NHS: Reform

Baroness Walmsley Excerpts

Thursday 16th July 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for his Statement. The Opposition support much of what he had to say. I will focus my remarks on the plan for seven-day working and then touch on a number of the other issues that he raised.

Ensuring our health services are there for everyone whenever they are needed, be it a weekday or a weekend, is essential to keeping people well and making the NHS sustainable. Of course the Opposition support the principle of what the Government are trying to achieve with seven-day working, and we will certainly work with them on making that possible. Where I urge some caution is in the manner in which the Government are attempting to achieve those changes.

The Minister will be aware that the NHS is in a rather fragile state at the moment. A&E performance has been very disappointing in the face of enormous pressures. He will know that primary care services are overwhelmed. We discussed in Oral Questions the failure of some ambulance services to meet their performance targets. We talked particularly about the London Ambulance Service. There is a shortage of staff and an overreliance on agency workers and undoubtedly patients are suffering as a result—on this Government’s watch. Staff are feeling pretty demoralised and rather unloved by the Government. It is important that the way the Government approach seven-day working does not make matters worse.

I am entirely unclear as to how seven-day working is to be achieved without significantly impacting the rest of the NHS. The real danger here, given the way the NHS will approach this kind of target, is that more staff will be produced at the weekend by cutting staff during the week. The Minister will be aware of the study published in Health Economics, which concluded:

“There is as yet no clear evidence that 7-day services will reduce weekend deaths or can be achieved without increasing weekday deaths”.

Clearly, it would be an absolute nonsense if we reduced weekend deaths but the price was an increase in weekday deaths.

The Government have produced no facts or evidence for the assertions they are making. If we are to take this seriously, we need to know a bit more about how the resources challenge and the current acute shortages in many staffing areas are going to be met—bearing in mind that the Government are cracking down on the use of agency workers; the ludicrous 2012 Immigration Rules, which mean that nursing staff who are not earning £35,000 a year after six years will be sent back to their country of origin; and the serious issue of staff morale.

The Minister mentioned the 2003 contract but will he confirm that the contract negotiated then was actually very largely based on the one negotiated by the previous Conservative Government in the 1990s? How does he think the Government intend to work in partnership with NHS staff to make those changes? The briefing from his department—phrases such as “declaring war on NHS staff”—does not seem to have got this policy off to the right start. The kind of provocative statements that are currently emanating from his department, no doubt under the authority of the Secretary of State, do nothing to create the conditions in which people in the NHS will actually want to work with the Government on developing these policies.

I also want to mention the impact of another five years of, in effect, real-terms pay cuts. What impact does the Minister think the Chancellor’s announcement on pay will have on future staff numbers and retention? I want to raise one issue with him, which is the subject of a statutory instrument in your Lordships’ House. If the pay of NHS staff is to be held down, how can he justify the 12% increase in fees by the HCPC, one of the key staff regulators for the healthcare profession? Will he withdraw this regulation? Does he not agree that it is absolutely disgraceful that staff are being asked to pay more money by what essentially is a government-owned quango when their own pay is being held down? It is utterly unacceptable.

Can the Minister tell me how this is going to be funded? Either the staff are going to be thinned out during the week or extra staff will have to be found. It is not just consultants and nursing staff; it has to be the whole infrastructure to make this work, including community services and primary services, and there will be a knock-on impact on social care costs. How is this going to be paid for? If he says that the Government are giving £8 billion to the health service overall, he knows that is dishonest. We know that that will probably be paid in 2021, according to the Treasury briefing. We also know that £30 billion per annum will be needed by then. Nobody I know in the health service thinks that it has any chance at all of closing that gap because the kind of efficiency saving required has never been achieved in this or any other health service. The excellent report on efficiencies by the noble Lord, Lord Carter, in itself will produce only £5 billion by 2017-18.

On whistleblowing, I welcome the Freedom to Speak Up report, which contained a number of important recommendations to foster a more open culture. The Minister will know that in recent years there have been a number of other examples of appalling care in social care settings, including Orchard View, Oban House and, of course, Winterbourne View. Many of those scandals were exposed only once undercover reporters infiltrated the care home. Of course, we welcome the action the Government are taking, but does the Minister agree with the point I have made to him previously: that if the Government really want an open culture in which people can raise their concerns, that has to apply right up the line, meaning that the leaders of NHS organisations can speak openly about their own concerns about the direction of policy and the actions of Ministers? He will know that at the moment those people are slapped down if they make any criticism at all of the Government. You will not get an open culture until everyone in the system feels that they can be open. At the moment they cannot.

