NHS Winter Crisis

Baroness Thornton Excerpts

Monday 5th February 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for that Statement. Before I ask my questions, I also thank the Secretary of State and the Prime Minister for their responses to the United States President’s bizarre attack on our NHS.

Over 95% of hospital beds were full last week, leaving just one bed in 20 available. We saw the highest number of accident and emergency diverts for any week this winter, with 43 incidents across England. I pay tribute to our NHS staff, who have gone the extra mile in very challenging circumstances. We know that 50,000 elective operations were planned to be cancelled, but it would seem that some urgent operations have been cancelled, too. Will the Minister explain to the House why those operations have been cancelled, despite NHS England’s advice to the contrary?

It would also now seem that the accident and emergency targets that are enshrined in legislation and the constitution have been abandoned until March—that is, March 2019. Will the Government bring forward legislation to amend the constitution? Finally, will the Minister accept that the winter plans that have been outlined are now being compromised in the light of the fact that at least 23 trusts are now on black alert, which means that they are under severe pressure?

[Lord O'Shaughnessy]

My Lords, I thank the noble Baroness for her questions. I agree with her that we are all proud of our NHS, on all sides of this House, and I am sure that we all have great pleasure in stating that through whatever means we are required to. I also join with her in paying tribute to the staff, who do such a fantastic job, often in challenging circumstances.

She asked first about urgent operations. It is clear in the guidance that they should not be cancelled when it would negatively affect patients’ outcomes. If that has happened, NHS England is investigating and reinstating those operations. The guidance is quite clear and NHS England has followed that up.

As for A&E targets, we know that they have not been achieved recently. It is important and instructive to look at the extraordinary increase, not just in winter but overall, in the number of episodes that are happening. They really are increasing at a very high rate. Demand is very high—higher than I think could have been anticipated—and it is a credit to the NHS that it has produced the performance that it has. The aim now, with funding given at the Budget, is to get us back to the four-hour target that we all agree ought to happen. That is what will be happening over the coming year.

NHS: Clinical Negligence

Baroness Thornton Excerpts

Wednesday 31st January 2018 Lords Chamber

[Lord O'Shaughnessy]

I point the noble Baroness in the direction of a five-year strategy that was published by NHS Resolution, the body that acts on behalf of what used to be the NHS Litigation Authority. The strategy looked at many issues, not only how we can prevent escalation. One of the drivers of cost is unsuccessful claims; more of those are going on. It also looked at how we can reduce incidents in the first place and learn from deaths and injury throughout the system, so that we can start to reduce the burden overall.

[Baroness Thornton (Lab)]

My Lords, it is telling that if you google “clinical negligence”, the first four or five pages that come up are companies offering their services to support people making claims. According to the Medical Protection Society report last year, the annual costs to the NHS in England of settling clinical negligence claims was equivalent to training 6,500 doctors. That is expected to double by 2023, so the noble Lord is quite right that this is a terrible drain. I am very pleased to hear that the Government have plans to reduce the number of claims. Have they included taking into account the recommendations in the PAC report published at the end of last year?

[Lord O'Shaughnessy]

We absolutely have. Indeed, the PAC investigation and the National Audit Office report on this issue are very thorough and looked at the causes and drivers behind it. One is increased NHS activity—not worse safety but the fact that the NHS is doing more. The investigation also looked at the legal environment and some of the changes that have occurred. The noble Baroness is right: a number of firms offer these services. That is important for access to justice but we also need to fix the costs that they can claim so that we get this budget under control.

NHS: Cancer Treatments

Baroness Thornton Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, at the beginning of this debate it became clear that we are dealing with one of those extraordinary parliamentary moments. In a way, I have a much easier job than the Minister today, so my sympathy is with him in answering this debate.

Are any of us surprised that when Tessa, my noble friend Lady Jowell, was diagnosed with what she called this “bloody tumour”, she tried with her usual courage, energy and vigour to try to improve the outcomes for all people with cancer? No, we are not, because this is the woman who, as the first ever Public Health Minister, promoted the tobacco control that we all now take for granted, facing outrage from the tobacco industry, its friends at the Sun and the Mail and, though probably less well-known to the public, many Back-Bench Labour MPs who thought pubs and clubs would go out of business if people were not allowed to drink in the smog created by cigarettes. “Nanny” was the label that the papers gave her at the time, but how many lives have been saved already as a result of my noble friend’s determination to do the right thing? The label of nanny was continued because of Sure Start—of course it was. But this is a woman whose determination led her to take on the Prime Minister and all comers to convince us that the Olympics should come to London, could come to London and, when they did so, to ensure, with others, that we all had an absolutely great time in 2012.

The reason I am reminding the House of these matters is not only because of my admiration for my friend Tessa. I am reminding the House, particularly the Minister, that in the face of opposition and scepticism, my noble friend will win through. She has proved to be correct time and again. I say to the Minister and the Government that they had better believe this noble Baroness and take what she is telling us very seriously. From the relatively modest suggestion that fluorescent dye to identify the tumour should be available in all brain surgery centres in England, which seems to me perfectly correct, to the more innovative—adaptive clinical trials, testing multiple treatments against a standard, which could speed up the introduction of new drugs as well as enabling existing ones to be repurposed, linked to a platform to share data across the world—my noble friend is saying: this is a demanding new paradigm, but the prize is surely worth the struggle.

