East Kent Maternity Services: Independent Investigation
Baroness Merron Excerpts(2 years, 1 month ago)
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Baroness Merron (Lab)
My Lords, I start by thanking Dr Bill Kirkup and his team for bringing together a report of harrowing events. This litany of failures makes for very difficult reading, and it marks another landmark for a further group of families fighting for justice who should not have had to do so. Forty-five babies could have survived had they received care at the nationally recognised standards. I am sure that the thoughts of the whole House are with the bereaved families at this extremely painful time.
This is, regrettably, yet another example of women’s voices being ignored and silenced, to the extent that some were told that they were to blame for the deaths of their babies. At a time when women are at their most vulnerable, they were let down by the very people who they were relying on to keep them safe. However, this is not a one-off: East Kent is the latest in a long line of maternity scandals, including at Shrewsbury and Telford Hospital NHS Trust and Morecambe Bay, while the upcoming review of services in Nottingham is expected to be highly critical. Dr Kirkup said that avoidable deaths happened because recommendations that had been made following reports into other scandals had not been implemented. I would be grateful if the Minister could respond to this.
We know that no woman should ever have to face going into hospital to give birth, not knowing whether she and her baby will come out alive. Those who allowed this culture of neglect and what was referred to in the report as a disturbing
“lack of kindness and compassion”
to take root must be held accountable. Can the Minister tell your Lordships’ House how this may happen?
It is shocking that there is a pattern of avoidable harm in maternity units across the country. Half the maternity units in England are failing to meet safety standards. Pregnant women were turned away from maternity wards more than 400 times last year. One in four women are unable to get the help that they need when in labour. The Government need to fully accept all the recommendations in Dr Kirkup’s review without delay. I hope the Minister will today confirm that this is the case.
In the wake of the Ockenden review, the former Health Secretary announced additional funding for maternity services to help deliver the reform that is clearly needed. Can the Minister tell your Lordships’ House how that funding has been spent and how its impact will be measured? Indeed, it would be very helpful if the Minister could bring a further report to this House on progress in the improvement of maternity services.
Underpinning the issues in maternity care and across the NHS is, of course, the workforce. But more midwives are leaving the profession than are joining it and there is now a shortage of some 2,000 midwives in England alone. Can the Minister indicate where we can find the workforce plan to get the staff needed to provide good and safe care in the short, medium and long term? It is evident that the Government must provide the staff that maternity services desperately need to provide safe care across the health service.
I am sure we were all concerned to read the Care Quality Commission’s report published just two days after Dr Kirkup’s report. It also makes sobering reading. It says that maternity services in England have deteriorated to their lowest level, services are worsening and, time and again, there are issues with the leadership and culture in maternity units.
The CQC’s chief executive said that the failings were systemic in the NHS, with two in five maternity services now ranked as requiring improvement or inadequate. This is a wholly unacceptable situation. Does the Minister share the view of the regulator that the issues in maternity services are a “national challenge”?
This CQC report shows that there has been a deterioration in maternity services overall and in relation to their safety, describing progress on improvement as “slow”. The proportion of maternity services ranked as inadequate or requiring improvement is, we see, the worst it has ever been. What actions will the Government take? Will the Minister be meeting the CQC urgently to discuss its findings? How will a major change in maternity services be brought about?
All that women and their loved ones ask for is to have confidence that they and their babies will be safe. This really is not much to ask. I hope the Government will provide the means to deliver this.
Baroness Brinton (LD)
My Lords, I want to start from these Benches by sending my deepest sympathies to the bereaved families and to say that we admire the parents for their campaigns over many years against the dreadful treatment by the east Kent hospitals trust for more than a decade. I echo the thanks and gratitude from the noble Baroness, Lady Merron, to Dr Kirkup and his team. Once again, he has risen to the challenge of providing a very clear picture of what has gone wrong at a hospital trust.
The trust failed to read the signals over an 11-year period. The Kirkup report puts this very bluntly and is exceptional in the way it uses evidence. Yes, there is the evidence of the voices of mothers and their families and the evidence from staff, but equally important is the use of data, especially the CESDI data from the Confidential Enquiry into Stillbirths and Deaths in Infancy. In the section headed “What happened to women and babies”, paragraph 1.16 says that
“we have not found that a single clinical shortcoming explains the outcomes. Nor should the pattern of repeated poor outcomes be attributed to individual clinical error, although clearly a failure to learn in the aftermath of obvious safety incidents has contributed to this repetition.”
