Nursing and Midwifery: Student Applications

Lord Harrison Excerpts

Tuesday 7th February 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Earl for that question. He is quite right that continuity of care is important. That is why we have brought about these changes to lift the cap on the number of places and become less reliant on foreign nurses filling those positions. It is also the reason, as he knows and I hope would welcome, that the Government have introduced a mental health strategy and are spending considerably more on it, with a Green Paper to come later this year.

[Lord Harrison (Lab)]

My Lords, given the ageing profile of the current midwives workforce, and given that the Minister has acknowledged this and said that he will go back and re-examine the figures, is it not a perilous time to change the basis of midwives’ recruitment?

[Lord O'Shaughnessy]

The Government took the decision to change to a fee-based system precisely because a bursary-based system involves caps and only so many places can be commissioned. A fee-based system allows the cap to be removed, with the intention of increasing the places available by up to 10,000 people a year, which will increase the flow into the profession to address precisely the issue that the noble Lord raises.

Cataract Operations

Lord Harrison Excerpts

Wednesday 16th November 2016 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government what plans they have to increase the availability of and capacity to undertake cataract operations.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, clinical commissioning groups are responsible for commissioning cataract surgery for their local populations. Patients have the right to start consultant-led treatment within 18 weeks of referral for non-urgent conditions. All patients should be treated without unnecessary delay and according to their clinical priority.

--- Later in debate ---

[Lord Harrison (Lab)]

My Lords, given the recent dispiriting report from the RNIB of ever-lengthening queues and waiting times for vital cataract operations, will the Government provide more money and stop offloading it—as the Minister has just done—on to CCGs? Will they at the same time embrace innovative and new practices and initiatives by the community optical service and practice?

[Lord Prior of Brampton]

My Lords, there is evidence of variation around the country, of that there is no doubt, although overall, the waiting times for cataract treatment are no longer than for other procedures. The RNIB has identified two issues of concern: second eye operations and follow-ups. We have asked NICE to bring forward further guidance in 2017 so that there is a proper evidence base for the threshold for cataract operations. As the noble Lord referred to in his Question, we are developing opticians in the high street to help do the follow-up consultations.

Health: Diabetes and Obesity

Lord Harrison Excerpts

Thursday 30th June 2016 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government what steps they are taking to ensure that those with diabetes have adequate support to tackle obesity.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, it is for healthcare professionals to identify, in consultation with their patients, what support is needed to manage diabetes effectively. This includes people with diabetes accessing programmes to help manage their weight, eat healthily and be more active.

--- Later in debate ---

[Lord Harrison (Lab)]

Can the Minister give us a date for the obesity strategy and, when it appears, can he ensure that in the reformulation advice to the food industry not only sugar but salt and saturated fat will be taken into account? Secondly, following Brexit, can he make a statement or at least write to me about the breakdown in the research being done across the whole of the European Union with our United Kingdom colleagues to defeat obesity and diabetes, as was worried about this morning by the former research director of the European Commission on the “Today” programme?

[Lord Prior of Brampton]

My Lords, it is still our intention to announce the obesity strategy soon. Clearly, there have been other events, which may create some delay, but we will announce the strategy as soon as possible. When we do, I am sure that there will be clear recommendations on diet that will include not just sugar but saturated fats and salt. Finally, as the noble Lord knows, I am arranging for him and the noble and learned Lord, Lord Morris, to meet people from the research community to discuss the outlook for research into diabetes, and I am sure that it will include any impact that Brexit might have.

NHS: Diabetes

Lord Harrison Excerpts

Thursday 26th May 2016 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government how they intend to deal with the financial burden on the National Health Service of type 1 and type 2 diabetes.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we want to ensure that the best possible care is provided for all those with diabetes, reducing the risks of complications and minimising the financial pressure on the NHS. Preventing type 2 diabetes—for example, through the Healthier You: NHS Diabetes Prevention Programme—and improving outcomes for all those with the condition, including through tackling variation in management and care and increasing take-up of patient education, are key priorities for this Government.

[Lord Harrison (Lab)]

My Lords, given that, currently, 10% of the NHS budget is absorbed by treating diabetes, which is set to quadruple by 2035, why is it that the prioritisation of diabetes foot care has been relegated below other objectives? The vast majority of amputations —135 every week in this country—are avoidable if attended to in time. Why have in-house specialist diabetes teams not been made regular throughout the country, given that they are shown to save three times their own set-up costs? Finally, on objective 2, can we hear what has happened to the obesity strategy?

