Health: Medical Respite for Children

Baroness Wheeler Excerpts

Wednesday 21st March 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right. Many of the children we are talking about are receiving continuing care to meet all their needs, and delivering that is very complex. A national framework for continuing care is being revised at the moment, and it will provide the picture for the skills mix that is needed at local level to ensure that these children are properly served.

[Baroness Wheeler (Lab)]

My Lords, my question is on the specific issue of parent carers, for whom funded respite care is vital to both themselves and the children they care for. The Minister mentioned the continuing healthcare framework guidance coming into force in October, which makes clear CCGs’ responsibilities to fund respite care for parent carers and breaks for families of severely disabled children. The High Court judgment clarifies the law and makes this duty clear now. What action have the Government taken to ensure that CCGs act on the Nascot Lawn judgment now?

NHS and Social Care: Winter Service Delivery

Baroness Wheeler Excerpts

Thursday 25th January 2018 Lords Chamber

Moved by

[Baroness Wheeler]

That this House takes note of the impact on front-line social care of Her Majesty’s Government’s NHS plans and the delivery of services over the winter period.

[Baroness Wheeler (Lab)]

My Lords, the most appropriate place to start this debate is with the WhatsApp open letter of 12 January to the Prime Minister from the heads of 68 accident and emergency departments in England. Its signatories included St Thomas’s in London, Heartlands in Birmingham, Addenbrooke’s in Cambridge, the Royal Liverpool, and Frimley Park, where Mrs May issued her new year apology for cancelling 55,000 non-elective surgical operations. With figures showing over 300,000 patients waiting more than four hours in A&E, a record half a million-plus emergency admissions, and 75,000 patients waiting more than 30 minutes in the back of an ambulance, these front-line doctors wrote about the hundreds of patients a day, some of whom were dying prematurely, being treated on corridors and about patients sleeping in clinics turned into stopgap wards.

One of the main purposes of the messaging was to swap practical tips about how to become “corridor specialists” as hospitals become overwhelmed with patients. This speciality includes the Red Cross delivering tea and blankets and sitting with patients waiting on their own. I can think of nothing worse than, for example, being a sick, elderly patient on a trolley without a carer or friend to stay with them, speak up for them or make sure they are being looked after. For the A&E doctors, their reality was that the Government’s winter plans,

“have failed to deliver anywhere near what was needed”.

Their key demand was more hospital beds and an urgent boost to social care. The president of the Royal College of Emergency Medicine warned:

“Our emergency departments are not just under pressure, but in a state of emergency”.


All this, of course, has a huge knock-on effect on social care while arising from the Government’s failure to fund and provide the everyday healthcare and community support, for millions of people who need it, which could stop many of them turning up at A&E and occupying hospital beds in the first place.

We know that the Minister’s response will be his repeated mantra about the extra £337 million the Government made available to trusts this winter and the £1 billion extra in social care funding allocated in the 2017 March Budget. Of course extra funds are welcome but, first, trusts were not told about their allocations until a few days before Christmas, so effective on-the-ground advanced planning was severely hindered as they had no idea of what money there was to spend. Secondly, the Government’s instruction was for half of the £337 million to be spent on servicing trust debts, not on emergency planning. Thirdly, such debts will be further increased by the cancellation of 55,000 non-elective surgical operations. Finally, as all the health think tanks, specialists and everyone involved in the provision and delivery of NHS and social care services have attested, the extra funding was simply nowhere near enough even to begin to redress the huge cuts that have been made in NHS funding and local government funding of social care over the past eight years.

The Government need to acknowledge and own up to the scale of the crisis. The Minister knows that the Budget did not provide extra funding for social care in the short term or address the predicted funding gap of £2.3 billion by 2020. Specifically on A&E care, can the Minister tell the House how the Government will assess the actual impact that providing additional funding in November and December had in dealing with the worst winter crisis the NHS has faced in decades?