This short paragraph encapsulates how failings have become cultural in the trust. Paragraph 1.19 says that
“we have found that the origins of the harm we have identified and set out in this Report lie in failures of teamworking, professionalism, compassion and listening.”
It is really worrying to have the report from the CQC of a few days ago, which echoed these exact points but more broadly across maternity services in England.
As has been mentioned, there is a wider problem. We know that. The reports on Morecambe Bay, Shrewsbury, Telford and now Nottingham, where Ms Ockenden is now working, show that systemic and cultural failures, especially with the complexity of regulators, are creating real problems. There is the idea that clinical staff will allow favouritism and the opposite of growing and supporting staff, while letting things fester and not caring to drag patients into their concerns.
Can the Minister outline the timescale for the independent working group report referred to in the Statement? The creation of the group is welcome; its main remit is to advise the maternity transformation programme in England—but by when? Is the work of the group revealing that other maternity services have problems, even if we do not know how severe they are or if they are as severe as East Kent?
In the section on the actions of the regulators on page 9, at paragraph 1.50, Dr Kirkup identified that
“the Trust was faced with a bewildering array of regulatory and supervisory bodies, but the system as a whole failed to identify the shortcomings”.
It is good that it is reported that NHS England and Innovation sought to bring about improvements, but every other trust is also facing that same complexity of different regulators. Are the Government looking at the roles of regulators and how their competing demands can be streamlined to avoid this problem?
The Commons Minister said that she would review all the recommendations and provide a full response once she has had time to consider it. I think we all appreciate that the NHS has a very large workload at the moment, but can the Minister say roughly what timescale we are looking at?
One key problem in many maternity services is with the workforce, especially midwives. Although NHS England made an exceptional grant in March of £127 million as a boost for
“safer and more personalised care”,
can the Minister say—I echo the point made by the noble Baroness, Lady Merron, which he will not be surprised to hear—where the workforce plan is for the next decade for maternity services? A year’s extra money is not going to help with training the midwives of the future and ensuring that maternity units are professionally and adequately staffed.
Dr Kirkup also criticised NHS England for firing chairs and chief execs too frequently, indulging in a blame game that reinforced the culture happening inside East Kent. It is no longer good enough to say, once again, that this must never happen again. This is the third devastating report in under seven years, and another is now being prepared in Nottingham. What will the Government do in the next three months to ensure that further appalling practice will be uncovered and dealt with immediately?
Cost of Living: Public Well-being
Baroness Merron Excerpts(2 years, 1 month ago)
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Baroness Merron (Lab)
My Lords, as the cost of living continues to spiral, I congratulate my noble friend Lady Drake on securing this timely debate focusing on the most pertinent issues of the day and speaking up for the many people whose health and well-being are deeply affected by a crisis that can only be said to have been made in Downing Street. I thank my noble friend for the incisive, informed and comprehensive way she set out the situation.
Over the course of the debate, I have been very struck by the way that noble Lords have so powerfully highlighted the inextricable link between the cost of living and our well-being. I have also been struck that throughout the debate I have kept coming back to just one question: how did the Government consider this link, if at all? Perhaps the Minister can offer some reflection on this point.
With inflation hitting over 10%, food inflation running at over 14% and millions worrying about their household finances, there is no sense that the Government have done anything other than make decisions that have sent costs through the proverbial roof. As my noble friend Lady Drake said, by choice the Government have made everything worse. The Prime Minister may have resigned, but the Government remain in office. As my noble friend Lady Smith said in the Chamber earlier today, this Government now have no mandate. As a number of noble Lords have said, it is time for the people of this country to have their voices heard and their votes counted.
We know that good nutrition, shelter and the ability to lead a dignified life are essential foundations of good health. If unaddressed, rising living costs will leave people in health-harming—even life-threatening—situations in the short term, while embedding a public health time bomb for the future. It is not now just economists but public health leaders who are sounding the alarm about the health consequences of failing to protect communities and individuals from the cost of living crisis engulfing our nation. So I ask the Minister: what assessment have the Government made of the short-, medium- and long-term effects of the cost of living crisis? I am also interested to hear his response to the proposal from my noble friend Lord Sikka for an inquiry, especially given the anticipated extent of further cuts to public services in particular.
We know that the impact of the cost of living crisis is not felt equally or fairly: quite simply, those who have less suffer more. This have been borne out by the Office for National Statistics, which reminds us that the extent to which the rising cost of living has a financial impact on different households is very much based on
“factors including their expenditure patterns and their ability to absorb increased outgoings.”
This was referred to by my noble friend Lady Drake, who also emphasised the impact of the lack of financial resilience of lower-income households.
