National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020

Baroness Watkins of Tavistock Excerpts

Monday 8th June 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, it is a pleasure to contribute to this debate in the name of the noble Lord, Lord Hunt of Kings Heath, on amendments to the NHS commissioning rates for the provision of NHS-funded nursing care to eligible residents in nursing homes. I declare my interests as outlined in the register, in particular as a registered nurse myself.

Prior to October 2007, there were three rates for NHS-funded nursing care, which were replaced with a single band for all newly eligible residents. The small number of residents who had been in receipt of the former higher band, prior to September 2007, have been protected and will continue to receive the higher band, unless their needs reduce. Therefore, the statutory nursing care funding for the majority of those entitled has increased to £183.92. This came into force on 20 May and will be backdated to 1 April. This is welcome.

The increase reflects the recommendations of an independent study produced by LaingBuisson into the 2019-20 rate. However, the research was conducted between November 2018 and February 2019, before Covid. Therefore, the report does not appear to take into account the increased cost of PPE equipment and the nursing time associated with its use in nursing homes. However, PPE is essential to prevent the transfer of Covid-19 in nursing homes; as we know, their residents are particularly vulnerable to severe problems when infected with the virus, including in many cases, sadly, loss of life.

I understand that the proposed uplift will be dealt with by NHS England and NHS Improvement. Will the Minister clarify whether additional funds will be made available to CCGs to fund the increase in nursing care payments, or will it have to be funded from this year’s allocations to CCGs? Will the Minister also explain whether there are any plans to fund CCGs to make additional payments to nursing and care homes for the additional costs of PPE equipment and staff time associated with both the changing and using of PPE for nursing and personal care work undertaken by staff for residents—for example, to include the changing of urinary catheters and stoma bags?

I welcome the uplift in the rates for nursing care, but, in the absence of a long-term plan for funding care provision in residential homes, ask whether Her Majesty’s Government should make further extra financial provision, for at least the next year, to ensure the safe and effective use of PPE to protect residents in the light of the number of deaths in care and nursing homes attributable to Covid-19.

Covid-19: Obese and Overweight People

Baroness Watkins of Tavistock Excerpts

Thursday 4th June 2020 Lords Chamber

[Lord Bethell]

My noble friend is right that personal responsibility and the leadership of those in areas of responsibility are incredibly important. Shame is not a policy that the Government particularly endorse, but I will confess to personally having a sense that I need to lose a stone in order to be match fit for the winter. I commit to my noble friend to undertake this arduous and difficult task over the next three months and will account to him on what progress I have made.

[Baroness Watkins of Tavistock (CB)]

My Lords, global scientific data is clear: obesity weakens immune systems, resulting in increased susceptibility to a range of diseases. Covid-19 has shone a light on the effects of being overweight, and I welcome the Government’s concern and intervention for the future. What plans do they have to work with survivors of Covid-19 who are overweight? There is a real risk that many will suffer post-viral fatigue, which will further exacerbate unhealthy lifestyles and could well result in a significant number of subsequent deaths that are in fact associated with the recovery—or non-recovery—period following Covid-19. Will the Government deliver clear and transparent guidance on healthy lifestyles and provide support to overweight people who have survived Covid-19?

[Lord Bethell]

The noble Baroness is entirely right: there is nothing new to the impact of Covid on those with a high BMI; it is entirely consistent with the impact of other diseases. She is also right that one of the nasty aspects of Covid is its long-term effects, which are not fully understood yet. Evidence suggests that these may be extremely damaging, and it is true that the Prime Minister has spoken about the impact of Covid on him. I have had pneumonia; I know the long-term damage of these kinds of diseases on people. We are looking very hard at offering the kind of support that she describes to those who have been hard hit by Covid.

Covid-19: Social Care Services

Baroness Watkins of Tavistock Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I welcome this debate and thank the noble Baroness, Lady Wheeler, for securing it. It is clear from yesterday’s NHS Providers briefing that the social care sectors, including hospices, care homes and domiciliary providers, are beginning to consider closing to new admissions or taking on new people for support in the community. This is due to worries about the need for PPE to protect residents and staff from cross-infection by Covid-19. As of 13 April, nearly one-sixth of care homes reported expected outbreaks of Covid-19. This means that many care homes do not have enough staff. Other noble Lords have spoken eloquently on this issue, but it means that it would be very difficult to discharge people from hospital care if either care homes cannot give short-term care or domiciliary care cannot be organised.

