Nursing Courses: Reduction in Applications
Lord Hunt of Kings Heath Excerpts(7 months, 3 weeks ago)
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Lord Hunt of Kings Heath
To ask His Majesty’s Government what assessment they have made of the causes of a reduction of 16 per cent in applications to nursing courses in England compared to last year, according to UCAS data for the 2023 application cycle.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The drop in nursing applicants reflects an expected rebalancing following unprecedented demand for healthcare courses during the Covid-19 pandemic. Nursing is still a popular career choice. Applicant numbers remain 15% higher than pre-pandemic levels. We also continue to see growth in the number of people pursuing nursing apprenticeships. This is not final data; figures are accurate as at the end of June application deadline, but the application cycle remains open through clearing until mid-October.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very grateful to the Minister, but I think he would accept that any drop-off in applications is something to worry about, alongside the current drop-out rate for student nurses in the UK of around 24%. On that basis, surely the NHS workforce plan in relation to nursing is simply not sustainable. If the Minister does accept that, is there not a case for looking at writing off debt run up by student nurses through tuition fees if they commit to working in the NHS for a length of time?
Lord Markham (Con)
We are delivering on a number of routes to recruit nurses. Obviously, the graduate route is one route, which, as mentioned, is above pre-pandemic levels; apprenticeships is another route, which is proving very successful; and associates is another route again. So there are many routes in, and the result is that our applications are 20% up on pre-pandemic levels. We set ourselves a target of recruiting 50,000 more nurses by the end of this Parliament and we are currently on 45,000, so we are going to hit it.
National Health Service: Major Conditions Strategy
Lord Hunt of Kings Heath Excerpts(7 months, 3 weeks ago)
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Lord Markham (Con)
I thank my noble friend. I think that is covered by musculoskeletal conditions, which is one of the six major conditions we are looking at. Key to pathways is moving treatment away from individual silos to patient-based treatment that looks across the board. We know that 55 year-olds have, on average, at least one condition, and that 80% of those over 85 will have one, two or three of these conditions. We need to ensure that we look at this across the board, rather than in silos.
Lord Hunt of Kings Heath (Lab)
My Lords, I understand the rationale for identifying these areas, but how will the Government ensure that integrated care boards do not deprioritise services for other clinical conditions, such as eye health or kidney disease, for which there is huge demand in the NHS, involving many patients?
Lord Markham (Con)
The strategy tries to provide a road map for how we want to do this. It starts with prevention, which I think we are all agreed on, then early diagnosis, quality treatment and then living or dying well with that condition. It is a philosophy: the idea is that we get it right in these six major areas with 60% morbidity, and then we roll it out across the board in all other areas. It is a way of treatment, really—a way of looking at the whole problem, centred around whole patient needs, that we will roll out to other conditions as well.
Reinforced Autoclaved Aerated Concrete: Hospitals
Lord Hunt of Kings Heath Excerpts(7 months, 4 weeks ago)
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Lord Markham (Con)
We have given guidance and are making sure that everyone understands exactly what they should be doing across the estate, whether we are the landlord or not. Clearly, there is a difference where we are the landlord because then it is our responsibility to do it. The prime example of this is that in the NHS Property Services GP estate—which is quite extensive—we are dealing with three RAAC GP surgeries. Where they are owned by other landlords, we need to make sure that they are on top of it and do the work without taking responsibility for it ourselves.
Lord Hunt of Kings Heath (Lab)
My Lords, the noble Lord mentioned 40 new hospitals by 2030, but he will be aware of the NAO report in July which made it clear that the original 40 target will not be met because of the substitution of the eight RAAC hospitals. Can the Minister tell us what is going to happen to the eight hospitals that were in the original programme and have now been delayed?
Lord Markham (Con)
I hope and trust that most of us would think that it was sensible to prioritise the RAAC hospitals. That meant that we had to move some others to the right-hand side of the budget envelope, so to speak. It is not publicised very much, but we now have an agreement with the Treasury to move to five-year capital cycles, like the Department for Transport, which I think is a real positive because we need long-term planning cycles. We are busy developing a 2030-35 programme now, which those hospitals that the noble Lord mentioned will be placed in.
