National Health Service: Key Targets
Lord Hunt of Kings Heath Excerpts(5 months, 1 week ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Markham (Con)
Funnily enough, I had this conversation in terms of productivity just today. The virtual wards—the 11,000 extra beds we have put in—are actually making a real impact on that, because of course it is much better that people can be treated in their own home, knowing they have the comfort of these virtual displays and treatment to look after them. We have 11,000 extra beds, with 72% utilisation, and, yes, it is really working.
Lord Hunt of Kings Heath (Lab)
My Lords, the Minister keeps talking about progress being made, but if he looks at, say, the four-hour A&E target, he knows that the latest figures show that the NHS reached only 69% in December. In 2010, his party inherited a performance of 98.3%. What does he think that says about his party’s stewardship of the NHS?
Lord Markham (Con)
I can talk about what we are doing now, which is showing real progress. But I have to say that the saying “People who live in glass houses shouldn’t throw stones” comes to mind, because, looking at those same targets, I notice that the Labour-run NHS in Wales never reached the four-hour A&E target; the last time it hit the 62-day cancer target was in August 2010, 14 years ago; and the last time it hit the hospital treatment target was in August 2010. I say politely that the noble Lord might want to get his own house in order first.
NHS Winter Update
Lord Hunt of Kings Heath Excerpts(5 months, 2 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Markham (Con)
I thank the noble Baroness for those points. Absolutely, I will need to come back on some of the detail on the virtual wards and how they are being used. One thing I will say about them, though, from my knowledge, is that the ability of people to communicate on a regular basis is one of the key advantages. On the point she makes about palliative care and the ability to have 24/7 communication, the beauty of the virtual wards is that they have that inbuilt, for want of a better word—they have that advantage. As noble Lords know, I am always eager to learn from practices all around the world, so I will very happily meet people and learn from them.
On retention, absolutely, we all know that the supply of doctors and medics is the key thing that we need, so I personally feel that we need to look at every avenue to make sure that we can maximise that supply. Again, it is something that I will inquire into as a result of that, and maybe when we have our meeting we can discuss that further.
Lord Hunt of Kings Heath (Lab)
My Lords, I too thank the Minister for the Statement and his response, but it takes the biscuit in terms of the Government really seeking to exploit the plight of the NHS by putting so much emphasis on the industrial action being taken. As the noble Lord has said, even before Covid the Government were way off meeting any of the core targets. In 2010, they inherited a health service that was running very well and met all the targets. They threw away that inheritance. When Covid hit, the health services were already running so hot that there was just no headroom at all to cope with the pressure that then came, with—my noble friend is right—hugely dangerous occupancy rates. There was simply no headroom.
Looking at the funding, from 1948 to 2019-20 the NHS received funding of 3.6% real annual growth, on average, per annum. The coalition Government slashed it to 1.1%. The May and Cameron Governments gave it 1.7%. Only with the Covid expansion were resources over that 3.6% average. It is no wonder that the health service is tackling such a momentous challenge. We need to hear from the Government some real plans to get investment back in the health service, to give it the kind of headroom it needs to start meeting the targets that are so important—would the Minister agree?
Lord Markham (Con)
I happily agree that we are investing record sums. The latest figures show that we are investing around about 11% of GDP in the National Health Service. I believe the figure in 2010 was somewhere in the 7% to 8% range—I am speaking from memory and so I will correct that if it is not quite right, but that is the sort of massive expansion we have seen. If I take one area as an example, the cancer workforce has trebled since 2010.
What we are seeing more than ever is a record level of investment in the health service but also a record level of demand. I was hoping to show in the Statement how we are looking to tackle that. I will freely admit the challenges, and that it is early days, but I believe we are showing signs of getting on top of it. As I have said many times, I really think that technology will be its future, and there will be lots more we can talk about when we show the profound changes it is going to make.
Adult Social Care: Staffing
Lord Hunt of Kings Heath Excerpts(6 months, 2 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Markham (Con)
We have tried to adopt a balanced approach here. While we all understand the necessity in the healthcare sector, I think most of us would agree that 750,000 net migration is a very high number. The balance we have struck is to protect this sector. Our figures generally show that we will be able to keep the recruitment coming. We are now moving on to part 2 of the reform, through the other things we are doing, particularly around qualifications—we know that people who are qualified are far more likely to stay in a social care setting. That is what the whole investment is about. It will be rolled out next year and will fund hundreds of thousands of places. I think it will make a real difference to the motivation, recruitment and retention of staff.
Lord Hunt of Kings Heath (Lab)
My Lords, to respond to the right reverend Prelate’s question, if I may, the Migration Advisory Committee has said that the reason we recruit so many people from overseas is poor terms and conditions in social care. The Government set the market for social care, through their poor funding of local authorities. When will they grasp the nettle and realise that we actually have to give care workers decent pay and conditions?
Lord Markham (Con)
It is absolutely understood that, to have a highly motivated workforce, you need to look at everything—pay and conditions, and training and motivation. We see that while, on average, staff turnover is almost 30%—which is way too high—about 20% of care home providers have a turnover of less than 10%. Why is that? It is because they are investing in their staff and they have a training programme. That is why we are trying to do a similar thing. The national care certificate that we are putting in place will take time; for it to be valuable, we will need to put the right things in order, including the digital platform to pay the 17,000 providers. These are all parts of the reform, which will make a difference.
Organ Donations
Lord Hunt of Kings Heath Excerpts(6 months, 2 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Hunt of Kings Heath
To ask His Majesty’s Government what assessment they have made of the impact on organ donations of the Organ Donation (Deemed Consent) Act 2019.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very glad to have tabled this Question for Short Debate. I was honoured to take through the House my Bill, which became the Organ Donation (Deemed Consent) Act in 2019. In the year before the Bill became law, over 400 people died while waiting for a transplant and a further 755 people were removed from the transplant list as they were just too ill to receive a transplant. The Act aimed to increase the number of organ donations and save more lives.