The shortage of PPE is more extensive, serious and difficult to overcome in some places than others. It appears that care homes which are members of large chains are beginning to find solutions to short-term procurement. However, even these larger companies are extremely concerned about the increased costs of PPE. It is therefore almost impossible for small domiciliary care providers supporting vulnerable children, people with mental health problems and older people in their own homes to purchase the necessary PPE in a timely and cost-effective manner. Can the Minister explain the Government’s approach to these providers, and how the Government intend to make access to PPE available through either national or local procurement and delivery in a cost-effective manner?

If social care is to be successful and sustainable in taking on new clients, as well as providing high-quality care to those who receive it, we must reduce the feelings of fear about employment and the right to remain among carers from overseas. The Government’s new post-Brexit immigration scheme is based on treating health and social care workers differently. The Home Office’s plan will enable doctors and nurses to apply for fast-track NHS visas, but care workers will have to apply to come under the points-based system. Nearly a fifth of all care workers in this country come from overseas. Many of them may choose to return home in the next year, yet the Home Secretary does not at the moment see a need to apply a fast-track system for care workers. Please can the Minister comment on this approach and inform the House whether it is to be reviewed?

I also have to ask, as other noble Lords have: will the Government consider scrapping the £400-a-year NHS surcharge for health and social care workers? If we are to recruit and retain our workers, doing so is vital at this point in our history.

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

I ask the noble Baroness, Lady Warwick of Undercliffe, to stop sharing her screen by clicking the box with an arrow in the command bar, please. I call on the noble Lord, Lord Turnberg, to speak next.

Coronavirus Bill

Baroness Watkins of Tavistock Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw the House’s attention to my list of interests in the register; in particular, that I am a registered nurse. We are here today at a time of public health challenge unknown to date on our globe. I will be brief and start with my support for the Bill, which is widely echoed by many Members who cannot be here today as a result of the social distancing advice to reduce the spread of Covid-19. However, they are following the Bill online and have aided my contribution. They include my noble friends Lord Patel, Lady Hollins, Lady Boycott, Lady Bull, Lady Hunt of Bethnal Green and Lord Bird. In addition, our Convenor has been in contact with our Members throughout the week. His message has been that while on first reading some of the measures in this Bill appear draconian, under the circumstances they are necessary. Knowing his concerns about the use of Henry VIII powers, this opinion should carry considerable weight in our deliberations.

The Royal College of Nursing and the British Medical Association have provided detailed briefings, as have many other parties, including the Royal College of Psychiatrists. In principle, they support the measures outlined in the Bill to protect the public and essential workers. However, they want reassurance that the measures will have regular parliamentary review, preferably at least every two to three weeks, to ensure the effectiveness and relevance over time. Can the Minister outline the plans for review once the Bill is enacted?

Nurses and other healthcare staff who have recently retired and those about to qualify have been encouraged to return to work or commence employment earlier than planned. We are assured that they will have the same employment rights as other workers. Sadly, we know from the management of previous infectious diseases that some healthcare workers will catch Covid-19 while carrying out their duties. Will these staff be entitled to proper sick pay in line with NHS employment rules? In the exceptional circumstances of such an individual dying, will death-in-service benefits be generous? These benefits often relate to length of service, so it may be necessary to change the current terms. Does the Minister agree?

Other noble Lords have spoken of the challenges in social care and the potential for some people to have, in effect, the current level of service reduced as demand rises. A range of groups associated with long-term disability ask: will any reductions be re-instigated after the emergency period? Can the Minister reassure the House on this issue, the details of which were brought up extremely effectively in the powerful speech of my noble friend Lady Grey-Thompson?

