other grants be available? Perhaps the Minister can answer that.

Many people in the healthcare system fear that the UK’s decision to leave the EU could result in the repeal of various regulations, including many implemented through directives designed to protect the rights of workers. Regulations also need to be correct for the safety of patients. The Medicines and Healthcare Products Regulatory Agency, the MHRA, has been very important to both the UK and Europe; whatever happens due to Brexit, I hope it will continue to play an important part in their work.

I hope the Government realise that morale among the healthcare profession is at an all-time low due to the many pressures on it. I hope this debate may make decision-makers realise that more support is vital, and that the NHS and social services must have the workforce they need to make it a safe and thriving service.

Hospitals: Unsafe Discharge

Baroness Masham of Ilton Excerpts

Wednesday 9th November 2016 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank the noble Baroness, Lady Wheeler, for bringing this most worrying matter before your Lordships today. The Parliamentary and Health Service Ombudsman’s report and its follow-up should be acted on by everyone responsible for the NHS and, by Members of Parliament who are responsible for helping their constituents, as well as by voluntary organisations and the public. Unsafe discharge from hospital can happen throughout the country. Pressure on most hospitals throughout the country has reached a tipping point. Better communication throughout the NHS is absolutely vital.

I want to bring to your Lordships’ attention the case of Mrs F, one of the cases illustrated in the report:

“A woman in her 80s was discharged from hospital to an empty house, in a confused state with a catheter still inserted”.

She had been,

“admitted to hospital with a urinary infection. She was seen by a consultant who decided she should stay in hospital for three days so that the infection could be treated and staff could monitor her. Despite this, and for reasons that are unclear, Mrs F was discharged later the same day to an empty home and in a confused state. She had been given no medication and still had a catheter inserted”.

A neighbour,

“contacted the ward sister at the hospital who said that Mrs F should not have been discharged”.

The report concluded that:

“It was wrong to discharge Mrs F against the consultant’s instructions. There was nothing in Mrs F’s medical notes to explain why the consultant’s instructions had been changed or who had changed them. This went against recognised standards about record keeping. The hospital accepted that Mrs F’s discharge was inappropriate, and that there was no documentation about the discharge or who arranged or authorised it. However, it failed to get to the bottom of what had happened”.

Is this not a clear example of a cover-up? I wonder how many such cases across the country never come to the notice of the ombudsman.

I must mention the unsafe discharge from hospital of people apart from the elderly. A baby died after being sent home from hospital with paracetamol when he had meningitis. His mother said:

“To lose your child to an illness that is both preventable and treatable is a tragedy. By sharing our story we hope to save lives in the future as people become more aware of the symptoms and of the impact this horrible disease can have”.

Another baby was sent home from a hospital department which had a warning poster about meningitis but the mother was told the baby had gastroenteritis. A schoolgirl of 16 was sent home from A&E after being told she had a migraine. She later returned to hospital with a rash but died. Waiting for a rash can be fatal. I wonder how many people have died in the past year from meningitis and sepsis due to misdiagnosis.

I have a friend whose son became mentally ill at the age of 18. He went berserk one afternoon, brandishing an air gun. As the situation was out of control, the police were called. They took him to Northallerton, where it was realised that he was seriously mentally ill. He was admitted to the local hospital’s one ward for mentally ill patients and was later transferred to a more secure ward at Middlesbrough, where he remained for six months. The consultant then told his parents that he could be discharged home. They said that they would not be able to cope, and they feared for his safety and that of the community. He was then sent to the first hospital, where the consultant told the parents that it would have been a disaster if he had been sent straight home. How many unsafe discharges of mentally ill patients will there be when the pressure on beds becomes insurmountable, with no slack in the system?

With the elderly population increasing and with complex conditions, the local population in North Yorkshire are dismayed at the closure of the Lambert Memorial Hospital in Thirsk. This hospital has taken the pressure off the local district hospital when people need 24-hour care but not acute surgery. Too much pressure on hospitals means too many unsafe discharges.

I am pleased to see that Healthwatch England has been involved in the safe discharge of patients. In 2014-15 it conducted its “safely home” inquiry, highlighting the impact on patients and their families when discharge goes wrong and identifying good practice where things go right. It also welcomed the publication of the Parliamentary and Health Service Ombudsman’s report and its role in highlighting the continued importance of ensuring that discharge is undertaken safely, effectively and respectfully.

