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!

Mental Health Services

Baroness Walmsley Excerpts

Thursday 25th June 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I thank the noble Baroness, Lady Thornton, for introducing this debate. I was delighted that she and her colleagues felt able to support the Liberal Democrat amendment on parity of esteem. The noble Baroness has given a very comprehensive outline of the problems highlighted by the report and I will not repeat them. Suffice it to say that we on these Benches will support anything the Government do to alleviate the problems of young people with mental health issues before and during crisis situations. Early access to treatment is the key to reducing the number of crisis occurrences and good planning of adequate services and information to patients are key to making sure that people in crisis can get the help, as the CQC says, “right here, right now”.

We are proud of the record of our Liberal Democrat Ministers, Paul Burstow and Norman Lamb, in the last Government. They were involved in announcing: parity of esteem for physical and mental health; an increase in funding for mental health, including more in-patient beds; increased focus on child and adolescent mental health; and equal waiting time targets. The Children and Young People’s Mental Health Taskforce report Future in Mind is an excellent blueprint for the five-year national programme of improvement commenced under the auspices of my right honourable friend Norman Lamb and it is part of his excellent legacy in the Department of Health. The mental health crisis care concordat was another great achievement and it is good to know that everyone has now signed up to it and that most local authorities have a plan to deliver it. However, resources have been scarce for most of the past five years so this progress has to be seen in the context of an earlier reduction in the number of mental health beds and years of insufficient focus on children and young people.

I welcome the Government’s proposal to ban the use of police cells for young people in crisis. However, I want to talk about timing. There are times when Governments, in their rush to do the right thing, forget that if they do not put other things in place before acting, they can make things worse. I can think of the spare room subsidy which the previous Government imposed without ensuring that sufficient smaller properties were available for people to downsize. That is why my party put forward a Private Member’s Bill to ensure that tenants would not have to contribute for spare rooms unless they had been offered suitable smaller accommodation and refused it. Sadly, that was defeated in another place. Another potential example is the current Government's plan for seven-day availability of GP services at a time when we have not even got enough GPs to fulfil current demand.

I am concerned that if the ban on use of police cells is brought in before the problems highlighted in this thematic report from the CQC are addressed, we will be leaving young people in crisis with nowhere to go. I do not want to see police officers disciplined for bringing young people into police stations when there are no age-appropriate therapeutic services available for them and that is the only thing they can do. I do not want to see A&E departments trying to cope with these young people, who need time that the staff do not have and a calm atmosphere—which is not going to be found in A&E. I do not want to see young people failing to call for help when they need it because they know that the police cannot protect them—often from themselves—and neither can A&E.

It really does not seem right that people are being turned away from services when they ask for help only to be detained when their condition deteriorates. However, although they are not the appropriate service to help in mental health crises, it has to be said that the police do their best, and many patients in this situation report that they get better help from them than from some other services. Some forces have implemented rather creative strategies. I have heard of at least one force where officers called out after hours to a person who clearly is having a mental health crisis take a community psychiatric nurse with them. These nurses are able to assess the situation and calm the patient, allowing him to be dealt with appropriately. This is an excellent example of thinking outside the box and is to be commended.

I ask the Government to ensure that before this very welcome ban comes into force they have all their ducks in a row, so to speak. My question, therefore, is: how will the Government assess when this is the case so that the ban can be safely implemented once the legislation has gone through?

There is one large group that is particularly at risk in these situations: young people who have recently left care, many of whom develop mental health issues soon after having to live independently. Many of these young people do not have a responsible adult to turn to and do not access services early, and far too many of them suffer a crisis and harm themselves or even commit suicide.

There is evidence that the problems overall may be understated by the official figures. Although only 53 under-15s and 312 16 to 17 year-olds were admitted to adult mental health wards in 2013-14, people were counted only once no matter how many times they were admitted in the year. These figures come from an Answer to a Written Question from Luciana Berger.