On social care, as the very comprehensive Lords Library brief for today points out, we talk of adult social care mainly in terms of the needs of older people, but it also includes care and support provided to physically disabled people, people with learning disabilities, people with mental health problems, drug and alcohol misusers and the carers involved in caring for them. That is the scale of the demand and the need that has to be addressed. I will focus today on carers and older people.

I am a carer, as many noble Lords will know. Emergency care, hospital admission and then discharge is a make-or-break time for carers and their families. Many people become carers for the first time when this happens, as I did. It heaps pressure on families and, despite all the guidelines, most discharges take place with little notice, particularly when there is a national directive to free beds to make way for winter. If you speak to carers, particularly if discharge takes place when the patient is medically unfit or without the proper facilities and care available at home, they will tell you that this is one of the most traumatic times for them.

The number of carers is increasing every day. It is now estimated at 6.8 million, an increase of 1 million over the past 15 years. As Carers UK has stressed, families are caring more, not less, as some would have it. On top of this, we see in the press that carers have been asked by one trust to collect their elderly from hospital to help with the discharge process and ease the winter crisis. Is this really where society wants to head?

For carers, frequent GP and hospital visits, providing and arranging transport and so on are a routine part of looking after partners or relatives with disabilities or co-morbidities or of caring for frail and elderly people. Cancelled operations mean desperately trying to reinstate the cancellations in domiciliary care support made for the hospital stay and, of course, dealing with huge upset and disappointment.

There is the added winter threat of norovirus or flu and the impact this will have on carer and cared for or on both together. Where there is a carer involved in A&E corridor waits, they will be there with their loved ones, doing their best to care for them in very difficult circumstances and sharing their anxiety and concern. Acknowledging the vital role carers play as partners in the health and social care system has to be backed up by providing the resources that are needed to undertake the caring role.

Can the Minister update the House on the call to action that the Government have promised in place of the national carers strategy refresh that carers were expecting two years ago? It was due in the new year and we are nearly at the end of January. Can he tell us when it is to be published and ensure that it provides the support and resources that carers need?

As Labour has emphasised, the winter crisis has consequences not only for those in urgent need, but for everyone using the NHS. The panic cancellations of elective operations and outpatients clinics in the face of hospitals running at full capacity will have a major impact on the many older people who rely on NHS services to stay well and on their carers. As Age UK has stressed, waiting for a hip or cataract operation or having an appointment postponed will leave many people experiencing pain, discomfort and anxiety. It will result in a need for more support in the home or from primary care and could even accelerate people’s need for urgent and emergency care.

The noble Baroness, Lady Campbell, wanted to participate in this debate today, but had a previous commitment. She asked me to raise the key issue of the impact that the winter crisis has on people with acute, long-term conditions and disabilities, such as muscular dystrophy, cystic fibrosis or acute asthma, who, if they go down with flu or chest infections, need emergency care in specialised respiratory units. The availability of these beds is increasingly under pressure because hospitals are unable to discharge severely disabled people occupying those beds back into the community if they require more social care support than they had before. She faced this very perilous situation three years ago when her local specialist unit was full to the brim for many days and a suitable, high-dependency placement could not be found, and she lives in fear of that every winter. Will the Minister undertake to write to her on the urgent measures and steps that will be taken to ensure that people with acute and long-term disabilities receive the integrated and joined-up care they need?

Planning for winter means planning across health and social care. As NHS Providers said last year:

“Too often winter pressures has just been about acute hospital capacity. Last winter showed that ambulance, community and mental health capacity are just as important, as is primary and social care capacity”.


Social care’s extra £1 billion pounds last year was designed to reduce delayed transfers of care and free beds, but only 28% of trusts managed to secure any commitment from hard-pressed local authorities to spend the money on delayed transfers. Most would have simply been unable to meet that commitment.