The Government and all of us should follow her example and not be afraid to commit to making this happen.

Public Health: Strength and Balance Programme

Baroness Thornton Excerpts

Thursday 18th January 2018 Lords Chamber

[Lord O'Shaughnessy]

I am grateful to the noble Baroness for pointing out the benefits of physiotherapy. She might be aware of a scheme in Middlesbrough that is providing for people who have fallen a precise pathway from physio into community activities involving strength and balance work. As ever, one of the challenges is to make sure that all local authorities know about such programmes and put them in place. They are not necessarily expensive, but they take a bit of time. I will make sure that Public Health England is taking that attitude of spreading good practice across the country.

[Baroness Thornton (Lab)]

My Lords, NICE’s most recent and excellent quality statements in January 2017 offer guidance on falls and the importance of multifactorial risk assessments and interventions. These interventions require resources, particularly from social care specialists and public health workers, who we know are at the sharp end because of the financial pressure the Government have put on local authority funding and the successive reductions of public health budgets. Now that the Secretary of State has responsibility for social care, will he therefore ensure that strength and balance programmes are properly resourced? When will NICE next update its statistics on the uptake of guidance on this matter?

[Lord O'Shaughnessy]

I will write to the noble Baroness with specifics on the NICE guidelines, which are incredibly important because they establish best practice. Of course, it is then incumbent on professionals to follow that best practice. We know that public health budgets have been under pressure, but local authorities are still getting £16 billion over five years. That is a lot of money and they can use some of it to focus on such activities. Moreover, in the spring Budget last year, there were big increases in the social care budget, which I know we all welcomed. That money is particularly focused on older people and preventing falls, which is what we want to see as part of that programme too.

NHS: Winter Funding

Baroness Thornton Excerpts

Thursday 11th January 2018 Lords Chamber

Tabled by

[Baroness Thornton]

To ask Her Majesty’s Government, given the timing of the grant of additional funding to the National Health Service to prepare for winter at the end of November 2017, how they will assess the use and impact of that additional funding.

[Baroness Wheeler (Lab)]

My Lords, on behalf of my noble friend Lady Thornton, I beg leave to ask the Question standing in her name on the Order Paper.

Agency Nurses

Baroness Thornton Excerpts

Wednesday 10th January 2018 Lords Chamber

[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.

[Baroness Thornton (Lab)]

My Lords, the Question further teases out the sometimes expensive inadequacies in workforce planning in our NHS. Under the circumstances of the winter crisis and the 40,000-nurse shortfall, clearly trusts have no choice sometimes but to take on agency staff in specialist and other services—and this is expensive. Does the Minister expect that the late funding made available for the winter crisis will be spent largely in this way? Will his department penalise trusts for using agency staff in this way?

[Lord O'Shaughnessy]

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

NHS Winter Crisis

Baroness Thornton Excerpts

Monday 8th January 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for that Answer, and I am pleased to see that he is still with us and in his place at this time. I wish him a very happy and prosperous new year. I question the idea that the Government and the NHS were prepared for this winter crisis. It seems to me that, if extra funding was made available in November and December, that does not smack of preparedness at all. I was very struck and somewhat chilled yesterday by what Andrew Marr said to the Prime Minister on his show. He said that had he experienced, when he had his stroke, the kind of five-hour delay experienced by Leah Butler-Smith and her mother, he would not have survived. I invite the Minister to have a stab at making a better job of answering that question today. What would he say to those whose lives have been put at risk by this winter crisis?

Will the Government be making available to us an analysis of the impact on patients, and the lives cost, of a combination of: 55,000 cancelled operations; 75,000 people held in ambulances; overstretched accident and emergency departments, with people on trolleys and even on the floor; up to 90% bed occupancy, which is very dangerous; a shortage of GPs; and inadequate social care due to the starving of funding to local authorities over a long period? When will we know what the impact of this has been on people? When will the Government properly fund and manage the winter stresses in our NHS?

[Lord O’Shaughnessy]

I thank the noble Baroness for her good wishes, and I wish her and all noble Lords a happy new year. She asked several questions, and I will try to deal with them all. Her first question was about being well prepared. Those were the words of Sir Bruce Keogh from NHS England, not mine. I should also point out that Keith Willett, the director for acute care for NHS England, said that the service is better prepared than ever. Of course, that does not mean that there are not challenges. We know that this happens every year.

One of the ways that we see challenges happen is that there are cancelled elective procedures. I have been looking back over the data for the past 20 years. In quarter 4 of each year—January to March—those cancellations do happen. In fact, I was looking back at 2000-01 and there were 24,000 cancelled or postponed operations that year, which is actually one of the highest over that period. These things do happen during winter, and that is one of the ways of coping. The Prime Minister has apologised for that, and I endorse that. Of course, it is not a state of affairs that we want to happen, but it is necessary to make sure that the most urgent cases are treated. It should be pointed out that the direction about elective procedures made it clear that time-critical procedures around cancer operations and others can go ahead. We will see over time what the impact of that was.

