NHS: Community Pharmacies

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Tuesday 6th December 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I do not recognise the figure of 7.4%. The actual reduction is 4% next year and 3.4% the following year. I echo my noble friend’s comments and recognise the huge importance of community pharmacy. If we look forward 10 years, we will see a much greater role for community pharmacy within the NHS in supplying many of the services that are currently supplied by more conventional NHS services.

[Baroness Pitkeathley (Lab)]

My Lords, the Minister mentioned clinical skills. Does he agree that in rural areas in particular, community pharmacies play a role much wider than their clinical function in giving advice, information and sign-posting to patients and their families? Does he agree that that is a very important part of their function that should continue?

Adult Social Care

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Tuesday 15th November 2016 Lords Chamber

[Baroness Pitkeathley]

To ask Her Majesty’s Government what is their response to the warning by the Care Quality Commission in their State of Care report, published in October, that adult social care is approaching “tipping point”.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we welcome the State of Care report. We know there are serious pressures on the care system. That is why we are giving local authorities access to up to £3.5 billion in new support for social care by 2019-20 so they can increase social care spending in real terms by the end of this Parliament.

[Baroness Pitkeathley (Lab)]

I thank the Minister for his usual courteous reply, but I think he knows that the funding he has announced there for the better care fund is both too little and too late. Does he agree that there have never been so many challenges for the social care system? There is terrible pressure on the NHS and on caring families, and many people have no care at all at home, however great their needs. Does he further agree that there has never been so much consensus about what needs to be done? Across all professions and political divides, we hear that what is needed is more money, and more money now. I am well aware that asking for commitments in the Autumn Statement is above the Minister’s pay grade, but could he please assure the House that he and his colleagues are stressing the urgency of this matter to the Chancellor of the Exchequer and asking him to make more funding for social care an urgent priority?

[Lord Prior of Brampton]

My Lords, I think most people in the health and care system, whether it is Simon Stevens, the chief executive of the NHS, or the Secretary of State, realise how serious pressures are in social care. There is no question about that. The State of Care report from the CQC supports that view. That is why we are putting in more money towards the end of this Parliament. It is back-end loaded—I accept that—but on the other hand the £3.8 billion that went into the NHS this year is front-end loaded. I think everyone agrees that the only way out of the difficulties we are in is for health and social care to work much more closely together.

NHS: Cancer Patients

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Wednesday 9th November 2016 Lords Chamber

[Lord Prior of Brampton]

There are lies, damned lies and cancer statistics. It is extremely difficult to make comparisons on survival rates with other countries. There is evidence that we are behind the best in Europe on five-year survival rates. There is also considerable evidence that we are making good progress—but, of course, other countries are making good progress at the same time. If we implement the cancer task force recommendations, it is estimated that we will save an extra 30,000 people’s lives per annum. We have a very ambitious programme to improve cancer outcomes, but I accept that we are starting from some way back from the best performance in Europe.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister accept that early diagnosis depends on patients or potential patients recognising the symptoms? Notwithstanding the pressure on services, are the Government continuing to encourage patients to recognise potential cancer symptoms?

NHS: Primary and Community Services

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Monday 7th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, delayed and inappropriate discharges are clearly a huge issue for the whole health and care system. Again, this is something the STPs are designed to address. The five-year forward view is explicit in saying that there are 5.5 million carers in England and their continuation goes to the very sustainability of the NHS. The importance of care is not in dispute. The Care Act, which the noble Baroness’s party and mine put through in the last Government, recognised that so as to give them parity of esteem with those they care for. There is no question but that better communication with carers would go a long way to improving the problems we have with inappropriate discharges.

[Baroness Pitkeathley (Lab)]

My Lords, the Minister has acknowledged that discharge from hospital is an important time for carers. You can literally become a carer overnight when your relative is discharged without warning. The carers strategy is currently being refreshed. Would the Minister consider an input into the carers strategy that meant it was incumbent on the National Health Service to consult carers and get their agreement before discharges are made?