Over last winter the lack of capacity to deal with expected demand across the whole system was clear: 64% of trusts lacked ambulance capacity; 71% lacked acute capacity; 76% lacked community capacity; 80% lacked mental health capacity; 91% lacked social care capacity; and 92% lacked primary care. Can the Minister explain why the Government’s winter crisis plan for this year did not take account of all these factors? Was this really the effective planning the Government insist went on? Will the lessons be learned for this year’s promised winter crisis ministerial review?

On delayed transfers we know that the NHS needs to get its act together. More than 58% of delayed transfers in November 2017 were attributable to the NHS, mainly through patients having to wait for further NHS non-acute care; 34% of delayed transfers were due to social care. What was the main reason? It was patients awaiting a care package in their own home. Financial penalties on local authorities or instructions to trusts to use the limited extra funding to reduce their debts do not address the crisis in either sector. As the Local Government Association puts it, delayed transfers,

“are a symptom, not the cause, of the pressures on the NHS and in many cases the solutions will lie in investment in prevention, primary care, community services and hospital avoidance schemes ... There cannot be a sustainable NHS without a sustainable adult social care system”.

We know that as a result of the cuts to local government, the availability of adult social care packages has fallen so dramatically that 90% of councils are now able to respond only to people with critical and substantial needs. At least 400,000 fewer people are getting publicly funded help. Age UK’s estimate is that there are now 1.2 million people with unmet needs for help with essential daily support, such as bathing, toileting, taking medicine, cooking, shopping and other everyday tasks.

All this makes it vital that the Government’s Green Paper this summer does not deal just with a cap in care costs or any disastrous proposal for a care cap floor, unless, of course, Jeremy Hunt throws in the towel and recognises that the Dilnot proposals that we all spent two years working on are actually the best chance we have for bringing fairness and some equity into the health and social care system in the near future. The Green Paper must also address how we can achieve the fundamental integration between health and social care that is needed to meet the scale of the current crisis and the rising demand and to provide the care and support that people should be getting.

The Government have tried very hard to make the change of Jeremy Hunt’s title to Secretary of State for Health and Social Care sound like a fresh and important sign of action and purpose. I must say that I am one of those who thought he was supposed to have that role anyway. However, if it means that the Green Paper will be health and social care-led—rather than led by the Cabinet Office—and that Jeremy Hunt will take leadership responsibility instead of, as is his frequent habit, blaming the health and social care crisis on everybody else, then that is at least a start. His recent recognition of the need for a 10-year strategy is also a step in the right direction.

Can the Minister confirm that the Green Paper is still scheduled for the summer? Can he be any more specific about its aims, scope and publication date? What work will be done alongside the Green Paper to produce a national integrated staff recruitment, training and development strategy for health and social care? Currently, Health Education England provides the NHS staff strategy and Skills for Care deals with social care staff. Is this not a key issue that needs to be addressed to ensure integrated working? Will the chronic low pay problems, particularly in social care, that are one of the root causes of staff shortages and low morale be tackled? How will health and social care budgets be joined up?

I am grateful that this debate has attracted so many experts among noble Lords, and I am very much looking forward to it. I close by paying tribute, on behalf of us all, to the extraordinary efforts and work of our NHS and social care staff, particularly over this Christmas and new year and this winter.

--- Later in debate ---

[Baroness Wheeler]

My Lords, I thank noble Lords for their thoughtful and wide-ranging contributions. I am not going to deal with them in detail because we want to move on to the next debate. I hope the Minister will write to noble Lords in response to the questions he has not been able to deal with and that he will draw the attention of the Secretary of State for Health and Social Care to everything that has been said today.

Motion agreed.

NHS: Winter Funding

Baroness Wheeler Excerpts

Thursday 11th January 2018 Lords Chamber

[Baroness Thornton]

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

[Baroness Wheeler (Lab)]

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

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

My Lords, in the Autumn Budget, we allocated £337 million to be available immediately for trusts to use this winter. This package funded more hospital beds, community services, mental health services and urgent GP appointments to manage the expected surge in demand. After Easter, the NHS, as last year, will undertake a full review of this winter and identify any lessons for the future. We expect that that will include an assessment of the impact of this funding.