The changes to the Mental Health Act are supported by the Royal College of Psychiatrists and will be necessary to protect people with serious mental health problems and to ensure rapid access to treatment. However, some human rights organisations are concerned that that will result in higher numbers of detentions than normally, particularly among disadvantaged groups. As a former acute ward psychiatric sister, I remind the House that once a patient is admitted, other professionals assess that patient quickly, and that treatment orders can be rescinded rapidly if appropriate. Will the Minister consider echoing this point to reassure those who are so worried?

NICE has given guidelines to prioritise patients for effective treatment and critical care, and these of course need to guide clinicians and be enacted by them in their work. However, there are some concerns that the guidelines from NICE on this issue refer to frailty. Can the Minister further assure the House that frailty with regard to physical and learning disability and severe and enduring mental illness will not disproportionately disadvantage these groups? My noble friend Lady Grey-Thompson raised this issue in detail, and I will not cover it further. I thank her again for her powerful speech on a range of social care challenges and the rights of people with a range of long-term conditions. I await the Minister’s reply to her questions.

Finally, will the Minister ask the Government to consider debt relief for the fees of healthcare students who are entering the workplace this year and who will work in our healthcare settings, probably for several years in the future? It is extraordinary that we are asking them back. They have paid their fees this year; they are willing to come back—we need some intergenerational fairness on this issue.

Covid-19: Critical Care Capacity

Baroness Watkins of Tavistock Excerpts

Monday 23rd March 2020 Lords Chamber

[Lord Bethell]

My Lords, we are greatly relying on an influx of staff such as freelance locums in order to increase the numbers at the front line in dealing with Covid-19. Arrangements for the pension scheme are included in the Bill that we will bring to the House tomorrow. On supplies to GPs and pharmacies, a huge procurement programme is going on at the moment, and we are taking stocks out of our no-deal preparations in order to ensure that both GPs and pharmacies are well stocked.

[Baroness Watkins of Tavistock (CB)]

My Lords, many healthcare workers are concerned about their own health, particularly with regard to carrying the virus from their work into their homes and infecting their families. The Financial Times reported this morning that the Government have approached Amazon to deliver coronavirus tests urgently to front-line health and social care workers. This of course would provide some reassurance to staff and enable them to know whether they are infected, and therefore whether they should stay at work. Can the Minister offer an estimate as to when such a scheme could be rolled out?

[Lord Bethell]

My Lords, the bravery and commitment of our front-line staff are to be commended. I think I speak for all of us when I pay tribute to everyone who has put their safety and health on the line. There is no doubt that those in the NHS who are working with those affected with Covid-19 are taking a huge risk, and it is our commitment to support them where we can. Hotel rooms are being booked for NHS staff who are reluctant to return home and who would quite wisely prefer to seek alternative accommodation. Tests are absolutely essential in order to get not only front-line clinical and ancillary staff but the whole country back to work. The Government are committed to finding a way to roll out a testing programme that gives British people confidence that we can beat this virus.

Covid-19: Helplines

Baroness Watkins of Tavistock Excerpts

Thursday 19th March 2020 Lords Chamber

Asked by

[Baroness Watkins of Tavistock]

To ask Her Majesty’s Government what plans they have to establish a COVID-19 specific helpline in addition to NHS 111; and whether any such helpline could be staffed by retired medical and nursing professionals.

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

My Lords, as part of its coronavirus response, NHS 111 has already trained an additional 1,000 call-handlers. NHS England has been clear that investment will increase as demand continues to rise. As part of the health system’s wider response to the coronavirus, the GMC, the NMC and other professional regulators have written to professionals who have left their registers within the past three years to ask them to return to support the coronavirus response.

--- Later in debate ---

[Baroness Watkins of Tavistock (CB)]

My Lords, I first acknowledge the Lord Speaker’s demonstrable leadership in deciding to work from home. We need to remember that we are televised and we need to model the behaviour we are asking of the rest of the country. I thank the Minister for his response, but draw his attention to the fact that there are many retired professional health workers who wish to contribute to the NHS and social care needs of our population in all four countries of the UK but who have their own health concerns. Many, like myself, are fit enough to return to clinical practice and are of course willing to do so. However, utilising others by quickly teaching them a specific algorithm for the Covid-19 virus could relieve anxiety and provide advice to our population and, in particular, relieve NHS 111 to deal with other concerns. We are very worried that, even in the short term, people with perhaps severe problems who should be ringing 999, but do not know that until they have rung 111, will have to wait a disproportionately long time. I wonder whether we could see how quickly we could get a specific line using the expertise of the people I referred to.

