Education (Student Support) (Amendment) (No. 2) Regulations 2018

Baroness Watkins of Tavistock Excerpts

Monday 21st May 2018 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw the House’s attention to my interests as listed in the register and I congratulate the noble Lord, Lord Hunt, on securing this debate.

I should like to put my contribution in context. At lunchtime I came back from Geneva, where I had been at the World Health Organization working with the International Council of Nurses, representatives from the Nursing Now campaign and the Chief Nursing Officer of the WHO in looking at the future of the profession. One of the big discussions was on the need to increase the number of nurses worldwide and to ensure that we have health security across the globe. A major topic of discussion was, not surprisingly, the re-emergence of Ebola in the Congo. At least one Health Minister asked me how, as a country, we could really justify a recent advertisement from, I believe, the Home Office, encouraging nurses with a two-year graduate qualification to come to this country.

The noble Lord, Lord Hunt, has outlined the key concerns over extending the normal student maintenance regime to nursing students undertaking programmes at postgraduate level. As others have said, these programmes take two years, including theory and practice, and enable successful students to register as nurses with the NMC. I do not need to remind noble Lords that this is an intensive programme with significant periods of work in a practical setting.

The aim of introducing new systems of funding was to increase the number of nursing students, yet on undergraduate programmes this was not achieved in the 2017 intake, where a fall took place, particularly in applications for mental health and learning disability nursing courses. Why should there not be a similar fall in the number of students entering the postgraduate programmes this year if the change takes place? In effect, this would result in an even more significant drop in the number of nurses qualifying in 2020, in that the undergraduate numbers due to qualify in 2020 will be much lower than originally planned. If we could boost the postgraduate intake numbers for 2018, this could provide additional nurses ready for registration in 2020—just as they will be so desperately needed according to the NHS Five Year Forward View.

Therefore, does it not make sense to delay the implementation of the regulations while a systematic review of post-18 education funding is undertaken and retain the current system of funding for the group due to commence in 2018? This would provide us with an opportunity to run a campaign to increase the numbers for this year in the way that campaigns have been conducted to attract people to social work and teaching programmes in areas where there are similar staffing challenges.

We know that sufficient levels of registered nurses are critical for the health and social care system to ensure patient and client safety. The sombre reading of both the Francis report and the learning disabilities mortality review reminds us that not only do we need to retain our current staff but that we must train new nurses to further enhance the quality of our provision.

Graduates who enter postgraduate nursing programmes add value to our workforce, bringing a range of life skills. In particular, many mature entrants come into mental health nursing through the postgraduate route, and yet we know we are not meeting the numbers required to meet mental health services workforce demands.

I recognise that the Government have offered a new pay deal for nurses that may improve retention and recruitment and plan to offer golden hellos in some hard-to-recruit areas for nurses entering the profession, both of which I have expressed my support for and hope will be effective. However, until the new degree apprenticeship routes into nursing at both undergraduate and postgraduate level are properly designed and funded through the apprenticeship levy, I urge the Government to think again and to wait to introduce the reform we are discussing today.

NHS Providers reminds us that plans to boost the NHS workforce will take years to deliver, but to change this decision for at least one year would result in a larger cadre of nurses qualifying in only two years. I urge this because society expects us as policymakers to ensure safe healthcare in the NHS. This, I argue, cannot be achieved without a sufficient supply of newly qualified nurses and allied healthcare professionals.

[Lord Clark of Windermere (Lab)]

My Lords, I find the Government’s approach to NHS staff very perplexing indeed. They continually pay tribute to them, and I think they do understand the commitment of the workforce, yet repeatedly they take action that makes the life of nurses and other staff even more difficult than it is at the moment. At the same time, they make it more difficult for those nurses to guarantee the safety of patients in our NHS.

I congratulate my noble friend on drawing this SI to the attention of the House and allowing us an opportunity to debate this critical issue. In making my case today, I accept the points made by the noble Baronesses from the Liberals and the Cross Benches—they were absolutely right in the points that they made. But let us remind ourselves of the serious situation we are in. The points I am going to make now are agreed right across the National Health Service; points which every royal college and every responsible organisation in the health service agrees with.