[Baroness Wheeler]

I thank the Minister for his response. He will have seen the BMA’s stark analysis of one week between Christmas and new year. In just those seven days, bed occupancy rose to 91.4%, 39 ambulances were diverted from A&Es that were too busy to cope, 731 beds were closed due to diarrhoea or vomiting, and by the end of the week, 3,400 escalation beds had to be opened because hospitals were full. Today’s figures and the warnings from NHS Providers tell the same sorry story. Does the Minister accept that announcing extra funding in November/December was far too late to prevent the worst period across the winter so far or the Government having to announce the bombshell of 550,000 cancelled operations? Can he also tell the House how the Prime Minister’s plan will now be revised to reflect these everyday realities and come up with the urgent action and funding that is needed to help the NHS cope with its worst winter crisis in two decades?

[Lord O’Shaughnessy]

I would hope that the noble Baroness would welcome the money that was set aside in the Budget. It is important to point out that in addition to that £337 million, half of which has gone to support plans that were already in place and being actioned before the Budget, there was a further £100 million to support A&E streaming, which is also a way of taking pressure off emergency services. That has had an impact, so I do not accept the accusation that the money came too late, and indeed there is still money in the pot as services come under pressure.

As regards the future, the noble Baroness will know that it was also announced in the most recent Budget that another £2.8 billion would be allocated to the NHS to help it get through the next few years. We know that the pressures are increasing because of the ageing population. The idea of that money is precisely to help the NHS get back on target on A&E waits as well as referral to treatment.

Social Care: Sleep-in Payments

Baroness Wheeler Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O’Shaughnessy]

It is not our position that they will not be funded. That is one of the options being explored at the moment. A huge amount of work is going on with providers and all parts of government. In the end, however, the Care Act 2014 means that local authorities have a responsibility to take on the commissioning of and, ultimately, provision for providers, if they are looking at exiting the market, to make sure there is proper and comprehensive provision in the local area.

[Baroness Wheeler (Lab)]

My Lords, it is absolutely right that sleep-ins are defined as working time and therefore subject to payment of the national minimum wage. However, the Government’s November compliance scheme proposal not only failed to offer support for hard-pressed providers but also means that thousands of care workers, who are among the lowest paid in society, could be waiting until March 2019 to get paid what is owed to them. Does the Minister agree that these low-paid workers should not have to pay the price for the Government’s £6 billion cuts in social care or their failure to take action on addressing the social care funding crisis?

[Lord O'Shaughnessy]

I am grateful that the noble Baroness has raised the compliance scheme. For those providers that enter it, the scheme offers the opportunity to take 12 months for self-review and then report to HMRC, which will then allow a further three months for the providers to pay. That gives a 15-month leeway compared with the usual default enforcement period of 28 days. There is clearly a balance to be struck between the financial challenges posed to providers and the money that staff, rightly, need to take. I think that the compliance scheme provides that balance so that we can do it in a way that is sustainable.

Social Care

Baroness Wheeler Excerpts

Thursday 7th December 2017 Lords Chamber

[Baroness Wheeler (Lab)]

I thank the Minister for reading out the Statement in response to the October Labour Opposition debate on the social care funding crisis.

We are told that the Statement builds on the extra £2 billion over the next three years provided by the Government to “meet social care needs”. However, for the record, the Minister will know that independent think tanks such as the Nuffield Trust and the King’s Fund, care providers across the social care sector, voluntary organisations such as Age UK, and organisations representing the staff who deliver the services have all shown clearly the inadequacy of this sum to meet existing and rising demand and to address the funding crisis. Government cuts to local authority budgets have meant cuts to adult social care funding since 2010, which are set to reach £6.3 billion by March 2018. That is the scale of the funding gap that needs to be addressed, and we know that social care did not get even a mention in the Budget. Can the Minister explain to the House why such a key issue was left out?