Analysis from the Institute for Fiscal Studies shows that the least well off are experiencing higher rates of inflation, while the New Economics Foundation confirms that the costs of the poorest are nine times higher than those of the richest 5% of society. Of course, key to addressing much of this will be the health disparities White Paper. The Minister will remember that last week I asked whether reports were true that this White Paper was not going to be published. Perhaps he might be good enough to provide a response today. If the reports are not true, when can we expect it to be published?
As my noble friends Lady Sherlock and Lord Monks and other noble Lords outlined, for those relying on welfare benefits, whether they are in work or not, inflation is not their friend. The Joseph Rowntree Foundation tells us that, if the Government uprate benefits by earnings rather than inflation, they will push a further 450,000 people into poverty. This will also increase poverty among working families by 350,000 more people, and families with a disabled person by a further 250,000, of whom a quarter are children. Could the Minister tell your Lordships’ House what discussions there have been with the Department for Work and Pensions about the health impact of failing to uprate benefits to reflect the reality of the cost of living? Following on from the comments of my noble friends Lord Hendy and Lord Pendry, where is the workforce plan to address low pay and record vacancy rates in the NHS and social care workforce—something that has been raised repeatedly in your Lordships’ House?
Many health conditions are caused or exacerbated by cold homes, and the cost of living deeply affects how people use their heating at home. Often, homes are heated less frequently and to a lower temperature to try to save money, and this can be a particularly acute problem for those who are older and disabled. Children and young people living in cold homes are more likely to suffer from respiratory and mental health problems. Cold homes can also have an adverse effect on the educational attainment of young people and increase the risk of social isolation.
Overall, cold housing costs the NHS in England an estimated £1.36 billion per annum and contributes to the excess winter deaths which take place every year in the UK. Can the Minister tell the House how he will deal with this rise in unheated homes? Can he share any analysis that the Government have completed regarding the consequences of fuel poverty for public health and death rates this winter and beyond?
When prices rise across the board, it is eminently understandable that households may choose the cheapest, and often the unhealthiest, food and drink, something that the noble Baroness, Lady Gohir, spoke of. The Food Foundation has found that 50% of people are buying fewer fresh vegetables and less fresh fruit. We know that people are paying £571 more on average for their groceries this year than last year and, as my noble friend Lord Howarth referred to, the latest data from the Food Foundation shows that nearly one in five households experienced food insecurity last month, which manifested in eating less or going a day without eating.
We know that food poverty is a driver of poor physical and mental health, including chronic diet-related conditions such as obesity and cardiovascular disease. As the right reverend Prelate said, experiencing food insecurity can limit children’s development and affect their ability to concentrate and engage in school, reducing educational attainment and long-term life chances.
Regrettably, the Government gave what I regard as an inadequate response to the opportunity presented by the national food strategy. Will the Minister revisit this? What will the Government do to make sure that those who are less well off can afford and access nutritious food at this time?
As we have heard in this debate, the mental health implications of the challenges the public are facing right now are heart-breaking. A Childhood Trust survey found that 23% of parents said that due to the impact of the cost of living, their children are expressing more anger, and more than one in five said that their children are smiling less. Stress, uncertainty, anxiety, inadequate income and having no cushion to fall back on all affect mental health and, as many noble Lords have said, people are scared. In June, the Lancet published an analysis of existing studies on the relationship between lower incomes and poorer mental health and well-being. Does the Minister accept this link and, if so, how will he address it?
In conclusion, I refer to the comments of my noble friend Lady Primarolo, who asked how the Government could sacrifice the well-being of people in this country in pursuit of ever-changing policies. This is a question for the Minister and his colleagues. I hope that what has been said today will impact the Minister’s response. A healthy population and a healthy economy are two sides of the same coin and, right now, we have neither.
Childhood Obesity
Baroness Merron Excerpts(2 years, 2 months ago)
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Baroness Merron (Lab)
My Lords, analysis of the national child weight management programme by the Local Government Association has found that not only are the Government heading towards missing their goal of halving child obesity by 2030 but, on current trajectories, childhood obesity is increasing. Do the Government remain committed to their target and if they are, what will they do differently?
Lord Markham (Con)
My understanding is that the figures for childhood obesity have been fairly flat for a number of years, apart from for the year of Covid, when they all went up. The year after that, they came down again. To me, that demonstrates the importance of free school meals and the action we are taking there for people to have good, calorific and sensible types of food. We have seen significant reductions in childhood obesity in the last year. To my mind, what is important in all this is the emphasis we are putting on the free school meals programme. We have the highest ever number of people on free school meals, up from 15% in 2015 to 23% today. Part of that is free school meals for all infant schoolchildren, so that we can make sure that their food is as healthy as possible.