We support the steps in the Kirkup report to improve the regulation of midwives but if the Government are so concerned about modernising regulation, why have we not had the Law Commission Bill containing a comprehensive approach to the modernisation of health regulation for individual professionals? Why are we carrying on with this antiquated approach and these wretched Section 60 orders, which cause a lot more expense and delay in the Minister’s department? Why has the new speeded-up system of dealing with regulation, for regulators such as the Nursing and Midwifery Council, been held up for many months now? Of course, one of the reasons why it has had to increase its fees is that the Government will not agree to this legislation coming before Parliament to streamline its proposals.

It is pretty disgraceful that the Rose report, which was mentioned, was not published alongside the Statement. Why are we having to wait until after this Statement to look at it? The noble Lord knows that Ministers received it months ago. What is in the report that they do not want the public to see?

On the merger of Monitor and the NHS Trust Development Authority, I welcome the appointment of Mr Ed Smith, who is a high-calibre chair. He is also pro-chancellor of Birmingham University, which is a very strong recommendation. I also like the name “NHS Improvement”. But how many staff in Monitor and the NHS Trust Development Authority have any concept of improvement, given their current record of bullying, hectoring and intimidating the agencies they are responsible for? Can I assume that there is going to be a drastic change of personnel in that combined organisation? Will the Minister confirm that no one employed in that organisation will earn more money than the Prime Minister, given that the Government have chosen to attack NHS chief executives in relation to their salaries? Will he also confirm that they will not use agency staff? Does he not find it rather ironic that Monitor, in order to instruct NHS bodies not to use agency staff, has employed temporary staff? What is sauce for the goose is sauce for the gander.

There is a dangerous gap between the kind of fantasy land that Ministers talk about in the health service and the reality of life on the ground. On the ground, people are struggling every day to meet the pressures with limited money and no support from the Government. The health service is in real danger of falling over. The Government should stop blaming the NHS and take responsibility.

[Baroness Walmsley (LD)]

My Lords, I, too, thank the Minister for repeating the Statement. It reflected much of what I heard this morning from the Secretary of State at the King’s Fund. It is a brave and realistic approach but there are some yawning gaps in it compared to what I should have expected in a major statement about NHS reform. However, I welcome several points.

The focus on culture change and nurturing staff is absolutely right. The NHS is the best and most cost-effective service in the world only because of the skills and commitment of its staff, yet we are told that in some places staff morale is poor. This is very sad to hear. It was good to hear earlier this morning about the beneficial effect on morale in those hospitals that are responding positively to being put in special measures.

I welcome the new personnel, processes and training that are being put in place to ensure that staff can safely express concerns about the quality of care, so that each member of staff can take part meaningfully in the improvement pathway of his organisation. We could do with ditching for all time the expression “whistleblower” with all its negative connotations. I welcome what the Secretary of State called “intelligent transparency”, a no-blame focus on what went wrong and how to put it right. In common with the noble Lord, Lord Hunt of Kings Heath, I think that merging the TDA and Monitor could be a good thing, with this focus on no-blame improvement. That should help, but we still need more signposting for patients and service users about how and where to complain if they have poor care in what is a very complex system.

I of course welcome the focus on better data-gathering, especially in the field of mental health, where we are rather short of it. Managers cannot make good financial decisions without the facts about what everything costs. Businesses could not survive like that and neither can the NHS.

I welcome the long-awaited publication of the Rose report and the acceptance of its recommendations. I look forward to seeing what they are. We need a new focus on the quality of NHS management. If we are to rise to the challenge of the £22 billion of efficiency savings, we need excellent managers and finance directors as well as excellent doctors and nurses. I welcome the fact that the noble Lord, Lord Rose, extended his remit to CCGs.

I also welcome the new requirement for hospitals and groups of doctors to provide a seven-day service but I share some of the concerns of the noble Lord, Lord Hunt, about how it will be delivered. People do not get sick to order just on weekdays, so that is important. I should, however, like assurance that this does not necessarily mean putting any further burden on individual hard-working doctors, nurses and laboratory staff. Good planning is needed to avoid further burdens. However, this will certainly mean the recruitment of more trained staff. We need assurance that they are in the pipeline. Can the Minister say, for example, what the Government are doing to stem the flow of staff, trained by the NHS at a cost to the taxpayer, who leave the country as soon as they qualify?

What was missing from the Statement and the speech this morning was context and understanding that filling the £30 billion black hole in the NHS requires a whole-Government response. If patients are to be in charge, they need good health education so that they know what a healthy lifestyle means. They need access to sports and leisure facilities and nutritious food, and they need warm, dry homes. Integration needs to be a lot broader than just integration between health and social care. Unless social care is properly funded, the NHS will not be able to find its expected £22 billion of efficiency savings while making the improvements outlined in the Statement because of the knock-on effect on acute hospital beds. Yet while there has been more money for the health service, there has been nothing but cuts in social care.

