Brexit: Health and Social Care Workforce

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Thursday 13th December 2018 Lords Chamber

[Lord O'Shaughnessy]

I recognise the picture that my noble friend paints. It is of course incredibly important that money gets to the front line. I am sure that she is aware of this, but I would point out the operation of the Better Care Fund, which brings together local authority and NHS funding specifically to support social care provision. The amounts of money going through that have been increasing over recent years.

[Baroness Pitkeathley (Lab)]

My Lords, the statistics quoted by my noble friend on the Front Bench are pretty frightening, but the knock-on effects on the 6.5 million unpaid carers upon whom our health and social care system depends are even more alarming. In a recent survey, 70% of them doubted their ability to continue caring if more support, much of which comes from these care workers, is not available to them. Will the Minister assure the House that the forthcoming Green Paper, which we know is imminent, and the NHS plan, will take full account of the needs of carers?

[Lord O'Shaughnessy]

I am grateful to the noble Baroness for raising the matter and for her persistence in doing so; she is quite right to. We were pleased to publish the action plan earlier in the year and I can tell her that the Green Paper, as I have said before at the Dispatch Box, will contain more policy on supporting carers.

Domestic Abuse: General Practitioner Charges

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Thursday 15th November 2018 Lords Chamber

[Lord O’Shaughnessy]

My noble friend is right to say that domestic abuse can affect anyone, although of course it happens predominantly to women. The police, local authorities and the third sector are there to provide support for both men and women when they are abused.

[Baroness Pitkeathley (Lab)]

My Lords, further to the question put by the noble Baroness, Lady Greengross, I understand that it is becoming more common for some general practitioners to see older people with a similar illness in groups. Would this not be quite prejudicial to the idea of having a confidential interview with one’s GP if abuse has been threatened?

[Lord O’Shaughnessy]

This would be for the discretion of the GP. I would be amazed if any GP would want to see someone who has come to them with a confidential matter, such as saying that they have been the victim of domestic abuse, in a group situation. That seems to be quite wrong. There is a role for group GP appointments for totally different issues, and indeed some of the emerging evidence shows that, for certain illnesses, they can be quite successful.

General Practitioners

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Wednesday 17th October 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree with that recommendation. It is certainly being considered as part of the long-term plan, for which workforce is clearly critical. That is one reason why it is significant that there are 3,000 more clinical staff in general practice who are not doctors—nurses, pharmacists and others. Clearly the nature of general practice is changing. Doctors do not have to do everything, and other well-qualified professionals can carry out essential roles.

[Baroness Pitkeathley (Lab)]

My Lords, when the Government launched their loneliness strategy last week, we learned that one in five people at GP surgeries is there for reasons caused by loneliness. Can the Minister expand on what is being done to change GPs’ training so that they can deal with such problems, or—following his answer to the previous question— on what other clinicians and associated professionals will be brought into the mix to help solve the loneliness issue?

Personal Social Care: Funding

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Tuesday 16th October 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for raising this important issue. She is quite right that extra funding is needed, which is why we have pledged £20 billion extra for the NHS and want to get this long-term funding settlement for social care. There are many proposals in the Independent Age document—nine, I think—and we are looking at a range of different options. As I said, there needs to be a fair balance between those who are working today and those who need care today, an issue that has evaded a number of Governments and which we sincerely hope to solve. On how the two plans will work together, the intention is that the long-term plan and the Green Paper will be published together around the same time and will therefore be complementary in trying to achieve the goal of integrated health and care.

[Baroness Pitkeathley (Lab)]

May I press the Minister further on his Answer to my noble friend about the consideration of free personal care? Those of us who were at the memorial for Lord Sutherland earlier today remember that he chaired a Royal Commission that came up with a proposal for free personal care. Sadly it was not implemented then, nor has it been implemented by any of the endless reports we have had on this issue in the ensuing 20 years. We need to consider free personal care as one of the options. I ask the Minister again: will it be considered?