Another problem is poor anticipation of a future crisis and poor communication between services. The report we are discussing found that the rate of people admitted to acute hospital via A&E for a mental health condition varied across the country. In 2012-13, more than 4,000 people had attended A&E multiple times—on average, at least once a month—in the five years before being admitted. This is likely to be a sign that local services are not working well together and that people are not getting the specialist help they need. Should there not be guidelines that a red flag is raised when these multiple attendances occur?

Given that the pathways into help in a crisis are several, can the Minister reassure us that local concordat teams are covering all the bases, ensuring good communication and providing services at the right time? Will he emphasise that patients need to know who to call to get help? One of the worst findings in the report was the large number of patients at risk of a crisis who said that they did not know who to call in an emergency—no wonder they land up in A&E.

I realise that the task for local commissioners is a difficult one. They need to predict what crisis services will be needed and at what times, and make those services available. This requires a deep knowledge of the status of patients in their area and a commitment to providing therapies which will prevent problems reaching crisis point. So my final question is: how are the Government assessing how well this is being done?

NHS: Immigration Rules

Baroness Walmsley Excerpts

Wednesday 24th June 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I agree with my noble friend; it cannot be right for a rich country such as ours to recruit nurses from much poorer countries. I will just say that the Philippines, for example, produces more nurses on a deliberate basis than it needs for itself, so that they can go overseas, usually for temporary periods, not permanently. Interestingly, over the last five years, the number of non-EU overseas nurses working in this country has reduced by 41%.

[Baroness Walmsley (LD)]

My Lords, if we need more home-grown nurses, what are the Government doing to address the flood of nurses leaving the profession, and the appalling attrition rate during training? My noble friend Lord Willis’s report on the Shape of Caring review showed that every year 20% of student nurses do not complete the year, and 40% of nurses do not complete the first five years in the profession. Since it costs £78,000 to train a nurse, is that not a terrible waste of money, and could we not do more to support student nurses to finish their training?

[Lord Prior of Brampton]

The noble Baroness makes a strong point. The drop-out rate of nurses is between 20% and 30%; it varies hugely from one nursing school to another. I am told that the peak of the drop-out rate is after their first clinical placement, which indicates that the way some nursing schools recruit their students is far from satisfactory. I hope that Health Education England will change the way it remunerates some nursing schools to ensure that they recruit the people with the right qualifications, temperament and vocation before they offer them places.

Health: Palliative Care

Baroness Walmsley Excerpts

Tuesday 23rd June 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I thank the noble Baroness for those comments. Over the years I have spent quite a lot of time with nurses who are specialists in palliative care and I have always been hugely impressed by their work. I have not seen the booklet produced by the RCN to which the noble Baroness refers and I would certainly like to do so.

[Baroness Walmsley (LD)]

My Lords, was the Minister as shocked as I was, when reading some of the case studies in this report, to realise that the problems did not require further legislation or regulations but required staff who would follow guidelines and who had common sense, compassion and good communication skills? Why are people who lack these skills and attributes not being weeded out at the training stage, before they get anywhere near a patient?

[Lord Prior of Brampton]

My Lords, if Members of this House have not read the report by the ombudsman, I recommend it. It consists of 12 short, fairly straightforward case histories, which make for appalling reading. There are many nurses in hospitals and community settings who deliver wonderful care. The issue is their ability. The CQC is now making regular inspections of end-of-life care in all its hospital visits. It is one of the eight core services that it looks at. It has found that in the vast majority of cases, end-of-life care is caring. The noble Baroness asked why such care is so variable. I think that in hospitals it is partly because they are often busy places. They are not ideal places to die in. Who would wish to die in a clinical setting in a very busy ward unless they had to? That may be a part of the explanation.

NHS: Innovation

Baroness Walmsley Excerpts

Thursday 11th June 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I, too, welcome the Minister to his first debate. I also thank the noble Lord, Lord Wills, for using this debate to raise such an important issue. I, too, want to ask about fast-tracks although most of my remarks will be of a somewhat more general nature than those of the noble Lord.