The thrust of the Statement was about getting it right first time and, if not getting it right the first time, then certainly the second and subsequent times. This has to be right for patient safety and confidence but also for cost-effectiveness. If we are to rise to the increasing demand on the health service, we must get it right as near as possible every time and we must support the staff in doing so.

[Lord Prior of Brampton]

My Lords, I thank the noble Lord and the noble Baroness for their comments. I was quite depressed listening to the noble Lord opposite. We had a debate in this House last week and we talked about a sense of political consensus on the NHS. I start by saying—rather personally—that, having listened briefly this morning to his right honourable friend Andy Burnham in the other place misquote me out of context from the debate that we had last week, I thought that there was no hope of a non-partisan approach to the NHS. For the avoidance of any doubt from anybody, and as I think I made pretty clear in last week’s debate, I believe fundamentally and passionately in a universal, tax-funded healthcare system—the NHS—that is free at the point of delivery and based on clinical need, not ability to pay. Having looked back on it, I do not remember uttering a word in that debate that would question that statement. Therefore, I hope the noble Lord opposite might have a word with his right honourable friend in the other place to make it absolutely clear that playing cheap party politics has no place in our discussions about the NHS.

Turning to the comments about my right honourable friend the Secretary of State for Health’s Statement today, seven-day services are in many ways at the heart of it. Thousands of people are dying because we do not provide seven-day services in hospitals. We cannot carry on with a system with thousands of people dying. It is not just that thousands of people are dying. The health of thousands of people is deteriorating in our hospitals over the weekend.

This is an anecdote, which may be unfair. However, two years ago, I met a radiologist walking down the corridor in an NHS hospital on a Friday morning. His wife had been admitted through A&E. She had abdominal pains. He could not get her a scan. She was going to have to wait in that hospital until Monday. Had it been a bank holiday, she would have had to wait in that hospital until the following Tuesday before she had that scan. That is an anecdote, but we know that it is happening all the time. It is unacceptable.

So I ask the noble Lord opposite to be more enthusiastic about this. Of course it will be difficult. This Government are putting in £8 billion of new money. This is more money than his party was prepared to offer before the election. It is the same amount of money that the noble Baroness’s party was offering to put in. This is £8 billion of additional money that we are putting into the NHS. It is a critical part of our strategy. It was laid out in our manifesto and is in the NHS Five Year Forward View that we would make seven-day services a main plank of these reforms. For those people who think that this cannot be afforded, put yourself in the position of a chief executive of an NHS hospital that works four and a half days a week because theatres stop work at lunchtime on Friday. Often, they do not start again until Monday lunchtime because every bed is taken up when they come in to work on Monday morning. Across the country, thousands of consultant surgeons, theatre staff and anaesthetists are hanging about on Mondays because they cannot start their work. This is because there is not a bed in the hospital because the flow of patients through that hospital came to a grinding halt on Friday. The noble Baroness is right that this is not just a hospital issue but about joined-up care. You cannot get the discharges out of the hospital unless social care, the physios and the OTs are working—the whole system needs to be working. Seven-day working is not only right for patients but will enable our hospitals to work much more efficiently.

I will pick up a few other issues. I remember when the 2003 contract was voted on by consultants. In my view, it was a disastrous contract, which deprofessionalised many professional consultants. They voted against it the first time and voted for it, grudgingly, only the second time. They voted for it because their pay went up by 28% as a result of it and they could opt out of providing care over weekends and outside normal hours—of course they voted for it. Looking back on it, some of the noble Lords and Baronesses opposite will maybe accept that it was a disastrous contract. It deprofessionalised a deeply vocational profession and fundamentally changed the culture of the NHS—a culture that we are now trying to change once again.

I welcome the comments of the noble Lord and the noble Baroness about Sir Robert Francis’s report on whistleblowing. We want an open culture, in which whistleblowing is a thing of the past. I agree with the noble Baroness that whistleblowing is not a great name. It would be great if we never heard about whistleblowing ever again because people felt able to raise their concerns in a proper, central and safe way and knew they could raise them without fear of any detriment to their employment prospects. The proposals put forward by the Public Administration Select Committee, which have been taken up by the Secretary of State for Health, are absolutely right. We need a safe place for when things go wrong.

I turn to the Rose report. Leadership is fundamental. Around a hospital, one ward will be doing well and one will not because there is a good ward sister in the first one; one hospital will be doing well and one will not because of good local leadership in the former. Leadership is absolutely fundamental, and I subscribe to all the comments that my noble friend Lord Rose has made in his report.

