Long Covid

Debate between Lord Bethell and Baroness Neuberger

Thursday 17th November 2022 Lords Chamber

[Baroness Neuberger (CB)]

My Lords, I declare my interests as chair of University College London Hospitals NHS Foundation Trust, chair of Whittington Health NHS Trust and a member of the North Central London Integrated Care Board, as well as other interests stated on the register. I am most grateful to the noble Baroness, Lady Thornton, a wonderful fellow non-executive director at Whittington Health, for securing this debate. I too am very grateful to the Library, which has been hugely helpful, and I am enormously grateful to all other speakers, because most have said most of what I was going to say.

I have a very specific point. At UCLH, we a run a well-known and much-admired long Covid service, which is led by the remarkable Melissa Heightman, who is also a national specialty adviser for NHS England and the co-chief investigator for the STIMULATE-ICP study, the largest long Covid trial to date. We know that the service is desperately needed; we have heard that all around the House. Those who run this particular service are working night and day; it does not have the resources to do what is needed, to the extent that those who run it are begging for bits of resource from elsewhere, mostly for people. So short is the service of staff that they recently asked UCLH Charity to fund an extra consultant for two years, which it has agreed to. I am well aware, as we all are, that today is the day of the Autumn Statement and that times are tough, but it is really serious when an NHS trust with a £1 billion turnover has to ask its charity to support an on-the-ground service led by the national lead, even for a limited period of time—particularly for a service designed to help other NHS staff across London.

Worse still, as other noble Lords have said, some 10% to 14% of reported cases are NHS staff. Although we all know that, it is not generally known among the population—but it is not really surprising, given the higher exposure to the virus that they all had. What a difference getting them well and back to work would make to the cash-strapped NHS and to the challenge over staff numbers. We have real trouble in recruiting and, as others have said, we have people leaving the service.

[Lord Bethell (Con)]

Can I personally endorse what the noble Baroness just said, in particular her testimony on Melissa Heightman and the team at UCLH? I had extensive dealings with them as a Minister, and their work is absolutely first class. I am heartbroken to hear that they are having to reach to charity for financial support.

[Baroness Neuberger (CB)]

I am extremely grateful to the noble Lord, and I shall make sure that Melissa knows about that.

Meanwhile, we have all the figures that everybody has cited, and the ONS has reported that long Covid has adversely affected the day-to-day activities of 1.6 million people—that is absolutely huge, and other noble Lords have mentioned that fact. The NHS has tried to help with that ongoing issue but, unfortunately, not enough. I want to go through that, because I think that it is relevant.

In October 2020, NHS England announced a five-point plan to support long Covid patients; it commissioned NICE to develop new guidance and established designated long Covid clinics to provide

“joined up care for physical and mental health”.

It also created the NHS long Covid task force to guide the NHS’s national approach on long Covid, and it funded NIHR research on long Covid better to understand the condition. In July 2021, NHS England published its long Covid plan for 2021-22, which included investing £70 million to expand long Covid services and £30 million in the rollout of an enhanced service for general practice, to support patients in primary care. But when NHS England published its updated plan in July this year, the previously enhanced service funding was not continued, so primary care no longer receives any ring-fenced funding for this condition—yet, as we know, it affects nearly 2 million people.

The problem is both insufficient resources to do all the work that is needed and insufficient forward planning to enable those services that do exist to build up capacity, engage in research, recruit, train, educate, and care for patients, including, importantly, the large number of NHS staff who appear to have been affected. We have a major health problem here that is likely to run for many years. Treatment is uneven across the country and research, which will need a lot of funding, is in its early days. This is an additional burden on an already very stretched NHS, both with patients with long Covid and with the large numbers of staff who have it.

What we really need is a properly NHSE-commissioned service to be put in place now, with secure funding for the next several years, even in these cash-strapped times. It feels like a hand-to-mouth, temporarily funded arrangement, so it is really hard to build a resilient service for the longer term. Can the Minister assure this House that such long-term commissioning will now be put in place, given the recent evidence of the numbers of people away from work with long Covid, the huge proportion of NHS staff affected, making other NHS backlog issues worse, the general impact on the UK economy, which others have mentioned, and of course the sheer suffering that long Covid is causing?

Health and Care Bill

Debate between Lord Bethell and Baroness Neuberger

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Lord Bethell (Con)]

My Lords, I came face to face with the nation’s health inequalities every morning in the departmental Covid response group, the COBRA meetings and the COBRA gold, when we went through the hospitalisation details and ICU data and heard stories from the front line of how people who had comorbidities particularly associated with obesity were filling up our hospitals as the virus spread through the country in wave after wave. That health inequality hit this country hard in very real terms. It cost a lot of lives, caused a lot of misery and cost our health system an enormous amount of money. It cost this country and its economy a huge amount of money and it is time that we came to terms with that challenge and solved the problem.

As a number of noble Lords have pointed out, the NHS must step up to its responsibilities in this area. There are complex reasons for these inequalities; some are environmental, some are behavioural and some are to do with access. But the NHS and whole healthcare system must realise that it needs to be involved in all aspects of those, and prioritise and be funded accordingly. The Bill already does an enormous amount to change the healthcare system’s priorities. Putting population at the heart of the ICSs is one really good example of that.