Edenfield Centre: Treatment of Patients
Baroness Merron Excerpts(2 years, 2 months ago)
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Baroness Merron (Lab)
My Lords, patients and their families rightly expect in-patient settings to be safe places. The bullying, abuse and clinical errors at the Edenfield Centre are deeply disturbing. It should not have taken an undercover investigation to expose this cruelty. Can the Minister tell your Lordships’ House what actions have been and will be taken to ensure that this abuse and these shortcomings are not happening in other settings? What are the Government doing to tackle the chronic staff shortages that exacerbate these situations and to recruit more staff across mental health services, including those focused on prevention?
NHS: Winter Challenges
Baroness Merron Excerpts(2 years, 2 months ago)
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Baroness Merron
To ask His Majesty’s Government what assessment they have made of the challenges facing the NHS this winter.
Baroness Merron (Lab)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, before the Minister responds, warmly welcome him to your Lordships’ House and to his ministerial role. I wish him well.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I thank the noble Baroness. If I may respond personally first, I am delighted, honoured and privileged to be taking on this role. I look forward to working with all noble Lords and learning from the vast experience and expertise around the Chamber. The Government are aware of the pressures facing the NHS this winter due to potential surges in Covid-19, the return of respiratory conditions and impacts arising from cost of living challenges. The Government are taking a range of actions, including increasing NHS capacity this winter by the equivalent of 7,000 beds and allocating £500 million of funds to speed up the safe discharge of patients from hospital. We will keep the House updated as we progress.
Baroness Merron (Lab)
My Lords, NHS Providers reports that 72% of trusts are extremely concerned about the cost of living impacting on their ability to manage winter pressures, tackle care backlogs and meet targets. Can the Minister tell your Lordships’ House what assessment has been made of the impact on health services of the ever-widening gap between the Government’s original assumption of inflation and the spiralling increase and, to protect patients, what will be done about it?
Lord Markham (Con)
As I am sure the noble Baroness is aware, we are investing an unprecedented amount of money into the NHS and have recruited more doctors and nurses. We are setting up 7,000 new beds to cope with it all. At the same time, I accept that we are in a period of unprecedented challenge from not just the cost of living crisis but the effects of Covid and the likely impact of flu this year. That is why I very much see our role as making sure that that record level of investment is used to the best effect and that we drive performance across the NHS. I am sure we all have lots of examples of brilliant services and examples of where more needs to be done, candidly. My role in this, as someone with a background of business experience, is to try to take those areas of best practice that I have seen in some of the hospitals I have already visited and make sure they are allocated across the whole NHS.
Health and Social Care Update
Baroness Merron Excerpts(2 years, 2 months ago)
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Baroness Merron (Lab)
My Lords, it may have been some weeks since this Statement was made in the other place, but its subject matter is as relevant today as it was when it first saw the light of day. The big questions remain: among them, where are the costings and how will it be funded?
The NHS is facing the worst crisis it has ever seen, with patients waiting longer than ever in A&E, stroke and heart attack victims waiting an hour for an ambulance and some 378,000 patients waiting more than a year for an operation. Those figures date back to the summer—before we even get to the winter and the challenges winter always brings.
At the time of the Statement, the NHS Confederation’s verdict was that
“these measures will not come close to ensuring patients who need to be seen can be within the timescales set out … they will have minimal impact on fixing the current problems that general practice is facing over the winter”.
But has not the situation got even worse since this Statement was first heard? The scale of the challenge faced by our health and social care services, the people who work in them and the public who rely on them has worsened as the state of the economy worsens. The country is now experiencing spiralling inflation which far exceeds the assumptions on which budgets were set, while those who work in the health and care services are struggling with the cost of living. What will be the response to this? How and where will the so-called efficiency savings demanded by the Treasury be found?
What we do know is that the impact will not be equal. As the right reverend Prelate the Bishop of London addressed at the weekend, it has been reported that the Government’s long-promised White Paper on health disparities has been dropped. Can the Minister confirm this? If that is not the case, can he advise on when can we expect this crucial plan to narrow the widening inequalities in health outcomes between the poorest and the wealthiest, between white and black, Asian and minority-ethnic people and between those in the north and south?