The noble Lord’s comments about the TDA and Monitor are harsh. David Bennett and others in those organisations have done a very good job in very difficult circumstances. We are fundamentally changing the roles of TDA and Monitor. Together, they are now, as the name suggests, an improvement agency first and a regulator second. The new role of the TDA and Monitor in NHS improvement will fundamentally change the way we approach performance management and improvement. The Secretary of State for Health alluded to the contract that the TDA recently signed with Virginia Mason, one of the safest hospitals in the world, which is one way of bringing best world practice into the NHS.

I will conclude on the context. Times are difficult in the NHS and we should not pretend differently. This Government are absolutely committed to seeing this transformation programme through. The noble Lord opposite said he did not know anybody who thought that we could achieve the £22 billion in savings that are set out in the NHS Five Year Forward View—he knows me.

Local Authorities: Public Health Budget

Baroness Walmsley Excerpts

Wednesday 15th July 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am hesitant to disagree with the noble Lord in view of the fact that he told me earlier that he qualified as a doctor in 1945, which was nine years before I was born. However, the devolution of responsibility to local authorities has been fairly universally welcomed. They are better able to take into account local priorities. I should also add that just over £2 billion of the public health budget is held centrally as well.

[Baroness Walmsley (LD)]

My Lords, is the noble Lord aware that many of the local authorities commission these important prevention services from NHS providers? Has any impact assessment been made of the effect on the NHS of this loss of income?

[Lord Prior of Brampton]

I think that the noble Baroness will know that we are due to go out to consultation on this matter, and that is an important issue that will be taken into consideration.

Health: Multiple Pregnancy

Baroness Walmsley Excerpts

Monday 13th July 2015 Lords Chamber

[Lord Prior of Brampton]

The Government may have figures on this. I do not have figures here today, but I shall certainly endeavour to find them as soon as I can and perhaps follow it up with the noble Lord in a meeting outside this House.

[Baroness Walmsley (LD)]

My Lords, given that mothers expecting multiple births need the expert care of qualified midwives and yet we have quite a shortage, and given that the Government are considering giving golden hellos to GPs, what about midwives?

[Lord Prior of Brampton]

My Lords, we are not considering golden hellos to midwives. There are, I think, some 6,400 extra midwives in training at the moment and some 2,100 more midwives today than there were in 2010.

National Institute for Health and Care Excellence

Baroness Walmsley Excerpts

Monday 13th July 2015 Lords Chamber

[Lord Prior of Brampton]

I am sorry—I did not quite understand the question. I realise that I cannot ask my noble friend to repeat it, so I wonder whether I could pick it up with her outside the House.

[Baroness Walmsley (LD)]

Is the Minister aware that in Wales 12% of NHS staff have made complaints about staffing levels in the past few years? Will the Minister join me in welcoming the fact that the Labour Government of Wales will be held to account for that next year?

[Lord Prior of Brampton]

From what I understand, the problems in Wales mean that there is a lot more for the Government to be held to account for there.

Health Funding

Baroness Walmsley Excerpts

Thursday 9th July 2015 Lords Chamber

Asked by

[Baroness Walmsley]

To ask Her Majesty’s Government whether they carried out an equality impact assessment before deciding on the recent in-year budget cut to public health funding.

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

My Lords, we pay close attention to equalities considerations when deciding how to distribute the public health grant between local authorities. The Department of Health is about to consult on how to implement the savings and we will address our equalities duties in full when announcing our final decisions.

[Baroness Walmsley (LD)]

My Lords, I thank the Minister for his reply, but given that these cuts will impact on teenage pregnancy programmes for the young, domestic violence programmes for women, HIV prevention programmes for gay men and some members of the BME community and TB prevention programmes for the poor and homeless, will he say where the equality is in that?

[Lord Prior of Brampton]

The noble Baroness will know that decisions on these matters are left to local authorities, and we wish to give them as much discretion as we can.

National Health Service: Sustainability

Baroness Walmsley Excerpts

Thursday 9th July 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, this has been an excellent debate, so ably introduced by the noble Lord, Lord Patel. It is quite clear that the NHS is a national treasure and something that is dear to the hearts of all noble Lords. The principle that it is free at the point of need is something that all political parties continue rightly to support.

Every one of us has cause to be grateful to the men and women from all nations who work in the NHS. We rely on their skills and knowledge, and those from abroad contribute enormously to it. That is why I start by asking the Minister whether he will work to persuade the Home Secretary that her determination to send home some foreign nurses who earn less than £35,000 per year is unjust and detrimental to the NHS and the people of this country.