[Lord O'Shaughnessy]

I shall have to disappoint the noble Baroness: the proposals will be set out in the Green Paper and I will not give a sneak preview today.

Adult Social Care

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Wednesday 11th July 2018 Lords Chamber

[Lord O’Shaughnessy]

That sounds like an excellent idea, and I would be delighted to consider it, as well as any other ideas that the noble Baroness has.

[Baroness Pitkeathley (Lab)]

I welcome the Green Paper but it is only a Green Paper. Does the Minister have any assessment of how long it will be before legislative changes can be brought in to make new initiatives a reality?

[Lord O’Shaughnessy]

I do not have that information, but it will be set out in the Green Paper.

Long-term Plan for the NHS

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Tuesday 19th June 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend sets a tremendous personal example in this case. He is a fearless and tireless campaigner on the causes of obesity. He knows that it is our hope and intention that we will return to this topic so that we can start to reduce this plague on children and adults.

[Baroness Pitkeathley (Lab)]

My Lords, in the Statement the Minister referred to full integration between health and social care. Does he mean full integration of services, workforce and budgets? If so, is he confident that it can be done without the kinds of reorganisation that all of us dread?

[Lord O'Shaughnessy]

The noble Baroness makes a good point from her experience. There is agreement across the House—and, indeed, across both services—that there needs to be an integrated service. It is clearly not satisfactory to delineate in the way that we have done historically. How we get there will obviously be difficult. We need the NHS and local government to take the lead and to come up with proposals. If we believe that those proposals will deliver what we want without creating upheaval, it is incumbent on us all to get behind them.

Carers: Health and Well-being

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Tuesday 12th June 2018 Lords Chamber

[Baroness Pitkeathley (Lab)]

I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I draw attention to my interests in the register.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)]

My Lords, the Government recognise and value the work that carers do and are committed to supporting carers so that they can provide care without compromising their own health and well-being. That is why, on 5 June, my department published a carers action plan, setting out a cross-government programme of support for carers. Furthermore, there will be a clear focus on carers in the forthcoming social care Green Paper.

[Baroness Pitkeathley]

I thank the Minister for that reply and for the action plan. The process was a bit protracted, as he will remember, but I am glad that the department managed to get it out in time for Carers Week. However, by its own admission it is a short-term plan only to bridge the issue of carers in the run-up to the social care Green Paper. In new research published for Carers Week, 70% of carers said that their own mental health had been adversely affected, while 60% said that their physical health had worsened, and two out of five said that they doubted their ability to go on caring unless they had more support. Given that that care is valued at £130-odd billion a year, that is a time bomb that must be addressed in the Green Paper. Can the Minister reassure the House that the needs of carers will be central to any plans for social care reform? Will he also understand that, as well as the moral imperative for supporting carers, to which I know he is personally committed, there is a very sound economic case for doing so?

[Lord O’Shaughnessy]

I thank the noble Baroness for her question and for her tenacity in pursuing me on this topic. I am glad that we were able to publish the action plan. It is appropriate during Carers Week to pay tribute to the amazing work that carers do. Yesterday, I had the opportunity to meet carers who were struggling, often against their own health needs, to care for those they love.

The action plan that we published is a two-year plan. It has some immediate actions but is not purely short-term and contains some actions for the medium term. I highlight one of those, which is important, particularly given these concerns about carers’ health and well-being: a commitment to creating equality standards for carer-friendly GPs. Carers mentioned to me yesterday how important it is for GPs to validate the fact that they are carers and signpost them in the direction of care. I can confirm that carers and support for carers will have prominence in the Green Paper.

NHS: Winter 2017-18

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I do not believe that we have specific statistics on the demand from overseas visitors during winter. I say to my noble friend that overseas visitors are most welcome to use the NHS but it is important that they pay. We are reclaiming more money than ever from overseas visitors to go into funding the NHS.

[Baroness Pitkeathley (Lab)]

Is the Minister aware that the pressures on the health service are compounded by the difficulties in the social care system? We are promised a Green Paper. We were promised a carers action plan in January; it is now mid-April. Will he update the House on where we are with the carers action plan?