The Statement says that patients will be able to get a GP appointment within two weeks, but let us remind ourselves that, prior to 2010, the guarantee of an appointment was within two days, not merely an expectation of two weeks. Can the Minister provide more detail as to how the two-week expectation will be met? I ask this in the context of the record numbers of GPs indicating that they will be retiring or leaving the profession, where burnout and low morale are at an all-time high. How will the numbers stack up when 4,700 GPs have been cut over the past decade, and the long-promised 6,000 GPs are not on course to be delivered? With 330 practices having closed in just the last three years, where will these appointments take place? Are there plans to open new practices?
The gaping hole at the heart of the Statement is, as we know, the lack of a workforce strategy. In the ABCD plan presented by the Health Secretary, the only reference is under D, which refers to doctors and dentists. They are important—there is no doubt about that—but what about the nurses, paramedics, technicians, care workers, cleaners and caterers? Without a plan to tackle the whole staffing crisis, there is not a plan for the NHS.
What are the Government going to do about the staff shortages of 132,000 in the NHS today? This cannot be overlooked. Earlier today, the Minister told your Lordships’ House that there were 200,000 more staff in the NHS than 12 years ago. Perhaps he could elaborate further. Are these full-time equivalents? Where are they and what roles do they perform? Crucially, does the Minister accept that there still needs to be a fully costed plan to deliver the workforce that we so desperately need?
The Statement refers to some £500 million to speed up delayed discharges. Can the Minister help with some more detail on this? Is it a new investment or a re-announcement? How will it be funded? It is indeed right to say that if patients cannot get out through the back door of the hospital because care is not there in the community, we get more patients at the front door and more ambulances queuing at the front. That is exactly the situation we see today. The crucial point is that unless the Government act on care workers’ pay and conditions, employers will not be able to recruit and retain the staff they need. What is the plan to address this?
Finally, can the Minister reassure the House and patients across the country that the response to the crisis in the NHS will not be to lower standards for patients but to raise performance instead? I am sorry to say that this Statement misses the target. I hope the Minister will reflect on the points that I have raised, and other noble Lords will undoubtedly raise, and take the opportunity to use his new and important position to make proper change and improvement.
Baroness Brinton (LD)
My Lords, I echo the comments of the noble Baroness, Lady Merron, about the nature of the plan. It is full of warm words and aspiration, light on detail, especially on funding, and seems to disregard the reality on the ground at the moment. I also echo her concern about the rumours of the White Paper on inequalities being shelved. That is really important. Many of us spent a lot of time in your Lordships’ House during Covid hearing about the problems of people with Covid, particularly those from ethnic minorities and deprived backgrounds. There is a lot of data to say that those people have really struggled.
The workforce plan is something else that from these Benches we asked for consistently long before work started on the Health and Care Act, but absolutely consistently since then. Turning to the plan itself, on ambulances, the announcement in July was welcome but three months on—and this was an emergency announcement—it feels as if nothing has changed. The number of delayed discharges remains stubbornly high, and we know that there is a new wave of Covid rising: the ZOE study figures today suggest around 230,000 new daily cases and 2.2 million active cases. That is going to continue to rise: all the medical experts in this area say we are now definitely at the beginning of this wave.
B stands for backlogs, and I am afraid that that is not really improving either. Although it is good to see that the two-year waiting list is reducing, the under-two year list continues to grow: 6.8 million at the end of last month. The plan talks about patients being redirected from hospitals, but our primary care system—GPs, community nurses, physios, speech and language therapists in the community, and especially social care—is already at breaking point. It is good to be offering Covid boosters, but why are under-12s excluded unless they are immunocompromised? Children at schools without proper ventilation were drivers of the last two waves of Covid, and it just seems ridiculous that they have not been included, because that would be an easy win.
In my question earlier today, I asked the Minister about care and particularly about virtual hospitals. It is good that the plan is picking up on some excellence in the NHS, and I am very proud of my local hospital for doing it, but the Minister did not actually answer my question, which was: given that this work of virtual hospitals creates more work for GPs, community nurses, physiotherapists in the community that in the past would have been done in hospitals, will there be extra resources for primary care? Without it, primary care is already at breaking point; they cannot just magic extra time and energy to do it.
The section about GPs is admirable in spirit, but doctors have repeatedly said that their main problem is a lack of doctors. We also know from the BMA survey back in the spring that GPs’ workload has increased by 30% on clinical administration alone. It is not Covid; it is mainly to do with digitisation and complex systems. It is all very well talking about getting administrators in to do it, but these are administrative tasks that doctors have to do themselves. Unfortunately, it is causing a problem, and I do not see any solution in the plan.
