NHS Winter Crisis

Baroness Masham of Ilton Excerpts

Monday 5th February 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord raises a very interesting issue. As he rightly points out, that number has been dropping over a long time. It has plateaued in recent years, but it has been falling. This is a difficult situation. We all agree that more care should be delivered in the community, but we also understand that at certain times of year you do need beds in hospitals. I will point to two things: first, making sure that bed capacity is more efficient so that people can stay safely for less time and can spend more time being treated in their homes—which often is where they want to be, and that is why the extra funding for social care is important; and, secondly, the reconfiguration test that has been introduced by NHS England, which is about stopping reductions in bed numbers—which, as the noble Lord said, has happened under successive Governments—where it cannot be proven that any reduction is for the benefit of patients in terms of their overall care.

[Baroness Masham of Ilton (CB)]

My Lords, I declare an interest as president of the Spinal Injuries Association. Is the Minister aware that at Stoke Mandeville’s national spinal centre, a ward that is absolutely necessary has been taken away from the spinal unit and used for general patients? There are waiting lists in the seven spinal units all over the country, affecting seriously ill patients who need specialised treatment. Will the Minister look into the situation?

[Lord O’Shaughnessy]

I was not aware of that but I shall certainly investigate and write to the noble Baroness.

NHS: Nurse Retention

Baroness Masham of Ilton Excerpts

Wednesday 17th January 2018 Lords Chamber

[Lord O’Shaughnessy]

The point about understanding the reasons that people leave is very important. Some hospitals use exit interviews for that; I do not know if it is a nationwide programme but I shall certainly write to the noble Lord about that as it is a good idea. As for attracting staff back, I mentioned the return-to-practice programme. I think my noble friend Lady Chisholm took advantage of a similar programme when she returned to work after having children. I come back to the issue of pay. We know that pay is important, which is why lifting the cap will make an important difference to showing how much we value these staff.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree with me that, if the National Health Service provided reasonable housing for nurses and flexible working for those with children, it would help to retain them?

[Lord O’Shaughnessy]

The noble Baroness is quite right. We know that housing costs are an issue, particularly in the south of England and cities, which is why we want to use the sale of surplus NHS land to deliver more homes specifically for nurses and other similar professionals. She is also right to talk about flexible working, which comes up time and again in staff surveys. The use of nursing banks can be very helpful in that regard, and we have seen a big switch away from agencies towards using such banks for those places that need to be filled temporarily.

Agency Nurses

Baroness Masham of Ilton Excerpts

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right that agency staff are sometimes used to fill vacancies—about nine out of 10 vacancies are filled in that way. The key is to make sure that they are used in a proper, planned way that is not expensive. The point about the “break glass” clause is that the rules that exist to cap agency spend can be broken where there is a need and where that need is approved by the trust for patient safety purposes. That is an important feature of the system.

[Baroness Masham of Ilton (CB)]

My Lords, in this present crisis, are more nurses taking advantage of the “break glass” clause?

[Lord O'Shaughnessy]

The number of uses of the “break glass” clause has actually fallen since April 2016, which was the peak. This shows that there has been a much more planned use of bringing in extra staff as they are needed, rather than an ad hoc response, which was what it was designed to address.

Brexit: Health Policy

Baroness Masham of Ilton Excerpts

Wednesday 6th December 2017 Lords Chamber

[Lord O’Shaughnessy]

The Secretary of State has set out very clearly that patients should not be disadvantaged as a result of the new arrangements, whatever they may be. Clearly, those new arrangements will be a matter for negotiation, but we will make sure that patients are not disadvantaged and that the industry can continue to get its drugs and devices to the UK market as quickly as it does now.

[Baroness Masham of Ilton (CB)]

My Lords, how many people from Europe who are in the medical field have already left because of insecurity and not knowing what is happening?