The first point has been raised already: we are 40,000 nurses short, and the Government have a real responsibility for that. The number of nurses and midwives leaving the profession is greater than the number of those entering the profession—that is a recipe for disaster. We have critically relied not only on nurses from the far ends of the globe but especially on nurses from the European Union. Since the Brexit vote, they are deserting the National Health Service, and who can blame them?

Let me go right back to 2010, when this Government assumed office. That is when they started making massive errors, from which they have not recovered. Neither, critically, has the National Health Service. In an Answer to me, the noble Viscount, Lord Younger, pointed out that, when they assumed office, there were more than 97,000 entrants to nursing courses. The coalition Government’s first response was cut, cut, cut, and by 2012 the figure had dropped from over 97,000 to 75,000, a drop of 22,000 nurses entering the profession in one year alone. The figure improves marginally but does not get much better for many years. When I say the Government are 40,000 nurses short, it is because of their mistake in 2012 in cutting the numbers of young people and older students entering the nursing profession. We have never recovered from that.

I accept the point that the Government want to widen the area of recruitment—I will come back to that—but, having made the mistake in 2012, only two years ago they scored another own goal by abolishing the bursary scheme and introducing a charge of over £9,000 a year for people training for the nursing profession. Last year that led to a drop of 705 students. I admit that is not the same as the 22,000 drop the Government were responsible for in 2012 but we cannot afford any drop whatever. Now, having created a serious recruitment policy, they are introducing even more costs into the system by this SI we are discussing today. It is affecting older graduate entrants, those who do postgraduate courses and usually graduate after about 18 months or two years, which is the quickest way to get qualified nurses, as we have already heard.

However, the Government do not seem to have learned anything. The point from the Liberal Front Bench was well made when the noble Baroness pointed out that the cost of training a postgraduate student was £33,500—a lot of money—but we should not forget the cost of the agency nurses needed to fill that vacancy. That £33,500 cost is less than the average annual premium paid by trusts for a full-time equivalent nurse filling a post that is vacant because of shortages. It is a false economy and yet the Government do not seem able to see the picture in the round, which is the position we should be looking at.

There are other ways in which the Government could ease the nursing situation. Instead of bringing forward SIs such as those we are discussing at the moment, if they have got a bursary scheme, as they have, why do they not write off the cost of repaying the student loan for nurses who have spent a number of years in the National Health Service? One of the Minister’s predecessors said that the Government were looking at a similar proposal for doctors but I never saw whether it materialised. However, that would be one way of equalising the situation.

Many nurses from European Union countries and other National Health Service workers have got permanent residence status to live in Britain. After five or six years, they were entitled to apply for permanent residency, and they got it. To me, and to most nurses, permanent residency means just that: you have residence in this country which is permanent, but the Government will not admit that. They say that the permanency may not be honoured after Brexit. That is a terrible thing to say. A British Government are breaking their word to people who work in the health service and give so much. Why not say that those people who have permanent residency can remain in this country permanently? That would do a lot to retain the confidence of EU nurses.

I shall finish with a word about financing nursing apprenticeships. As we have heard, the Government’s target of 1,000 apprentices in nursing has not only fallen short, it has fallen ridiculously short. The Minister may have more up-to-date information than either I or the Royal College of Nursing have, but its figures show that there are not 1,000 apprentice nurses, there are 30. Of course, one of the difficulties lies in the whole concept. An apprenticeship requires a mix of work on the ward and work in the classroom at university, but that is exactly what undergraduate nurses do at the moment. Over the three-year period, 50% of their time is spent working—I emphasise that word—on the wards. Why should they pay more than £9,000 when apprentices may get that for nothing—or is it nothing? The universities which provide the classroom opportunities for these apprenticeships tell me that they have no alternative but to charge for them. I do not think that the apprenticeship levy will cover it because they are talking in terms of £7,000 a year for apprentices to do the university courses for their apprenticeship. I wonder who is going to pay that £7,000. Is it to be the student, or is it the trusts which are already hard pressed, or is it the Government? Most of us would agree that it ought to be the Government. It is their baby, their scheme and how they see the gap being filled—their salvation to ease the nursing shortage. It is the Government’s responsibility.