[Lord Bethell]

The noble Baroness, Lady Watkins, reflects the feeling of all the House in her comments on the Lord Speaker, and I entirely endorse her comment that we must all respect the guidance and advice given to us by the Government. I pay tribute to the Lord Speaker for his comments on that subject.

In terms of 111, she is entirely right that the NHS is under acute pressure, which is particularly felt on the front line in the interaction with concerned people who are understandably phoning 111. The 111 system is recruiting a large number of new handlers. In addition, we have put a letter through the GMC, NMC and other professional bodies and there will be a registration page on the front page of those bodies’ websites—it will be going up very shortly, either tomorrow or very soon afterwards, I believe—for recently retired professionals to register their interest in rejoining their local NHS health authorities in some way. Those applications will then be passed on to the local authorities and triaged, and the applicants will be allocated suitable responsibilities. I pay tribute to all those who are thinking of returning or have returned to active service, often putting themselves in danger and taking risks in the service of the NHS to look after patients. The skills of the recently retired may range from those who are younger and active and can be on the wards through to older people who may have desk-based tasks, but it is up to the local authorities to decide where best they can conduct their services.

Health: Learning Disability and Autism Training

Baroness Watkins of Tavistock Excerpts

Monday 10th February 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register and thank the noble Baroness, Lady Hollins, for securing the debate. I will speak only briefly because other noble Lords have made several of the points that I wished to contribute, particularly the noble Baroness in relation to the co-design and co-delivery of inclusive education with experts by experience, and the noble Lord, Lord Sterling, in his statements about teacher education and early diagnosis. Of course I follow the noble Lord, Lord Wigley, and his excellent outline of how Mencap is working successfully in Wales through Treat Me Well.

In 2019, the Government held a public consultation on the potential introduction of mandatory training relating to learning disability and autism for all health and social care staff in England. The review was predicated on concerns identified in the learning disability mortality review programme. As already outlined, it made specific reference to the circumstances of Oliver McGowan, a teenager with autism who died in 2016 after being given anti-psychotic medication when treated for a seizure.

In response to the consultation, the Government made a commitment to pursue the introduction of mandatory training in this area, with trials beginning in April this year and due to report in March 2021. This is extremely welcome, and the results of the trials will inform the content and nature of the delivery in future. However, I particularly ask the Minister whether sufficient resources will be made available to ensure that the training, even at tier 1, will not rely on computer-assisted learning alone. Without interaction with families and other people with lived experience of supporting people with learning disability and autism, success will not be achieved. In tier 2, for example, it is essential that staff are trained in the accessible information standard, so that they can explain to people seeking help in care what is actually going on.

For tier 3—education for staff directly providing care and support for people with learning disability—learning disability nurses are key. Noble Lords will be aware of the ongoing shortages of learning disability nurses and the challenges of recruiting them, particularly as students of nursing. The Council of Deans of Health welcomes the new student support arrangements, as I do, particularly the additional student maintenance grant for learning disability and mental health nursing students. That will assist in recruitment. It is vital that there is increased partnership working between the independent and voluntary sector, the NHS and universities to ensure the sustainability of the profession and appropriate clinical placements during training. Let us be clear: CPD and the NHS alone will not solve these issues. Can the Government clarify that the new maintenance support arrangements will be fully funded for nurses in training for at least all new intakes during this Parliament?

The development of a postgraduate certificate programme in learning disability and autism, with co-creation from patients and families involved in a meaningful way, may be a gateway to encouraging more health and social care staff to enter learning disability care, and to retaining those staff with clear pathways for career development. If the Government are to achieve their mandate of further reducing in-patient provision by 2023-24 at the latest, it is essential that significant investment in staff development and recruitment of new staff is undertaken. Not everyone who works in a hospital environment is well suited to more community-oriented provision, as we found when we closed mental health hospitals in the 1980s and other learning disabilities facilities.