The Policy Innovation Research Unit at the London School of Hygiene & Tropical Medicine is undertaking an evaluation for the Government on the implementation of the Act. It described the situation we have as a “soft opt-out” system, where it is presumed that people are happy to donate their organs after their death unless they have indicated otherwise or registered their decision to opt out. The principle behind the Act is simple: decisions not to donate should rest with individuals to make during their life, and families should not be able to make decisions on their behalf after they have died. The question is: has the Act made an impact?
My understanding is that there were just under 7,000 patients waiting for a transplant, with a further 3,800 temporarily suspended from the transplant list, at the end of March 2023. In 2022-23, 439 patients died while on the active list waiting for their transplants, compared with 429 in the previous year. A further 732 were removed from the transplant list, mostly as a result of deteriorating health and ineligibility.
NHS Blood and Transplant reported that:
“In 2022/23, there was a 2% increase in the number of deceased donors … and the total number of patients whose lives were potentially saved or improved by an organ transplant increased by 5%”.
Worryingly, its evaluation of opt-out legislation in England observed a consent rate of 61%, which was lower than the predicted post-legislative opt-out consent rate of 78%. We can conclude that, in England, while there has been a little progress, there is no evidence of significant change in consent rates in the initial years after implementation.
So what has gone wrong? I want to identify six issues. The first is whether the NHS is geared up to respond to higher deceased donor rates, if we can get them. The second is whether we have enough specialist nurses. They have the extremely difficult role to play of initiating discussions about potential organ donations with families, at a sensitive time. The family is still always involved in those discussions, but we know that investment in transplant co-ordinators is often cited as one of the key factors for Spain’s world-leading organ transplantation service. The third issue is whether we have a strong enough communications strategy. The Government committed £18 million to this but, in essence, Covid got in the way. It seems to have been left to patients themselves and the charities that support them, such as Kidney Care UK, to raise awareness of the Act.
The fourth issue is bureaucracy. While the Act covers some elements of deceased donation, it excludes less common organs, tissues and research. There are now multiple pieces of legislation and consent systems working in parallel, which provide a confused picture for those trying to operate the transplant service. The fifth issue is that there clearly needs to be a lot of work done to reverse the poor donor participation affecting patients with ethnically diverse backgrounds. Finally, we need to think further about the role of families. Although families no longer have a veto in law on organ giving, in practice they are still influential. This contrasts with other countries where opt-out systems are in place, where there tend to be fewer families vetoing the organ donations of their loved ones.
In advance of the evaluation that the Government commissioned, three reports have identified and looked at some of these issues. The first was that of the All-Party Parliamentary Group on Ethnicity Transplantation and Transfusion. Its recent report highlighted how the lack of donor participation affects patients with ethnically diverse backgrounds. It reports that a patient’s chance of surviving diseases such as blood cancer, and chronic conditions such as kidney disease, is heavily swayed by their ethnicity. On average, those of mixed heritage and from ethnic-minority communities wait longer for diagnosis and for the best donor to be found for their treatment. The APPG says that its key discovery is how hard it is to get sound data and what little progress has been made on this. The APPG thinks that our healthcare systems do not record ethnicity with the consistency or granularity necessary to be clear about the gaps in need and outcome of treatments.
Kidney Research UK echoed this in its 2018 report on the health inequalities of kidney disease, which found that people from ethnic-minority groups waited between 168 and 262 days longer for a kidney transplant than Caucasian kidney patients. I find that both remarkable and utterly unacceptable; think of the impact that must have on the life chances of those people waiting, on average, much longer for a transplant.
Coupled with that, Kidney Research UK pinpointed in a recent health economics report that demand for kidney transplantation could be as high as 12,000 per year by 2033. In the UK, the current levels are around 3,000—we have an awful long way to go there.
I will mention a final report produced last month by the Cystic Fibrosis Trust, which stated that organ utilisation is a key issue affecting transplant rates in the UK. It pointed out that in 2022-23 only 15% of donor lungs offered for transplantation were utilised. It also pointed to a February 2023 report by the Organ Utilisation Group—I believe Ministers have looked at it very carefully—which highlighted the unwarranted variation in practice between organ types and transplant units contributing to disparities in more general access.
I put the following questions to the Minister. First, is he satisfied that NHS Blood and Transplant and NHS trusts are putting sufficient priority into work on organ donation? Is NHS Blood and Transplant far too risk averse? Has it struggled to adapt to a soft opt-out programme? It looks to me as if it has continued to operate on the basis that the family needs to give consent. Secondly, does he think enough resources have been put into the programme? I particularly have in mind the specialist nurses who are the key professionals in the service in terms of relating to families, alongside transplant services themselves. Do we have continuous communications campaigns and, if not, should we not be prepared to invest some resource in stepping that up? Around that is the message of individual choice; is the choice to donate organs and tissues sufficiently clear to the public?
As patient support charities, including Kidney Care UK, are working across all regions to increase awareness and encourage those vital family conversations about organ donations, can we give those organisations more support?
Is the Minister satisfied that NHS Blood and Transplant is really grasping the opportunities that having an opt-out law can bring to increasing public awareness? During the progress of the Bill, I received huge support from its medical director. He came to briefings very enthusiastic about getting rates up, but I do not get that sense of enthusiasm from the organisation any more. Is it fully committed to taking advantage of the legislation?
Finally, are the Government cognisant of some of the issues that bureaucracy is causing?
I very much welcome this debate and look forward to hearing other contributions.
Sexually Transmitted Infections
Lord Hunt of Kings Heath Excerpts(6 months, 3 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Markham (Con)
The figures are slightly misleading because, of course, that was in comparison to a Covid year, when there was much less testing. In fact, if you look at it versus pre-pandemic figures, the numbers are 16% down compared with 2019; that is the real comparison we should look at here. At the same time, I think we would all agree that £3.5 billion is a big investment in this space. It has gone up slightly over the past year but, as I mentioned earlier, education is also key in this space.