On the Green Paper and the Government’s preparations for yet another round of consultation, the Minister will accept that this stop/start Green Paper has been a very long time coming, particularly when viewed in the light of the agreed Care Act provisions that were first promised for full implementation in 2016. On 16 November, the Minister told the House that a group of independent experts, including Andrew Dilnot and Kate Barker, would support government engagement with stakeholders. Today’s Statement says that these two are among a range of experts who will “provide their views”. An inter-ministerial group has also been set up. What role will these key experts—who have widespread respect and authority among key stakeholders —play in overseeing the review and consultation? Will they be involved at the heart of the review or will they just feed their views to Ministers?

The Minister will know that it is particularly upsetting for those of us who were involved in the painstaking work on the Care Act to be lectured again about how complex the issues are and on the need to “build consensus around reforms”. That consensus was part of the Care Act and the Government chose not to go ahead with it. We know, too, that they consulted on their proposed care “floor” during the general election; it was roundly rejected by the electorate, causing huge despair and consternation among the millions of disabled people and their carers struggling to cope. Meanwhile, many people are still faced with the catastrophic and rising costs of paying for care.

I mention carers specifically. The Minister is right to acknowledge that they are vital partners in the health and social care system, but the reality is that they have now been waiting nearly two years for the national carers strategy to be updated, refreshed or called to action, with promised deadlines being set back time after time. Last summer, carers were finally told that the strategy would be morphed into the end-of-the-year Green Paper. It was not a satisfactory situation, but carers organisations put huge effort and time into consulting with carers across the country to meet the deadline—only to then receive the announcement of the delay of the Green Paper to summer 2018.

Katy Styles, a carer and campaigner for the Motor Neurone Disease Association, contributed to that consultation and hoped that her voice would be heard. She said:

“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth”.


We now have the promise of an action plan in the new year. Does the Minister acknowledge that he now has to be straight and play fair with carers and provide them with a date for the action plan? Can he be more specific about the scope and funding that will be allocated to the action plan?

Finally, Age UK estimates that there are 1.2 million people currently living with unmet care needs and that almost a quarter of all adult social care services receive the poorest safety rating from the Care Quality Commission. Can the Minister tell the House how the Statement will help people going without essential daily care, such as help with washing, dressing and toileting, to receive a better quality of care?

[Lord O'Shaughnessy]

I thank the noble Baroness for her response and her questions; I will deal with them in order.

First, she asked about funding. She is quite right to point out the £2 billion of extra funding that was announced in the March Budget; of course, we have had two Budgets this year, so extra funding was included in a Budget this year. I should also point out that that was the latest tranche of additional funding, which totals over £9 billion over three years, taking into account the additional funding announced in recent financial Statements. The precise purpose of the funding is to address the fact that we have a growing and ageing population. The number of people requiring care packages is rising, and often the complexity of those packages is becoming more acute—hence the need for more funding, as we all recognise.

Experts will be fully engaged in the Green Paper, providing advice to Ministers and supporting engagement. There is no point in having such an august group and not drawing on their expertise. I do not think that there is any contradiction in the way that I have described their role. We would not want to involve those people—and they would not want to be involved—if they were not going to be listened to.

On carers, I acknowledge the delay in the carers strategy and I understand that that must be frustrating for those who have invested so much time in it. I have two things to say in response. First, it is right that the position of carers is considered in the round, with care costs. Secondly, that is why the action plan is important: it provides a staging post between now and the intention to introduce fully fledged policy proposals in due course. I am afraid that I do not have a specific date or a funding package for that, but I will write to the noble Baroness with as much detail as I can find and place a copy in the Library.