I warmly support the Government’s plans but seek assurance from the Minister that adequate investment will be made in health and social care education for competence to work with people with learning disability and autism to enhance services for this vulnerable group, not only to save lives but to improve the experience of people with learning disability and autism who access and rely on the NHS and social care services. For once, I will steal a line from an independent insurer, Bupa: we need to ensure that people with learning disability and autism

“live longer, healthier, happier lives.”

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank all noble Lords who took part in this short debate. In particular, I thank the noble Baroness, Lady Hollins, for her Question, which has allowed us to have this important and moving debate, and for her dedication to this issue; she said that she has been working on it for more than four decades. She has certainly gained this House’s unremitting respect for her work. In particular, I thank her for her vital work as independent chairperson for the care and treatment reviews of people with a learning disability and autistic people in long-term segregation. That work could not be more important, and her contribution in that respect is invaluable.

Noble Lords will know—they have demonstrated this—that the care and treatment of people with learning disabilities and autistic people has come under intense scrutiny in recent months, with widespread concerns about how we care for and support some of the most vulnerable in society—and rightly so. Tonight’s debate has been part of that. Everybody should receive the same high-quality care, whether or not they have a learning disability or are autistic. Despite this, as has been said, there remain serious disparities in the quality of care and support that they receive. As has also been said, evidence shows that they can experience poorer health and die sooner than the population as a whole. We must change that.

As the noble Baroness, Lady Hollins, rightly said, these disparities can arise as a result of health and social care professionals lacking the training or experience—or, sometimes, just the confidence—to deliver effective and compassionate care. I have no doubt that staff want to support everyone, including people with a learning disability or autism, to the best of their ability. Like the noble Lord, Lord Wigley, I pay tribute to Mencap’s survey for its Treat Me Well campaign, which found that almost half of staff responding thought that a lack of training on learning disability might be contributing to avoidable deaths and that two-thirds of staff wanted more training focused on learning disability. We are listening to that.

As noble Lords are aware, last year DHSC consulted on proposals for mandatory learning disability and autism training. The consultation was in response to the Learning Disabilities Mortality Review programme’s second annual report, which recommended the introduction of mandatory training. A common theme in the deaths reviewed by the programme was, as has been pointed out, the need for better training and awareness of learning disability. The same is true of autism. We published our response to the consultation in November, setting out our plan to introduce the Oliver McGowan mandatory learning disability and autism training across the health and social care system. The training is named in memory of Oliver McGowan in recognition of his family’s tireless campaigning—including a previous debate on this matter—for better training for staff.

In future, we want all health and care professionals, before starting their career or through continuing professional development—a point made by the noble Lord, Lord Addington—to undertake learning disability and autism training, covering common core elements so that we can be confident that there is consistency across education and training curricula. We are working with professional bodies and the devolved Administrations to align syllabuses and training requirements with the learning disability and autism capability frameworks at the earliest opportunity.

We have committed £1.4 million to develop and test, during 2020-21, a package of learning disability and autism training in a range of health and social settings to help us better to understand the implications of mandatory training and the associated costs before wider rollout in 2021. I assure the House that the training will involve people with lived experience at every stage throughout its design and delivery, which I know is critical to its success.

We are also clear that, to realise fully the benefits of this training, it must be mandatory. We will undertake a number of actions, recognising that different approaches will be needed for different staff groups to make sure that it is effective. These will include proposed changes to secondary legislation to ensure that providers who carry out regulated activities ensure that staff receive training that is appropriate to their roles. We will also explore options for those working in non-regulated activities.

I will just pick up on a few of the specific points raised. The first is e-learning, raised by the noble Baronesses, Lady Hollins, Lady Watkins and Lady Thornton. In the consultation on mandatory training, we heard very clearly that having a face-to-face component is important. We will consider how to build this in in an appropriate way as we develop and trial the training package. We are currently developing the specifications for trial and evaluation.

In response to the question about the timeframe from the noble Lord, Lord Addington, and the noble Baroness, Lady Thornton, the strategic oversight group met for the first time last week. We will publish invitations to tender later this month, and will then seek to appoint and sign contracts with suitable training and evaluation partners in April. We will commission and publish an evaluation of the training package by March 2021 to inform a wider rollout of mandatory training across the system. I hope that is reassuring. Of course, we will seek to learn best practice from anyone we think can help us; this will include the devolved nations, which I hope is reassuring for the noble Lord, Lord Wigley.