Lord Hunt of Kings Heath (Lab)
My Lords, can we come back to the issue raised by the noble Lord, Lord Black: whether community pharmacies could play a bigger role in relation to PrEP? Does the Minister accept that, although there is much that community pharmacies could do, they face a fundamental financial crisis at the moment, with many going out of business? Will the Government accept that they are going to have to give more support to community pharmacies for them to do the kind of things that the noble Lord is asking for?
Lord Markham (Con)
Yes. I believe that there is a real win-win possibility here, where we can get more services through Pharmacy First—obviously, that is good for primacy care access—and give further support to pharmacies. I was having this conversation just this morning. We made contraception available through pharmacies in April 2023; we will get the results of that back shortly. Things such as sexual health and PrEP are absolutely what we are looking at.
National Health Service: 75th Anniversary
Lord Hunt of Kings Heath Excerpts(6 months, 4 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Hunt of Kings Heath
That this House takes note of the 75th anniversary of the National Health Service and its performance in waiting times.
Lord Hunt of Kings Heath (Lab)
My Lords, I refer the House to my membership of the GMC council. I was privileged to lead a debate 25 years ago in your Lordships’ House to celebrate the 50th anniversary of the NHS. My noble friends Lord Brooke and Lady Pitkeathley spoke in that debate, and I am delighted that they are speaking today—they are great survivors.
In 1997, the Labour Government inherited an NHS in crisis, with low morale and long waiting times. I was privileged as a Minister to contribute to a complete revival of the service’s fortunes. I pay tribute to my colleagues, to the right reverend Prelate the Bishop of London, who played a pivotal role as Chief Nursing Officer, and to my noble friend Lord Prentis, who took up the post of general secretary of UNISON at a very important time in the turnaround in the service’s fortunes.
The NHS plan of 2000 was a programme of huge vision: 100 new hospitals built; major investment in the workforce and an agenda for change; new services such as NHS Direct and walk-in centres; maximum 18-week waits for elective treatments; maximum four-hour waits for A&E; patients were actually able to see their GP. In 2010, the British Social Attitudes survey showed satisfaction with the NHS at over 70%, the highest rate it has ever recorded. Today, satisfaction has plummeted to 29%—the lowest figure ever recorded. The main reasons for this dramatic drop are waiting times for GPs and hospitals, staff shortages and lack of government spending.
How did the coalition and then the Conservative Governments throw away such a brilliant inheritance? The evidence is very clear: austerity was to blame, based on a small-state ideology and introduced just as the economy was recovering to a 2.2% growth rate in 2010. Growth was killed off by the coalition Government, who devastated public investment. The huge social cost of this self-imposed harm is plain to see. By 2020, poverty in working families had reached a record high. Life expectancy increases stalled for the first time in this country in 100 years. In 1952, the UK had the seventh-highest life expectancy at birth in the world. OECD data shows that, by 2020, it had fallen to 36th.
Austerity targeted local government the worst. It had a huge impact on adult social care and, today, has left half a million people waiting just for an assessment, let alone any support. We now have the prospect of the Home Office wanting to restrict care workers coming from abroad by increasing the salary requirement and restricting dependants. The obvious solution—to pay care staff more—is not viable because, as Juliet Samuel wrote in the Times this morning, the same Government are the care sector’s main customer and will not pay up. You could not make it up.
The NHS has been through the longest financial squeeze in its history. Its annual growth from 1948 to 2019-20 was 3.6%, but under the coalition Government dropped to a miserly 1.1%. Any increased funding that came post Covid has been eroded in real terms due to high inflation, resulting in a very stretched NHS. It is no wonder waiting lists are now a record 7.8 million people. In 2022-23, only 56% of those attending A&E were admitted, transferred or discharged within four hours, compared to 98% in 2010.
What has the Government’s response been to all this? First, we had the costly disaster of the Health and Social Care Act 2102, which enforced a wasteful market on all clinical services, disrupted collaboration and the integration of services, and cost millions of pounds. Earlier this week, the Minister was here bringing in a regulation to get rid of the whole wretched thing. We also had a former Prime Minister’s pledge on 40 new hospitals, which was exposed as a deceit early on. Even the current Prime Minister some time ago, in one of his many pledges, promised to cut NHS waiting lists, but that has been downgraded because NHS leaders have been told to prioritise controlling costs. Up and down the country, the NHS is stopping schemes to cut waiting times because it cannot get the funds; for instance, for new equipment to increase productivity.
The NHS has faced two major periods of crisis in its history. The first was in the early 1990s and the second is now. The common cause is a long period of Conservative government. We fixed it last time and we can do it again, but it will be tough. As Paul Johnson from the IFS commented after the Autumn Statement,
“a combination of high spending on debt interest, low growth, and the demands of an ageing population mean that there is little scope to increase spending on hard-pressed public services … growth is the only way out of this”.
But this Government’s dismal performance offers little hope of that. Interest rates are set to remain high according to the Governor of the Bank of England who, two days ago, said that the UK economy’s potential to grow is
“lower than it has been in much of my working life”.
How do we go forward from here? We need a Government who will drive through a huge modernisation programme. Inescapably, funding will have to keep pace with demography and technical advances, but we also clearly need to get the most out of every pound we spend.
Data from the Office for National Statistics reveals that more working-age people are self-reporting long-term health conditions, with 36% saying that they have at least one. The case for investing health resources to get those people back to work is convincing and ought to appeal to the Treasury. Wes Streeting has suggested that we also need cultural change which gives local services much greater freedom to reform and to try new and different ways of providing healthcare while embracing the latest technology. This is really important: productivity will not be improved by beating a big stick so, please, we do not need any restructuring, crony contracts, wasted payments on management consultants, rip-off outsourcing or agency bills—all characteristic of the current Government’s approach.