Whenever Ministers talk about doctors, they talk about the highest number ever—indeed, the Minister did so earlier—but there are two problems with that. There are more patients than ever, and that is never reflected in any comments by Ministers. Government funding for doctor training has not been sustained. This year, far too many—hundreds, just under 1,000—newly qualified doctors, fresh out of university, could not get training places because there was no funding for hospitals to be able to do it. The exodus of NHS staff was reported in the Times just last Saturday. The net change is not positive now; it is negative.
On dentists, it is very good news about the simplification of government rules regarding overseas dentists qualifying to work, and we look forward to seeing the regulation shortly, but the main problem is the drastic need to overhaul the government contract. While the Statement says first steps are being taken, I ask the Minister when the major work funding for it will be concluded. Will he also tell your Lordships’ House what provision there will be for the 3 million people who are either immunosuppressed or immunocompromised—for example, because of blood cancer or because of strong medication which has to suppress their immune systems? The government advice on the web page still says that people in this group should not mix with people who are not fully vaccinated or may possibly be brewing Covid, but a year ago all support to this group was ended. Along with other people in this group, because I am one of them, I am about to have my sixth Covid jab, but I have no idea how long I am going to be protected for—that is why I wear a mask a lot of the time in the Chamber. Half a million of the most severely immunocompromised people cannot make any antibodies in response to the vaccine. They were promised antiviral medication or Evusheld. Five million doses of antivirals were ordered, but only 50,000 were handed out, and the Government have just refused to allow Evusheld to be used. What will the Minister do to ensure that this group of people will be protected?
Finally, the Health Service Journal has said that two out of three integrated care systems have fallen off track on their financial plans because of the impact of inflation, Covid cases not being funded this financial year and higher spending on agency staff. This plan will not work if the new integrated care systems cannot work. It is vital that the Minister tells us what plans there are to make sure that ICSs will be supported properly.
The plan for patients has many warm words for delivery. I know this is something the Minister cares greatly for, and we will support him, but the words on their own will not do it. Our NHS and care sector are on their knees already. The Nuffield Trust report says that data shows that even without the pandemic, the backlog would have been well over 5 million. It says the NHS was already stretched. I look forward to hearing the Minister explain how the NHS and care sector will be able to deliver on this plan in their current state.
Lord Markham (Con)
As I mentioned, we have 3,500 more doctors, but the 50 million more appointments target, which we are well on the way to delivering, is from not just GPs but across the piece. It is also from nurses and community pharmacies. I think we would all agree that doctors are our most precious resource. Given the comments on not wishing to overburden them and the stresses of that, we need to make sure that their limited time is focused on the patients that most essentially need that time. We are expanding supply and spreading it among nurses—as I mentioned, from my experience with my mother, they are very capable and willing to pick up a lot—and among pharmacies as well.
Baroness Merron (Lab)
My Lords, I appreciate the answers that the Minister has given your Lordships’ House, but would he be good enough to write to address a number of the more detailed questions raised and give the information requested?
NHS: End-of-life Care
Baroness Merron Excerpts(2 years, 3 months ago)
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Lord Kamall (Con)
The noble Baroness will be aware that earlier in the week, when we had the debate on integrated care boards and their responsibilities, we added—thanks to the work, once again, of the noble Baroness, Lady Finlay—palliative care services to the list of services that integrated care boards must commission. Integrated care boards will be accountable to NHS England, but also the CQC will be doing a lot of evaluation and they will be measured against the list of services that they have to commission. Clearly, there will have to be accountability on palliative care services.
Baroness Merron (Lab)
My Lords, when a child is at the end of their life, quality palliative care should ensure, of course, both the child’s comfort and managing pain and symptoms, but also provide support and care for the entire family. These are clearly heartbreaking situations for everybody involved, so will the Minister assure your Lordships’ House that the review will take account of the support that is given to the whole staff team, including ancillary workers? They, of course, have a key role to play.
Lord Kamall (Con)
One thing that often happens at reviews is that we realise how complicated these issues are. One often cannot pinpoint one key issue, or one silver bullet, as it were. Therefore, quite often—and I was on a call on a different issue yesterday—we thought we had to tackle certain issues but realised there were wider systemic issues. Clearly, that is going to be the case here. NHS England’s palliative and end-of-life care programme is an all-age programme, but there are specific pieces of work focused on children and young people. We have also been working very sympathetically with charities such as Together for Short Lives. It has been commissioned to produce written guidance to provide ICBs and ICSs more detail, as the noble Baroness asked for, but also to make sure we make it a better environment and learn.