We are debating a statutory instrument which shows how ill thought through and chaotic the Government’s policies are when it comes to nurse training in this country.

--- Later in debate ---

[Lord O’Shaughnessy]

If the noble Lord will let me finish, I will get to that point. Like other graduates, student nurses will be required to repay these government-funded loans only once they are in employment and earning. It is important to state that the student loan repayment terms are progressive. From April 2018, individuals will make their contribution to the system only when they are earning more than £25,000. Monthly repayments are linked to income, not to interest rates or the amount borrowed, and the outstanding debt is written off after 30 years.

I am not the Education Minister in this House, although I seem to be covering this topic not only tonight but in other forums, but it is important to underline that the reason this system was introduced into this country by a Labour Government, reaffirmed by a coalition Government and continued by a Conservative Government, is that it means that the best-earning graduates, instead of having their fees entirely paid by taxpayers, including people who have never gone to university, make a contribution to the costs incurred, whereas those who are lower-earning through their lives, including those who will perhaps never earn more than £25,000, will make no contribution. That is a more progressive system of funding than one in which everybody gets it for free, no matter how much money they make in their life.

As I said, these reforms give student nurses access to more financial support, albeit they have to pay that back if they can afford to do so later in life. It also provides a level playing field with other students. But perhaps most importantly of all, these actions released about £1 billion of funding to be reinvested in the NHS front line. As a consequence, Health Education England plans to increase the number of fully funded nurse training places by 25% from September 2018. It is important to stress that Health Education England has made that decision as an independent body to meet the need for more nurses that we all agree is there.

As the noble Lord, Lord Hunt, pointed out, this equates to around 5,000 more places each year—a major and welcome boost to our much-admired nursing workforce. My background is largely in education and I assure the noble Lord, Lord Puttnam, that we understand the urgency of this task and the parallels with education that he mentioned.

[Baroness Watkins of Tavistock]

Is that for the clinical placement funding?

[Lord O'Shaughnessy]

That is quite right. That is fully funded clinical placements—just for the sake of clarity. I thank the noble Baroness.

There is understandable concern among noble Lords, which has been expressed previously in this House, about the new system of financial support, but I want to be clear that we are giving the group of postgraduate students that we are discussing access to undergraduate maintenance and tuition fee loans, just as we do with postgraduate teachers. This represents a more generous package of support than the postgraduate master’s loan. We are also making available additional funding for childcare, travel to clinical placements and exceptional hardship funding to ensure that the students are fully supported and are able to complete their studies.

Furthermore, as many noble Lords have mentioned and as the noble Lord, Lord Hunt, and the noble Baroness, Lady Watkins, welcomed, in the debate on the regulations in the other place on 9 May, my honourable friend the Minister of State for Health set out a range of additional support that we are investigating for postgraduate nursing students. This includes specific incentives such as “golden hellos” for postgraduates who go to work in mental health—where the noble Lord, Lord Willis, was quite right that we need to attract more nursing and where there has been a shortfall—the area of learning disability and community nursing. The Government have announced £10 million to support such incentives and we are considering how this should be best delivered.

Many noble Lords have expressed concern about the drop in number of undergraduate applications to nursing courses. We acknowledge that early indications from the latest UCAS data, published in April, show that the number of students applying to study nursing has decreased from this point in the cycle last year. However, that cycle is not yet over, so we need to apply some caution.

It is also worth noting, as noble Lords have pointed out, that there is a distinction between the decline in number of applications and that in the number of students starting their courses. That was exemplified last year, which showed a 23% drop in the number of applications compared to a 3% decline in the number of acceptances. That is regrettable, but it was still the second-highest number of acceptances on record. Several noble Lords have expressed their desire for further information on how this develops. I can confirm that my department has committed to publish an update in autumn 2018 following the close of the 2017-18 application cycle.

As the noble Baroness, Lady Watkins, pointed out, there is a global challenge to recruit more nurses. We are working hard to make nursing as attractive a profession as possible. As a result of constructive dialogue over recent months, NHS Employers and the relevant trade unions began a consultation exercise on a three-year pay deal for NHS staff employed under the Agenda for Change contract. Under the plan, the starting salary of a nurse will rise to £24,907 by 2021, not only rewarding current staff for the incredible work they do but sending a clear signal to the country about how much nurses are valued.