The NHS needs to plan with multiyear revenue settlements, and it needs investment in capital. We are years behind other countries in investing in capital. The result, as the NHS Confederation reported this week, is a less productive service, still hampered by
“Victorian estates, too few diagnostic machines and outdated IT systems”.
We need system reform. Primary care is overstretched, with too many patients ending up inappropriately in A&E. Planned treatments get cancelled as a result. Patients’ conditions deteriorate and hospitals then find it difficult to discharge them, owing to pressures on adult social and community care. Add in mental health demands and it is no wonder the system is falling over, but we need a whole-system solution to deal with that problem.
Ministers are fond of talking about integration but, for patients, the experience of seamless care between primary, secondary, tertiary and social care is a distant dream. We also need to take advantage of our fantastic science base, and our pharma and medical technology sectors. The problem is that investment in R&D and clinical trials has dipped. We must get that back and ensure that the NHS adopts the innovations being made in this country to get the advantage to patients and improve productivity. This is key to what we have to do in the future.
Our workforce is all important. The Institute for Government was absolutely right in arguing that an improved approach to setting pay, workforce planning and enhancing working conditions would help to reset the relationship with our staff and start to resolve recruitment and retention problems. We will have to pay particular attention to the lowest-paid staff and try to align social care staff more to NHS terms and conditions.
We know that there is a huge demand for healthcare professionals globally. It is very unlikely that countries’ demands will totally be met, so we have to look at the smart use of AI and technology to liberate clinicians from the clunky and frustrating IT systems found littered across the NHS.
We need a stronger preventative process to reduce health inequalities and improve life expectancy. We need social care to be given a fundamental boost. Do your Lordships remember that Prime Minister Johnson promised to fix social care? That went well. As a minimum, every vulnerable person should expect an assessment and some form of care and support. In the long term, we have to end the lottery of care which leaves many people who are above the means-tested level none the less struggling hugely to pay care home fees.
Primary care also needs a reset. I commend Sir John Oldham who, under the last Labour Government, did fantastic work in helping GPs to improve their effectiveness. Primary care has to become a place again where GPs want to work and where if patients want direct access to their GP, they can get it.
There must be no delay in bringing legislation to reform the Mental Health Act 1983. The failure of the Government to bring the Bill before us because it is not a measure that would show a gap between them and us is deplorable. That Bill has consensus support and was produced by an expert. We know the way forward, but it has been delayed yet again. I commend a report, A Mentally Healthier Nation, which was recently signed by dozens of organisations with an interest in mental health. It sets out a fantastic programme for better prevention, quality and support.
Finally, I will mention the people who I represented for a lot of my earlier life, when I did proper jobs—NHS managers and leaders. If we are serious about an improvement agenda, can we stop disparaging those people? Can we stop false economies by restricting the number we invest in and start to invest properly in their training, support and development? Amanda Pritchard, the chief executive of NHS England, gave evidence to the Health and Social Care Select Committee only a couple of weeks ago in which she talked about the patchiness of giving those crucial people the kind of support they need to do the jobs that need to be done.
I am grateful to so many noble Lords for taking part in our debate. I am convinced that, with drive and determination, we can turn the NHS around. Wes Streeting has described his reform programme as having three aims: hospital to community, analogue to digital, and sickness to prevention. They sound about right to me. Despite the Government’s dismal record, austerity funding and attacks from the right, the NHS’s founding principles—being comprehensive, free at the point of use and tax-funded—remain in place.
In ending, I think it is appropriate to give the last word to Nye Bevan, founder of the NHS. He said:
“The NHS will last as long as there’s folk with faith left to fight for it”.
There are plenty of people prepared to do that. I beg to move.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I would like to start by giving our side’s condolences to the family of Alistair Darling. I echo the points on him made by the noble Baroness, Lady Merron. The noble Lord, Lord Brooke, talked about the cross-party working. Alistair Darling was one of those people who, while clearly a Labour politician, approached things in a very objective, cross-party manner. I know he will be missed by all of us.
I thank the noble Lord, Lord Hunt, for tabling this debate, which has been fascinating. It started off with a very informed and fascinating history of the NHS from my noble friend Lord Lexden, which enshrined the point that the noble Lord, Lord Allan, made: it has given us all that wonderful freedom to go to bed at night and feel secure, and to make life choices about where we work and who we live with without that being a worry. I agree with the basic premise that that is the duty of any Government.
I am also kind of—I am not quite finding the right words to say, but I was really marked by the point that the noble Lords, Lord Hunt and Lord Brooke, and the noble Baroness, Lady Pitkeathley, were at the 50th anniversary and took part in these conversations. That is quite humbling, particularly since I found out, strangely enough, that I am currently the longest-serving Health Minister. I am not sure that I will make it to the 100th anniversary, but I will take the advice of the noble Lord, Lord Prentis, by trying not to walk in the middle of the road and get hit. If I do make the 100th, I will definitely follow the idea from the noble Lord, Lord Dubs, of having a party.
I welcome the debate. While I will try to answer the points raised, given the 75th anniversary, and as others have mentioned, it is important that we try to make this forward-looking and look at the innovation agenda, which the noble Lord, Lord Hunt, and the noble Baroness, Lady Taylor, mentioned.
I will also address squarely and up front the funding point, which was mentioned by the noble Baroness, Lady Crawley, and others. Rather than only putting a nickel into this, we are putting in 11% of GDP—by far the highest amount in history. Tony Blair has been mentioned a lot. I well remember the Wanless review in the early 2000s, which talked about increasing the spend to about 8%—my memory might not be quite right, but it was about 8% of GDP. I do not think that anyone would say today that 11% does not absolutely show our commitment.
It is comparable to all other European countries. In fact, there is only one country in the world which has a significantly higher spend: America. I want to put that record level of investment on the record. As many have mentioned, it is of course important that we allocate that and use those resources as well as possible. I was very struck by the points that the noble Baroness, Lady Tyler, made about the productivity conundrum, so to speak, and those that the noble Lord, Lord Drayson, made on the technology agenda and innovation. I hope to address some of those points a bit later.