The prediction is that costs in the NHS will rise at 4% per year, and more and more health trusts are going into deficit, as we have heard. Yet voters are reluctant to pay for this from either raised taxes or cuts in other public services—hence today’s demand for a royal commission, which I support. The Government’s Five Year Forward View needs to act as a catalyst to create new models of delivering care that are better suited to modern health needs and promote more efficient use of NHS resources, contributing to a more sustainable health and social care system.

I think of the NHS as an inflatable bucket with a hole in the bottom. It is impossible ever to fill up such a device with enough money. It is inflatable because the demands on it are constantly growing as we live longer and the birth rate increases. Life expectancy is going up. The number of those aged 65 to 84 will increase by more than a third in the next 20 years, and the number of those aged over 85 will double—I hope to be one of them. In addition, with ever more wonderful developments in treatment, there are more demands for them to be available for patients, but they are usually very expensive.

The hole in the bottom of the bucket is the fact that as we learn to treat, and even eliminate, certain diseases, other preventable diseases are increasing in prevalence because of our lifestyles. Even though the Chancellor promised more money for the NHS in his Budget yesterday, there will still not be enough unless we stop up the hole in the bucket. So I think there are three watchwords: integration, innovation and prevention—the demand side referred to by the noble Lord, Lord Desai.

On prevention, we need to get people to take more responsibility for their own health—the noble Lords, Lord Patel and Lord Crisp, called for that—and support them in doing so. We need to ensure that young people and their parents understand what a healthy lifestyle looks like and are given the means to live it, with exercise facilities, access to fresh, nutritious food, and warm, dry homes. We need to eliminate child poverty, since poverty is the major factor leading to the health inequality which decreases lifetime opportunity. We need health education to be carried out well in all schools, and public information and treatment programmes so that those adults who missed out on such education can still get the message.

Public information programmes work well—one only has to look at the public information programme on HIV set up by the noble Lord, Lord Fowler, all those years ago to understand how well. In Australia, you cannot move without seeing information about protecting your skin from the sun and skin cancer. We could do with one of those campaigns here. Such programmes are also cost effective because many preventable diseases cost a great deal of money. Smoking costs the NHS £5.2 billion every year, but smoking prevention programmes and anti-bullying programmes in schools can return as much as £15 in savings on physical and mental health for every £1 spent. Obesity costs the NHS £4.2 billion per year and lack of exercise costs it £1.1 billion per year, according to the King’s Fund. Yet despite the fact that every £1 spent on free use of leisure centres returns £23 in reduced NHS use, quality of life and other gains, many local authorities are having to close centres rather than give free access to them. Musculoskeletal problems such as back pain and arthritis are the most common conditions that limit people’s daily lives and the largest single cause of loss of working days. They affect 8.3 million adults in England. Some, but not all, of these problems are preventable by keeping to a healthy weight and taking moderate exercise. The costs to society of poor air quality, ill health and road accidents induced by road transport exceed £40 billion per year. It has been calculated that getting one more child to walk to school can save £768. All these things can be done fairly cheaply and prevent a lot of burden on the NHS.

Most of these preventable diseases are focused on by local authorities in their public health programmes, so I ask the Minister whether any of the extra billions of pounds for health services announced by his colleague the Chancellor yesterday will go towards prevention in the form of the vital public health programmes run by local authorities and schools. A short-term approach which reduces prevention activities, such as we have recently seen, will have a longer-term impact on healthcare services in the future, putting additional and avoidable costs on the health and social care system. Cardiovascular disease is a good case in point, where obesity and lack of exercise cause a great many of the 33,000 premature deaths from that disease every year. Here we see another problem. According to the British Heart Foundation, there is wide variation in both access to and quality of care for patients across the UK. This is of particular concern given the range of evidence-based interventions, commissioning guidance and NICE guidance that exist but which are not universally adopted across the system, resulting in suboptimal care and avoidable use of NHS resources. Significant opportunities to identify and optimally to manage patients are too often missed. Think how much could be saved if the worst lived up to the standards of the best.

Prevention also includes vaccination and screening programmes. There is good news and bad news here. There are still parents who are reluctant to have their babies given the triple vaccine and the measles vaccine despite all the reassurances that have been given by experts, and we now find that whooping cough and measles are rising again. I was shocked to hear that the very good uptake of the human papilloma virus vaccination has recently fallen. This is a group of completely preventable diseases, so what are the Government doing to encourage all teenagers to have the vaccination?