Nurses: Tuition Fees

Baroness Wheeler Excerpts

Wednesday 29th November 2017 Lords Chamber

[Lord O'Shaughnessy]

The system that we have means that the people who benefit most from higher education are those who pay for their higher education and, in doing so, they subsidise those who go into the professions that my noble friend has mentioned, which are extremely worth while but might not be that well paid.

[Baroness Wheeler (Lab)]

My Lords, the Health Foundation research has shown that the change in nurse training funding arrangements in England has led to a fall in student numbers, rather than the Government’s promised increase. One of the most alarming statistics shows a 31% shortfall in the number of applicants aged 30 and over, just the group with the background and experience the NHS needs, many of whom are care workers with hands-on experience wishing to develop their skills by becoming qualified nurses. Does the Minister agree that these are the very people whom nursing needs, but for whom taking on a huge debt, often at a time of heavy financial commitment, seems an impossible hurdle? Does this not all underline the need for urgent reinstatement of nurse bursaries?

[Lord O'Shaughnessy]

I think that the figure on shortfalls that the noble Baroness has given is not right. If one looks at the UCAS data, it shows, as I said, a small drop of around 6%, but the numbers going into training are comparable to 2014-15. She is quite right about the need for additional financial support, and there is £1,000 available for childcare support for those who need it, as well as exceptional support funds of up to £3,000.

Mental Health Care: Vulnerable Children

Baroness Wheeler Excerpts

Tuesday 28th November 2017 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what actions they are taking to address the concerns raised by the Care Quality Commission in its review published in October about the particular difficulties faced by children and young people in vulnerable circumstances, such as looked-after children and those with learning disabilities, in accessing mental health care.

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

My Lords, improving children’s and young people’s mental health is a priority for the Government, especially for the most vulnerable. The Government welcome the CQC’s recent report in this area, which was commissioned by the Prime Minister in January. Government initiatives to improve the mental health of vulnerable children include piloting new approaches to the mental health assessments that looked-after children receive as part of their initial health assessment, and testing models for personal budget use for looked after children.

--- Later in debate ---

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his response. With the Green Paper promised before Christmas, I hope we will not have to wait until the next CQC review for the urgent action that is needed, given the scale of unmet need for mental health care among vulnerable children. Barnardo’s recent survey showed that one in four looked-after children faced a mental health crisis on leaving care, and yet nearly 65% of them did not receive any statutory support; and whilst in care, local factors such as a lack of permanent or settled placement can lead to support action being denied. On children with learning difficulties, in all my research for this Question I was truly alarmed at the lack of information that is available on the scale and problems of this vulnerable group of children. What action is the Minister taking to ensure that the CQC, Ofsted and, sadly, the police and probation inspectors combine their efforts to investigate this issue as closely as it deserves?

[Lord O'Shaughnessy]

The noble Baroness is right to highlight these disturbing facts about the mental health of looked-after children. Nearly 50% of looked-after children have a diagnosed mental health disorder, so that is what we are up against. In terms of how we are dealing with it, the increases in funding to raise the number of treatments that are taking place by 70,000 will obviously help vulnerable children, and there is the additional assessment that I have talked about. She asked particularly about children with learning difficulties. I am sure that she is aware of it, but I would point her and other noble Lords to the Lenehan review, which set out several recommendations, all of which the Government have adopted. One of the actions that stems from that includes new guidance from the Local Government Association and NHS England on commissioning mental health services for children with learning difficulties.

NHS: Deficit

Baroness Wheeler Excerpts

Wednesday 22nd November 2017 Lords Chamber

[Lord O’Shaughnessy]

The Chancellor has confirmed that he will fund an Agenda for Change, as it is known, pay deal on the condition that the pay award enables improved NHS productivity and is justified on recruitment and retention grounds.