Prescription Drugs: Dependence

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Monday 19th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I can attest to the benefits of both those courses of treatment. The review will look at prevention of dependency in the first place and in doing so will look at alternative courses of treatment. Of course, in the end there is a balance to be struck between the clinical needs of the patient and the right course of treatment. It is about making sure that clinicians are as informed as possible.

[Baroness Pitkeathley (Lab)]

My noble friend mentioned that many of the services for people who are addicted to prescribed drugs are provided by the charitable sector. He also mentioned that many of those services are under threat or have closed down because of a lack of local authority funding. Will the Minister consider what can be done to replace those vital services? Will the charitable sector, which is doing such good work in this area, be consulted in the course of the review?

[Lord O'Shaughnessy]

I completely echo the noble Baroness’s praise for the charitable sector. We have some very high-quality treatment centres in this country, provided both by the state and by charities. They do a fantastic job. In the most recently published figures, local authorities’ actual spend on funding for adults for drug misuse was about £490 million a year, so a substantial amount of money is going in. Of course, we need to make sure that it is getting to the people who are addicted to prescription drugs as well as illegal drugs.

Agency Nurses

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

It is that last issue that we are trying to address. One factor is that there is now an hourly rate price cap on agency spend, precisely to drill down into that issue. The reason that the number of agency staff went up was in response to the Francis review and what it said about safe staffing levels in the service. The immediate response was to deal with that through agency staff. That was expensive, of course, which is why we have had to push down those costs. Nurses have to come from somewhere, and my noble friend is quite right that using existing nurses and support from nursing banks is one way of meeting demand with better value for money.

[Baroness Pitkeathley (Lab)]

My Lords, I noted carefully the Minister’s words about 10,000 extra nurses on the wards. Can he update the House on the position for community and district nurses?

[Lord O'Shaughnessy]

The number of those nurses has fallen—as have the numbers in mental health, which is worth pointing out—and we are trying to address this. I think I made a slip of the tongue a moment ago when I said that £5,000 more will be spent each year on training nurses; I meant that there will be 5,000 more student nursing places.

Child and Adolescent Mental Health Services

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Monday 30th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight the fact that we need more staff to meet the mental illness burden in society, which is sadly growing. I hope that she will have seen that Health Education England has announced that there will be 21,000 more mental health staff by 2021, of which 13,000 will be qualified clinical staff, including 700 more doctors. The warning she has made has been heard loud and clear and those changes have been made.

If I may, I would like to use this opportunity to say that I made a mistake in my previous answer, when I talked about there being 21,000 people eligible for flu jabs. If that really was true, that would be a poor place to be. It is actually 21 million, which is slightly more reassuring.

[Baroness Pitkeathley (Lab)]

My Lords, I would like to ask the Minister about the 700,000 young carers, who often have severe mental health needs because of the stress of the duties they undertake, as he will know. We had high hopes of specific action for young carers in the refreshed carers strategy, but I understand that this is being rolled up into the consultation on the social care Green Paper. I am concerned and would like to be reassured that the Government have not abandoned the long-awaited carers strategy. If we are waiting for the social care consultation, how will he ensure that the mental health needs of young carers are urgently addressed?

[Lord O'Shaughnessy]

I know that the noble Baroness cares passionately about this group of people. My understanding is that those policy issues are being considered in the round with the social care consultation. I shall write to her to clarify that point. She might like to know that, in the upcoming Green Paper on children and young people’s mental health, there will be an expansion of some of the work that has already gone on around providing mental health first aid and various other things in schools, which will capture some of the young people that she is talking about.

Care Homes: Hospital Discharges

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Monday 16th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is right to highlight the issue of community nurses, where in particular there has been a reduction in numbers even though the total pool of nurses has increased in recent years. He will hopefully have noticed an announcement at the Conservative Party conference from my right honourable friend the Secretary of State about more nurse training places—25% more—to address the kind of issues he is talking about.