[Lord Prior of Brampton]

My Lords, diabetes is a key priority of the Government and part of the mandate that was given to NHS England for this year. The noble Lord is right—the direct cost to the NHS of treating diabetes is actually about £5 billion every year. Variation is the critical aspect that we should focus on. Whether it is foot care or the incidence and treatment of diabetes, across the country there is a huge degree of variation. The work being done with Diabetes UK on a national audit for diabetes will play a big part in reducing that variation.

Mental Health Services

Lord Harrison Excerpts

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

I think there is a general recognition that mental health has been the Cinderella service of the NHS for generations and that, within that, mental health provision for children and young people has been a Cinderella service within the Cinderella service. We are putting a great deal of resource into it. Yes, I have visited a number of mental health care trusts. We all know at first hand that the service is highly underfunded, which is why we have committed to spend this extra money on it over the next five years.

[Lord Harrison (Lab)]

My Lords, is not the underlying problem for the health service that we simply do not have the quantum of money and resources available to deal with the many challenges, of which mental health is one? The Minister will well know that diabetes, which is threatening to explode out of all recognition, is one of the others. We need more resources.

[Lord Prior of Brampton]

It is partly a question of resource, although I point out to the noble Lord that the country that spends the most money on healthcare and has the worst results is America. It is not just a question of resource. It is how we spend it as well as the amount of money.

National Health Service

Lord Harrison Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Harrison (Lab)]

My Lords, like the noble Baroness, Lady Ludford, I too will concentrate on diabetes, which absorbs 10% of the national budget—some £10 billion—which will inevitably grow as we move from the current figure of 3.5 million diabetics to some 5 million in 2025. We have epidemics of type 1 and type 2 diabetes. I report from the front; as a high-risk foot person with diabetes I attend a monthly podiatric clinic. Those lists are now being slimmed, including for diabetics. The clinic tells me that it is as worried as anything because future problems, which inevitably arise from diabetics with poor feet, will not be identified. Similarly, I stand here today because I benefit from the shoes that are made for me in Liverpool to protect my feet because of the neuropathy I have—I have no feeling in my feet. That enables me to stand here today and enables other people to be economically active. We must not contract these services, as is now happening, with delays falling upon delays.

Diabetes UK has identified that four out of 10 diabetics do not get the necessary care processes. It has identified that some 135 amputations as a result of diabetes take place every week, when four out of five of those amputations are preventable. What are the Government doing about that startling statistic? The Diabetes Think Tank also recognises that 95% of diabetic care is self-administered, and we should concentrate on this area. However, in January two years ago for some reason the Government gave up the Patient Experience of Diabetes Services survey, which had been so useful in analysing what diabetics felt about the services they received. I therefore invite the Minister, as I did when he first came in, to attend the Diabetes Think Tank, and I hope that he will be able to attend it. I commend what my noble friend Lord Turnberg said in introducing this debate, that there are enormous opportunities in sharing best practice with our colleagues within the European Union which we are about to neglect.

I finish on an optimistic note. When I was declared a diabetic in 1969, they said, “You’ll get a medal after 40 years if you survive that period”. I can now report that I have long been past the 40-year mark, but an 88 year-old type 1 diabetic has recently received the HG Wells medal—he was a diabetic—for surviving for 80 years.

Health Funding

Lord Harrison Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness raises a good question. This will be a crucial part of our consultation, which will take place very soon.

[Lord Harrison (Lab)]

Does the Minister not recognise that, as was the case in our recent debate on diabetes, wise investment in public spending on health can save billions later, not only in terms of the tragedies in the lives of people who experience suffering from something such as diabetes but also in the weight placed on the public purse to fund the health service?

[Lord Prior of Brampton]

I agree fully with the noble Lord. Early prevention is crucial, not just for diabetes but for a whole range of mental health issues as well, and prevention will remain a critical part of the five-year forward view.

Health: Diabetes

Lord Harrison Excerpts

Thursday 2nd July 2015 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government what steps they are taking to assist those with type 1 and type 2 diabetes to educate themselves about the management of the disease.