We are boosting the attractiveness of the profession in a number of other ways, too. Nearly 4,500 nurses have started the return to practice programme and 3,000 have completed it. Across the country, NHS trusts are developing arrangements for flexible working and there is a concerted effort to tackle workplace bullying through an NHS-wide call to action. Our homes for staff programme is supporting NHS trusts to dispose of surplus land to help up to 3,000 nurses and other staff access affordable housing. I hope that gives the noble Lord, Lord Clark, some concrete examples to back up the warm words we use about supporting the nursing profession.

Several noble Lords have touched on new routes into nursing, which the Government are prioritising. The most significant innovation in this area was the announcement of a new nursing associate role in November 2016. Health Education England has already trained 2,000 nursing associates in a pilot programme and is planning to train up to 5,000 in 2018, with up to 7,500 nursing associates trained through the apprenticeship route in 2019. As well as creating a much-needed new role in its own right—I emphasise “in its own right”, as it is an augmentation to the nursing and other professions—nursing associate training offers an alternative route to becoming a registered nurse. We expect this “earn and learn” approach to be more attractive to older students, a concern which many noble Lords have raised.

To support this career path, Health Education England is developing a shortened nurse degree apprenticeship to facilitate transition from nurse associate to registered nurse, which will also automatically recognise the prior learning and experience gained in the nursing associate role. For the first time, apprentices will be able to work their way up from entry-level health work through to advanced clinical practice in nursing.

Several noble Lords expressed their concern about the apprenticeship route and the figure of only 30 nurses. The official data has been delayed and we believe that the figure is more like 250. We will be able to confirm that. It is a better start but, clearly, not yet the target that we want to reach. However, we believe that this stepped approach through the nursing associate role, giving the opportunities for a pause after two years and then to go on for two years, ought to be more attractive to employers than the current four-year commitment. This development of the nursing associate route therefore provides for a better use of the apprenticeship route.

I want to address a couple of what are perhaps misconceptions. The figure of 40,000 vacancies is used often in this House. I might be pedantic and disagree with that number—the quantum is just about right—but it is important to say that these are not empty places. They are being filled by agency and bank staff. Part of the reason for that is that people want flexibility and more pay, two of the things that we are trying to address so that we can provide more permanent contracts for those people who currently work flexibly.

The noble Lord, Lord Clark, and the noble Baroness, Lady Garden, talked about EU staff. I hope your Lordships will agree that I miss no opportunity to say from this Dispatch Box how much we value those staff and that they have just as much right to apply for settled status as anyone else in this country, provided they fit the criteria. However, it is worth pointing out that there are more EEA staff in the NHS than there were in June 2016. The one category where the figure is lower is in nursing and midwifery but the reason for that was the introduction of a more stringent language test. We are dealing with that issue, which I hope will mean that we continue to see an increase in EEA staff working in our NHS.

The noble Lord, Lord Willis, asked specific questions about the apprenticeship levy. I will need to write to him on that issue having consulted my colleagues in the Department for Education.

Turning quickly to the second point of the Motion, several noble Lords, including the noble Lord, Lord Hunt, the noble Baronesses, Lady Walmsley, Lady Watkins and Lady Garden, and others said that we should postpone the introduction of the reforms until the post-18 education and funding review has been completed. As noble Lords know, the Prime Minister launched the review earlier this year to ensure that we have a better system of higher education support that works for everyone. Many aspects of the current system work well and, as was set out in the terms of reference for the review, there are important principles that the Government believe should remain in future. One of those is that sharing the cost between taxpayers and graduates is the right approach, as I rehearsed earlier in my speech.

I take the point made by the noble Baroness, Lady Walmsley, about looking at the Welsh example. I have looked at it myself and I am sure it is something that the review would want to consider. However, it is important that we do not prejudice the work of the expert panel established to support the review or prejudge its outcomes. The fact of the review should not delay these healthcare education reforms, not least because they predate the launch of the review by some distance and already apply to the vast majority of nursing students. We believe it would do more harm than good to further delay these reforms, although it is worth underlining that any relevant reforms stemming from the review will apply equally to this group of student nurses.