[Baroness Pitkeathley (Lab)]

My Lords, with the pressure on hospitals to discharge people and the lack of nursing and residential care beds, does the Minister agree that undue and unfair pressure is sometimes put on families and carers to accept discharge in an unsuitable situation? Last week, I spoke to an 87 year-old carer, herself frail and with severe angina, who was induced—I use the word advisedly—to accept discharge of her 91 year-old husband, still immobile after a fall, with a promise of visits from a community nurse twice daily. Of course, those visits have not yet materialised.

[Lord O'Shaughnessy]

I am sorry to hear about that particular issue. I obviously have not seen the details; perhaps the noble Lady might write to me about it. Clearly, nobody should be induced or otherwise forced to accept the care of somebody for whom they are not capable of caring. Looking at our growing and aging population, I think we all accept that the number of operations and admissions going through the NHS is increasing. We need much more capacity in the system, whether in nursing and residential homes or, increasingly, in domiciliary care.

Adult Social Care in England

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Tuesday 10th October 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness makes an excellent point. We will certainly look at those funding models. Co-ordination, as we have been saying, is the way forward, because if you are a user of care in your eighties, you may be visiting a GP, you may be based in a nursing home, and to you, it ought to be one system and you ought to be travelling through it smoothly. Of course, we know that that is not the case at the moment, and the noble Baroness is quite right to highlight that there are great gains to be made, whether from having pharmacists in nursing homes or from having GPs coming to visit. Her point about technology and data is a good one. We still have an argument to win in reassuring people that their data are safe within the NHS so that they can be confident that they are used wisely for their direct care. That is the policy area I am now responsible for, since the election, so I am focused on providing that reassurance so that we can unlock the kind of innovation she is talking about.

[Baroness Pitkeathley (Lab)]

My Lords, is the Minister able to give us any idea about when we may see the Green Paper for which some of us feel we have been waiting 40 years? Will it contain any revisiting of the Government’s response to the so-called Dilnot proposals about a cap on social care costs, about which there was so much confusion in the general election?

[Lord O'Shaughnessy]

I am sorry to disappoint the noble Baroness but I am not able to give her any more details on the timing of the consultation.

Health: Sepsis

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Thursday 14th September 2017 Lords Chamber

[Lord O'Shaughnessy]

That is absolutely right: there was an issue with coding. The noble Lord will be pleased to hear that from April this year NHS Digital published new guidance on coding for sepsis to deliver exactly the kind of improved reporting he wants.

[Baroness Pitkeathley (Lab)]

My Lords, as a survivor of total-body sepsis, I very much endorse what my noble friend Lord Turnberg said about the speed and danger of this illness. What was so difficult for both my family and the professionals who treated me to understand was that it could lead to a total failure of all the body’s organs—as it did in my case—within, literally, hours. The urgency of this must be emphasised in any public awareness campaign.

[Lord O'Shaughnessy]

I am very sorry to hear that the noble Baroness suffered that but am obviously delighted that she is still here. Just to re-emphasise the point about speed, I encourage noble Lords to look at the quality standard because it is very stringent about the speed at which treatment must be administered. Of course, the critical thing is making sure that there is proper triage and assessment ahead of that. That is where we still need to make some progress.

Adult Social Care Services

Debate between Baroness Pitkeathley and Lord O'Shaughnessy

Thursday 6th July 2017 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, the Minister has reminded us just how many consultations there have already been on this subject, most of them not moving us very far forward, sadly. It is welcome news, therefore, that the consultation will focus on solutions, not just problems. Does the Minister agree that if we are doing this for the long term—and it essential that we are—a whole-population solution and, dare I say it, a cross-party solution is required?

[Lord O'Shaughnessy]

The noble Baroness is quite right. We need to move forward on the basis of consensus, which is one thing that has been lacking in the past. There is no doubting the point we have reached: we cannot wait any longer and we need to move ahead. That is why we will do so, on the basis of consensus.