I put all this into the context of our knowing today that a digitally mature trust will be 10% more efficient. We have done quite a bit of work on this; it will be 10% more efficient than other trusts in its output and efficiency. Since a few people mentioned the new hospitals plan, I should say that we know that a new hospital where you unite the best in technology with the best in physical real estate will be 20% more efficient in its output. That is not just in productivity; more importantly, probably, we are also seeing a 20% reduction in the length of stays. The one statistic that has impressed me the most, as I have gone around in the year or so that I have been in this job, is that for every week a patient spends in hospital they lose another 10% of their body mass if they are elderly, so their ability to go home—back to the normal environment—degrades day by day.
We have been talking about what we are trying to do with the technology agenda and the new hospitals programme, but we are all here because we care about patient care. That is vital. We all want people to get back into their home environment sooner. We all know that the problems often come when you are locked in for too long. Then you need a social care space and can get into the downward spiral that we all know about.
As someone actively involved in the new hospitals programme, I assure everyone that there are action steps happening on all 40 of those new hospitals. They are all very real. I will happily talk to anyone about any of them if they should wish it, and show them my photos from visits to many of them as well.
The noble Baroness, Lady Donaghy, made a very good point: often, it is the short cycles which are hard. One thing that has not been spoken about very much, but was very much part of our new hospitals plan and the announcement in May, was our moving to five-year capital cycles. That will be really important for that long-term planning; work is going on as we speak around having 25-year to 30-year capital cycles.
I am trying to address the points raised. The noble Baroness, Lady Merron, understandably mentioned the waiting lists, as others did. Obviously, that is an area of concern but we have made good progress in the area of two years and are making good progress in the area of 78 weeks. We are focusing on those areas where there is the most impact. Undoubtedly, industrial action has impacted this, which is why I think we are all pleased that we now have a likely deal with the consultants. I am hopeful that it will extend to the junior doctors as well, but we have been working hard on that. We are trying to get on top of it: in terms of supply, there are the 130 CDCs with their 5 million tests. There is also the use of technology, such as patient choice with the app and the FDP, and we will see big improvements in what that does.
Through all this, we have been talking about the 13 years in which Conservatives have been in charge of the NHS in England. Of course, there have been 25 years that one party has been in control in Wales. I noticed that no mention has been made of Wales. While none of us is happy with the waiting lists, I know for sure that they are a lot better in England than in Wales.
I turn to the 62-day backlog for cancer. We all know that time is of the essence in cancer. We are seeing a 27% reduction in that backlog since 2020 and a record level of referrals; we are treating 12,000 people per day. We are starting to hit the 75% target of diagnosing people within 28 days. To put this into context, we are treating 32% more people for cancer than we were prior to the pandemic. We know that fast diagnosis is key.
One of the key differences in inequalities in life expectancy, as raised by the right reverend Prelate the Bishop of London, is lung cancer. Of the nine-year disparity, one year is caused by lung cancer. That is why we have things such as mobile screening, which we take on the road to areas where lung cancer is most prevalent—for example, in some of the mining communities. Rather than the majority of people with lung cancer not being found until stage 4, when it is too late, in the areas where they have been doing this we are finding the majority of people in stage 1 or 2. That is so much better in terms of life chances. That is how we will achieve the target of detecting 75% of cancers by stage 1 or 2 by 2028. To give some context to that, we estimate that it will mean that 55,000 more people will be surviving as a result by then.
There has also been talk about waiting times for ambulances and A&E. While they are too high, I am glad to say that they are improving. We have been making sure that we have learned lessons. We are taking action for this winter by increasing supply, with 800 new ambulances, 5,000 more beds to increase capacity and the 10,000 virtual ward beds we will have in place. We are using technology, which I will come to later, to make sure that they are being most effectively used. We are making sure the hospitals are digitised. We have features such as those I saw in Maidstone, such as flight control, where you allow the clinicians to manage the flow of patients right the way through.
Key to all this and to the length of stay is discharge and the adult social care end. Quite rightly, as the noble Lord, Lord Prentis, said, the flow is important. It is vital not only on the social care side, but for the whole hospital and the UEC—urgent elective care—waiting lists. I have seen at first hand the impact of step-down areas. Patients can be put there early on, and everything is organised around that. I have seen the improvements that makes to the flow.
We are trying to learn the lessons of last year by getting the money and commitments out early. That is why we are making a commitment of £600 million extra spend. We told the local authorities and systems that in the summer, so they could plan now rather than hearing about it too late and not being able to impact it then. That is all part of an increase of up to £8.1 billion over the next two years—a 20% increase. Staff are at the centre of that, as mentioned by the noble Baroness, Lady Pitkeathley. It has been a difficult area, but we are now up in terms of staff versus last year. I accept that there is still a long way to go. My notes show that we have about a 15,000 increase in staff, but clearly, we need more within that.
Mental health is obviously a key part of this. As the noble Lord, Lord Davies, and others mentioned, now more than ever we are seeing a massive increase in the number of young people with mental health issues—we had a good debate on this the other day. As I have said, I am determined that we understand the reasons underneath that. Covid might be part of it, but there are also long-term reasons, such as social media, that we need to understand. As the noble Lord, Lord Davies, mentioned, we need to make sure we diagnose those early, because that is crucial, particularly for young children. As noble Lords know, I have personal experience of the importance of acting early on this.
On the mental health Bill, we are committed, as mentioned, to do as much as we can without the legislation—hopefully we can explain a lot of that when we have the round table. Although getting it in the manifesto might be above my pay grade, I personally agree to make sure that all my colleagues understand its importance today and in a year’s time or so, if we were to win a general election.
Many noble Lords—the noble Baroness, Lady Tyler, and the noble Lords, Lord Prentis and Lord Hunt, to mention a few—raised the importance of staffing and how everything is underpinned by it. The noble Baroness, Lady Walmsley, and the noble Lord, Lord Hunt, in particular picked out—and I completely agree with them—that it is not just the clinicians but the managers, the admin and the non-clinical staff who are key to this as well.