I heard a bit of good news at a presentation in your Lordships’ House recently. I was told about plans for a bowel scope screening programme for all 55 to 64 year-olds. The pilot schemes have shown that this reduced people’s chances of developing bowel cancer by a third and reduced the death rate from this disease by 43% because of early diagnosis. This has the potential to save the NHS £300 million each year plus great human misery. Can the Minister say when this programme will be rolled out across the country and whether it will become available also for those over 64? The breast screening programme has also saved many lives, including mine, but it ends at age 70. Given that we are all living longer, are there any plans to raise the cut-off age for routine screening?

Prevention also requires patients to be vigilant about their own health and to go to their GP promptly if they are worried about symptoms. It then requires GPs to recognise the signs and refer people to specialists as soon as possible. Some GPs are reluctant to do this until they have commissioned more tests, but this could cause serious delay to those with disease, on the one hand, and waste a lot of needless tests, on the other, where a specialist might have recognised right away which patients needed tests and which did not. I refer particularly to skin cancers, where it can be difficult for the non-specialist to distinguish the benign from the dangerous.

Early diagnosis is, of course, both a life saver and a money saver. However, it is worrying to note that the uptake of NHS health checks is currently at a disappointing 48%, well below Public Health England’s target of 66%. Some diseases are estimated to be grossly under-diagnosed. For example, four in 10 adults with hypertension, estimated at more 5 million people in England, are currently undiagnosed. This is a preventable killer disease which responds well to treatment and lifestyle changes, so we need to get on top of this under-diagnosis.

I am pleased that the Government plan more support for British scientific and medical research. Britain has the potential to lead the world in the discovery of new personal genomic treatments which match the patient’s DNA with new drugs. As an integrated healthcare system with tens of millions of patient records, the NHS is well placed to exploit the immense potential of genomics. But these treatments have many barriers to breach before they reach the patient, and we know that the United States has a much better track record when it comes to approvals of new drugs. So I would like to hear from the Minister about the progress of the accelerated access review which was initiated in response to this situation by his noble friend Lord Freeman but about which I have not heard much recently. Can the Minister tell the House what progress has been made on that?

Health: Children and Young People

Baroness Walmsley Excerpts

Tuesday 7th July 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I thank the noble Baroness, Lady Hollins, for introducing this debate. I hope she will forgive me, but given the other recent debates on children’s mental health, I feel that I have said all I need to say on that subject for the moment, so I will concentrate on children’s physical health, although I am of course well aware that there is a major link between the two.

There is good news and bad news about the health of our children in the UK. On the good side, according to research from the King’s Fund and the LGA, some damaging health behaviours among children have halved over the past 10 years, with fewer children taking drugs, smoking and drinking alcohol. This is particularly good news, because we know that half of the big adult health-risk factors are initiated in adolescence, so if we can nip it in the bud at that age, we will save lives and money. Smoking is still a big killer in this country and is a particularly large factor in health inequality. Alcohol, too, is particularly harmful to immature livers, and abuse of alcohol also leads to other risky behaviours, so a reduction there is also very good news. The finding about drugs may or may not take into account the so-called legal highs, because the finding was up to the year 2013, but any improvement is good. The paper does not postulate a reason for these improvements but it could have been caused by an improvement in the standard of PSHE in schools. I still regret the fact that this life-skills learning is not mandatory in all schools but I concede that the last Government put a great deal more emphasis on it and took some of the good advice offered by the PSHE Association.

On the other side of the balance we have rising childhood obesity, many children who do not take enough exercise—for various reasons, including lack of facilities—one of the poorest records on child mortality in Europe, far too many unwanted teenage pregnancies, abortions and sexually transmitted diseases among young people, and poor children who can have up to seven years’ shorter lifespan than their well-off counterparts down the road.

Let us talk about obesity. I will not repeat the many and varied serious disease risks that result from obesity. We need to invest in prevention. I am a firm believer that good health begins at home—as does poor health—and that it can be reinforced by schools. Indeed, it is wise for schools to care about their children’s mental and physical health, because they affect academic achievement. Therefore, if we are to have a long-term effect on the health of the population, we need to start, as many noble Lords have said, with the parents, before birth if possible. Again, there are considerable inequalities here. The percentage of premature and low birth-weight babies among deprived communities is much higher than among the higher demographic groups. Some of this, as we were told by Simon Stevens this morning at a seminar, is due to the higher incidence of smoking in pregnant women, but not all of it. Poor nutrition, stress and poor antenatal care are contributors. Stress is a killer and is particularly damaging to the brain development of young babies and children, especially if it is caused by domestic violence.