Children’s Health: Sugar
Lord Hunt of Kings Heath Excerpts(8 months ago)
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Lord Markham (Con)
Yes, the noble Baroness is absolutely correct, and that is why in the major conditions survey we have an ambition to reduce sugar intake by 20%, working right across the board and especially with baby food manufacturers. As I set out earlier, there are a range of things that we have already done: the sugar tax reduced intake by 46%, and the movement of the so-called “pester power” has made a big impact. We are seeing companies reformulate food. But it is something we will keep under review, and we will do more if we need to.
Lord Hunt of Kings Heath (Lab)
My Lords, I declare my interest as the president of the British Fluoridation Society. Coming to oral health, is he alarmed at the number of intensive dental treatments that children need because of the rise in decay? Could he update the House on any speed up in fluoridation schemes?
Lord Markham (Con)
The noble Lord is absolutely correct. As many are aware, the most common reason for six to 10 year-olds to go into an A&E visit is tooth decay. The noble Lord will recall that we passed an SI quite recently expanding opportunities for water fluoridisation. I know that is now increasing and I will happily follow up with the detail in writing.
Respiratory Syncytial Virus
Lord Hunt of Kings Heath Excerpts(9 months, 2 weeks ago)
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Lord Markham (Con)
This is where nirsevimab is very promising, in that it gives six months’ protection. The problem with the previous jab is that it needed monthly injections and was only 50% effective. We are talking about 70%-plus effective now, which makes it more practical to have that sort of rollout. To date, we have been looking at the very targeted group of 75 year-olds only, particularly as each course costs £2,000 and has to be given monthly over the winter months. Now that we are opening up to this injection, which is much cheaper and lasts for six months, we can look at a broader range, and then there is a much more general education programme to go with it.
Lord Hunt of Kings Heath (Lab)
My Lords, will the Minister comment more generally on vaccine manufacturing in the UK, which comes into play here? During Covid, we learned that having our own vaccine manufacturing capacity was important. Is that the Government’s position going forward?
Lord Markham (Con)
The noble Lord is correct. I have two good examples of that, BioNTech and Moderna, where as part of commercial arrangements for us to buy large amounts of Covid vaccines from them they are making investments in UK plants. It will not always be practical, but those examples are billion pound-plus investments which I think we all agree are welcome news.
National Health Service (Performers Lists) (England) (Amendment) Regulations 2023
Lord Hunt of Kings Heath Excerpts(10 months ago)
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Lord Hunt of Kings Heath
That this House regrets the lack of an impact assessment and a full consultation exercise being undertaken in relation to the changes made through the National Health Service (Performers Lists) (England) (Amendment) Regulations 2023 to the National Health Service (Performers Lists) (England) Regulations 2013, given the wide-ranging effect of those regulations on NHS primary care dentistry in England.
Lord Hunt of Kings Heath (Lab)
My Lords, it is a great pleasure once again to draw your Lordships’ attention to dentistry matters in relation to this statutory instrument. I declare an interest as president of the British Fluoridation Society and related bodies.
These regulations are important in themselves—more important than first meets the eye. They come within the context of wider issues around the problems that patients are having getting access to dentistry under the NHS. In our previous debate, a few weeks ago, I referred to the GP patient survey last year, in which 12.9% of those surveyed said that they had failed to get an NHS dental appointment in the last two years. If you count only those people who attempted to get an NHS appointment the first time, 24% failed to get an appointment in the last two years.
In the last few weeks, I have had urgent representation from the Shildon and Dene Valley branch of the Labour Party about the impact that the closure of BUPA Dental Care in Shildon and Bishop Auckland has had on providing NHS dental services. As the branch says, this is an area where only a minority of people can afford expensive private dental care. The closures will lead to an overall decline in dental health and to increases in related health problems. This is happening up and down the country.
When we debated this in June, the Minister referred to the July 2022 package of dental system improvements, which was aimed partly at improving patient information and at changes to the contract to provide some incentives. However, that is not sufficient to tackle the chronic access problems that patients have.
The announcement in the NHS workforce plan that the Government intend to
“Expand dentistry training places by 40%”
is, of course, very welcome indeed. However, the Minister will need to find some capital funds to help dentist schools expand, and I know the Minister will not be surprised if I mention that the
“tie-in period to encourage dentists to spend a minimum proportion of their time delivering NHS care”
has caused some eyebrows to be raised—although I actually sympathise with that proposition.