The overriding purpose of innovation must be the better care and treatment of patients. Financial considerations are of course important but when patients’ lives are at risk, speed is of the essence, so we must do everything in our power to get proven new treatments and practices to patients without delay. A primary focus of innovative practice in the past two years has been the interface between health and social care. The devolution of new responsibilities to local authorities has the potential to let many flowers bloom and stimulate a lot of new thinking. However, local authorities, suffering deep cuts in their budgets and without ring-fencing of their adult social care and public health budgets, have found it very challenging to respond to their new powers. “No change” has not been an option. Indeed, in many areas, councillors and officials have felt that wholesale change is the only answer to providing integrated services to their ageing communities in a sustainable way.

A very good example of how this has been done is the Greater Manchester Integrated Care Programme. The 10 local authorities involved suffer some of the worst health outcomes and inequalities in the UK. The number of over-85s is forecast to rise by more than 28% in the next 20 years, while suboptimal management of these patients is currently placing significant strain on acute hospital services. As a result, older people in the area have high rates of emergency admission to hospital, of non-elective bed days and of readmission. What a challenge this is. By setting up three common integrated programmes with locally agreed variations that focus on user experience, health and well-being outcomes, productivity and multidisciplinary working, and with a strong programme of liaison and oversight, the 10 authorities have made real improvements in outcomes and reduced costs. Digital technology has been a key element in overcoming the barriers to integration. That was a quick skim through one very complex response to the Health and Social Care Act 2012. It is only one example of the innovation which councils all over the country are leading.

Turning to new drugs and equipment, as I understand it, the main control over whether these are approved for use in the NHS, and can therefore be commissioned by CCGs, is the NHS Business Services Authority. Some manufacturers are concerned that the approval process can take up to two years. When all the evidence for efficacy and cost effectiveness is available, this can surely be speeded up. Can the Minister say whether the Government are in favour of a fast-track procedure for drugs and equipment where all the evidence is available that would allow new ideas to be brought to the patient sooner? I can understand things taking longer if further evidence is needed, but some companies are in a position to bring all the evidence to the table. Such applications should be able to go through or be rejected very quickly if the figures do not stack up. Have the academic health science networks succeeded in their objective of ensuring rapid evaluation and early adoption of innovations?

Even when a piece of equipment has been NICE-approved, it can take far too long to reach all the patients who could benefit from it. For example, the latest innovation in diabetes treatment to be approved is the insulin pump. This has been available for four years and is suitable, according to NICE, for 12% of adult diabetics and 33% of children. However, distribution has reached only 4% of the patients who would benefit from it, far behind other European countries. This is not encouraging for other companies which are currently working on even more innovations to make the lives of thousands of diabetics better and safer.

Of course, it is not only drugs and equipment that must be considered. New practices and procedures at trust level and in primary care can also bring benefits to patients, raise standards and save the NHS money—standards being the key to a good health service. Very often even the low-hanging fruit is not plucked. I refer in particular to hospital infection control. There have been many examples of cases where better implementation of simple hygiene procedures can make an enormous difference in hospital-acquired infection levels. Yes, there are clever new things such as using bactericidal services and UV light cleaning equipment, a US invention being trialled in two hospitals over here. These have their place, but often much simpler solutions are overlooked. For example, I have recently been treated in two hospitals, one in England and one in Wales. The English one swabs patients for MRSA during their pre-operative assessment; the Welsh one does not. It is obvious which one has the higher rate of MRSA. This practice was recommended by the Science and Technology Committee of your Lordships’ House in 2003 when I was a member, in its report called Fighting Infection on the control of infectious diseases. It might have been a new idea then but it is not new any more and it is still not being used universally. It is a simple, cost-effective procedure and I am amazed that it is not being carried out in every hospital. So good care is not just about innovation, important though it is.