I will just pick up on the question raised by the noble Baroness, Lady Watkins, regarding workforce, which will of course be critical to making sure that this is effective. In addition to our new maintenance grant funding for eligible pre-registration nursing, midwifery and allied health students, we announced additional payments of £1,000 for new students who study in challenged specialisms, which would include learning disability specialisms. I think that answers the question she raised.

On the question regarding the review of the Mental Health Act raised by the noble Baroness, Lady Hollins, this was completed in December 2018 and its findings were clear that we need to modernise the Mental Health Act to ensure that patients are not detained longer than absolutely necessary. We have said we will bring forward a White Paper in the coming months. We intend to pave the way for a reform of the Act and tackle the issues raised in that review to ensure that people subject to the Act are treated with dignity and respect. The intention is to ensure that we provide more patient choice and autonomy and enable patients to set out in advance their care and treatment preferences, and also to improve the process of detention, care and treatment. I hope that is reassuring. The reason for doing it in this White Paper process is because of some of the complexities around the legislation and to ensure that there is appropriate pre-legislative scrutiny.

[Baroness Watkins of Tavistock]

I would just like to clarify that my question about funding for the maintenance support was not about whether it applies to the learning disability group but whether it will apply for all five years of intakes of this Parliament.

NHS: Targets

Baroness Watkins of Tavistock Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the noble Lord, Lord Hunt, for securing this debate. It is a pleasure to follow other noble Lords, who have made very cogent arguments for change, and in particular the maiden speech of the noble Baroness, Lady Wilcox of Newport; it seems like nirvana to think we might have to pay only £90 a week to many people in England.

Clearly we want to reform health and social care to best serve the health and well-being of people in England. I declare my interests as outlined in the register, particularly as a registered nurse, president of the Florence Nightingale Foundation and a former sister in accident and emergency.

At the heart of the issue is whether the NHS should reform the A&E four-hour waiting target a decade after its inception. The national medical director of the NHS considers that a change to the four-hour target and some cancer treatment targets may, based on sound data, serve the population more effectively. I will concentrate on the A&E target and delays to patients’ transfer of care from acute hospitals to their own homes, nursing homes and registered care facilities.

The NHS is piloting a new A&E scheme entitled “rapid care measures” with 14 trusts. The new standards include the rapid assessment of all patients in A&E, coupled with faster life-saving treatments for those with the most critical conditions, including sepsis, heart attacks, strokes and acute psychotic episodes. The initial results are promising, with the number of patients spending over 12 hours in A&E falling faster than in control groups. There appears to be broad public support for these measures. It is vital that any change to targets are clinically appropriate and supported by evidence-based healthcare interventions, which the proposed changes reflect.

Therefore, unlike many in this House, I urge the Government to revise the A&E targets in this way and set clinical teams free to work in a more independent, evidence-based approach focused on individual patient need rather than keeping to a four-hour target set in stone. This is likely to enhance staff morale and improve time from attendance to treatment for those most critically ill. It may also reduce the number of people attending A&E for very minor problems as they may have to wait longer than four hours. We know that many people go to A&E for health problems much better suited to community-based services because they have difficulty accessing a GP or community nurse. The need to increase the number of GPs is essential, but so too is developing and enhancing the role of other healthcare practitioners in the community if we are really serious about system redesign in the NHS and social care.

In the US there has been an increasing focus on systematic change associated with the affordable health care Act, which elevated the role of both physicians’ assistants and nurse practitioners. I have witnessed the positive effects of the introduction of these roles in Washington State, particularly in supporting people with multiple physical and mental chronic health conditions in community settings. An analysis of US census data published this week shows that the number of nurse practitioners has grown at an unprecedented rate across the USA, from around 91,000 in 2010 to 190,000 in 2019. These practitioners are filling a primary care void, particularly in rural areas. A professor of nursing at Montana State University estimates that there will be two nurse practitioners for every five physicians by 2030, compared to one in five in 2016. Will the Government look at this research and investigate whether one way of improving primary care and reducing A&E visits would be to invest more significantly in a range of advanced roles for community healthcare practitioners?