Lord Hunt of Kings Heath (Lab)
I am very grateful to the Minister, and to my noble friend and the noble Lord, Lord Allan, for their comments on the statutory instrument. As ever, I think we have had a very interesting debate.
It was interesting to hear the insights of the noble Lord, Lord Allan, on the website, which I have just tried out. It is easy to use and, as long as you know the name of the dentist, it finds it just like that. If you do not, I am not sure where you are. The other thing is its peculiar language. Why “performer”? That is a very odd name to use for a serious dental professional. What does “status: included” mean? Yes, they are included on the register, but I suggest it needs refreshing, and surely more information can be given. In the GMC, of which I am a member of the board, we too are looking at our registration details for the public. There is an appetite for the public to know more about the professionals—some of them specialise in certain techniques. Picking up the question of Scotland, Wales and Northern Ireland as a whole, I suggest that this is worth having a look at.
The noble Lord, Lord Allan, made a very good point on fees. I understand the issue about unfunded pay increases—we as Ministers have all had to go through some of those tensions—but that seems to be spiting yourself when, let us be honest, we are absolutely desperate for overseas recruitment. Using GMC figures, of the 20,000 or so extra registrants last year, 39% were homegrown, 11% came from the EEA and 51% came from overseas. We need to be very careful about dissuading overseas professionals from coming in, particularly when we know that the expansion in the workforce will take, I do not know, maybe a decade before we see its fruition—certainly with doctors and dentists—on the front line.
I thought my noble friend Lady Merron’s point about the cutback in NHS work post Covid was very interesting. Access issues are getting really worrying in some parts of the country where people do not have the wherewithal to go private. Somehow or other, we desperately need to do something more about access.
On the issue of impact assessment and consultation, I thank the Minister for the apologies about the tie-in statement, but there comes a time for a reset of relationships with the BDA. When the announcement about the extra training places was made, that might have been the time when a short consultation—although I think two weeks is too short—was tactically a good thing to do. Relationships between the department and the BDA are always full of interest—they are sometimes warm; they are sometimes not so great—but you cannot ignore the representative of the profession.
I accept the point the Minister made about sensible incremental changes. Small changes put together can lead to improvements. That is why the SI is welcome overall, as are the measures that we saw and debated recently.
Ultimately, we also need Governments to show more interest in dentistry. They need to understand that the access issues are very serious indeed and that we should not regard dentistry as a kind of marginal addition to the core issue of NHS services. I am sure the Minister will agree that dentists are an essential part of health promotion and healthcare provision in this country. Having said that, I am very grateful and beg leave to withdraw my Motion.
NHS Long-term Workforce Plan
Lord Hunt of Kings Heath Excerpts(10 months, 1 week ago)
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Lord Markham (Con)
That is absolutely my understanding. For it to be a living document, people clearly need to have input and to be able to debate it in exactly the way we are doing here today.
Lord Hunt of Kings Heath (Lab)
My Lords, I remind the House of my membership of the GMC Council. The GMC has warmly welcomed the plan and its role in the expansion of medical education, the development of physician and anaesthesia associates, and the apprenticeship programme. I want to follow on from the point made by the noble Baroness, Lady Brinton. The key point the GMC has made is that it is absolutely essential that there are sufficient clinical and educational supervisors, particularly for the F1 grade—newly qualified doctors going into postgraduate training. NHS trusts will have to release more of their doctors to provide this. Is the department in touch with and talking to the chief executives of NHS trusts to ensure that, as the pipeline develops, there will be sufficient clinical supervision? This is essential in order to get the quality of doctors that we need.
Lord Markham (Con)
The noble Lord is correct that it is essential. I emphasise that this is an NHS document, and the whole point is that it does not look to go “zoom” on recruitment. There is absolutely the understanding that this is a pipeline that has to be built brick by brick. There is no point front-loading the number of university places if, as the noble Lord mentions, there is no follow-up behind it in clinicians. The plan has been developed from the bottom up, including with clinicians and the trusts. There is an understanding that they need to build their own part of the pipeline towards this as well.