Primary and Community Care: Improving Patient Outcomes
Baroness Merron Excerpts(2 years, 3 months ago)
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Baroness Merron (Lab)
My Lords, I also congratulate the noble Lord, Lord Patel, and thank him for bringing this debate before your Lordships’ House, which he did with his customary attention to detail, but also searing analysis of what is before us today. This has indeed been a very sobering debate, and I hope it will be of use to the Minister and also to the new Secretary of State, who of course we wish well in her endeavours.
The noble Lord, Lord Patel, spoke of primary and community care as the bedrock of the health and social care services, and indeed it is the door through which most of us enter when we are seeking to access health and community care. However, our access to it and its suitability are deeply affected by the lack of co-ordination, resources, staffing and planning, as we have heard during the debate.
Dissatisfaction is running at an all-time high. This is not only a bad thing in itself but it affects confidence in the system. It is of increasing concern that those who should be making contact with their local GP are simply put off from doing so because they cannot access the service they require, not least because getting an appointment is beyond them, or so delayed, or difficult. This is not how it should be.
My noble friend Lady Pitkeathley hit the nail on the head when she reminded your Lordships’ House that people do not know or care who provides services; they just want the right service, at the right time, in the right way. People need to be seen as whole people and not only according to the bit of the system that is seeking to treat them. I think there is a very strong message for the Minister about the organisation of health and care services being around individuals and all that comes with them, rather than the other way round.
There are critical backlogs in both the sectors we are considering. There are some 1 million people waiting for care services within the community. The backlogs are a key factor in the dire ambulance delays that we are seeing, and they are added to by the number of patients who are in hospital beds when they should be in their own beds, either in their own homes or in a care setting—something about which the noble Baroness, Lady Masham, spoke so clearly.
The Community Network, which is comprised of organisations including NHS Providers and the NHS Confederation, has called for the Government to treat waits in the community sector on an equal footing to backlogs in the acute hospital sector, including through the development of a plan to address these delays as well as accelerating work to improve the quality of national data collections in community care. Could the Minister confirm whether the department has explored this option, because it would be a helpful way forward?
The noble Lord, Lord Kakkar, was right to put down a challenge to how systems are organised and about whether hospitals are the right place—the best place—for dealing with chronic conditions when there is so much opportunity to deal so much better with a number of these closer to home. I hope the Minister will reflect on this.
It is the case, as we have discussed so many times, that the issue of the workforce comes up time and again. We know that there is an increasing volume and complexity of demand, a rapidly aging population and, with that, huge workforce shortages. I must repeat the call for a long-term workforce plan to address what is a stark situation. Failure to address this will only exacerbate the backlogs and health inequalities still further.
The response so far has been disappointing, as we saw in the passage of the Health and Care Bill. This is not just about numbers, important though they are. It is also about what staff do, and whether we have the assessment available to make a judgment as to whether we have the right range of staff, as the noble Baroness, Lady Watkins, referred to, to make sure that they can be available to meet peoples’ needs.
Although it is welcome that there are, as we have heard, additional roles to be developed and additional staff to be made available to work in primary care networks—including pharmacists, physiotherapists and link workers—and it is welcome that there is to be recruitment, there is a gap: how will general practices implement a multidisciplinary model of care, either within or across practices, which will embrace these roles? This is lacking, as we have seen from the King’s Fund investigation into this issue, and it is leaving staff isolated and demoralised. How will this be dealt with beyond recruitment? How will these additional and new roles come into play?
How will the fact that appointments are getting ever more difficult for people to get be dealt with? A GP Patient Survey found that only 56% have reported having a good experience of making an appointment, and there are early signs that the pressure on GPs is affecting patients’ experience of their appointment even when they actually do get one. Similarly, the British Social Attitudes survey showed that satisfaction with GP services fell to 38% last year, which is the lowest level ever recorded. What will be done to address this problem?
On GP numbers, my noble friend Lord Hunt again raised the important question about the reduction in GP training places. What is the thinking on this reduction? How does this square with the expectation that we need, and are told that there will be, greater numbers of GPs?
Improving access will require actions from across the health and care system, and it is critical that integrated care systems and their partners consider how they will provide support to general practice to improve access in the short term. How will this manifest itself within the new integrated care boards?
As we know, and as the noble Lord, Lord Bethell, referred to, the pandemic accelerated new ways of working, including a rapid uptake of existing digital tools to deliver patient care. While this has benefits for patients and staff, there is a proportion of the country who are digitally excluded or who have needs that make digital access less appropriate for them. How will this be addressed so that nobody is left behind?
Finally, I refer to the proposal from the noble Lord, Lord Patel, for a special Select Committee to take forward how we can address the lack of co-ordination in the primary care sector. I hope that the new Secretary of State will consider this worthy of consideration, because there is no doubt that the debate today has shone a very clear light on the fact that we need to step back, make the change and build the system around the needs of the patient, and not the other way around.