I am a bit of a data anorak, and one of the things I did when I first came into my post was to try to understand all the differences in hospital performance, looking at certain areas’ demographics and whether they happened to have more funding through a quirk of the formula. I put in all sorts of variables, but we could only ever explain 50% of it—for the data anoraks, I say: the r² never came out higher than 0.5. The only conclusion that I and others could come to from that was—this is not earth shattering—the management and the leadership. I have had the privilege of visiting a lot of hospitals, and when you walk into one you know early on about the leadership—you can tell it on the tour and through the reaction, less from the leaders and more from the staff. You get a vibe about a place. I totally agree about the importance of that.
I come to the specialist areas. The noble Baroness, Lady Taylor, mentioned optometrists, and, funnily enough, I had this conversation with one the other day, and they mentioned that many of the early, indicating warnings are picked up when they take retina scans. That is why the long-term workforce plan is important, as are the extra training places. But, as the noble Lord, Lord Prentis, said and as I know from my experience with my mother, the other routes, such as apprenticeships, are just as important if we are going to get them there, because you should not need to be a graduate to be a nurse or clinician. As the noble Baroness, Lady Finlay, mentioned, it is vital that it is a rewarding and accommodating profession. Training and development are obviously part of that. I hope to talk more to noble Lords soon about using the estates for a lot more housing, because we know that can be a key recruitment and retention tool. Then there are things such as flexible rotas—hopefully, we will be able to use technology for that.
In terms of talking and working with the staff, I have to say that is something that is early days, but we are seeing the style and the engagement of the Secretary of State already and it is very welcome. Underpinning the long-term workforce plan, which many noble Lords have mentioned, is the move away from hospital treatment and into primary care and prevention. We know that that is the first line, and we are now close to achieving the 50 million increase in appointments—but we know, given the demand, that that is still not enough. That is where the Pharmacy First scheme will make a material difference, in expanding the supply of places where you can get the advice and treatments that you need.
I have seen some great examples of prevention, also mentioned by the noble Baroness, Lady Pitkeathley. Funnily enough, just yesterday I was talking to one of the doctors—I am sure that many of you know him—Sam Everington from east London. He was talking about how he was taking type 2 diabetes treatment totally out of the hospital environment, and the difference that it is making there. I have mentioned before the Redhill frequent flyers, looking at the people who are having the most hospital treatments and how they can get upstream of it all. Screening is important to that, which is exactly the point that the noble Lord, Lord Cashman, was making about the HIV screening programme. That needs to be welcomed—making sure that many more people are seeing that and understanding it.
The noble Baroness, Lady Taylor, talked about an active and healthy lifestyle and its role in social prescribing, which I completely agree with. I know that all noble Lords are on the same page here. The anti-smoking legislation that we are talking about is the biggest single thing that we can do towards that active lifestyle going forward.
I have mentioned it a few times, but I really believe that what we do in terms of technology and the app will be key to this, in terms of people’s access to primary care. People can use the app as their front door, from which they will be guided to the right service—to the 111 service—and then directly make an appointment, be it with a doctor or nurse or with a pharmacy. We have seen already that because people are reminded on the app, the numbers of “do not attend” have gone down by 10%, when people make their appointments digitally in that way. Of course, that means a much more effective use of time. Talking of time, I notice that I am out of it, so I shall quickly finish up. I see massive ability in the app for people to take control of their health and give us that sort of data, so people have the information and trust behind it.
I could have written the speech made by the noble Lord, Lord Drayson, myself—and I quickly acknowledge everything that he said about the problem. He said that we have great examples of innovation and really difficult cases of how to scale that up. I am exaggerating slightly to make a point, but when they have a great example in one place, they say, “Fantastic, it works in X hospital, how can we get it elsewhere?” It is like, “Here’s the telephone directory with 140 trusts and the buyers—good luck”. A lot of what I am trying to do, as the noble Lord, Lord Drayson, mentioned, is to look at how we scale that up, and have a way to buy sensibly from the centre and get that spread out. In the area of digital therapeutics, that is obviously vital.
Given the time, it is probably time for me to sum up, as I say. As ever, I shall write to noble Lords in detail. I have not answered the points that the noble Lord, Lord Cashman, raised about international cosmetic operations, and others. Likewise, I have not addressed the fracture liaison services, and the points made by the noble Baroness, Lady Donaghy, and the noble Lord, Lord Lexden, so I shall make sure that that is properly followed up in writing.
I finish by echoing what the noble Lord, Lord Brooke, was saying, which is to try to take this out of the Punch and Judy and make it as cross-party as possible—
Lord Hunt of Kings Heath (Lab)
My Lords, does the Minister understand that I will have no time at all to respond?
Lord Hunt of Kings Heath (Lab)
I have only a minute now to respond: I understand that the clerk will time us out at 2.56 pm.
All I will say then is, first, that I thank the Minister and my noble friend Lady Merron for their tributes to Alistair Darling, who was such a formidable colleague, Minister and public servant.
Secondly, the conclusion I reach is that we have to have a whole-system reform; we need a Government who are determined to do it; I do not believe that the current Government can do it at all; I look forward to a Labour Government who are going to do the business; and I beg to move.
Health Care Services (Provider Selection Regime) Regulations 2023
Lord Hunt of Kings Heath Excerpts(7 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Hunt of Kings Heath (Lab)
My Lords, like the noble Lord, Lord Stevens, I very much welcome these regulations. As he put it—in a very kind way—in essence they withdraw the wretched health Act 2012, which enforced competitive tendering on clinical services and, as the noble Lord said, was not only bureaucratic and costly but got in the way of integration and collaboration. Of course, the Explanatory Notes that go with this SI are very explicit in saying so. I noticed, though, that the Minister failed to mention the 2012 Act. In fact, the Explanatory Memorandum was just the thing my noble friend Lady Thornton used at the Dispatch Box as we sought to scrutinise the wretched 2012 Bill, which cost so much money and staff time and achieved so little.