[Lord O’Shaughnessy]

I recognise that there is uncertainty. That is why we have set out our intention of offering a route to settled status for those people working here, and why we want the issues of citizens’ rights to be dealt with as soon as possible in the next phase of talks. The noble Baroness and other noble Lords will be interested to know that, if you compare June 2016 to June 2017, there are more EU workers working in the NHS from one year to the next.

HIV Prevention Services: Public Health Funding

Baroness Masham of Ilton Excerpts

Thursday 30th November 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to point out the difference. If you look at the performance in London against the UNAIDS 90-90-90 targets, you will see that they have been met. However, England as a whole is at least slightly behind on at least one of those factors—people with HIV not being diagnosed—which points to the fact that out of metropolitan areas there is more work to do, as she says. One of the ways in which local authorities meet that challenge is through offering home testing kits, which are being sent out and which are now seeing the kind of return and diagnoses levels that you would see in sexual health clinics.

[Baroness Masham of Ilton (CB)]

My Lords, is it correct that six clinics have closed in London recently? Is he aware that other infections, such as gonorrhoea, have become drug-resistant? Many people from ethnic minorities need to know where to go, and communication is so important.

[Lord O'Shaughnessy]

I did not know about the closures that the noble Baroness mentioned. I reiterate that more tests are taking place. Indeed there has been a substantial decrease in the amount of new diagnoses, which is good news because it means that transmission is falling. We want to focus on the outcomes here, which are positive, particularly in London. She is of course quite right about other STIs being important. There is good news there as well, because diagnosis is falling, so some of the public health plans being put into place are starting to pay dividends.

NHS: Wound Care

Baroness Masham of Ilton Excerpts

Wednesday 22nd November 2017 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for selecting this very important subject and the noble Baroness, Lady Wheeler, for leading the debate.

I must declare an interest. I have been a paraplegic, paralysed from the chest down with no feeling, since breaking my back in 1958. I know only too well how important it is to have a high standard of wound care in the NHS. I also have to confess that I have a pressure sore, which needs constant care. It developed after one of my helpers inserted a slide board with too much gusto when I was getting out of my car. This broke the skin in a very difficult to heal place. My skin can be problematical and some wound dressings can give allergic reactions. There should be a good choice of dressings, as different wounds need a variety of dressings and patients like me can react and heal in different ways.

Wound care should be raised up the agenda. We need an upgrade, but some interested parties fear that wound care might be downgraded. Billions of pounds are involved and this is a very serious matter. I ask the Minister: does that figure include the millions lost to the National Health Service because of litigation from bad care?

I also declare an interest as a patron of the Lindsay Leg Club Foundation, which is a charity concerned with the leg ulcers that affect about 700,000 people in the UK. The cost of leg ulcer treatment and management is around £1.94 billion. The ulcers are painful and debilitating, they consume a vast amount of district nurses’ time and they often lead to social isolation. The Lindsay Leg Club Foundation helps promote a social model of care which improves healing rates, decreases social isolation and enables healed legs to be maintained with a “well leg” regime of care.

Does the Minister agree that a key aspect of improving wound care and reducing infections within hospitals rests with good hand hygiene? The first step in improving hand hygiene to reduce hospital infections is to acknowledge that the current method of direct observation is inaccurate. The availability of modern technology means that NHS trusts can today seek more accurate methods to monitor and drive improvements in hand hygiene and hence to reduce the risk of infections.

The Surgical Dressings Manufacturers Association is concerned that likely changes to NHS procurement in wound care could compromise patient safety and increase NHS costs. A possible reduction in the availability of clinically appropriate dressings will cause suffering to patients, as wounds will take longer to heal and place an increased burden on the NHS. If hospitals and care homes do not use the most appropriate dressings, patients with pressure ulcers will have to stay in hospital longer and will have a poor patient experience and outcome. The same applies to patients living in the community, but there is the added problem of the shortage of district nurses.