[Lord Harrison (Lab)]

My Lords, I welcome the noble Lord, Lord Prior, to the fight to beat diabetes. He is a doughty warrior, as are all my other colleagues who join me today to focus on educating all diabetics—types 1 and 2—to manage their condition better through structured education and training.

Believe you me, managing diabetes is a pain in the neck. For someone with type 1 diabetes, it means constantly estimating how many carbohydrates you have eaten and figuring out the right amount of insulin to inject while taking into account the amount of physical activity you have taken. For someone with type 2 diabetes, it means learning how to treat the condition with diet and exercise, and possibly also coming to grips with having to take medication and insulin. For everyone living with diabetes, it means being aware of potential complications that can develop. It means not only keeping a careful watch over your blood glucose levels but having your cholesterol and blood pressure checked, looking out for your eyes and examining your feet. Everyone with diabetes needs to understand what the condition means for them in relation to holidays, employment, driving, maintaining a balanced diet and being physically active.

There are currently 3.9 million people living with diabetes in this country. If this trend continues, that will rise to 5 million by 2025. The NHS already spends 10% of its budget on diabetes but the majority of that is spent on treating complications that are largely preventable through good care. But when people do not have the necessary skills and knowledge to manage their condition, their risk of developing nasty complications such as heart disease or kidney failure shoots up. Such complications are not only expensive to treat; they are devastating for the individual and often lead to early death. For example, diabetes is responsible for more than 135 amputations every week, but diabetes-related amputations are avoidable. We can do more to help people reduce the risk of developing complications that result in amputation by offering the opportunity to attend diabetes self-management education.

When I was diagnosed in 1969, I was never offered any form of diabetic education. Like many people living with type 1 diabetes, I learned over many years of private trial and error how to adjust the insulin to what I was eating. Diabetes self-management education now has an opportunity to make a marked difference to diabetes care. It enables diabetics to take charge of their own care, reduces the risk of developing complications, improves individuals’ well-being and has the potential to save the NHS money and allow valuable resources to be deployed elsewhere. Despite these clear benefits, according to the latest data published by the National Diabetes Audit, fewer than one in six people newly diagnosed with diabetes has been offered access to a diabetes self-management course. This number is lower still for all people who are currently living with diabetes.

The All-Party Group for Diabetes recently did a year-long inquiry into the low take-up of diabetes education. We found that many diabetics had never been offered an opportunity to attend self-management education. We discovered that too few such courses were commissioned across the land. In my own Cheshire and Merseyside Strategic Clinical Network, only three in 10 diabetes patients said they had ever been offered access to a programme.

Even when diabetes education is commissioned, barriers arise. Too many GPs are lukewarm in encouraging patients to attend these education courses. Information about participating in them is too scarce, so patients do not always understand the benefits. Another barrier is that even where there is diabetes education, there are simply too few courses offered, so the newly diagnosed diabetic does not get on to the course in the first place, and thereby benefit. Other barriers include having the wrong places to meet for such courses or long periods of time off work. Could the Minister look into whether more corporate social responsibility might be taken, to the advantage of the firms involved, to encourage diabetics to take these courses as time off work to improve not only opportunities for themselves but the contribution they make to the firms they are involved in?

However, there is substantial evidence that these barriers can be overcome and uptake rates can be increased. The Health Foundation’s work on person-centred care and diabetes has demonstrated that in helping people help themselves, we can improve the monitoring of diabetics so that they self-monitor blood glucose levels, take appropriate medication and go for regular eye examinations. Its Co-creating Health programme showed how self-management support programmes have helped to improve the knowledge, skills and confidence—collectively known as patient activation—of people in managing their own condition. Diabetes UK has also outlined a series of strategies that are being used across the United Kingdom to dramatically improve the number of people attending. How does the Minister respond to what Diabetes UK has done?

Access to diabetes education is a real problem for everyone, but particularly children. We have programmes such as DAFNE for type 1 diabetics and DESMOND and X-PERT for type 2, but they are not tailor-made for children. Can the Minister say a little more about that and the carers involved? If a mother needs to inject a baby or a child, that produces potential psychological problems. We should be running education courses for carers as well, in my view.

We would also advocate education for healthcare professionals, who too often do not fully understand the opportunities that arise, especially when new technologies appear. Again, will the Minister address that in his reply? Is there also a role for pharmacies? I have found that one of the most useful places to get information on treating my diabetes is from the very helpful Morrisons pharmacy in Chester. Can we take opportunities such as that?