[Lord Prior of Brampton]

My Lords, I am not sure we could go so far as to say that one should always have their agreement—sometimes, discharges from hospital are incredibly complex and difficult—but there is no doubt, arising from the Carers UK report, that where there is proper communication with carers, the discharge procedure is much better for everyone, from the point of view of the carer, the patient and the hospital. If proper arrangements are not put in place, delays arise long after the patient should have been discharged home. It could be to do, for example, with a care package or altering the patient’s home.

NHS: Unsafe Hospital Discharges

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Wednesday 15th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there are millions of interactions between patients and consultants and doctors every day of the year, and there will be some mistakes. We cannot draw conclusions from one or two desperate situations. In so far as they reveal systemic problems, it is valid to draw attention to individual cases of this kind, and there are some systemic issues lying behind the PHSO’s report. In particular, it states:

“We are aware that structural and systemic barriers to effective discharge planning are long standing and cannot be fixed overnight … health and social care … have historically operated in silos”.

That is the issue on which we should be focusing.

[Baroness Pitkeathley (Lab)]

My Lords, I ask often in this House and elsewhere about co-operation between health and social care. Does the Minister agree that one thing we lack is a cohort of people, be they nurses or paid professional carers, who can work across health and social care in hospital and follow patients into the community? Will the Minister update the House on what is happening to encourage that kind of cohort?

Learning Disabilities: Transforming Care

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

All the transforming care partnerships will comprise both CCGs and local authorities, so all the experiences learned by local authorities should be paid into the process.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that when such in-patients leave in-patient care, much of the responsibility for looking after them actually lies with their families? As this is Carers Week, would the Minister update the House on the Government’s attitude to this with the revision of the carers’ strategy?

[Lord Prior of Brampton]

I think we have a direct Question on carers next week. We are absolutely committed to supporting carers. Where people who have been in hospital for more than five years are discharged back into the community, as it were, the CCGs will provide them with a dowry to cover their costs. It will be very clear that the funding of those patients will stay with the CCGs.

NHS: Hospital Overcrowding

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Tuesday 15th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, a lot of what was said by the person, whose name I cannot remember, to whom the noble Lord refers, was absolutely right, but when he said that there were no more efficiencies to be gained he was completely wrong. We can still achieve huge efficiencies throughout the whole healthcare system, in the context that the NHS is one of the most efficient systems in the world, but it can be better. It would be completely wrong to say that no more efficiencies can be achieved.

[Baroness Pitkeathley (Lab)]

My Lords—

--- Later in debate ---

[Baroness Pitkeathley]

My Lords, will the Minister agree that there is bound to be overcrowding in hospitals if we have a point of entry without any guaranteed point of exit? Therefore, unless social care is adequately funded and organised, we will always have this problem of overcrowding, particularly where old people are concerned. I would be very glad if he did not refer me to the better care fund as the answer to this, because it is already oversubscribed many times.

[Lord Prior of Brampton]

My Lords, I will not refer to the better care fund, but I agree with the noble Baroness that flow through a hospital is essential. Blockages at the end of the flow can cause problems further down the line in A&E departments. I entirely agree with the noble Baroness’s analysis, but it is more complex than just looking at social care. Two-thirds of the delayed transfers of care are caused internally within the NHS, compared with only one-third by social care, but the noble Baroness makes a very strong point.

Four Seasons Group

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Monday 11th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I could not see where the question was coming from. I am not fully briefed on the financial instrument that my noble friend—I am sorry; the noble Baroness—referred to. I will have to research it and get back to her.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that Four Seasons, which is the subject of the Question from my noble friend on the Front Bench, is only one of the groups facing financial crisis? It is estimated that by 2020 there will be a funding gap of £3 billion for the residential care sector, and 15 social care groups warned the Chancellor of this before the Autumn Statement. Have the Government any long-term plan for funding and improving social care or are they committed to short-term solutions and to saying that it is a matter just for local authorities?