I hope the Minister will give the House some assurances tonight that wound care will not be downgraded and that there will be a strategy that will include the NHS and public health and that the private sector can learn from it too. We need people to work in this field who understand the importance of good wound care and who have the necessary skills and dressings to look after civilian men, women and children, the Armed Forces and people in prison in the best way possible.

Health: Sepsis

Baroness Masham of Ilton Excerpts

Thursday 14th September 2017 Lords Chamber

[Lord O'Shaughnessy]

That is absolutely right but I draw the attention of the noble Lord to a couple of things. First, in the NICE quality standard published yesterday there are some very clear statements about the speed with which people suspected of these symptoms should be treated. Those are quite robust in terms of getting intravenous antibiotics to people within an hour, being reassessed by a senior clinician if they then fail to improve within an hour and so on. That is very clear and there is implementation guidance going through. Another thing announced yesterday is quite important. It is a slightly odd phrase but “safety netting” is where someone has been assessed on whether they have sepsis, does not have it but is sent away with materials that show what the symptoms might be and how to report back if their condition deteriorates.

[Baroness Masham of Ilton (CB)]

My Lords, as has been said, sepsis can be a big killer if the correct antibiotics are not given. Should it not be conditional to report sepsis so that more research can be done? Should there not be a very quick test for it?

[Lord O'Shaughnessy]

The noble Baroness is quite right. Trusts are now incentivised to report incidences of sepsis and their performance against these quality standards. That is happening. Unfortunately there is still variation within the system. That is why the documents that came out yesterday are so important. For the first time, we have an operational definition of adult sepsis. Clearly, that is critical to making sure that it is spotted in time.

National Health Service (Mandate Requirements) Regulations 2017

Baroness Masham of Ilton Excerpts

Wednesday 6th September 2017 Lords Chamber

[Lord Clark of Windermere (Lab)]

My Lords, the noble Baroness is absolutely right to sing the praises of the National Health Service, and she is quite right to point out that we are undertaking more operations than we have in the past. She is also right to say that, as we grow older, more of us will need the health service. That is a fact that we have to face and accept and about which we have to persuade people—who do not need much persuading—that something has to be done. My noble friend Lord Reid and I served in the Blair Cabinet and we spent hours trying to bring about the political will to make sure that waiting times, which caused so much grief and pain in the 1990s, were cut. So we are talking about political will.

There is an interesting public opinion poll produced by YouGov and published today on behalf of the Royal College of Nursing. It shows that 72% of the general public believe that the NHS lacks sufficient staff to enable them to do their job properly. When we talk about altering waiting times, it is worth remembering that healthcare is a labour-intensive industry in all its aspects. We all know that, and we all know that the NHS achieves what it does only through the dedication and commitment of the staff and the hours that they work, from the consultants through to the nurses, the healthcare assistants, the porters and everyone. We have to try to assist them because they are getting towards breaking point. The Royal College of Nursing has balloted its members and is talking about taking industrial action. Therefore, we look to the Government to have the political will to act.

I accept that there is no magic wand. This Government bear a lot of responsibility because they were the key partner in the coalition that cut the number of nurses in training after 2010. The onus is now on them, and they are beginning to increase the numbers, but they must do more. However, it obviously takes a long time to train consultants, doctors and GPs. There are shortages everywhere, including a shortage of 40,000 nurses. I do not know the figure, but there is a shortage of GPs running into the tens of thousands. There is a shortage of hospital consultants and shortages everywhere.

So what do we do? It is not easy, because more nurses are leaving than entering the profession. We cannot do anything about the training, as that will take a number of years, but we can do something about retaining people in post, by persuading GPs to carry on a bit longer and persuading nurses to stay in post as it is worth while doing what they do. That is what we should be doing. It would be a great help if the 1% cap on wages could be lifted, because that has meant that the average nurse is probably 12% worse off than they were a few years ago. That would be one way of making it easier to retain people.