A big worry I have, which I hope the noble Lord might address, is that I do not know whether the very useful Patient Experience of Diabetes Services survey will persist. I understand that Jane Ellison, the Public Health Minister, is looking at it, along with the national clinical audit. Someone wrote to me recently following the diabetes think tank to say:

“At a time when we know the resources are tight, it is a crime not to capitalise, through patient education, on the biggest resource we have—the patients themselves”.

I wonder whether the Minister might reply to that.

I conclude by saying that we need to improve the outcomes for all people with diabetes and to reduce the cost to the healthcare system. Will the Minister explain how NHS England plans to deliver on its promise, made in the five-year forward view, to support people in managing their own health and to invest in self-management education courses? Will he commit to setting up the necessary infrastructure and governance arrangements to do that?

It was a great loss when Adrian Sanders, the former chair of the All Party Group for Diabetes, lost his seat at the last election. He told us that he had two constituencies: the one he lost at the election, and all the diabetics throughout the country. He served them well, and the Minister can do the same.

NHS: Maternity Care

Lord Harrison Excerpts

Thursday 5th February 2015 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government what steps they are taking to improve maternity care and to ensure that maternity staff are trained and developed to meet future needs.

[Lord Harrison (Lab)]

My Lords, today, we call the midwife. We do so in England and Wales, and I am particularly indebted to the National Federation of Women’s Institutes for bringing to my attention its excellent report, Support Overdue: Women’s Experiences of Maternity Services.

My adult children’s contemporaries are now growing families. In chatting to one new mother and friend of the family I learnt that her experience of childbirth was unsettling, to say the least, and her anxieties find all too ready an echo in the WI report. The report highlights that 700,000 women give birth each year in England and Wales. Indeed, that is the single biggest reason for admission to hospital. Midwives play the crucial role of setting families on the right path, from pregnancy through to birth itself, and then shape the first few weeks of family life. The report highlights shortcomings, which I will examine, while it readily acknowledges that mothers in England and Wales enjoy some of the highest quality maternity care in the world.

Choice of location of birth still remains an aspiration, not a reality, for many women. For too many women the choice of the four standard location options is a chimera. Thus the Government’s pledge to deliver choice in NHS maternity is defaulted on.

Secondly, maternity care is still fragmented; it is still a long and bumpy road that a woman treads from preconception through to pregnancy, birth and postnatal care. Thirdly, despite the best efforts of NICE, a postcode lottery for postnatal care remains, with wide variations in quality and standard of care across the country. Too often when we call the midwife, she is not there. Despite an increase in the birth rate of some 15% over the past decade, we still fail to provide the promised 1:28 midwife to birth ratio keenly advocated by the four royal colleges involved in midwifery. Despite the recent baby boom, some 50 trusts and boards even now employ fewer midwives than they did previously, which is astonishing. Call the midwife. Unfortunately, some 34% of women complained that they were not given the name or number of a dedicated midwife they could phone if worried or wanting advice. Surprisingly, some nine out of 10 women had not met any of the midwives who cared for them at the time of labour and birth before going into labour. Some 30% of mothers urgently wanted the designated midwife to,

“remain responsible for my care (not pass me on to someone else)”.

Call the midwife—but only one in 10 mothers had the full four choices of where to give birth, a promise unfulfilled in part because we have trained too few midwives. Matters are beginning to look up as more trusts and boards are promoting and expanding location options by building new, freestanding or colocated maternity units, or funding home birth services. Can the Minister update us on offering the full four locations, and give us figures on the provision of complementary services, such as birthing pools and partner accommodation? Can he give us up-to-date figures on the worrying incidence of temporarily closed units or suspended maternity services attributable to staff shortages and capacity problems due to unavailable bed space? Why do only one out of two women obtain the desired home birth?

Finally, three out of five mothers want more not less postnatal care, but a quarter of mothers were unable to call the midwife to fix up appointments convenient to themselves, as new mothers deal with the baby. Will the Minister ensure that CCGs develop transparent frameworks for postnatal care? We all know how crucial the transition to parenthood is for new mums and dads—and, please, do not forget the dads. Can the Minister respond to the Support Overdue report by the WI, and say which recommendations the Government might take up?