I want to pick up one or two points that the noble Lord, Lord Stevens, raised. The first is to acknowledge that there is a huge challenge for the procurement profession. I remind the House that I am patron of the Health Care Supply Association. I understand that the provider selection regime regulations come into effect in January, but these are ahead of the procurement regulations which come into effect in October next year. It is important that the Minister mentioned the guidance and I am very glad he mentioned the work that will be done by NHS England in supporting the service implement these regulations. However, I say to him that if you are trying to work out the relationship between the 2022 health Act, the 2023 Procurement Act, these regulations and the forthcoming procurement regulations, to a procurement manager sitting in an NHS trust this can be rather complex. The more help and guidance that can be given to those professionals, the better.
The Minister may well be aware that at the same time as procurement teams have been asked to implement this big change, they are having to generate short-term savings to meet the financial pressures in-year at the moment and actually cut their department operating costs. It is a short-term saving that may have long-term consequences, particularly as investing in procurement for the long-term value we wish to see enhanced in the health service makes economic sense. I point out to the Minister the recent announcement by NHS England that it is investing £600,000 in new commercial roles to unlock £1.5 billion of savings. That is very welcome, but we should be investing similarly in local and regional procurement teams as well. It is also important that the analysis behind the £1.5 billion savings is made available in order to guide the procurement function in the areas they need to be focusing on.
What is being done to support the skills, training and development of the NHS procurement and supply chain people? Will we invest in learning and development through organisations such as the HCSA and the NHS Skills Development Network to support upskilling and developing their functions? I commend the strategic framework for NHS Commercial, published only in September, and support the establishment of academies of commercial excellence—these are good initiatives—but you also need to support the people on the ground to do the job most effectively.
The noble Lord, Lord Stevens, said that there is a good balance in the regulations, because, while we want to get rid of the bureaucracy of automatic competitive tendering, as there is clearly no point doing it, we do not want to lose the opportunity of inviting innovative companies to play a part in the health service in the future. There is an issue around conflict of interest in the new structures. He will be aware that, around the table at integrated care boards, the chief executives of the local trust will often be in membership. In these regulations, and more generally, there are rules about how you mitigate that in a competitive process, but the decisions that ICBs make will sometimes be not to go down a competitive process at all—decisions, as I understand it, that those trust CEOs can be part of. I have had a briefing from Specsavers, which says that there surely needs to be some kind of requirement for ICBs, particularly for community services, to consider proposals from non-commercial providers who can demonstrate that they can improve value, quality of care and clinical outcomes. It is there that the conflict of interest issue arises.
How will value-based procurement be driven forward? In the draft PSR statutory guidance, “value” and “social value” are two of the national criteria for procuring health services. As I understand it, value-based procurement is about looking at which product is not only cheapest per item but best for patient outcomes, quality of life and avoiding relapses or unintended side-effects. I have been championing value-based procurement because in the long term it provides better value for money and better quality of what is being procured. The Minister has kindly agreed to meet me—I am grateful for that—but a statement from the Government on the importance of value-based procurement would be helpful.
Finally, I will ask the Minister about health technology. How far does he think these regulations support our vital health technology sector? I have been in discussions with ABHI about the potential that health tech offers the UK—it is fast—but there are worries that, in the new world, there are issues limiting the ability of many of these companies to be competitive, some of which are clearly to do with regulatory uncertainty. He will know of the issues with the MHRA’s performance. I pay tribute to the MHRA, but there is no doubt that it has resource issues—both money and staff—when getting things approved where they need to be approved. Coming back to Brexit, surely one of the advantages of having an independent regulator is that we can be seen as a place that, for medicines or medical devices technology, has a first-rate regulator that takes these processes through as quickly as possible. The problem, as he will know, is that there has been a blockage inhibiting innovative companies, so we really need to do something about it.
Overall, I warmly welcome the regulations. I thought that the Minister could have acknowledged a little more the failings of the 2012 Act, but we will pass on that. I certainly very much support the general thrust, but the procurement function in the health service needs every support it can get in understanding the new architecture and implementing it fully.
Lord Allan of Hallam (LD)
My Lords, this is an altogether weightier statutory instrument than the previous one we discussed, running to many pages and with lots of interesting new acronyms. The noble Lords, Lord Stevens and Lord Hunt, have set out effectively the case for why the changes are necessary, in a kind of Birmingham pincer movement as I stand here in the middle. I also have ringing in my ears the comments of the noble Baroness, Lady Merron, on the previous statutory instrument, when she talked about a particular instance where procurement went wrong. We need to have that in mind.
It is worth putting a marker down now on the potential impact. We are talking about many billions of pounds of expenditure; how many billions is an interesting question that we will come to in a minute. The potential benefits are hundreds of millions of pounds of savings, as the noble Lord, Lord Stevens, pointed out, but we must acknowledge that there is a potential downside risk, which could be millions in fraud and legal fees. It is worth spending a moment as we debate the instrument to make sure that everything is being done to ensure that we get the upside but minimise the downside.
My first question is around the integrated care board members and conflicts of interest—something that was raised by the noble Lord, Lord Hunt—particularly where they are not in a competitive tender situation, where we are talking about direct awards and most suitable providers. Once that decision has been made, there are some valid questions around what that means. Candidly, we do not want to create 42 ICB VIP fast lanes where people can talk to the ICB and somehow get themselves out of the normal procurement process when they should not be out of it. Therefore, there are risks at that level; we must be conscious of that. Given the roles that ICB board members have, and since these are local entities, it is likely that an ICB board member will have relationships with people in the local community who deliver services that will be subject to the tender.
My next question is about the variability and the number. It is flagged in paragraph 4 of the impact assessment that the expenditure over a period was
“estimated to be between £75bn-£380bn”.