[Lord Prior of Brampton]

My Lords, clearly, it is a matter principally for local authorities. However, the Government are making available in the spending review another £1.5 billion for the better care fund and allowing local authorities to raise a special precept of 2%. The oversight provisions of the CQC cover 45 providers, which cover some 20% of the market. It is intended that that will give early warning to local authorities of any likely collapse.

Social Care and Support: Funding

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

I thank the noble Baroness for those comments. I do not recognise the size of the cut to which she alluded. The figures that I have seen indicate that in cash terms it has been broadly neutral over the last four years, representing a real-terms cut of probably more like 10%. However, I think we are cavilling over numbers here because I agree with her broader comments about the state of the social care sector. We have, indeed, noted the savings gained from the delay in implementing the Dilnot proposals, which have been brought to the attention of the Treasury.

[Baroness Pitkeathley (Lab)]

My Lords, while I recognise the Minister’s concern about the spending review, does he accept that the lack of proper provision of social care has a very profound effect on the rest of the economy? I offer as evidence a family carer to whom I spoke last week. She is a single mother. She looks after her mother, who has Alzheimer’s, and a son with severe learning difficulties. She has been doing so for many years. She has been receiving two afternoons a week of respite care for the son and gets one day of daycare for the mother. This rather minimal provision has just about enabled her to cope. Both those services have now been withdrawn. I fear that she will have a breakdown because she is so distressed and under pressure. If she does, all three of those people will be a charge on the state. Will the Minister explain how that makes any kind of economic sense?

[Lord Prior of Brampton]

There is no doubt that what the noble Baroness says is true: the impact on other parts of the economy will be significant. It is also true that the impact on the healthcare system of reduced resources in social care will have an effect, which is why we are developing the better care fund and why we believe that more of the health and social care budgets should be pooled and used as one. Again, that is an integral part of the Five Year Forward View. At the risk of being boring, I am afraid that I will repeat myself: we will have to wait until the end of November before we know what the financial settlement is.

Social Care

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Thursday 15th October 2015 Lords Chamber

[Lord Prior of Brampton]

The position on the savings from deferring the introduction of the Dilnot proposals is that they are being taken into account under the spending round and I cannot comment further today.

[Baroness Pitkeathley (Lab)]

My Lords, is the Minister aware that data from the Health & Social Care Information Centre show that without doubt the social care system is not just under pressure, as he has said, but at breaking point? The figures also show that family carers are under increasing pressure and receiving far less support and back-up. In fact, their quality of life and satisfaction with social services have dropped hugely in the past two years and now only 39% of them say that they have as much social contact as they want and need. Does the Minister agree that support for family carers is an absolute priority and must be maintained since they are, after all, the main providers of social care?

[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.

Local Authorities: Public Health Budget

Debate between Baroness Pitkeathley and Lord Prior of Brampton

Wednesday 15th July 2015 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, with the leave of the House and at the request of my noble friend Lord Beecham, I beg leave to ask this Question.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the Department of Health recognises the importance of implementing this saving in ways that minimise any possible disruption to services. It is about to consult publicly on how best to do that, and on how best to monitor the impact on services.

[Baroness Pitkeathley]

I thank the Minister for that reply. In view of the very strong statements that we have had in recent weeks from the Prime Minister and the Secretary of State for Health—and indeed from the Minister himself from this Dispatch Box—about the importance of prevention to help the NHS cope with future demand, is it not extraordinarily short-sighted to impose reductions which inevitably will result in cuts to preventive services, such as contraceptive services, drug and alcohol services and weight reduction? Does this not absolutely undermine the Government’s objective of improving public health?

[Lord Prior of Brampton]

I shall give a short quote from the Prime Minister:

“when you look at the costs of obesity, smoking, alcohol and diabetes, we know we need a completely new approach to public health and preventable diseases. A real focus on healthy living. That’s why it’s at the heart of the plan”;

that is, the Five Year Forward View. We accept that prevention is extremely important. This reduction in spending is £200 million out of a grant for local authorities of £3.2 billion—a reduction of about 6%. Local authorities have demonstrated in many other areas an ability to extract savings. I am sure they will do the same in this case.