In conclusion, I recognise the well-motivated concerns expressed by noble Lords during this debate. However, I hope I have been able to demonstrate that the student finance reforms that this Government have introduced have allowed both the removal of the artificial cap on nurse training places and the largest expansion of student nursing places in a single year ever seen. These two facts are not coincidental; they are inextricably linked. The latter is possible only because of the former and they form part of a wider set of workforce reforms designed to expand, train and reward our nursing profession better so that we can continue to deliver the high standards of NHS care that patients demand. On that basis, I hope the noble Lord, Lord Hunt, will feel able to withdraw his Motion.

Carers: Back Pay Liability

Baroness Watkins of Tavistock Excerpts

Wednesday 16th May 2018 Lords Chamber

[Lord O'Shaughnessy]

On the extra £2 billion of funding, I have not tried to link it with this; it is of course at the discretion of local authorities to use that to support the social care sector in the way they see fit. It is worth pointing out that Allied Healthcare is in this social care compliance scheme. My honourable friend the Minister for Care has written to it to express her disappointment at the approach it has outlined. Its liabilities have not crystallised yet, so it is not right for it to refuse that and she has written to it to demand clarification. However, clearly we understand that the clock is ticking and that there is an urgency to this.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister explain what the legal liability is of commissioners who commissioned care services based on the previous costs?

[Lord O'Shaughnessy]

That is an excellent question and I will write to the noble Baroness with an answer to it.

Children: Obesity

Baroness Watkins of Tavistock Excerpts

Thursday 10th May 2018 Lords Chamber

[Lord O’Shaughnessy]

My Lords, for the avoidance of doubt, I thank my noble friend for pointing out that we are talking about obesity rather than the NHS constitution—which is just as well because I had not prepared for that. She has been steadfast in campaigning on this issue. We know that the problem presents some uncomfortable truths. The Government have taken some significant actions in this area, such as the soft drinks levy, but we have always said that we will not rest if we do not think they are having the impact that we want them to. There is emerging evidence that we need to go further. I cannot give my noble friend a date on further action but I can tell her that this is the subject of most serious consideration at the centre of government.

[Baroness Watkins of Tavistock (CB)]

I first congratulate the Government on last night’s announcement that there will now be golden hellos for postgraduate students into hard-to-recruit nursing posts in mental health, learning disability and district nursing—which, in the longer term, will help solve some of the problem of childhood obesity. The relationship between obesity and poor health is proven, yet our schools fail to fully embrace tackling this issue. Does the Minister agree that if pilot schools and their pupils were exposed to substantial public health interventions from community-based nursing teams, and their successes and challenges were part of a BBC series, it would be an experiment that might have significant benefits both in assisting a reduction in weight gain and promoting mental health and well-being in children and adolescents more widely?

[Lord O’Shaughnessy]

I am grateful to the noble Baroness for her acknowledgement of that important step forward in recruiting nurses to hard-to-recruit areas. That is important because we want more mental health, learning disability and district nurses in the future. They have an important role to play in schools. If I may say so, the noble Baroness is slightly underplaying the work that schools are already doing in this area. We have talked about the Daily Mile programme, which is going very well, with 900 schools in England adopting it. Learning about food, healthy eating and nutrition is a compulsory part of the curriculum in key stages 1, 2 and 3. However, I agree that there is always a need to do more.

The Long-term Sustainability of the NHS and Adult Social Care

Baroness Watkins of Tavistock Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

I thank the noble Lord, Lord Patel, for securing this debate and for his work as the Select Committee chairman. I particularly congratulate the members of the committee on providing an excellent report, despite the fact that there was no nurse and five medical staff on the review team. The committee has produced a thoroughly excellent report that highlights the fundamental issues to consider if we are to preserve the notion of health- care that is free at the point of delivery, funded through the taxpayer, for future generations. Note that I do not say “the NHS” because, coming from a mental health background, I know that a tremendous amount of good care is provided by a range of charities and voluntary organisations as well as the mainstream NHS; however, it needs to be funded through the public purse.

I draw attention to my interests in the register, particularly as I am a nurse, as noble Lords know. With that in mind, I was initially intending to speak largely on nursing, but many noble Lords have done that so I have added one or two other issues to my speech.