I believe that more use can be made of the simple things that we all use, such as the phone. Everybody has a phone—indeed, 4 billion people in the world use a mobile phone, whereas only 3 billion use a toothbrush. In Durham and Darlington, dieticians won an award from Health Service Journal for using telephony to improve the monitoring of patients with nutritional problems. Formerly, they could only see about six patients a day, but with this system, an automated phone call regularly goes to a patient who is self-administering prescribed nutritional supplements. They are asked to answer certain questions by pressing buttons on the phone. Clinicians receive an email alert if the information input is outside of predetermined parameters, or if they have failed to respond to the call. They can then check on the patient directly. This is a scheme well deserving of its award. This is a very simple mechanism but it improves productivity; patients love it and feel more confident in their treatment.

How many other uses could telephony be put to? We are lagging behind countries that we consider to be less developed than ours. Some years ago I went to India to look at some aspects of their health service. They were way ahead of us in what I would call distance health. In other words, because of the extreme rural nature of much of the country, and the fact that most medical expertise is located in the cities, they had set up village health centres with videolinks to hospitals. Doctors could be face to face with a patient many miles away, question him, get answers and even see the problem. The village health workers also helped with the consultation and could administer simple treatments under the instruction of the doctor.

We may not be as rural or poor as India, but we do have many patients who cannot get to their GP easily or get a timely appointment. It occurred to me at the time, years ago, that we could increase the productivity of our GPs if we had a system like that. The now discontinued NHS Direct was not popular with patients because the people at the end of the phone were not sufficiently well qualified, and too many people were just directed to their nearest A&E. Its replacement, NHS 111, has yet to prove itself. If it is co-ordinated properly with GPs’ practices and other services, as it is intended, it could be a great success, so I wonder whether the Minister can tell us how its success is being monitored and what role it will play in the Government’s ambition to make the NHS a 24/7 service. Finally, I look forward to the Minister’s maiden speech and to hearing some of the answers to my questions.

Jimmy Savile: NHS Investigations

Baroness Walmsley Excerpts

Thursday 26th February 2015 Lords Chamber

[Earl Howe]

I understand the point made by my noble friend. At the same time, it is clear from the executive summary of Kate Lampard’s report that Stoke Mandeville is by far the most important and salient element of the report and I had hoped that that would have guided readers’ attention towards the section of the report that deals with Stoke Mandeville. Nevertheless, I am sorry that my noble friend has found it necessary to say that and I understand why he has.

[Baroness Walmsley (LD)]

My Lords, the Statement referred to inadequate systems and the need for a culture change. Does the Minister accept that many people are of the view that what we have is inadequate law and not only inadequate systems? I do not know whether my noble friend heard the “Today” programme this morning in which Mr John Humphrys, in interviewing a lawyer acting for one of the many Jimmy Savile victims, was astonished to discover that there is no offence of ignoring knowledge of child abuse that has been reported. Indeed, a majority of the British public think that it is already the law but the Minister knows that it is not.

I welcome the commitment to a public consultation that resulted from an amendment I tabled to the Serious Crime Bill, but several months have passed since that commitment was made by the Government and we still do not know which department will lead the consultation. Will it be the Home Office, the Department of Health or the Department for Education, or will it be a combination? I heard that in another place the Minister undertook that the consultation would be complete and the Government’s response given within 18 months of the Bill becoming an Act. Can the Minister confirm that that undertaking stands and say whether there has been any progress on which department will lead on this consultation?

[Earl Howe]

My Lords, I cannot give a specific undertaking on the timescale that we envisage for the consultation or on any legislation that might ensue from it because that raises the question of whether any legislation is necessary. That is what we want to know from the consultation process. However, I can tell my noble friend that the Home Office will be leading the consultation in conjunction with all the other relevant government departments.

Tobacco: Packaging

Baroness Walmsley Excerpts

Thursday 28th November 2013 Lords Chamber

[Earl Howe]

It most certainly is relevant, which is why we are taking the legislative opportunity in the Children and Families Bill to drive home that very point. My noble friend is right.