[Baroness Wheeler (Lab)]

My Lords, is the Minister aware that the number of GPs has fallen sharply over the past year, despite the government pledge to increase the supply of family doctors by 5,000 by 2020? How many more targets are likely to be missed by the Government? When did the NHS last achieve the A&E 95% target or the 92% 18-week treatment target? What will the actual impact of today’s funding announcements be on the Government’s performance on these key targets and their ability to ensure that planned improvements in priority areas of care such as cancer and mental health will not be stopped, as Simon Stevens has warned?

[Lord O’Shaughnessy]

The noble Baroness has pointed out the disappointing numbers as regards GPs. I should point out that there has been an increase in training places for future years. It is critical that we deliver those places and bring more staff into the service. I am glad that she drew attention to where the additional funding will go. There will be £340 million to help the NHS through this winter, £1.6 billion of additional revenue in 2018-19 and £900 million in 2019-20. That is precisely, as the Budget pointed out, to improve A&E waits, turn waiting list growth around and improve performance against the RTT targets.

NHS: Wound Care

Baroness Wheeler Excerpts

Wednesday 22nd November 2017 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what plans they have to develop a strategy for improving the standards of wound care in the NHS.

[Baroness Wheeler (Lab)]

My Lords, in my noble friend’s unavoidable absence, I shall ask the Question standing in his name on the Order Paper. Wound care is a massive challenge to the NHS, but it currently lacks priority, investment and direction. This debate is designed to press the Government to recognise the need for urgent action and for the development of a strategy across care providers for improving the standards of wound care.

I am delighted that so many noble Lords with expertise on this highly important matter have put their names down to speak. It will ensure that we can cover a wide range of issues across medical, nursing and patient care and the quality of medical supplies. It will also give the Minister the stepping stone for developing the national strategy that I hope he will recognise is sorely needed.

A staggering 2 million patients are treated for wounds every year at a cost of more than £5 billion. The overwhelming majority of this figure goes towards paying for nursing care costs rather than products such as bandages. In other words, the cost is more than, for example, we spend on tackling obesity, which is the centre of major national campaigns. Treatment costs include more than 700,000 leg ulcers and 80,000 burns. Pressure sores also feature highly, with estimates of an 11% increase overall each year.

While 60% of all wounds heal within a year, a huge resource has to be committed to managing unhealed wounds. The NHS response is very variable. Healing takes far too long; diagnosis is not good enough; and inadequate commissioning of services by clinical commissioning groups compounds the problem, with undertrained staff and a lack of suitable dressings and bandages. There has also been a very worrying drop in the number of district nurses, whose role in ensuring safe and effective wound care in the community is crucial.

Ideally, 70% of venous leg ulceration should heal within 12 to 16 weeks and 98% in 24 weeks. In reality, however, research shows that healing rates at six months have been reported as low as 9%, with infection rates as high as 58%. Patients suffer and the cost of non-healing wounds is substantially greater to the NHS. The failure to treat wounds swiftly and effectively can lead to more serious health problems, such as sepsis, which is often the result of an infected injury; we also know that foot ulcers on diabetics can lead to amputations if they are not dealt with properly.

The situation will only be turned around with a nationally agreed strategy to reduce variation, prevent wounds getting worse and improve outcomes. Wound care therapy strategies are needed and national care pathways for wounds must be established to cover the complexity and variety of wounds, using evidence-based health economic data and academic and clinical expertise. The Bradford study and survey that is summarised in the Lords’ Library brief for this debate—a good brief but sadly received only yesterday—underlines the point about the importance of evidence-based care, with nearly one-third of patients interviewed in the study failing to receive an accurate diagnosis for their wound. As the study puts it:

“Wound care should be seen as a specialist segment of healthcare that requires clinicians with specialist training to diagnose and manage. … There is no doubt that better diagnosis and treatment and effective prevention of wound complications would help minimise treatment costs”.