NHS: Access to Treatments
Baroness Merron Excerpts(2 years, 3 months ago)
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Baroness Merron (Lab)
My Lords, the QualityWatch report by the Nuffield Trust and the Health Foundation found that the record waiting lists we now see cannot be attributed to the pandemic, as has so often been suggested in this House. What is the Minister’s response to this report’s findings?
Lord Kamall (Con)
The Government are well aware of the waiting list problem. In fact, we have virtually eliminated two-year waiting lists, except for some of those difficult cases. The targets, working with various partners across the system, is to make sure that we eliminate 18-month waits by April 2023. When we look at this, those waiting 18 months or longer will be reviewed every three months at a minimum. Diagnosis and treatment of patients will be prioritised according to clinical urgency, then length of wait. NHS England has introduced six categories of prioritisation and is regularly reviewing those to make sure that patients are treated appropriately.
Urgent and Emergency Care
Baroness Merron Excerpts(2 years, 3 months ago)
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Baroness Merron (Lab)
My Lords, as the new Prime Minister is appointing her first Government, I am very glad to see the Minister in his place this evening. I have a sense of despair over the dire situation in the ambulance service that led to yet another Statement. However, I welcome the inclusion of the importance of vaccination and the funding for motor neurone disease. I also pay tribute to St John Ambulance and am pleased that it has now been formally commissioned. Could the Minister confirm that this extra capacity is being used by the system today?
The outgoing president of the Royal College of Emergency Medicine has said that ambulance delays have got so bad that the NHS is now “breaking its promise” that life-saving emergency care will be there when it is needed. The facts are that 29,000 patients waited more than 12 hours in A&E in June—more than ever before—and 10,000 urgent cases waited more than eight hours for an ambulance last month. But this is not just about life and death; it is about the distress and severe discomfort of those who are kept waiting. Analysis by the Financial Times estimates that the deteriorating state of emergency services could be costing 500 lives a week, so can the Minister give an estimate of the number of people the department believes have died unnecessarily because they have been stuck in an ambulance waiting to get into A&E, or because an ambulance has turned up late or not at all?
We have gone from no crisis in the system in 2010 to annual winter crises, and now to there being a crisis all year round. We hear that the NHS will tell patients to avoid A&E as the winter crisis bites early. Can the Minister tell your Lordships’ House when the winter crisis will now start? What is the forecast of how much worse excess deaths will be over this winter? What is the Minister’s response to the QualityWatch report’s assessment that the roots of record waiting lists and delays to ambulance services predate the pandemic?
Ambulance delays are directly related to one in seven hospital beds being occupied by patients medically fit to leave but who cannot be discharged because there is no social or community care to support them. To give but one example, there are reports today of an elderly man who, sadly, died last month in the back of an ambulance after waiting six hours to be admitted to Norfolk and Norwich University Hospital. The chief nurse at the hospital said that the man
“remained in the ambulance due to significant pressure on our emergency department and inpatient wards.”
However, at the same time, more than 200 patients in the hospital were medically fit to be discharged. Will this matter be considered in the investigation? How will situations such as this up and down the country be resolved?
How do the Government intend to ensure that we have the supporting social and community care workforce we so desperately need? Why is there continued resistance to workplace planning and reporting to this House?
Care workers, who are desperate for a decent wage, are being lost to the likes of Amazon. The Government’s answer has been to pull the “immigration lever” and to recruit people from overseas on lower wages. How will this be sustainable? What difference will it make in the long term?
The Statement mentioned the new mandate for Health Education England to train 3,000 paramedic graduates. What is the Government’s reasoning behind conversely capping the equally important number of medical graduate training places, which the Medical Schools Council has criticised?
We all know that the cost of living crisis is likely to be devastating. If people cannot afford to keep themselves warm, they are more susceptible to illness and infections. We know that 10,000 people a year already die as a result of cold homes, and that this could be far worse this year without action. Could the Minister say what the Government will do to address this? Have they assessed the impact of the cost of living, which continues to rise alarmingly, on health outcomes and well-being? Do they have a strategy to help people proactively?
What consideration has been taken of the fact that rising energy costs will push care providers to breaking point, with some homes facing closure, unable to absorb increases of 500% or more? What plans do the Government have to protect care home residents from finding that they have no home?
The reality of the ambulance services’ situation is that things are getting worse, not better. Can the Minister advise your Lordships’ House on what exactly the Government will do to reverse this trend?