Then there is the other point that was made by my noble friend who introduced the debate, whom I thank, about the number of nurses and doctors who have worked in the health service who are from the European Union. Can we offer them something to persuade them that we want them to stay in our country? For example, as the Minister knows, anyone from the European Union who has spent five years working in this country, which includes people in the health service, can apply for the right of permanent residency. But we cannot get the Government to say what that means. Does permanent residency mean that they can stay here, or will they be sent back to Europe? That increases the uncertainty and anxiety. I urge the Minister to go back to his colleagues and say, “All right, if we can’t or won’t make a commitment to the European Union citizens to stay in the health service, let us say that at least those who have gained permanent residency can stay”. That would help the issue.

I return to my basic point. This now requires political will. I do not doubt the Minister’s commitment. I know where the Minister stands and how much he believes in the health service. He has made that quite plain in a number of debates that we have taken part in. But we need political will and we are looking to the Minister to try to argue his corner and punch above his weight and give every support that he can to try to make health staff in the health service more satisfied so that they stay in their jobs and help us to reduce waiting times.

[Baroness Masham of Ilton (CB)]

My Lords, I want to ask the Minister about the better care fund, which is for health and social care working together, which also comes under the mandate. The better care fund document was not available for scrutiny purposes, as it was not published until 15 days after the instrument was laid before the House. All relevant documentation should be available. Without that, effective scrutiny is not possible. What is the present situation, as this deals with some very vulnerable people?

[Baroness Thornton]

My Lords, I draw the attention of the House back to the resolution on the Order Paper moved by my noble friend. I hope that the noble Baroness, Lady Redfern, will forgive those of us on this side if we look sceptical because the reason that my noble friend, when he was Secretary of State, had to set the targets that he did was because of the record of her party’s Government over many years. If we are a little sceptical, it is because there is form on this.

Being a veteran of the passage of the Health and Social Care Act 2012, like my noble friend, I recall that there were many assurances given about the legal framework that would make the reorganisation work, particularly on the importance of the mandate. Therefore, I would be most interested to hear from the Minister on the last part of my noble friend’s resolution, which calls on the Government to publish the advice that they have received on the legality of their actions. Did they seek advice about the legality of their actions, given that they had been so keen to have that legality exist during the passage of the Act that set this framework and, if so, what did that advice say?

National Stroke Strategy

Baroness Masham of Ilton Excerpts

Wednesday 5th July 2017 Lords Chamber

[Lord O’Shaughnessy]

My noble friend is quite right to highlight that issue. I must congratulate him on the progress made in stroke treatment during his time as Secretary of State for Health. I shall certainly look at whether the better care fund can be used in the way that he has described.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that there is fragmentation across the country and that care differs in some areas? Did the strategy not pull it together and pass on good practice to those less experienced?

[Lord O'Shaughnessy]

The noble Baroness is of course right that the strategy had that galvanising effect. As I said, it has been superseded by a broader cardiovascular strategy, which is leading to some of the improvements that I have discussed. The other thing to focus on is the fact that stroke is now being included in the new urgent and emergency care standards that are being introduced, which will ensure, and indeed require, that all stroke patients are seen within 14 hours by consultants who are stroke specialists. That is precisely about ironing out some of the discrepancies in actual practice that happen across the country.

Brexit: Nursing Staff

Baroness Masham of Ilton Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord O'Shaughnessy]

The critical point is to have enough nurses and, indeed, enough medical staff. Of course, where they come from is going to be dictated by various circumstances. As I have discussed already, language controls have been introduced in order to focus on patient safety. We do need to increase the number of nurses in the health sector. That has happened since 2010. There has been an increase. There are more in training. But clearly there need to be more as we have a growing and ageing population.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister know how many unfilled vacancies there are at this time for nurses?

[Lord O'Shaughnessy]

I do not have that information at my fingertips. Of course, at any time there will be unfilled vacancies as nurses move around. As I said, we know that recruiting more nurses into the health service is an important priority for the years ahead, which is why we are undertaking the programmes that I mentioned.