Emergency Healthcare (Public Services Committee Report)

Lord Bishop of St Albans Excerpts

Thursday 20th July 2023 Grand Committee

[The Lord Bishop of St Albans]

My Lords, I thank the noble Baroness, Lady Armstrong of Hill Top, not only for chairing this committee and producing an excellent report but on now bringing it to your Lordships’ committee for us to debate. I declare my interest as president of the Rural Coalition and a vice-president of the LGA.

I associate myself with the noble Baroness’s concerns that a subject of such huge importance has so few people speaking on it. I understand the problems, but I encourage His Majesty’s Government, the Whips and so on to look at how we can give such topics the time they deserve.

I have long expressed my concern about healthcare in England, particularly in rural areas, so I read this report with great interest. I have seen the strain on emergency care in my own diocese of St Albans, which covers Hertfordshire and Bedfordshire. In Hertfordshire, category 1 ambulance calls—those reserved for the most life-threatening injuries—were responded to in just under 12 minutes, on average, well above the national average of seven minutes.

Rural areas have always faced unique challenges in providing care and recruiting and retaining healthcare professionals to care for a predominantly older population. Of course, people who live in rural areas accept that geographical factors mean that it will be more difficult. However, a number of issues particularly associated with rurality make the problem more complex, not least connectivity. In many areas where people rely on mobile phones and there is no coverage, delivering emergency healthcare is even more challenging. I hope the Minister appreciates the profound emergency healthcare challenges faced by rural areas such as those in my diocese.

As the report highlights, it is important for us to recognise that pressures on emergency healthcare are both a cause and effect of the strain on health services across the board. They are a cause because we know that the longer people remain on waiting lists, the more likely they are to acquire co-morbidities that compound the original underlying health issue, often making treatment more complex; and they are an effect because patients often access emergency healthcare because they feel they now have no other avenues to treatment. The squeeze on healthcare services across the board, including preventive and community healthcare, manifests itself in the kind of pressures on emergency services outlined so accurately and precisely in this report.

The Government have rightly recognised the severity of the problem in the NHS Long Term Workforce Plan, which refers to the need to increase training and retention of staff rather than relying on international temporary recruitment. Statistics from the British Medical Association show that 40% of junior doctors are actively planning to leave the NHS as soon as they can find another job, and many are planning to work abroad within the next 12 months. We see a similar story for nurses: more than 40,000 left the NHS last year. With an ever-increasing workload and stagnating salaries, there is no doubting the reason why so many professionals are leaving our health service. We hear regular reports that British junior doctors are being offered packages in places such as Australia that pay more than double what they can achieve if they stay in this country.

Given the profoundly challenging circumstances in rural areas—an ageing population and problems such as connectivity for emergency workers—it is essential that the Government’s response helps to tackle them. Will the Minister assure us that the Government’s response will be properly and fully rural-proofed as we look at how we respond to it? The Government need to increase investment in people. The report rightly notes the immense difficulty and stress faced by those in the emergency care profession, compounded by shortages across the entire health service. If we cannot encourage our healthcare professionals to stay, then it seems that, unfortunately, they will vote with their feet, as so many are doing. How do the Government plan to compete with the generous packages being offered from overseas?

Then, there is the question of how we can do more joined-up thinking. I was particularly interested to hear what the noble Baroness, Lady Armstrong, said about seeing through the whole process from start to finish and trying to work out how people move through the system, so that it can be done efficiently and effectively. Allied to that is the question of how the NHS and others are going to work with the third sector, with so many churches, community groups and medical charities being capable of offering non-urgent care support. We need to think about how we can relieve the pressure on emergency care described in the report, in order to ensure that patients get not just focused medical treatment but all the social support, friendship, follow-up and other things that add to the holistic approach to health. What discussions are His Majesty’s Government having with the third sector in this important area?

To conclude, I thank the noble Baroness and all those who worked on this committee and this report for this excellent and timely debate on emergency healthcare.