Nursing and Midwifery

Lord Crisp Excerpts

Thursday 30th January 2020 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to celebrate Florence Nightingale’s bicentenary and the World Health Organization’s Year of the Nurse and the Midwife in 2020.

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

My Lords, the Government are working with the Chief Nursing Officer for England on plans to celebrate the bicentenary of Florence Nightingale and those in the nursing professions. Plans includes supporting the Nursing Now campaign across the NHS in England. The Chief Nursing Officer is also working in partnership with the Florence Nightingale Foundation to plan many activities, culminating in an international conference organised by the foundation and the Burdett Trust for Nursing in October 2020.

[Lord Crisp (CB)]

My Lords, I thank the Minister for that reply. This year is a chance to celebrate the legacy of great nurses and midwives of the past such as Florence Nightingale, notably, but also great figures such as Mary Seacole and others in this country and elsewhere. It is also a chance to celebrate today’s nurses and midwives, and thank them for what they do. In passing, I am delighted to be wearing a piece of the new nursing tartan, designed by Scottish nurses and commissioned just last month. However, this is also an opportunity to look again at nursing and midwifery, recognising how far the professions have developed in recent years and that they perform a very wide range of roles, all with customary care and compassion.

Nurses are true health professionals in their own right, no longer handmaidens to doctors—if they ever were—and have the potential in the future to do even more. With that in mind, I ask the Minister two questions. First, what plans do the Government have for investing in training and increasing the numbers of advanced nurse practitioners? Secondly, what plans do they have for reversing the decline in community nurses, school nurses and health visitors in this country, who will play such a vital role as services move more towards the community?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important question. I am envious of his tartan and I definitely identify with his praise for nurses, who work long hours and serve the most vulnerable at the moments of their greatest need. To answer his specific questions, as part of the NHS people plan, we are committed to supporting career development for nurses, which includes supporting a diverse range of careers. An example would be the advanced practitioners within multi-professional teams. This is an important point that the noble Lord raises. We are also developing a plan for district and community nurses to work with healthcare providers, practitioners and higher education institutions. The plan will set out how we will grow the community nursing workforce, which includes mental health and learning disability nurses, and it is expected to be published later this year.

National Health Service Infrastructure

Lord Crisp Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Crisp (CB)]

My Lords, given that the NHS is seeking to shift to being a more community and primary care-based organisation, can the Minister say more about what investment is going into community and primary care in capital terms?

[Baroness Blackwood of North Oxford]

We have been looking at providing additional funding and support to councils to meet the rising demands and to continue to stabilise the social care system. We announced access to an additional £1.5 billion of funding for adults and social care, and we will be considering this further in the spending review.

European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018

Lord Crisp Excerpts

Thursday 7th March 2019 Lords Chamber

[Lord Crisp (CB)]

My Lords, some concerns about nursing were raised in the committee by my noble friend Lady Watkins. She cannot be in her place today, but I understand that those concerns largely related to the points the noble Baroness, Lady Jolly, just made about Spanish and Irish nurses who will be disadvantaged by these regulations. The Spanish nurses will be disadvantaged for the reasons just mentioned—their time in the UK will not count towards their qualifications in Spain—and the Irish nurses because, for the first time, they will have to pay a fee for registration. Could the Minister assure us that steps are being taken to do something about those two points? Both of them affect groups of nurses from different countries, but they profoundly affect us. We should remember this in the context of the fact that 33,000 EU nurses are registered in the UK.

I will also make a wider point. Health staffing is one of the most vulnerable of all the Brexit issues—particularly if no deal is put in place. I note in the regulations that there will be a review within two years. However, I suspect a whole range of unforeseen issues will arise in the short term. Could the Minister let us know what arrangements will be in place to monitor those, and what liaison she and colleagues will have with employees, employers and staff organisations to monitor and deal with the issues that arise within that period?

Health Inequality: Autism and Learning Disabilities

Lord Crisp Excerpts

Thursday 10th May 2018 Grand Committee

[Lord Crisp (CB)]

My Lords, I too congratulate the noble Lord on securing this debate, on what he said and on the very powerful points that he made, as well as his final call for equality and whether it is too much to ask. This is a really important set of issues, not just for the people we are talking about but for the NHS as a whole, as it seeks to move towards a much more personalised approach to care—and what could need a personalised approach more than the sort of issues that we are talking about here?

As everyone here has, I have received very good evidence from the different charities involved in this field, which make an enormous number of very powerful points. Of the various questions that they ask, I select three to ask the Minister. The first has already been mentioned by the noble Lord, Lord Touhig. Will the Minister confirm that an autism care pathway will be established in the way the noble Lord talked about? Secondly, will the review of the Mental Health Act that is under way look at how it works in particular for people with autism? Thirdly, I am struck by how many other health issues people with autism and learning disabilities have. I was struck by the evidence that we received—I suspect that we all received it—from SeeAbility that there are GP health checks for people with learning disability and special dental care but nothing at all for access to specialised eye care, with which an awful lot of people in this area have problems.