Furthermore, are maternity health planners taking into account the wider health needs of women during pregnancy? How is the midwife’s crucial role of influencing new mothers’ lifestyles being supported and expanded? Is the pivotal role of the supervisors of midwives being protected? Too often these valuable personnel are used to cover up midwife shortages, instead of supervising their charges. When will we fund and ensure one-to-one maternity care, surely the crucial relationship in any happy birth? Has the troubling and outmoded use of handheld notes and paper records to give vital information on risk status during birth been eliminated? I would be grateful if the Minister could update us and respond to the 2013 State of Maternity Services report published by the Royal College of Midwives.

The Government have funded the increase in midwives begun by the previous Labour Government, but it is worrying that the midwifery workforce has not kept pace with the rising number of births in the last decade, and worrying that the marked ageing profile of the current cohort of midwives threatens real instability to future maternity services as experienced midwives leave in droves. Student midwives’ recruitment stalled in 2014, and even though the baby boom has now paused, the RCW calculates that births still need to fall by some 130,000 before we can satisfactorily match midwife numbers to the current birth rate.

I turn to the findings of the National Audit Office report of these services, and ask whether there is a reply from the Government to the concerns of the Commons’ Public Accounts Committee. Should the department not more rigorously assess whether it can afford to achieve its declared policy objectives? Indeed, are the current tariffs for maternity care set at the right level? What is the Government’s view on the finding that many efficiencies and savings in the service could be found and implemented if more midwife-led birth centres were established, as set out in the Birthplace in England study by NICE?

The PAC also points out that still too few women secure the birth location of their choice. Local maternity networks are an important route to share and spread best practice between and within networks, thereby improving quality and helping to eradicate unacceptable variations across the country. Does the Minister accept that current maternity networks are less well developed than other NHS networks? What can he do about it?

I am pleased that the noble Baroness, Lady Manzoor, will speak on mental health services for pregnant mothers. Indeed, I hope that other colleagues and maybe the Minister will pursue other aspects of maternity services that I do not have time to turn to, including maternal mortality rates and their breakdown into socioeconomic groups, perinatal deaths and the comforting of mothers suffering still births, the availability of hospital beds, the screening of babies for debilitating diseases, and data collection in maternity services, which is crucial in developing policies.

Will the Minister say more about pay, which has been frozen for midwives since 2011 and 2012, with just a 1% rise in 2013 and frozen again in 2014? This is an important recruiting angle that needs to be prized. Will the Minister confirm that in future the Government will listen to and implement the recommendations of the independent pay review body?

In my final minute, I turn to the European Union and ask the Minister whether there is sharing of practice across the EU. If it stands for anything, the European Union is the swap shop of ideas, which the National Health Service should be involved in—and nowhere more than in maternity services.

Finally, are we doing anything to recognise the wonderful nurses who go out to deal with the Ebola problems that have been experienced, and are we doing more to share the best practice with other parts of the globe, where improving maternity services is so crucial to getting a better world?

I look forward to the debate and hope that the Minister will be able to reply to some of those points and to write to me on those that he does not have time to cover.

Health: Midwives

Lord Harrison Excerpts

Tuesday 22nd July 2014 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government what is their assessment of the sufficiency of midwives in the United Kingdom.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, we are committed to improving maternity care and have charged Health Education England with ensuring that staff with the right skills are being trained and developed to meet future needs. Between May 2010 and March 2014, the numbers of full-time equivalent midwives increased by more than 1,700 and over 6,000 are in training. Health and social care is a devolved matter and the responsibility of individual devolved Administrations.

[Lord Harrison (Lab)]

My Lords, what are the Government actively doing to retain experienced, longer-serving midwives at a time of recruitment shortages? Why is it that, according to the National Federation of Women’s Institutes, only one in eight mothers giving birth is helped by a midwife known to her?

[Earl Howe]

My Lords, we attach great importance to choice in maternity care and, in particular, to each mother having a named midwife throughout the care pathway. That is what we are aiming at and what NHS England and Health Education England are charged with delivering. As regards the age profile of midwives, my advice is that there is not a particular age bulge, although we are keen to ensure that we do not lose qualified midwives who, clearly, we can ill afford to lose. However, we have made a commitment to ensure that the number of midwives in training is matched to the birth rate and, so far at least, we have been successful in that.