[Baroness Walmsley (LD)]

My Lords, I congratulate those in your Lordships’ House on their persistence in keeping this issue before the Government, including my noble friend Lady Tyler of Enfield. I also congratulate the Government on their determination to base policy on evidence. However, if the Government, in the fullness of time, use their regulatory power to introduce standardised packaging, will they keep a watching brief on the tobacco companies? In the past, whatever procedures we have brought in, they have been extremely clever in finding ways round them to lure young people into starting smoking. Therefore, will the Government watch the situation very carefully and try to make sure that the tobacco companies do not get round standardised packaging, thus continuing to attract young people to a habit that will kill them?

[Earl Howe]

My noble friend makes a very important point. She is, of course, right that the tobacco companies protect their commercial position with great vigour. We will indeed keep an exceedingly close eye on the actions of the tobacco industry and, should we decide to introduce regulations, we will do all we can to ensure that they are watertight.

Organ Transplantation

Baroness Walmsley Excerpts

Monday 27th February 2012 Lords Chamber

[Earl Howe]

No, my Lords, and that is part of the problem.

[Baroness Walmsley]

Will the Minister accept that it can be very difficult for doctors to approach a bereaved family to ask about organ donation? I know this from personal experience, because doctors did not approach me when I lost my late husband; I had to raise the matter myself. It is understandable that they do not want to upset the family. However, can it not be even more upsetting for a bereaved family who have not been asked about donation to realise some time later that they have missed the opportunity for their loved one to give life to other people?

[Earl Howe]

My noble friend raises an extremely important set of issues. This was one issue identified by Chris Rudge when he took up the post as National Clinical Director. A great deal of work has been done in the NHS to increase the number of organs available to patients and to have the kinds of conversations with families that are necessary but very delicate. There has been an increase in the number of specialist nurses for organ donation who are of course highly trained in that area, and appointments of clinical leads for organ donation have also helped.

Health: Children and Young People

Baroness Walmsley Excerpts

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, the outcomes framework that I have just referred to should assist in the latter regard. I think the noble Baroness would agree that the system we have at the moment is not sufficiently joined-up, and in that sense does not adequately serve the needs of children. The approach we have taken to the proposed NHS reforms is to promote the importance of the integration of care and service provision for everyone, including children. We believe that strong partnerships at a local level, supported by professionals and local leaders, are the way forward, not top-down direction. The health and well-being board provides the forum for repositioning the joint strategic needs assessment into a truly joined-up strategy for local people.

[Baroness Walmsley]

I welcome what my noble friend the Minister has said about getting the views of children, but does he think that giving the commissioning of the excellent Healthy Child programme to local authorities is going to bring about the universal dissemination and delivery of that programme?

[Earl Howe]

The role of local authorities will be pivotal in this because it is at local-authority level that public health, social care, and indeed the discussions that will go on in the health and well-being board context will bring together policy in a way that informs NHS commissioning. I think that the approach we have taken has been widely welcomed, and we are absolutely determined that all sectors of society, including children, are included in these processes.

Queen's Speech

Baroness Walmsley Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Walmsley]

My Lords, I make this speech for the first time from the government Benches, in the first coalition Government for many years. Coalitions are commonplace in local government and are nothing to be afraid of, and this one has been welcomed by at least two-thirds of the population. It is only a pity that some of the more vicious national press lags behind public opinion. I therefore congratulate my noble coalition partner, the noble Lord, Lord Hill of Oareford, on his new role and his maiden speech. He will find that we, his partners on these Benches, will play our part in helping to guide the elements of the coalition agreement through this House. In listening to one or two of the speeches over the past few days, the image has been brought to mind of the apocryphal Japanese soldier who staggers blinking out of the forest several years after 1945 under the impression that World War 2 is still under way, unaware that peace has broken out. I am not one of those; the war is over, long live the peace.

So let me start my comments on children and schools by welcoming some important policies from the coalition agreement. First, I am delighted that we will scrap ContactPoint, change the rules on collecting and storing DNA, and ensure that children are no longer fingerprinted in schools without their parents’ permission. But could I ask the Minister whether the erection in public places of the notorious mosquitoes, which make a high-pitched noise which only children can hear, will also be banned unless there are very good public interest reasons for them? They are discriminatory and restrict the freedom of movement of law-abiding young people, and have been condemned by many organisations that speak for children, as well as by children themselves.