I will mention one other thing about preparedness. The noble Baroness talked about bed occupancy. Of course, we know that high levels of bed occupancy are a concern. Bed occupancy was below the target of 85% going into this period—on Christmas Eve it was 84.2%, I believe—so that was put in place. We know it is going to be challenging. We know that flu is going to continue to have an impact over the next few weeks, and we will see what we can do, but we know that the NHS has put in unprecedented levels of preparation to make sure that we can get through what is always a difficult period.

NHS: EEA Doctors

Baroness Thornton Excerpts

Tuesday 12th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I recognise that, as the noble Baroness pointed out, there has been uncertainty. That is why I am sure that the entire House will welcome the agreement reached last Friday to provide that certainty, and I encourage all noble Lords to look at and circulate the letter written by the Prime Minister to EU citizens explaining how much we value them, how much we want them to stay and how we have now agreed with the EU a process for doing that. The noble Baroness will be interested to know, as I am sure will other noble Lords, that there were 470 more EU doctors working in the NHS in June 2017 compared to June the year before—so, happily, we have not seen the exodus that so many people have warned about. We need to grow more of our own in the future, of course, and there are 1,500 training places for doctors coming on stream in September 2019, but I shall certainly look at the issue that she raises about providing opportunities for doctors—not least refugees; that issue has been raised with me—to upgrade their qualifications so that they can serve in the NHS.

[Baroness Thornton (Lab)]

My Lords, can the Minister guarantee, if the Government sort out the immigration status of EU medical staff in a timely fashion, that this will be with the retention of existing workers’ legal rights such as the working time regulations and related employment directives in UK law for the current and future workforce?

[Lord O'Shaughnessy]

I think I may have detected a qualified welcome from the noble Baroness for the achievements of last year in providing that reassurance. Clearly, we want to make sure that there is the best possible working environment for our medical staff, wherever they come from, and that involves, as the Prime Minister has set out, having world-leading employment rights.

Brexit: Health Policy

Baroness Thornton Excerpts

Wednesday 6th December 2017 Lords Chamber

[Lord O’Shaughnessy]

I thank my noble friend for mentioning the sector deal. There are some big announcements in it on investments and creating growth and jobs in the UK, which is a huge endorsement of our leading role as a life sciences hub throughout the world. We have said that we want a continued relationship with EMA. The MHRA, our sovereign regulator, makes a huge contribution, by both approving licences for medicines and issuing safety notices. It is our intention as we move to the next phase of talks that we will have that kind of relationship going forward with the EMA.

[Baroness Thornton (Lab)]

My Lords, to follow on from the point made by the noble Lord, Lord Lansley, there is great anxiety in the medical research and clinical worlds about research, medical trials, the regulatory framework and access to drugs, including new drugs. Can the Minister give the House a categorical guarantee today that UK patient access to crucial drugs will be maintained and that this access will not be restricted in any way when the UK leaves the European Union?

[Lord O’Shaughnessy]

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

Nurses and Midwives: Numbers

Baroness Thornton Excerpts

Monday 4th December 2017 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government, in the light of the report of the Nursing and Midwifery Council published on 2 November which found that the number of nurses and midwives joining its register from the European Union had dropped by 89 per cent over the last year, how they plan to make good the anticipated shortfall.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, the Government value immensely the contribution of EU staff working across the NHS and social care systems. We are committed to ensuring a clear pathway to permanent residency for these EU citizens. The figures in the NMC report represent a 0.2% decrease in those currently registered. Meanwhile, there are more nurses on our wards since last year. Numbers will increase because of a 25% increase in training places.

[Baroness Thornton (Lab)]

I thank the noble Lord for that response, although I think it borders on the complacent. I asked this Question because the statistics are very stark and concerning. Although we know that registration of UK-based nurses is falling—by 9% last year—the decrease from the European Union varies between 70% and 95%. That means that instead of there being 1,966 nurses from Spain, for example, the number has dropped to 104 in the last year. The numbers from Poland have dropped from 305 to 34. Even from Ireland the numbers have dropped, from 381 to 204. That looks, with winter looming, like a crisis might be looming. Given that it takes at least three years or so to train nurses and midwives, I return to my Question: how will the Government make up the immediate shortfall and replace those nurses and midwives that come to us from the European Union?

[Lord O'Shaughnessy]

I agree with the noble Baroness that there is a need for more nurses. That is why we are introducing more training places and new routes into nursing, such as the nursing apprenticeship. I know that she is particularly concerned about EU national nurses and health visitors. I think noble Lords will be reassured that between June 2016 and June 2017, there was an overall 5% increase in the total number of staff from the EU within the NHS, which is welcome. The one area, as I said, that has fallen marginally—by about 162 in practice—is in nursing and health visitors. That was significantly due to the new language test that was introduced. That is something that the NMC is looking at to make sure we are getting nurses capable of practising in this country to come here.