The purpose of Healthwatch England and the 152 local Healthwatch organisations is to understand the needs, experiences and concerns of those who use health and social care services, and they were granted the statutory powers to speak out on their behalf. Healthwatch needs to stand up and be counted by helping uncover cover-ups, supporting patients and promoting good practice in both NHS and social care. The combination of services is important.

The Royal College of Nursing stresses the vital contribution of the community nursing workforce in relieving pressure on the system and delivering care in the community. The RCN is clear that any poor care is unacceptable and that action must be taken where breaches of the Nursing and Midwifery Council code occur. It is important—so that solutions can be found—that these cases are viewed within the wider context of the pressures facing the health and care systems.

I am pleased that the BMA supports the conclusions of the ombudsman’s report and welcomes the committee’s follow-up inquiry. It states that it is of paramount importance for patients, as well as their families and carers, that they are discharged from hospital in a safe, appropriate and timely manner that is co-ordinated and centred on their needs. There are extra needs for people with dementia and their carers. I hope that the Government, too, will do their very best to make the discharge of patients safer and better. This is not only a local matter; it is a matter of national concern.

NHS: Cancer Patients

Baroness Masham of Ilton Excerpts

Wednesday 9th November 2016 Lords Chamber

[Lord Prior of Brampton]

I think I was being honest, actually. I have never hidden the fact that these targets are very tough and difficult to meet. But we have increased activity enormously. We accept that early diagnosis is critical and probably as important as the 62-day referral for treatment target, which is why the 28-day target from urgent referral to diagnosis is so critical and will be one of the four key targets that will be in the CCG assurance framework. I accept what the noble Lords says; early diagnosis is critical. We are making progress and Sir Harpal Kumar, who developed the cancer strategy a year ago, is overseeing performance and progress towards meeting those targets.

[Baroness Masham of Ilton (CB)]

My Lords, is it not the case that many patients have their cancer picked up in an A&E department, having been sent away from their GP several times?

[Lord Prior of Brampton]

The noble Baroness is right. In 2006 one in five of all new cancers was picked up in an emergency setting. That has reduced to one in four. We are making progress. I think we all accept that our performance on cancer outcomes has lagged behind the best in Europe. The strategy developed by Harpal Kumar is designed to address that. We are making progress but we have some way to go.

Medical Students

Baroness Masham of Ilton Excerpts

Wednesday 26th October 2016 Lords Chamber

[Lord Prior of Brampton]

I think it will be helpful if I quote from the Health Secretary’s speech at the Conservative Party conference, talking about overseas doctors. He said:

“They do a fantastic job and the NHS would fall over without them. When it comes to … EU nationals, we’ve been clear we want them to … stay post-Brexit”.

Let us be absolutely clear: we want overseas doctors from the EU or elsewhere to stay here post-Brexit.

[Baroness Masham of Ilton (CB)]

My Lords, how many medical students drop out during training? How many, when qualified, do not take up medicine and go into other specialties?

[Lord Prior of Brampton]

My Lords, the attrition rate for students at medical school is about 5%. Some of those leave for medical reasons and come back subsequently, so the figure will be less than 5%. I do not have the drop-out rate for doctors who are further advanced in their training but I will find out and write to the noble Baroness.

Smoking-Related Diseases

Baroness Masham of Ilton Excerpts

Wednesday 14th September 2016 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, since I was a young child I have been passionate about the dangers of smoking and the unpleasantness that it causes to non-smokers. Someone left a medical book in our nursery and, as I was looking through it, I saw pictures of lungs that had been blackened and damaged by smoking. So much more should be done to show children and young people the dangers of smoking. The pictures that I saw did impress.

Two weeks ago, on 28 August, my daily’s husband—a smoker—died of lung cancer. He had undergone chemotherapy and radiotherapy, which he found very difficult. After treatment, he went downhill very quickly. His funeral was this afternoon.

Our National Health Service is struggling to survive. There are so many added worries and insecurities, and pressures and demands on the service. Will the Minister do all he can to stop it going downhill? If the Government are to achieve their targets, they will have to address smoking as part of an overall picture of public health. Smoking is one of the dangers of addiction. The cuts to the NHS and public health are savage when there are so many people needing treatment. We need more research. One question is: why do some people respond well to treatment and others fail?

At the age of 18, I watched my father die of coronary heart disease. He had been a smoker. The doctor who came out thought he had a chest infection. My father died an hour later. Smoking increases the risk of developing more than 50 serious health conditions; for example, many cancers, stroke, heart and vascular diseases, many respiratory conditions including asthma, and damage to unborn and born babies.