Without doubt, we simply need enough appropriately skilled and motivated staff to provide care in the health service and social care—not just adult social care but children’s social care. This has been highlighted by many noble Lords, particularly the noble Lord, Lord Willis, and my noble friend Lady Emerton. This requires a focus not just on recruitment and pre-registration training but on nurturing and developing the staff we already have. As Public Health England’s report Facing the Facts, Shaping the Future distinctly put it:

“The most cost-effective way to ensure the health and care system has the staff we need is to keep the people we already employ”—


including those of the Windrush generation and their successors, many of whom I have worked with in my clinical experience.

Yet unprecedented numbers of nurses are leaving the NHS for reasons other than retirement—more than 5,000 more, in real terms, than five years ago. The Royal College of Nursing gave powerful evidence to the Commons Health Select Committee earlier this year about nurses feeling undervalued and not supported. Reasons for leaving cited included the pressure of the workload, with nurses often feeling that they are unable to undertake their full role in terms of care and kindness to their patients, but also a lack of flexibility, pay and career development. There have been significant cuts in CPD budgets, which have obviously prevented nurses and allied healthcare professionals in developing further competences to take over some of the roles traditionally undertaken by medical staff.

It is not merely that we need more money but how money is spent most effectively. At the most basic level, we need to support newly qualified staff of all types to ensure that they can undertake their roles safely and with confidence. However, at a time of transformation, with new models of care being introduced, a flexible, adaptable and resilient workforce is key to leading the NHS into the future. Upskilling the workforce to specialise in priority areas and to advance practice and leadership skills, so that people see working in the NHS as a career, not a job, will enhance productivity and facilitate change and improvements. These benefits would represent good value for money.

Much has been said on funding for health and social care. However, I will briefly mention how we might fund it in the future. The NHS is a source of national pride, with near universal support. There is much evidence to suggest that a large proportion of the public are willing to pay more to have a high-quality NHS. However, we need to be careful that whatever we do to increase funds for the NHS demonstrates intergenerational fairness. We cannot expect the younger generation to pay entirely for the older generation. I fail to understand why we could not undertake some of the other issues people have recommended here on older people paying more.

I have raised points about the workforce, but I will take one extra minute to talk about care. If we are to reduce expensive, prolonged stays in hospital that are harmful to patients’ health and prevent unnecessary admissions, and allow ourselves to provide kinder care where people want it, in or near their homes, in a more cost-effective way, we need to think how we can do so. For example, I hear of children in mental health in-patient care being admitted 100 miles away from their homes and families, with essential components of their care and treatment, such as family therapy and liaison with social care, unable even to start until they can be moved closer to home. This is clearly not kind or cost-effective.

I have also just read a very poignant account of the provision of “comfort care” at the very end of life in the obituary of Barbara Bush, the former US First Lady. It noted that she rejected further treatment in hospital and selected a comfort care package at home for her last days. This illustrates how people with sufficient knowledge can plan the most comfortable care in a personalised way. I urge us to think how we might adopt the term “comfort care” rather than “end-of-life care”, because it demedicalises the concept and may be particularly pertinent to people suffering from dementia.

I therefore support the concept that we should pool the risk for all people in terms of social care as well as healthcare. I very much hope that, as a result of this report, we will find a cross-party collaboration that will enable us to get not a 10-year funding plan but a 30-year vision for health and social care.

NHS: Staff Pay

Baroness Watkins of Tavistock Excerpts

Wednesday 21st March 2018 Lords Chamber

[Lord O’Shaughnessy]

I thank my noble friend for making that point. It is not only about the lowest paid staff whom she has described. It is also worth dwelling on the fact that a newly qualified nurse will see a significant increase in his or her pay, which will be 12.6% higher in 2020-21. This is a package which takes account of the fact that starting salaries have been too low. We are trying to address that because it is one of the ways we can attract more people into the profession.