Mental Health In-patient Services: Improving Safety
Lord Hunt of Kings Heath Excerpts(10 months, 1 week ago)
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Lord Markham (Con)
We see that as being very much in the remit of the Health Services Safety Investigations Body. In fact, the first thing we are asking it to do is to consider how we can learn from those unfortunate deaths, where they have taken place, in terms of their care. The intention is that it will report back. It will start in October and will report back on that within a year, so that we can get some rapid findings.
Lord Hunt of Kings Heath (Lab)
My Lords, can the Minister return to the contribution from the noble Baroness, Lady Watkins? I note that the HSSIB has been asked to look at and develop a safe staffing model for in-patient services, but I re-emphasise the point made by the noble Baroness: you cannot look at in-patient services only; you have to look at the whole spectrum. Surely, he accepts that. For instance, with young people, the huge waiting times for CAMHS services, which eventually lead to some of them being out-of-area placements, is shocking. Surely, HSSIB should be looking at the whole picture. Can he also say how this will relate to the workforce plan? In other words, will the conclusions of HSSIB’s report go forward into the workforce plan, so that for the future we are developing enough people in the mental health field?
Lord Markham (Con)
As I am sure the noble Lord is aware, the second thing that the HSSIB is being asked to look at is exactly the point about how people are cared for as in-patients and how we can improve that approach. On staffing—again, we will debate this more tomorrow night following the Statement repeat—it is vital that there is a feedback loop in terms of the long-term workforce plan. That feedback loop, as I am sure noble Lords are aware, is built into it, so that when new data comes along, as will potentially be the case with the HSSIB, there is a way for that to feed back in again.
Mental Health Services: Huntington’s Disease
Lord Hunt of Kings Heath Excerpts(11 months ago)
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Lord Hunt of Kings Heath
To ask His Majesty’s Government what assessment they have made of the number of people with Huntington’s disease displaying mental health symptoms who are being denied access to mental health services on the grounds that it is an organic brain disorder.
Lord Hunt of Kings Heath (Lab)
In begging leave to ask the Question standing in my name on the Order Paper, I apologise to the House as I should have declared my GMC board interest in the previous oral intervention.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
NHS England has not made an assessment, as this is not data that is routinely collected or would be captured. Minister Whately has asked NHS England to look into reports that people with Huntington’s disease are being denied access to mental health services. NHS England is also in the process of developing a neuropsychiatry service specification, which will outline the approach to caring for patients with neurological conditions who require mental health support.
Lord Hunt of Kings Heath (Lab)
I am grateful to the Minister for that positive Answer. He may be aware that the Huntington’s Disease Association has research which shows, first, that many people with that disease suffer from severe mental health issues and, secondly, that in many parts of the country NHS mental health services refuse to give mental health treatment to those people. In addition to the work that his fellow Minister is requiring from NHS England, will the department look at the training of mental health staff so that they have the capability to support people with Huntingdon’s disease who have mental health issues?
Lord Markham (Con)
Yes. The noble Lord has heard me say many times that I have really come to appreciate the Questions format for looking into areas that might otherwise not be seen. I thank the noble Lord and the Huntington’s Disease Association for bringing this to our attention. We have the steps in place but that is a good point about the training.
General Practitioners: Recruitment and Retention
Lord Hunt of Kings Heath Excerpts(11 months ago)
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Lord Markham (Con)
I agree with my noble friend that recruitment and retention are key. To clear up the figures, the numbers I gave referred to all doctors working in GP surgeries, including people who have been qualified for five years and are just finishing off the GP element. Within that we absolutely need to increase training numbers. We already have 4,000 doctors in training, which is a record number, but we are looking to grow that. We are introducing specific actions on retention, such as the new changes to pensions.
Lord Hunt of Kings Heath (Lab)
My Lords, plugging the gap in relation to GPs will take many years. The noble Lord will know that in hospitals, specialist and associate specialist doctors have increased in number. Many would like to work in primary care but are prevented by bureaucratic barriers. Do the Government not think that one way to get an immediate injection of doctors into primary care is to get SAS doctors there and to lift the current barriers?
Lord Markham (Con)
I completely agree that we need to look creatively and flexibly. We are on target to deliver 50 million more appointments, which is 10% more each day. That is through recruiting more staff. We have about 29,000 more staff in the GP work space, and that is using them flexibly and creatively.