Dedicated wound clinics in the community are also needed, alongside a co-ordinated treatment plan to achieve best outcomes for patients. A focus on the prevention of wounds, as well as treatment and healing of wounds, is also very important. The NHS must also invest in high-quality bandages and dressings, in contrast to the current skimping that takes place in many areas. We know, however, that with the NHS as financially hard pressed as it is, there is huge pressure to reduce the costs of medical equipment and clinical supplies such as dressings. The result is that in the procurement of dressings and other forms of treatment, there is not enough emphasis on the cost of patient care and too much focus on the unit cost of products. Not only does this lead to poorer and more costly outcomes for patients but there are a number of unwelcome side-effects. Products will be less innovative and effective; a reduced amount of educational support will have a detrimental effect on patients; there will be fewer appropriate treatments available; and all this will lead to job losses if there is less sourcing from high-quality British suppliers and manufacturers.

With cost as the primary driver, suppliers to the NHS will have a race to the bottom, compromising quality. Poor-quality dressings simply cannot withstand the rigour required to produce effective healing. It is massively counterproductive. Reduction in the availability of clinically appropriate dressings, which comprise only 10% of costs, will result in patients suffering as wounds take longer to heal. An increased burden on the NHS will follow and the result is longer hospital stays, particularly for the elderly, more readmissions, compromised quality of life and repeated visits to GPs and community services.

Of course, we fully support improvements in the way that medical equipment and other supplies are procured. I am not sure whether, in his absence, I have to declare my noble friend Lord Hunt’s interest and commitment to these matters as president of the Health Care Supply Association but I am sure he will value it being mentioned. We also support the work of my noble friend Lord Carter and his 2015 review on how the NHS can avoid unwanted and unnecessary variations in the cost of supplies. The overall aim of his review was to see how the NHS could reduce spending by £5 billion by the 2020-21 financial year. It proposed £600 million in savings for supplies, half of this to be saved before October 2018; limiting the NHS to 40,000 products instead of 300,000, with an overwhelming majority of this—80%—going towards a newly revised supply chain process; as well as replacing local formularies with a national formulary.

Although we welcome the report’s efforts at saving the NHS money, we need to ensure that any shift in focus to the short term will not lead to the knock-on effect of costs rising in other clinical areas. There is also strong concern that the short-term focus could lead to a scarcity of supplies in the future. I would be grateful to hear reassurances from the Minister on the steps being taken to guard against these two unwanted outcomes. Evidence clearly shows that the current problems can only worsen. The average number of adult wounds that every CCG will have to manage is expected to rise from 11,200 in 2012-13 to 23,000 in 2019-20.

The Government urgently need to get a grip, with a nationally driven strategy. Without it, patients will receive worse care for their injuries and the financial burden on other parts of the NHS will continue to increase because patients will develop chronic wounds or catch an infection that could lead to potentially life-threatening illnesses. I look forward to the contributions of noble Lords to this very important debate and to the Minister’s response.

Health: Flu

Baroness Wheeler Excerpts

Monday 30th October 2017 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what preparations are being made to deal with the anticipated rise in flu cases this winter.

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

My Lords, it is too early to predict the impact of flu this winter. As part of the Government’s preparedness, every trust has developed plans for the coming winter season. The seasonal flu vaccination has been offered to those at particular risk of flu, and to all health and social care workers. A nasal spray vaccine will be offered to all children aged two to eight years old to help to protect them and their families.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. Last week’s Healthwatch report showed an alarming increase in the number of hospital readmissions, which have risen by nearly a quarter in four years. The survey also showed a rise of 29% of people readmitted to hospital as emergencies within 24 hours. Does not this raise huge concerns about patients being discharged unsafely and before they are medically fit in order to meet the Government’s empty beds targets, not to mention the trauma and upset caused to the patients themselves and their carers and families? Do the targets take account of readmissions? What additional funding and contingency plans are in place across NHS trusts and local authorities, if there just are not enough beds to cope with the winter flu crisis? Is not the Government’s flu preparedness in urgent need of review?