[Baroness Watkins of Tavistock (CB)]

My Lords, I welcome this Statement as a sign that the Government have at last recognised the effect that the pay cap has had on recruitment and retention, in particular in nursing. I hope that this pay increase will lift many nurses out of hardship and improve morale. It is a sign that the Government value NHS staff and I especially welcome the significant increase for newly qualified nurses for 2020-21. These new recruits, who commenced their training in 2017 without bursaries, will be in a far better position—comparable with other graduates in terms of starting pay—as they proceed to repay some element their salary after achieving an income of more than £25,000 a year. My only concern is that the charitable and social care sectors, which employ nurses, will need to match these salaries. How can we ensure that they will be able to do so?

Abortion: Misoprostol

Baroness Watkins of Tavistock Excerpts

Tuesday 20th March 2018 Lords Chamber

Asked by

[Baroness Watkins of Tavistock]

To ask Her Majesty’s Government, further to the Written Answer by Lord O’Shaughnessy on 21 January (HL5321), why there are no plans to enable women undergoing early medical abortion to take the second dose of the medication, misoprostol, at home, if they so wish.

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

My Lords, the Government’s priority is to ensure that women who require abortion services have access to safe, high-quality care. Abortions must be performed under the legal framework set by the Abortion Act 1967. We are not currently in a position to approve homes as a class of place under the Act. However, we will continue to keep this matter under review and assess further evidence as it arises.

[Baroness Watkins of Tavistock (CB)]

I thank the Minister for his Answer, but can he inform the House of the expected timeframe for the Government’s decision regarding enabling women to choose the dignity of being as comfortable as possible in their own homes when they experience medical abortion, rather than some of them suffering while travelling home from the clinic? Journeys of over two hours are not uncommon, particularly for women from rural areas. It is also worth noting that the procedure is endorsed as a safe practice by the World Health Organization.

[Lord O'Shaughnessy]

I thank the noble Baroness for her question. No timeframe has been set for any decision on a policy change. She will understand that any change of policy would need to be done cautiously, in the light of the evidence and of legal developments—for example, relating to Scotland’s decision to name homes as a place. It is on that basis that we will consider any further evidence.

Alcohol: Minimum Unit Pricing

Baroness Watkins of Tavistock Excerpts

Wednesday 28th February 2018 Lords Chamber

[Lord O’Shaughnessy]

I would be very happy to meet my noble friend and the colleague he mentioned.

[Baroness Watkins of Tavistock (CB)]

In terms of austerity, can the Minister justify neglecting the £3.2 billion cumulative reduction in alcohol-related harm over five years that the Public Health England evidence review into the policy cites with an MUP of 60p? That is what would be generated.

[Lord O’Shaughnessy]

As I have said, and reiterate to the noble Baroness, we will look at the impact of minimum unit pricing. We must not just take into account any revenue that we generate and the health benefits that could accrue, but make sure that it provides a fair deal for those who drink sensibly.

NHS: Charitable Donations

Baroness Watkins of Tavistock Excerpts

Thursday 22nd February 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness asks a very interesting question. Clearly these are emerging organisations and most of the charities are attached to hospital trusts—although not exclusively: some are attached to primary care. None of these are yet quite in being. Once they are in being, this will be an excellent suggestion that we should take forward.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister explain why we should not at least be clearer about what care costs by publishing the tariffs within hospitals so that people understand, if not individually, how expensive some of the day-to-day treatments they get are?

[Lord O’Shaughnessy]

That is an important point. We are not yet in a position where we have mandatory collection of all that unit pricing data. That will happen from the next financial year onwards, so we will be able to publish that data. It is important, though, to resist the urge to send out to people information itemising costs, precisely for the deterrence reasons that I mentioned.

NHS Winter Crisis

Baroness Watkins of Tavistock Excerpts

Monday 5th February 2018 Lords Chamber

[Lord O’Shaughnessy]

This is an afternoon of agreeing to meetings—but, yes, I would be delighted to do so. I am not knowledgeable enough about the issue that the noble Baroness mentioned but, while of course there is a huge difference in the kinds of workloads of those different types of A&E, the target incorporates all of them. They all have the obligation to reach the four-hour waiting time standard and we want to make sure that, whatever the situation and whatever the venue, we can do that.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain how, five years after the Francis inquiry, there is a lack of investment in the health and care nursing workforce in England, as outlined in the RCN report published today? That report, Left to Chance, shows that even if we had more beds we would not be able to staff them. In comparison, Wales has invested heavily in new nurses and continued professional development, and is doubling the number of district nurses that it intends to train this year. In England we currently have 4,400 qualified district nurses, but in 2010 we had 7,500. How can we resolve this quickly and ensure that we have more district nurses in training by this September?