I conclude by speaking briefly about a personal example about the importance of the personal focus here. I have a close relative, aged 56, who has Down’s syndrome, who lives with his 94 year-old father. I have three observations to make. First, as he ages, there is less and less evidence and research about what will happen to him as he moves on into his 60s and 70s, simply because people have not lived that long so far. There is a real need here for the continuation of the research and making sure that it is of a high quality. The second point is the obvious one that quite a lot of people are living with ageing parents in this way. It is important that there is support for them.

The third point comes from a recent occasion when my relative ended up having an operation on his knee and it is about the health service staff’s understanding of the condition and how to talk to people with these conditions. I was struck that my relative would tend to agree with you if you asked a question and would try to work out what you wanted him to say. If you asked, “Is the pain worse on this side?”, he would reply, “Yes”, but if you then asked, “Or is the pain worse on this side?”, he would say “Yes”. You need to understand how to work through those sorts of issues. I was struck that the GP found this difficult, but the orthopaedic surgeon did it brilliantly. There is a real personal aspect here and it is important to have people in the health service who understand how to do that.

I finish by congratulating the Government, because I understand from a recent press release that they have established a new “golden hello” for nurses coming in at postgraduate level who are working with people with learning disabilities, and for mental health and district nurses. This is a very positive step forward.

NHS Winter Crisis

Lord Crisp Excerpts

Monday 8th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I thank my noble friend. He is right to point out that there is variation across the country. He mentions Luton and Dunstable University Hospital. It has been a pioneer of how to make sure that people coming into A&E are properly dealt with. Indeed, the £100 million that was invested in A&E services to support better triaging was based on the Luton and Dunstable model. Obviously, we need to make sure that those high standards are replicated across the country.

I will give one further example of an area where that planning has taken place. We know that there has been pressure on ambulance services and that there has been a variability of performance there. There is now a national ambulance control centre which is keeping real-time data and looking at how to manage that performance so that we can get a proper national grip on this picture.

[Lord Crisp (CB)]

My Lords, does the Minister acknowledge that 59,000 people a day going into A&E is an indicator that there simply is not enough support in the community? Can he give us any indication of how many people he thinks could have been prevented from going into A&E and causing these sorts of problems in hospitals if there were more support in the community, which would mean, for example, that people with infections were caught early and would not need to be admitted? Does he also note that a recent survey showed that one-fifth of the people in adult mental health hospitals were there simply because there was no provision for them in the community? That does not mean just social services; it means housing.

[Lord O’Shaughnessy]

I thank the noble Lord for that point. He will have experienced a few of these difficult winters when he was running the NHS. It is difficult to say what number or proportion of those 58,000 or 59,000 people could have been treated in the community. We do know that the 111 service has been successful this year, with nearly 40% of calls involving a clinical opinion keeping people out of A&E, as has primary care. It is difficult to estimate, but we know that a number of people have been kept away. Of course, there is a growing and ageing population, and that is the underlying driver of demand. On mental health, the noble Lord is quite right. We have not done enough in mental health over many years, and that is one of the reasons that it has been a priority for the Prime Minister, with a big increase in the number of mental health staff in the years ahead.

Healthcare: Spending

Lord Crisp Excerpts

Tuesday 4th April 2017 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right to point out that there are different funding systems in different countries. We, of course, have a taxpayer-funded system that is free at the point of use, which this Government are fully committed to. There are different ways of funding healthcare. However, it is worth reflecting on polling carried out by Ipsos MORI which showed that 69% of the public said they get good healthcare in the UK, contrasted to just 57% in France and 59% in Germany. That is a huge testament to the work that everyone in the NHS does.

[Lord Crisp (CB)]

My Lords, does the Minister accept that there is a real problem here? On prevention and the work that NHS England is trying to do to change the system, does he further accept that there is a need for transitional funding, not least for running services in parallel? Additional funding is needed to make the changes that need to happen.

[Lord O'Shaughnessy]

The noble Lord is quite right and he speaks with great authority on this issue. The sustainability and transformation plans are providing the changes that we are looking for. That is precisely why additional capital funding was announced in the Budget: to provide and seed that kind of change so that we can run in parallel services that we need to reduce and upscale those that we need to increase, particularly community care.

Adult Social Care: Funding

Lord Crisp Excerpts

Thursday 16th March 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank my noble friend for bringing that to the House’s attention—some might describe it as a hospital pass, if noble Lords will excuse the pun. The Government remain committed to implementing Dilnot from April 2020. My noble friend is quite right that this is not a blank sheet of paper. There have been some really important reforms over the last seven years, including the better care fund and the Care Act. In the Budget, we have more funding for the short-term sustainability of the social care system, as well as a commitment to the Green Paper.

[Lord Crisp (CB)]

My Lords, I would like to ask a question about children’s social care, where I notice there is also a problem. For example, in the last year local authority support for palliative care services for children was cut by two-thirds, and it now provides only 1% of the expenditure on children’s social care. First, does the Minister acknowledge that there is a problem here as well and, secondly, what are the Government going to do about it?