There are also the effects of passive smoking on so many people. I used to spend my time at meetings and social gatherings dodging the smokers, but it was so often impossible. It is a great relief that so much has been done to stop smoking in public places. The UK should be congratulated on the improvements so far, but it must not stop now. Much more needs to be done. We need a new tobacco strategy now. I hope the Minister will give your Lordships a positive response tonight.

NHS and Social Care: Impact of Brexit

Baroness Masham of Ilton Excerpts

Thursday 21st July 2016 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank my noble friend Lady Watkins of Tavistock for having secured this most important debate and congratulate her on her speech.

Since the European Union referendum result in England, there have been some most unfortunate incidents of rudeness and abuse to people from other European countries. If these people do not feel wanted and valued, they may not wish to stay and help us. People who have skills to work in our NHS and social care service are desperately needed.

The Library Note for this debate gives numbers of the various Europeans from different countries, but not of those people who are working in private hospitals or are employed privately helping disabled and elderly people living in their own homes, saving social services millions. The private sector must not be forgotten—it employs many people from overseas. We have an explosion of elderly people, many of whom have complex conditions and need help. Many of the carers themselves are also getting older. With this increasing problem of people needing care, there needs to be replenishment with younger active people as the needs increase.

Over the years when my husband was ill, we employed many helpers from the EU and other places such as Belarus. Carers for severely disabled people have to be honest, be willing and have a work ethos. Every person with a severe disability has different needs—I declare an interest in that I train my own helpers. I do not think many people who voted to leave the European Union realised that they would be creating so many difficulties and causing so many insecurities in a very unstable world. I think many people thought life would be better, with more money.

There is a crisis in social services. Unless the Government look at the workforce and realise how we might become isolated from the European Union, there will be a disaster in medical, nursing and social care. I received a letter from a friend of mine, a retired senior nurse from St Thomas’ Hospital, who happened to be in hospital with a complication during the referendum vote. I quote from her letter to me about the morning after: “The day staff came on duty, markedly more subdued than yesterday, and there was a palpable sense of gloom and anxiety—we’ve left”. Among the small group of staff looking after just her little patch of the ward were a Portuguese nurse, an Italian nurse and a Romanian nurse, plus a Lithuanian cleaner, previously a nurse, from Vilnius. Later in the day, she met a Slovenian radiographer and a Polish porter. Without exception, she wrote, their English was excellent.

It is undoubtedly true that the NHS benefits from the use of already trained staff from the EU and elsewhere abroad, and it will not survive without them. At least one London teaching hospital has recently had to send a recruiting team to Italy because there are insufficient British-trained nurses for its needs. Should these trained and untrained National Health Service staff be asked to leave this country because the UK is about to leave the EU, can they be replaced? There is already a national shortage of nurses and doctors despite our friends from the EU.

For some time, morale in the NHS has been very poor. It is no good pretending otherwise. Since the referendum vote, there are not only worried staff but very worried patients, especially the most vulnerable. I now declare an interest as president of the Spinal Injuries Association. I ask your Lordships to think for one moment what it would be like to be paralysed from the neck down and dependent on a respirator to breathe. Many such patients who live at home have to rely on trained carers. What will happen if the supply dries up? As it is, it is not easy to get the right people with the correct skills.

In the UK, there are 750 to 1,000 new paralysed patients a year, about 10 to 15 per million of the population. They have a multisystem physiological impairment and malfunction dynamic. They need specialised care and treatment. In Germany, there are 1,200 special beds for spinal injury patients in special units, while the UK has only 430 spinal beds. The population of both countries is about the same. This means that paralysed patients living in the community often do not get the correct treatment when they need it, as the units are full. Because the work is demanding, these units often have to rely on medical and nursing staff coming from other European countries and beyond.

The Royal College of Physicians has considered the implications of the EU referendum. It states that doctors from the EU make up a significant proportion of the NHS doctor workforce—about 10%. The UK is already facing significant recruitment problems: 40% of advertised consultant posts remain unfilled. The number of medical trainees has decreased by 2.3% within the past year. This is creating significant implications for the future delivery of care, particularly as the needs of patients increase.

Care England has told me that one of its larger corporate members was due to go to Portugal this month to recruit care workers, but, further to the result of the referendum, more than 50% of the people in Portugal who had expressed an interest withdrew their names. This period of uncertainty is causing problems. I cannot understand why the Government cut funds to Health Education England, which trains medical and nursing staff. It seems extraordinary.