The Government intend to publish plans to reform the social care system this year. That is essential because it will improve people’s lives and, we hope, reduce delayed transfers of care from hospital to the community. Will the Minister please note my support for altering the four-hour A&E targets in the light of the results from the pilot sites? I urge her to ask the noble Baroness, Lady Harding, to work further on the NHS people plan in the way outlined by the noble and gallant Lord, Lord Stirrup, and to consider piloting the NHS funding care packages for a fixed period on discharge for those due to leave hospital, in the way so ably outlined by the noble Lord, Lord Turnberg.

Coronavirus

Baroness Watkins of Tavistock Excerpts

Monday 3rd February 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord will not be surprised to hear that it is important to put the public health response first and foremost when it comes to a risk of this kind, and that is exactly what is happening in this case. The actions that the UK has taken in this regard have been appropriate, proportionate and commensurate with the data and evidence that have come forward, and they are based on clinical evidence. Having said that, he is absolutely right that an economic impact as a result of quarantine measures taken by China and others cannot be avoided, and it is right that we should consider the impact for UK businesses. I am sure that consideration will be given to what can be done about that.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister define what she means by mainland China? I asked a question about Hong Kong last week and I note from the Foreign Office website that the Hong Kong Government have announced that all border crossings with mainline China will close at midnight tonight, Hong Kong time, which is an excellent idea in terms of containment. I am also aware that people who work for international companies in Hong Kong have been told to work from home for a minimum of two weeks from last Friday—three days ago. What will we do about people coming to our borders from Hong Kong in the immediate future?

[Baroness Blackwood of North Oxford]

The noble Baroness asked that question last time and I did not forget. At the moment, Foreign Office travel advice is that anyone who has travelled to the UK from anywhere in China other than Wuhan or Hubei province, but not including Macau and Hong Kong, in the past 14 days and has developed symptoms should immediately self-isolate, even if symptoms are minor, and call NHS 111. Macau and Hong Kong are not included because those territories do not have evidence of sustained community transmission, as has been observed in mainland China, to date. They are therefore not currently included in the same travel advice as mainland China. However, the epidemiological situation in Hong Kong and Macau, as indeed in the rest of the region, is kept under constant review and will be considered in travel advice as we go forward, and reported to this House accordingly.

Wuhan Novel Coronavirus: UK Citizens

Baroness Watkins of Tavistock Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. At the moment, there are 5,974 cases in mainland China and 6,064 cases globally, and there have been 132 deaths. It is important to understand that coronavirus is a large family of viruses, ranging from the common cold to much more severe diseases, such as MERS. The data we have puts the mortality rate at about 3%, so the risk is comparatively low compared with SARS and MERS. I just want to say that at this point.

In terms of wider travel advice, the FCO is now advising against all travel to Hubei province and all non-essential travel to China, and is advising British citizens to leave if they are able to do so. Wider public health advice for those travelling around the region can be seen on the Public Health England website. It is very clear and detailed. Any further advice on travel can be seen on the Foreign Office website. We are co-ordinating very closely; indeed, there was a COBRA meeting on this issue just yesterday.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister clarify that Public Health England is working closely with the other three public health departments in the UK and is taking the lead on this for people who are returning? Further, what is our strategy for Hong Kong, where nurses have said today that they will go on strike unless the borders between mainland China and Hong Kong are closed in order to protect the population?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: all the public health authorities across the United Kingdom will work closely together to ensure clear co-ordination, as always happens on public health issues. On Hong Kong, we will be discussing those issues through the WHO, which met yesterday to consider whether WN-CoV should be declared a public health emergency of international concern. It did not declare a PHEIC yesterday, but it will meet again. If it does declare a PHEIC, we will of course review our recommendations. However, we should be confident about the actions that we have taken. They are measured, proportionate and based on the highest level of scientific and clinical advice available at this stage of the outbreak from the Chief Medical Officer and Public Health England. We will keep the situation under continuous review and report to the House as it develops.