I also welcome the commitment to the overseas aid target on which so many of the world’s most vulnerable children depend, and the coalition Government’s continued commitment to ending child poverty by 2020. This policy was one of the best actions of the former Government. I am also pleased that the Government have stated their continuous support for Sure Start, another of the previous Government’s achievements for children.

Noble Lords may recall that I have always regretted the reduction in the health visitor service. Health visitors, as a universal service, avoid any stigma for the family visited, are trusted by mothers and are a useful signposting mechanism to other services. Therefore I am delighted about our commitment to increase their numbers. However, I am keen that we get the balance right. The Sure Start peripatetic outreach workers have done a valuable job in reaching those families with multiple problems who other services have found hard to reach. I want to be sure that the new health visitors will be trained to reach out into the community, identify problems and direct the appropriate services towards families. At a time of economic belt-tightening, we need to make every pound work hard, and early intervention provides the best value for money.

One of the declarations of which the coalition can be most proud is that children will no longer be detained for immigration purposes. This was an unnecessary blot on the record of the previous Government, who did so much for children, and got in the way of this country implementing fully its duties under the UN Convention on the Rights of the Child. Every step towards full implementation of the convention is a step in the right direction.

On criminal justice, I welcome the proposal to conduct a full review of sentencing policy to ensure that it is effective in deterring crime and reducing reoffending. The rate of reoffending, in particular among teens and early 20s, is appalling. The evidence for the effectiveness of rigorous community sentences and restorative justice initiatives is compelling. So many young offenders have themselves been failed by society and need treatment, therapy and education to get them back into useful lives. I hope the evidence from these initiatives will be taken seriously in the review. I also hope it will consider the evidence for restoring the age of criminal responsibility to its pre-1998 age of 14.

In the section on the NHS I find little about children’s health, apart from the welcome reference to children’s hospices, which do such a wonderful job. What concerns me is the lack of any reference to child and adolescent mental health services. I am aware of the financial problems the Government have inherited but I would urge Ministers to consider the long-term financial savings that could result from early intervention for children with mental health problems and personality disorders. Emphasis on child poverty and family support can avoid some of those problems but we still need to improve what has been a Cinderella service. If we do, we will reap financial as well as human benefits.

Time does not allow me to say much about schools but I shall get my opportunity to do that on Monday. I have already pointed out the educational disadvantage of many young offenders, for example, so it is vital that all our children get the best possible education we can provide. Despite the economic problems, the Government have declared that schools will not suffer and neither will 16-to-19 education. Indeed, the commitment of my party to providing the financial premium needed to enable children from the most deprived backgrounds to overcome their disadvantage is one of which I am most proud. I am delighted that our coalition partners have agreed that this cannot be done without a commitment to that funding promise. It is for the long-term future of our country, as well as a basic human right for our children.

The noble Baroness, Lady Morgan, asks where the money is coming from. It really is breathtaking when the Opposition shoulders no responsibility for where the money went. We will be coming to the Second Reading of the first of two education Bills on Monday, so I shall not say much about academies here. However, I will be playing my part in ensuring that the objectives of the Bill are achieved without jeopardising the coalition’s declared intention of providing the very best for the most vulnerable children. Their welfare as well as their education is of paramount importance—and that includes those with SEN, disabilities, those in public care and young carers. We have to look very carefully at the possibly unintended consequences of the structural reforms that are proposed to ensure that no child is left behind as we improve schools.

Both our parties have often said that we should trust the professionalism and dedication of teachers. However, there is currently excitement and concern among teachers and heads about the Government’s plans and we must ensure that these concerns are taken into account. If we are to enable schools to improve, we can do so only with the commitment and energy of our teachers, and so it is vital that we listen to them.

I commend this programme of government to the House and I will work with my partners to ensure that, as usual, legislation leaves this House in a better state than when it came in.