I end by saying that it is depressing to see that our results in cancer care are at the bottom end of the European ladder. There is no doubt that working together in research is vital. The UK has been very successful in attracting research funds from Brussels. Losing generous sources of financial support will set research back. Senior researchers are likely to find ways in which to keep direct bilateral collaboration going with colleagues overseas, but the opportunity to take a lead role within EU funding programmes will disappear—very sad.

Probably the biggest loss will be for the younger generation of science graduates, whose options will be reduced. Biomedical science relies on shared ideas, international co-operation and professional ability. It will take time to find alternative pathways for young scientists. The uncertainty over the specific nature of Britain’s role in Europe could make for a bumpy ride for British science.

I was very sorry to hear that the department responsible for life sciences has gone, along with the post of the excellent Minister, George Freeman, who did so much to raise morale and interest in this highly important subject. The National Health Service and social services need good morale.

NHS: Junior Doctors’ Contract

Baroness Masham of Ilton Excerpts

Wednesday 6th July 2016 Lords Chamber

[Lord Prior of Brampton]

There is no indication that large numbers of junior doctors are resigning because of the introduction of this new contract. If it does happen, we will have to address that issue when it occurs.

[Baroness Masham of Ilton (CB)]

My Lords, how much of a safety issue is this? Does the noble Lord agree that there are not enough doctors as it is?

Health: Diabetes and Obesity

Baroness Masham of Ilton Excerpts

Thursday 30th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, that issue will be addressed in the obesity strategy, which comes out later this year. The levy that has been announced will, I think, lead to the reformulation of high-sugar fizzy drinks, which is a start in the right direction. It is largely a question of diet, as the noble Lord said, but also exercise and many other factors, which will be in the obesity strategy that comes out later in the year. Clearly, making it more difficult for young people to access junk food will be an important part of that strategy.

[Baroness Masham of Ilton (CB)]

Does the Minister agree that diabetes is a very complex condition and can be very expensive to every country in the world? Does he also agree that many diabetics love sweet things? Will the Government stimulate more health education in schools so that children grow up learning about diabetes?

National Clinical Director of Adult Neurology

Baroness Masham of Ilton Excerpts

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

I do not think I agree with the last part of the question. We have set up NHS England as an arm’s-length body, and a key part of the reforms—the bit that probably everyone supported in the 2012 Act—was to get politicians more out of the day-to-day running of the NHS and to give more power to clinicians. It is better that clinicians rather than politicians should make these decisions. On what the noble Lord said about decimating the influence of clinical advice in NHS England, I just do not think that that is the case. In so far as he has raised it with me, I will have a meeting with Bruce Keogh and put that point to him and get his response.

[Baroness Masham of Ilton (CB)]

My Lords, is the Minister aware that there are many very complex neurological conditions? Surely there should be a co-ordinator and an adviser. It is really very difficult. Surely it should be upgraded, not downgraded.

[Lord Prior of Brampton]

My Lords, it would be a great mistake to think this was a downgrading exercise. This is NHS England deciding to get its clinical inputs from a clinical reference group rather than having a national clinical director. It has reduced the number of clinical directors by six. We are not talking about just neurology; five others have gone in different specialties—for example, pathology. It would be a great mistake if the House went away with the impression that NHS England was in any way decimating or downgrading the importance of neurology.

NHS: Bursaries

Baroness Masham of Ilton Excerpts

Wednesday 25th May 2016 Lords Chamber

[Lord Prior of Brampton]

That is a good question. Nurses spend 2,300 hours of their three-year course in clinical placements in hospitals. They are supernumerary. They are clearly supervised and mentored in that setting, but they also provide a fair amount of care in those hospitals as well. I am pretty confident that hospitals will work out an arrangement with universities to ensure that they create enough clinical placements for those nurses.

[Baroness Masham of Ilton (CB)]

My Lords, is the Minister aware that nurses used to have free accommodation and were also paid, but now they have these debts hanging over them? What is the view of the Royal College of Nursing?

[Lord Prior of Brampton]

My Lords, I think that the Royal College of Nursing, Unison and other unions have concerns about moving from bursaries to student loans; it would be idle to pretend otherwise. But we are convinced that the demand for young people to go into nursing is very strong and that the availability of more money through the loan system to nurses at university will therefore encourage more people to go into nursing.