I am not great at maths but that is quite a significant variability. It talks about how the £75 billion concerned procurement processes that went through the EU process and were notified, while the long tail of the other £300-odd billion concerned other procurements that were not notified. However, we should be able to get better information than that. One of my requests for the Minister comes with a suggestion: there should be a machine-readable database somewhere where all health and care procurement can be analysed and studied. I know that the department intends to do that but, actually, the best way for us to understand that we are getting good value for money is this: if anyone, whether a researcher at one of our excellent universities such as the University of Birmingham or another interested party, wants to be able to look at NHS purchasing data and can analyse it, they should be able to do so.
This seems to me to be a reasonable request to make of government: that information about procurement—including the status and how the contract was awarded, whether it was competitive or elsewhere—is publicly available and analysed by any third party who chooses to do so. The Government would benefit from that, as would individual NHS procurers, as people will analyse those patterns of purchasing and perhaps suggest something that they had not thought of themselves where they may be able to make more savings.
The final area that I want to cover is one that the noble Lord, Lord Hunt, touched on: skills in procurement. I suspect that all of us who follow healthcare have seen the Health Service Journal article in October that talked about integrated care boards in the south-west of England paying £1.7 million in compensation for a procurement failure. Obviously, that is happening under the existing regime, but it is a strong warning sign that we need to heed what happens when we get this wrong. Again, the impact assessment helpfully talks about the litigation process and the different costs that may be assigned to each area. I think that we tend to underestimate these things. If anything, once you get into a litigation process, the pressure to settle and resolve it means that money is often thrown at the problem. This could mean a significant cost to the NHS if we get it wrong. The fact that we have a new process means that new risk is being introduced. What is being done around training? That comes in two aspects. The first is general awareness raising, which applies to everyone. Certainly, I have had experience in business of working for an American company where you are subject to the Foreign Corrupt Practices Act, meaning that you go to prison if you try to bribe a member of a foreign legislature.
Adult Social Care
Lord Hunt of Kings Heath Excerpts(7 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Markham (Con)
That is a good point. We have given the CQC responsibility for measuring local authority provision of care. Overall, we are seeing a high satisfaction rate—89%—and the number of complaints went down by 16% in the last year, so these things are making a difference.
Lord Hunt of Kings Heath (Lab)
My Lords, does the noble Lord agree that if we are truly going to fix the problem, as the noble Lord, Lord Forsyth, said and as Prime Minister Johnson promised, we have to deal with the issue of self-funders, who are having to pay thousands of pounds over years without any support from the state above a very limited means-test level? When will the Government come forward with proper proposals to deal with this?
Children’s Hospices: Funding
Lord Hunt of Kings Heath Excerpts(7 months, 2 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Hunt of Kings Heath
To ask His Majesty’s Government whether they are on target to provide £25 million for children’s hospices for 2023-24; and whether they intend to repeat this on an annual basis uprated in line with inflation and allocated directly to each children’s hospice.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government and NHS England recognise the vital role that hospices play in delivering high-quality, personalised palliative and end-of-life care for all ages. The children and young people’s hospice grant plays an important role in enabling that to happen. As such, grant allocations of £25 million have been paid in full to hospices in 2023-24. A further £25 million has been announced for 2024-25, with the funding allocation mechanism currently being worked through by NHS England.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the Minister. He will be aware that 80% of the income that goes to children’s hospices comes from fundraising. With the cost of living problems we have at the moment, that is increasingly difficult, so the £25 million grant is a lifeline. Do the Government accept that making this grant permanent, so that hospices know about it going forward, and uprating it by the rate of inflation will give enormous help in stabilising the finances of children’s hospices?
Lord Markham (Con)
First, I absolutely recognise the noble Lord’s point that 80% of hospices’ funding comes through charities, so they represent an excellent resource for us. That is why we are pleased to confirm the £25 million for next year. The debate, which I am sure we will get into more later, is about making it a direct grant. We generally think that ICBs are best placed to take control of health services in their area, and it is about trying to get the right balance between making direct grants for the provision of places and saying that ICBs know what is best for their area and should cater for them in that way. I would be happy to talk further about that balance with the noble Lord.
Domestic Violence and Brain Injury
Lord Hunt of Kings Heath Excerpts(8 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Hunt of Kings Heath
To ask His Majesty’s Government what analysis they have undertaken into the links between domestic violence and brain injury.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
In June this year, the Government, through the Medical Research Council, announced the £9.5 million traumatic brain injury platform, which will facilitate research and analysis of victims of brain injury following domestic violence. The platform is being led by the University of Cambridge, with the aim of revolutionising data collection and curation for TBI research. This will include data linkages between the underlying causes of head trauma, such as domestic violence, and health outcomes.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very grateful to the Minister for his Answer. The death of Sir Bobby Charlton, that great footballer, has brought attention to the impact on sportspeople of head impacts in relation to an increased incidence of dementia. Professor William Stewart from Glasgow University, who has undertaken much of the work in the sports arena, is doing parallel work in relation to domestic violence. The scale of intimate partner violence, with between 20% to 30% of women affected, is huge, and 90% of those women may suffer brain injury impact. In addition to the welcome news about research, could I ask that the Minister’s department looks very closely at stepping up the research but also at increasing knowledge and awareness throughout the health system, in terms of prevention and treatment as well as research?
Lord Markham (Con)
I add my condolences following the passing of Sir Bobby Charlton—a true great. I thank the noble Lord, Lord Hunt, for the work he has done in this space; it is another example of where being asked a Question forces us to look at the situation. The noble Lord made the point very well. Sport is in the news, and we have all seen the head injury assessment protocols, especially in rugby, but you are 11 times more likely to suffer a traumatic brain injury from domestic violence than you are from sport. When we get the findings from the research, early in the new year, I invite the noble Lord, Lord Hunt, to join me in ensuring that we have an action-oriented approach to make sure that the awareness and research supports a good action plan.