It is appalling that in this highly developed country, there are pregnant women who do not have access to good fresh food. There are food deserts: places where people cannot get to shops that sell good fresh food because there are none; moreover, they do not have the means of transport to get to one. The main problems, however, are the lack of cooking skills, and poverty. Cheap food tends to be highly calorific and low in nutrition. As we know, overweight mothers more often have overweight children—and so the cycle continues. I would like to see compulsory cooking lessons in schools and good-quality health education, through which children are taught how to eat well. Many schools have done really well on this. They have school meals staff who are passionate about providing fresh and nutritious food; in some places, they even grow it.

Of course, this requires leadership from head teachers, who have a lot of other things to worry about, but as I said, it pays dividends, because well-fed children learn better. That is why the Liberal Democrats in the last Government were keen to bring in free school meals for key stage 1 children. School meals in local authority schools have to be up to certain nutritional standards, which is why I want to ask the Minister why the Government do not insist that academy schools abide by these standards. Currently, they do not have to.

School food is particularly important for very poor families who may be in houses with poor cooking facilities, who may have had the electricity or gas cut off, who may be in bed-and-breakfast accommodation with no cooking facilities at all, and who may have chaotic lifestyles, meaning that the children do not have regular mealtimes. School food is therefore particularly important to poor children. We really need to pay attention to this issue for the sake of their future health.

You may ask why I am concentrating so much on food—apart from the fact that I like it. The reason is that if we instil healthy eating in children, we are carrying out a major preventive programme against heart disease, diabetes, strokes, musculoskeletal diseases and the rest. Given that resources are scarce and the population is both growing in number and ageing, this strikes me as common sense.

Let me turn from prevention to care. As the noble Baroness, Lady Hollins, said, 40% of GP visits are made by children, so those who suffer most when it is hard to get a GP appointment are children. The Government have a commendable ambition to reduce weekend mortality by making primary care services available seven days a week, but if this is done without more resources, by spreading out what is already there, the result could be disastrous. I have already mentioned our poor child mortality figures. Like the noble Baroness, I was horrified to learn that every day in the UK, five children die who would not have died if we had the same child mortality figures as Sweden. Will the Minister look into this? That is five family tragedies every single day that could have been prevented. If they can do it in Sweden, why can we not do it here?

I am also concerned about services for children with physical and learning disabilities. In the last Parliament, Sarah Teather, as Children’s Minister, initiated education, health and care plans in an attempt to co-ordinate all those services around children. But many of these services are delivered by local government, and there have been many cuts to local government funding. I am therefore concerned that the thresholds above which children become entitled to such services may not be appropriate. Will the Minister say something about that?

Health inequality is worse in this country than in many other developed countries, so we need to focus on child poverty and scrutinise every statement from the Chancellor about taxes and benefits, asking what effect they have on the health of our children. Will the Families Minister be doing this tomorrow, when the Chancellor announces his Budget? I doubt it but I shall be pleasantly surprised if the Minister assures me in a few minutes that she will.

NHS: Whistleblowing

Baroness Walmsley Excerpts

Tuesday 30th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord makes a very important point. There are many junior doctors from BME backgrounds who do indeed feel that it is difficult to raise concerns. One recommendation in Sir Robert Francis’s report is that every NHS organisation should have a local freedom to speak up guardian, which I hope will help. But whatever we do to change the law or codes from the GMC and others, it will not replace the need to have an open, transparent and learning culture in all NHS organisations.

[Baroness Walmsley (LD)]

My Lords, would it not be more likely that such discrimination as mentioned by the noble Lord, Lord Desai, would be stamped out if there were more black and ethnic minority members of staff at senior levels in the NHS? Is he aware that the proportion in London NHS trusts of those from a BME background is only 8%, compared to 45% in the general population and 41% among NHS staff?

[Lord Prior of Brampton]

The noble Baroness has probably read The “Snowy White Peaks” of the NHS, which sets out very clearly for all to see the really shocking lack of representation of people from BME backgrounds at senior levels of the NHS. This is an absolute priority. NHS England has appointed Yvonne Coghill to look at all the racial inequality issues, and she and NHS England have my full support in their endeavours.

Mental Health: Young People

Baroness Walmsley Excerpts

Tuesday 30th June 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I congratulate my noble friend Lady Tyler of Enfield on introducing this important debate. We have heard some very thoughtful speeches, ranging widely across the subject. My noble friend called for wise spending of very scarce resources and emphasised the need to consult children themselves and their families when putting together the transformation plans that are so important. She called for better access to services for young people, particularly the most vulnerable groups, and for some monitoring as to how well we are doing through an annual report.

The noble Lord, Lord Patten, emphasised the importance of parity of esteem for physical and mental health and called for early intervention. He was particularly concerned about the effects of social media on young people—something that of course did not affect your Lordships when we were growing up.

