NHS: Access to Treatments

Baroness Morgan of Huyton Excerpts

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord is absolutely right. There are a number of issues to do with social care. One of the reasons, frankly, is that it has been treated for far too long as a Cinderella service. One of the things we are doing is registration—there is a debate in the care community about whether it should be a voluntary or compulsory register; it is voluntary to start—to make sure that we really understand the sector. No one really has an overall picture of the care sector, and there is a range of different qualifications, which are quite often inconsistent. If we can get all that together, understand what is out there and understand the qualifications, we can make it a proper vocation and career for people. That is what we are doing at the moment.

[Baroness Morgan of Huyton (Lab)]

My Lords, I urge the Minister to talk to the new Secretary of State and urge her, after 12 years, to actually start governing rather than campaigning. As we have just heard, a series of headlines—ABCD and all the rest—may tick some boxes for the media but does not change the system. The fundamental issue is social care and there is still no plan to change that.

[Lord Kamall (Con)]

I am afraid I shall have to disagree. I ask noble Lords to think about what we have been doing with the Health and Care Act: for the first time, we are talking about properly integrating health and care together. They will be completely connected from the beginning of life and all the way through life. We also had the paper on integration and we are taking a number of different steps to make sure that social care is no longer the Cinderella service, but properly joined up all the way through people’s lives.

Health and Care Bill

Baroness Morgan of Huyton Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Morgan of Huyton (Lab)]

My Lords, I draw attention to my interest in the register as chair of Royal Brompton and Harefield hospitals, now part of Guy’s and St Thomas’ Trust. Like others, I pay tribute to both the speech and the work of the noble Lord, Lord Stevens, and thank him for assisting us in making a merger of two trusts work where both sides wanted to do it.

Like so many of us, I am hugely proud of the NHS, its formation and its evolution, but I am also hard-headed. To be funded properly and remain broadly supported as a universal service, it needs consistent investment and intelligent, well-evidenced reform. I was aware of that before the 1997 general election, when I felt that the very foundation of a universal service was at stake. Underneath the warm noise, I feel that somewhat now again. I am hugely supportive—indeed, incredulous—of those who work in the NHS, but that must not morph into unconditional support without challenge for the outcomes and delivery of the service around the country.

I have spent more time, really, connected to a different public service—education—where arguably there has been a more sustained principle of reform for 20 years or more. We have seen a sustained push to raise standards across the piece, with a particular focus on under-attainment and disadvantage. We have seen devolution of budgets and responsibility to the front line, clear accountability and action on failure, facilitated by inspection and data, and support for getting talented people into teaching and leadership. Do not get me wrong: it has not all been rosy, and I have had many disagreements, but today is not the time for that. My point is that there has been a visible approach and journey over the last couple of decades.

Contrast that with health: centralisation, then decentralisation; PCTs; SHAs; CCGs; regional NHS bodies; Monitor; NHS England and NHS Improvement —then merged; we could all go on. Now we have ICSs, acute collaboratives, myriad reviews and too many meetings and demands for information. Those demands are made on the very people who are trying to deliver services for patients all the time.

The Bill, laudably, aims to improve and move the NHS from a siloed approach to a properly comprehensive system of health and care. It wants patients to be treated at the right time and in the right place and outcomes and treatments to be more equitable. Who would not support that? Of course we want greater integration; it makes complete sense, but the devil is in the detail. What I and, I suspect, others will want to understand during the passage of the Bill is how it will improve outcomes—or will it simply even things out? Will there be action on failure or a soggy “Let’s all help each other out”? By that, I do not mean shouting at press conferences at overstretched people, because we all know that simply will not work.

Will there be space to encourage clinicians, managers, scientists and entrepreneurs to be innovative and drive new practice and efficiencies? Will there be incentives to get improvement? Will AI and machine learning really be exploited? Where is the focus on life sciences to harness the huge opportunity that a national health service offers? Will data be used to empower patients, and will data systems work so people are not tied up with endless requests from the layers—using different data systems, of course?

I also wonder whether Covid “gold” has, understandably, in many ways allowed a command-and-control system to become paramount. How we will turn that back to allow talent and ideas to flourish, or will that be sacrificed? I have to say that the Statement from the department on foundation trusts and capital is a warning sign for me. We must incentivise performance at the front line.

Will the really hard issues be examined and reformed—I am thinking particularly of primary and community care—or will that be left to “working together”, with the usual focus on hospitals, albeit probably through the parallel acute collaboratives? Crucially—others have said this far better than me—where is the comprehensive workforce plan? Without it, too much of this will be hot air.

I suppose I am sceptical—and I do want to be convinced—because I find it unusual, let us say, to see integration leading to extra layers and bureaucracy. Of course I want better partnership, better leadership and better care and for that to be spread widely around the country. But I have to say that my experience as an NHS chair for four years has been that good governance has to be tangible, transparent and provide clear differentiated responsibilities and accountabilities. You need strong and effective boards with a range of backgrounds and experience, and I do not really see this here. The governance is a muddle and I suppose that in some ways, I am arguing that I do not think it is bold enough.

I get the arguments for more integration of local care—of course that makes sense—but I do not yet see the Bill delivering what we really need. My plea is that, together, we really examine the Bill on the basis of why, what, how and who. Otherwise, we will end up doing another set of reforms five years from now and will not deliver the modern, integrated, universally supported system we all need and want. Please let us take the chance to get this right, or at least make it much better than now.

Childhood Obesity: Yoga

Baroness Morgan of Huyton Excerpts

Thursday 21st June 2018 Lords Chamber

[Lord O’Shaughnessy]

I wish the noble Lord a very happy birthday and I hope he has done his sun salutations this morning.

[Baroness Morgan of Huyton (Lab)]

My Lords, widening the conversation, when the NHS settlement is detailed in full, will the well-being of schoolchildren be looked at very carefully, particularly in relation to school nurses and the support that a lot of young people, particularly teenagers, need in schools and possibly are not getting sufficiently at the moment?

[Lord O’Shaughnessy]

The noble Baroness is quite right to raise that issue. Of course, it is something we are looking at. I also point to the pledge made in the children and young people’s mental health Green Paper to dramatically increase the number of staff on mental health support teams, which are providing not just help for children who are in crisis or having difficulties but well-being skills so that they do not experience those problems in the first place.

Social Care

Baroness Morgan of Huyton Excerpts

Thursday 15th October 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness says that the care system is at breaking point. The CQC’s report out today says that it is “fragile”. I think it is very variable. Some care providers are finding life extremely difficult but it is highly variable; it depends very much on the mix of clients that care providers are looking after and the extent to which they are funded by local authorities and the extent to which they are funded privately. But I take on board what the noble Baroness says and take it very much to heart.

[Baroness Morgan of Huyton (Lab)]

Does the Minister agree that one of the issues in the CQC report this morning was the hospital sector appearing to be in a level of crisis? We have also heard about the funding problems. That is directly related to the crisis in the social care system. It is one for thing for Ministers to say that the Government are aware of that but I suppose the real question is: what are the Government going to do about the huge current pressures in the social care system, which everybody recognises?

[Lord Prior of Brampton]

What the noble Baroness says is absolutely right—the two are linked closely, although it is interesting that the main concern coming from the CQC report is around safety, which is not directly related to the point that she raised. The better care fund is a start on this road. The devolution in Manchester is another point along the journey. Increasingly, over the next five or 10 years, we will see a coming together of the health and social care system.