[Lord O'Shaughnessy]

The issue of children’s palliative care came up in the debate the other evening on palliative care. A review is taking place with the charitable sector of the distribution of funding, particularly for children’s hospices, over the next year. In terms of children’s social care—this may come as a surprise to some noble Lords; it certainly did to me—the fastest-growing part of the adult social care budget is for adults with learning disabilities. Of course, that often comes in at the point at which people leave the children’s social care system and the school system and move into the adult social care sector, so there is an important point about continuity from one to the other.

Hospital Beds: Availability

Lord Crisp Excerpts

Thursday 9th February 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is of course quite right about the need for more money. I re-emphasise that an additional £7 billion or more for social care is going to councils during this Parliament. Councils have the ability to raise council tax, although the leverage obviously varies from place to place. This is why the Better Care Fund was created—to provide extra help to areas that do not get the same income from council tax increases as the better-off places.

[Lord Crisp (CB)]

My Lords, a year ago, the Royal College of Psychiatrists published a report which showed that about one-fifth of adult mental health beds were occupied by people who were ready for discharge or who should not have been admitted in the first place. They were only admitted because there were no adequate facilities in the community. Could the Minister tell us what the figure is today and what is being done about mental health specifically?

[Lord O'Shaughnessy]

The noble Lord is quite right to raise the issue of mental health. I do not have the specific figure with me but I will write to him with it. We know that there has been a historic disparity between the two services. This was recognised by the Prime Minister in a very important speech she gave a few weeks ago, setting out some of the ways in which the Government are doing more on this. However, there is clearly a lot more to do.

Health Workers: Training

Lord Crisp Excerpts

Wednesday 18th January 2017 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to increase the number of training places for doctors, nurses and other health workers.

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

My Lords, on 4 October the Health Secretary announced that from September 2018, the Government will fund up to 1,500 additional undergraduate medical places each year. Reforms to the funding of nursing, midwifery and allied health preregistration training will come into effect on 1 August 2017. The reforms will enable universities to offer up to 10,000 additional training places by the end of this Parliament.

[Lord Crisp (CB)]

I thank the Minister for his Answer and welcome him to what I think is his first parliamentary Question. I am sure that the Government recognise that there is a growing shortage of health workers globally that comes about as countries, particularly in Asia, expand their workforce enormously. There is a global market and global competition for health professionals. The UK was going to be affected by it regardless of Brexit, but the uncertainties of Brexit make it worse. First, what assessment have the Government made of the scale of the risks from those two factors? Secondly, what assessment have they made of the opportunities? The UK is a world leader in the education of health professionals. What are the Government doing to help universities and others take the opportunity to train more health workers both here and abroad to meet both the UK’s and the world’s demand for increased numbers?

[Lord O'Shaughnessy]

I thank the noble Lord for his welcome. The WHO has identified a global shortage of medical staff of more than 2 million, so clearly there is a big need and, as he says, it is being driven by the development of countries, particularly those with large populations, and the need to grow their own staff. At the moment, about 25% of NHS staff in the UK come from abroad and, like all NHS staff, they do a fantastic job for us. Clearly, given the problem that the noble Lord identified, we will need to become less reliant on overseas staff, which is one reason driving our desire to increase the number of training places for doctors, nurses, midwives and others.

In answer to the second part of his question, I think something like 10 of the world’s top universities are based in the UK. We are a world leader in education; that is a great strength of ours and something that we want to continue. Healthcare UK is the government body responsible for working with universities to unlock partnerships with other countries, and there have been a number of successful examples of where that has happened.

Smoking-Related Diseases

Lord Crisp Excerpts

Wednesday 14th September 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, I, too, congratulate the noble Lord, Lord Faulkner, on his comprehensive and clear introduction to this important debate. I also acknowledge and congratulate everyone, including the Government, on the progress that has been made over recent years. But we must keep the pressure on. It is easy to think that smoking is beaten as it is relatively rare in public, but it is still very common in some parts of the country.

Most key points have been made. I will bring in only one additional point, but I will first reiterate three fundamental aspects that have already been mentioned. The first is the importance of having a tobacco control plan. The evidence is there that those countries that have one, such as Australia and Canada, do much better in controlling smoking than those such as France and Germany that do not have a strategy. Of course, a strategy is only as good as its contents, and a good strategy and a good plan are needed. The important point here is that there is evidence: local smoking cessation works, properly constructed mass media campaigns work, and the use of vaping or e-cigarettes is also important. So when will we see this strategy and plan, and will it be built properly on the evidence?

The second point, simply put, is that smoking hits poorest people hardest. As the Prime Minister said, if you are born poor you are likely to die earlier. There is evidence that 50% of that impact is due to smoking-related diseases.

The third point I will reiterate is that this is of course not an isolated subject and that stopping smoking has an impact on other diseases and on the health of people in so many different ways, including reducing stillbirths, as has already been said. The key point here is that smoking should not be treated in isolation—although smoking cessation clinics are important—but should be part of a properly integrated health promotion policy.

My single additional point is on overseas development. I was interested to see that the Public Health Minister said in December 2015 that the Department of Health had received a grant to help other countries with their tobacco control strategies and was setting up a dedicated team. This is a global problem that is still growing in many low and middle-income countries. I would be interested if the Minister were able to give us an update on this work by the Department of Health and perhaps by other parts of the UK Government.