The noble Earl, Lord Listowel, in his usual way championed, as he has done so wonderfully over the years, looked-after children. He called for services to take account of their particular vulnerability to mental health problems and their need for emotional well-being, which they may well not have grown up with given their difficult backgrounds.

The right reverend Prelate the Bishop of St Albans talked about the good work of charities. He called for more data about prevalence and emphasised the difficult position of 16 and 17 year-olds being very inconsistent in legislation.

For my own part, like the noble Lord, Lord Patten, I am particularly interested in the prevention of mental health problems. Like him, I believe that that is the cost-effective approach. There is so much evidence that perinatal mental health, proper parental attachment and early intervention are not only more effective for the human beings involved but more cost effective for the taxpayer. So I welcome those elements of the report that focus on early intervention.

My noble friend emphasised perinatal mental health services, and I would like to start by asking the Minister what progress has been made on the recommendation that there should be a specialised mental health clinician available to all perinatal units by 2017? How much emphasis is given in antenatal classes, for example, to making mothers aware that they need to focus on their own well-being, minimise stress and ensure that they bond well with their baby when it arrives? One cannot start too early when fostering good mental as well as physical health.

There are some excellent charities working in this field, such as OXPIP, which focus on good attachment. They have learned many lessons about what works well in relation to identifying poor attachment and addressing the situation. What is being done to ensure that these lessons are being used all over the country?

The report focused on the need for early support initiatives, and it is clear that health visitors are key to this ambition. However, some health visitors have been in the profession for many years. Although their long experience is enormously valuable, since it allows them to develop deep knowledge and good judgment, it may also mean that they have not had time in their busy schedule to keep up with the latest on early intervention. Can the Minister assure us that they will be allowed enough time for this sort of continuous professional development?

Learning the lessons of what works is a key element of the new HeadStart initiative funded by the Big Lottery Fund and this is to be very welcomed. The project is focused on a key group, those aged between 10 and 14, to better equip them to deal with difficult life experiences and develop their resilience as protection against future events that might damage their mental health. Since half of all adult mental health patients first had problems before they were 14, this is exactly the right target group. Although £75 million sounds like a lot of money, there is a big task ahead. I understand that 12 pilot projects are under way, providing early support to children who need it, both in and out of school. Lessons learned will be shared with schools, youth groups and decision-makers. Partners include, as they should, GPs, local authorities, schools, youth groups et cetera. Some of these are used to working in partnerships, but others are not—I hope that the worst come up to the standard of the best.

Schools, of course, play an enormous role. With others in your Lordships’ House, I have long called for compulsory PSHE in schools, starting early in an age-appropriate way. Some people think that we are just talking about sexual health and relationships, but we are not. We are talking about developing self-esteem, self-confidence and resilience, as well as the life skills and knowledge to help the child cope with the modern world when he or she leaves school. Will the Minister go back to his colleague the Secretary of State for Education—who I think has more of an open mind about the matter than her predecessor—and encourage her to change the Government’s mind about this, because it is a vital weapon in our armoury against the epidemic of mental health issues among young people?

The task force also recommended that there should be a CAMHS contact in all schools. Earlier this year, the Department for Education proposed to implement pilot schemes in 15 areas. Can the Minister say whether this has begun and how the schemes’ success will be assessed, since we have heard nothing about it since March?

Many schools, of course, are not waiting for government to catch up. They have counsellors, anti-bullying programmes and partnerships with excellent organisations, such as Place2Be, which does wonderful work in schools at a very moderate cost. However, it is not easy for hard-pressed head teachers to find a room for them to work in and the small amount of money to fund their programmes.

The noble Earl, Lord Listowel, talked about the importance of training those professionals who work with looked-after children. But I have become very concerned just recently to realise how few doctors are trained in psychiatry in their initial training. Given that one quarter to 50% of patients presenting to GPs have mental health problems at the root of their illness, it really is important that we have some consistency across the training of doctors in this country, and in particular those Jacks of all medical trades, the very important GPs working in primary care.

I await the Minister’s response with interest, particularly on those questions about prevention.

NHS: GP Clinics

Baroness Walmsley Excerpts

Thursday 25th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is quite right. We do need GPs, and they will be at the heart of the renaissance in general practice. The Government are committed to recruiting an extra 5,000 GPs into general practice over the next five years—that figure is net of people retiring. We accept entirely the noble Baroness’s proposition that we must persuade more newly qualified junior doctors to opt for general practice rather than for working in hospitals.

[Baroness Walmsley (LD)]

My Lords, what discussions have the Government had with the Royal College of Emergency Medicine about the idea of collocating GP clinics in A&E departments? Surely such a strategy has the potential for killing two birds with one stone.

[Noble Lords]

Oh!