NHS and Social Care: Winter Service Delivery

Baroness Watkins of Tavistock Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw attention to my interests as outlined in the register. I thank the noble Baroness, Lady Wheeler, for securing the debate on this important topic and for her excellent speech which, together with that of the noble Baroness, Lady Pitkeathley, and others, covered some areas which I will now not repeat. This topic should be of concern to all parties in this House, given the public’s expectation of access to high-quality provision, not only of healthcare but of social care.

Some 40 or 45 years ago, when I was at school, I read in a series of papers about the scandal in mental hospitals. It really encouraged me to go into mental health nursing and improve the lot of people who now no longer suffer in that way in institutional care. However, in the Times last week, there was the headline:

“A million lonely pensioners left to starve in their homes”.


A group of MPs from across all parties have talked about this. We are beginning to create what we had in institutional mental hospitals 40 years ago in people’s own homes, where they are even more isolated and alone than those who were in the system that I worked to change.

In all four countries in our United Kingdom, patients are waiting in ambulances or on trolleys in A&E prior to the full assessment of their conditions. One reason is that our acute hospitals are full, with bed occupancy rates of higher than 90%—completely different to the international recommendation that 80% to 85% is a safe way to practise. We know, as others have already outlined, that this is frequently because patients who are deemed fit enough for discharge are not fit enough to go home without significant levels of social support and care.

Rural England reported earlier today that, in Cornwall, there are on some days 60 people in hospital who are ready to go home, but part of the problem is that it is difficult to recruit home carers. Is that a surprise, when these carers are on less than £9 an hour and are not paid to travel, particularly in rural areas? At least when I was a district nurse I was paid for my travelling time. Patients are therefore held in ambulances, although with excellent paramedic care and support. Yesterday, South Western Ambulance Service NHS Foundation Trust told me that this costs about £66 an hour for individual ambulances and the clinical crew. Let us compare that to the £9 an hour for carers—if we could just turn the system around, could we not improve for the same amount of money? We know that people wait for long periods for discharge from hospital, which costs a minimum of £450 a day. We need a coherent total systems approach to health and social care. How can we do this? Well, is it not time for the Department of Health and Social Care to reimagine community services, as the recent King’s Fund report suggests?

As a short-term measure, we could set up some pilot sites, with acute trusts given the funds and authority to purchase and maybe even provide community support, including residential and nursing homes, for the first six weeks after discharge. Indeed, we could set up success measures to see whether we can reduce social isolation, enhance older people’s nutrition and thereby reduce admissions.

We need not only to remember that the current situation is affecting social care but to think about the perception of those whose planned operations have been postponed. These elective operations involve both young and older people, perhaps waiting for a simple hernia repair or orthopaedic operation. How do they feel about our NHS? Surely they would rather have innovative solutions than stay with the status quo. The issue of intergenerational fairness and a potential hypothecated tax was raised by the noble Lord, Lord Macpherson. We will turn the next generation off the health service unless we can provide the care they need as well as the care for their grandparents.

What plans are there to consider more innovative pooling of health and social care budgets, to provide the best seamless care for our people, and to reduce the stress caused not only to patients but to NHS and social care staff in our hospitals and community teams who—believe it or not—want only to provide high-quality services to those they serve? These are the questions that our staff want answered and we need to answer to encourage recruitment and retention in our vital services. I have given some of the simplest costs in financial terms that the public would understand, so surely a reorganisation with a community focus for older people’s care may enable better services for the same cost. This of course also includes suitable housing for frail elderly people and, possibly, NHS nursing homes.

Finally, does the Minister agree with a summary in a paper on economics from the BMJ last year, which concluded that spending constraints, especially for personal social care, were associated with a substantial mortality gap? The paper suggested that spending should be targeted on improving care delivery in care homes and people’s homes, and on maintaining or increasing nursing numbers.