To anticipate some of his remarks, I know that the Minister will point to the Office for Health Improvement and Disparities. As the noble Lord pointed out, however, it has a tiny budget and cannot take responsibility for the nation’s health. Our councils are stony broke, as I found in my experience of dealing with them over the last two years. There is no one else to do this; this is not someone else’s problem. This is to do with the British healthcare system, and it needs to stand up to that responsibility. Zero progress has been made in the round over the last few years and we have gone backwards in the last two years in a big way. We need to make this a massive priority.

This is a fantastic Bill; I am really supportive of it. It came from the healthcare system originally. In this one area, however, there is a graphic lacuna that needs to be addressed. The noble Lord, Lord Kakkar, put it so well in his inimitable way. The prioritisation of inequality must be put in the Bill and it needs to be heard throughout the healthcare system that this is the new, central priority that needs to be added to everyone’s job description.

If, for some reason, we do not do that there will be huge consequences. The healthcare system is unsustainable in its current form. We cannot continue to have a large part of the population carrying grievous comorbidities or disease and afflictions which are undiagnosed or not properly mended turning up in our hospitals at a very late stage and costing a fortune to mend. These health inequalities, whether they relate to disease, injury or behavioural issues such as obesity, are costing us a fortune. Only by putting tackling inequality on the face of the Bill can we really give it the priority it deserves.

I also say to the Minister that there is a sense of political jeopardy about this as well. We went into the last election committed to levelling up on health. We have gone backwards in the last two years through no fault of the Government, but if the Government do not step up to their responsibilities in this area, and if the NHS and the healthcare system do not change their priorities, the voters will judge us extremely harshly. For that reason, I urge the Minister to listen to this debate and look very carefully at ways of amending the Bill.

[Baroness Neuberger (CB)]

My Lords, I want to pay tribute, as other noble Lords have, to the noble Baroness, Lady Thornton, for her very thoughtful introduction. It is remarkable and absolutely wonderful to see consensus breaking out across the Committee. I will speak specifically to Amendments 152, 156 and 157 in the name of the noble Lord, Lord Young of Cookham, whose words on the need to make this really serious by stating it on the face of the Bill I echo.

I am a former chief executive of the King’s Fund and am currently chair of University College London Hospitals and Whittington Health. These issues are very dear to my heart and the hearts of those institutions. I also want to say thank you to Crisis for its briefing and add to the words of the noble Lord, Lord Young of Cookham, in praise of Pathway, which has done the most extraordinary work in this area over very many years.

I want to talk particularly about the NHS-funded Find & Treat service, which was set up 13 years ago and is run by UCLH, which I chair. This service was set up in response to a TB outbreak in London and aimed to provide care for people experiencing homelessness and people facing other forms of social exclusion. The service did exactly what it says on the tin: it went out and found people—and still does—who were at risk of contracting TB, wherever they were sleeping, and offered them diagnosis and treatment. Back in 2011, a study concluded that this service had been not only effective in helping to treat people with TB who were experiencing homelessness but cost effective in doing so, both in terms of costs saved to the health service and improved quality and length of life for the people receiving care. Fast-forward a decade and the evolution of this service meant it could be similarly mobilised at the beginning of the Covid pandemic. It provided urgent and necessary care to people who continue to experience the poorest health outcomes.

The King’s Fund published a report in 2020 on delivering health and care for people sleeping rough. It supported the need for inclusion health services to be provided much more broadly than at present. Importantly, it also concluded that local leadership is absolutely vital in crafting that approach and said that local leaders should model effective partnership working across a range of different organisations.

Embedding inclusion health—I cannot say I really like the term, but everybody knows what it means—at the level of integrated care partnerships will help ensure that our healthcare system can no longer ignore, forget or overlook people who are all too often considered “hard to treat”, despite proven interventions showing the opposite. It will ensure that integrated care partnerships and systems take that vital first step towards closing the gap of the most significant health inequalities in our society by having to recognise and consider people facing extreme social exclusion and poor health outcomes in their local areas.

We all know that there will be considerable discussion during the course of this Bill on the need not to be overly prescriptive and burdensome to ICSs and ICPs by way of legal duties. But ICSs and ICPs know all too well the realities of failing to support people with complex and overlapping needs. I know that the chair of my own North Central London ICS, Mike Cooke, is sympathetic to the spirit of these amendments and believes it is important that extra steps are taken to meet the health needs of the most excluded, such as street homeless people. The chief executive of UCLH, David Probert, and the chief executive of Whittington Health, Siobhan Harrington, concur in thinking that if we extend the aspiration to reach out to excluded groups to something that all ICSs, ICPs and systems must focus on, it would be hugely beneficial for planning and joining up systems to avoid inappropriate or unnecessary admissions and poor care planning. Plenty of people want to do this within our health system.

I support Amendments 152, 156 and 157 and look forward to working with the Government and colleagues across the House and within the NHS to ensure their success in achieving a critical and long-needed systemic change to our health and care system. Addressing the needs of the most excluded has to be on the face of the Bill.