NHS: Abuse of Nurses

Lord Laming Excerpts

Tuesday 5th April 2022 Lords Chamber

[Lord Kamall (Con)]

I hope the noble Baroness will appreciate that I have laid out some of the initiatives that are taking place, and which are not only trying to prevent abuses against members of staff and nursing staff but supporting staff to de-escalate them. On well-being and getting more nurses, the Government are committed to continuing to grow the NHS workforce. We are still committed to the figure of 50,000 more nurses and to putting the NHS on a trajectory towards a sustainable long-term supply in the future. We are working on a number of well-being schemes to ensure that nurses are supported and feel safer and more willing to stay in service.

[Lord Laming (CB)]

My Lords, does the Minister agree that sometimes, nurses find themselves in this difficult situation because, as the most junior staff, they are required to give unwelcome messages about the limitations of resources? There are a lot of managers in the health service, but they put nurses forward to give that unwelcome message to patients and their relatives. Can the Minister see whether there are better ways to protect the most junior staff in the organisation?

[Lord Kamall (Con)]

I must admit that I was not aware of that, but I will take it back to the department to investigate and will write to the noble Lord. We have been looking at how to train staff not only to deal with abusers but to handle different situations and to de-escalate. There are also a number of staff health and well-being support programmes, including website session support lines, certain apps, well-being seminars and coaching seminars.

NHS: Pre-pandemic Facility Levels

Lord Laming Excerpts

Tuesday 29th March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for those questions and will try to answer as many of them as I can. We are aware that this idea of returning to normal is patchy in different parts of the country. Some people have told me that visiting their GP or a hospital is fine, while others have had real trouble. Therefore, when these issues come up, I hope that noble Lords and others make us aware, so that we can ask the NHS what is happening. It is clearly an issue of capacity, but also, some people are trying to get face-to-face appointments with their GPs, while some practices are trying to move towards a technology-based service offering. I am aware of that. GP appointments are up to 60% of what they were pre-pandemic, but we understand that there is progress to be made in other areas.

[Lord Laming (CB)]

My Lords, I wonder whether the Minister realises that he could make himself hugely popular in the country if he could persuade GP practice reception facilities to be more user-friendly and welcoming to the clients.

[Lord Kamall (Con)]

The noble Lord makes an important point, and I can see a lot of agreement, judging by noble Lords’ body language. However, we must always be careful about this issue because patients have had different experiences. I have been speaking to noble Lords about this. Some have told me that it is really good and has gone back to normal; others are having real trouble getting access to a GP or even getting someone to answer a phone in the first place. We must be careful, because if I say, “GPs should be doing more,” I will be criticised for being tough on GPs, but if I say that we must understand that GP practices are under a lot of pressure, I will then be criticised for not pushing hard enough to solve the problem. The pandemic accelerated pre-existing trends. We were already moving more towards the use of technology. Some people were quite happy to contact their GP by phone or online, and we will see some of that. We will never go back to 100% face-to-face, but certainly, patients should be able to have face-to-face appointments unless there are good clinical reasons why they cannot.

Health and Care Bill

Lord Laming Excerpts

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Lord Laming (CB)]

My Lords, the House will recognise that children have very different needs. They are vulnerable in many ways and in need of the recognition that all the services have to work together. It seems strange that in a Bill on health and social care, children are not identified as a special group. I support these amendments.

[Baroness Wheeler (Lab)]

My Lords, today’s debate has shown the strength and depth of feeling across your Lordships’ House that children and young people should be properly provided for within the scope of the Bill and not just as an afterthought, as many noble Lords have said.

Intervening in the early years of a child’s life is the most effective way of shoring up their good health and well-being as an adult. This group of amendments seeks to do just that, ensuring that our children are not sidelined in a healthcare infrastructure currently designed with adults, and just the NHS, in mind. This group also seeks to strengthen the Bill by including safeguarding, interagency working, service integration and data sharing, especially between government departments and the NHS and social care.

I thank noble Lords for putting forward these amendments, particularly the indefatigable noble Baroness, Lady Tyler, for her proposals across Clauses 20 and 21 to ensure the joining up of the roles and work of ICBs and ICPs in these crucial areas. Indeed, what is particularly striking about today’s debate is that the experience and contributions of noble Lords have joined up children’s needs across a whole range of service provision and support in a way that government structures currently fail to do. This is a major issue that needs to be addressed, particularly to address the needs of vulnerable children, as my noble friend Lord Hunt and other noble Lords have stressed.

If the Bill is to stand any chance of improving government health outcomes, it must start with the youngest among us all. Right now, in this, the fifth-biggest economy in the world, child health inequalities are widening, while 25% of children in the average reception class will be overweight. By the time those children are in year 6, it will be 40%. The all-cause mortality rate for under-14s in the UK is among the worst in Europe, and the World Health Organization tells us that 50% of lifetime mental illnesses start by the age of 14. Noble Lords will recall the debate last week about the need for robust mental health services, which include those around potential young suicides, self-harm and eating disorders. As the charity YoungMinds reminds us, after-care and follow-up are crucial although, sadly, ignored in current sustainability plans, as the noble Baroness, Lady Finlay, pointed out.

The Royal College of Paediatrics and Child Health has expressed particular concern that there is currently no duty in the Bill to include representation from children’s health and care services on integrated care boards. The noble Baroness, Lady Finlay, underlined in her Amendment 87 the importance of safe staffing levels and of this in driving forward improvements in child healthcare outcomes and ensuring that children and young people can access the care they need, when they need it and from the most appropriate person or team.

Barnardo’s is similarly worried about the absence of a child impact assessment, without which there will be no clear, objective idea of the impact of the changes in this Bill on young people. The right governance and rigorous evaluation, aimed at providing lessons learned for future service design and reform, can surely only be a good thing. We strongly support Amendment 142 on this issue, in the name of the noble Baroness, Lady Walmsley, which calls for the impact assessment to be undertaken within two years of the Bill’s implementation. It also emphasises the need for an annual report and debate in Parliament on the impact of changes, scrutinising, in the first year in particular, how the changeover from CCGs to ICBs is working in practice.

Following last week’s debate on the appalling backlog of waiting lists and the NHS’s duties under the mandate and constitution, I remind the Committee that last month’s National Audit Office report showed that more than 288,000 children and young people are waiting for NHS treatment, 86,000 of whom have been waiting for longer than the 18-week target I asked the Government to reaffirm.

Whether it is ensuring proper information sharing between care providers, safe staffing levels or clarifying how the Better Care Fund can specifically be used to better integrate children’s services, these amendments have compassion and common sense behind them. We have an opportunity in this Bill to give our children a healthier future. I hope that the Minister will agree.

Care Workers: Professional Register

Lord Laming Excerpts

Monday 10th January 2022 Lords Chamber

[Lord Laming (CB)]

My Lords, I am sure the Minister will agree that if the pandemic has taught us anything, it has confirmed that those in need of social care are much more dependent now and much more vulnerable. They require very intensive personal care. That being so, is it not time that we recognised carers for what they are, because apart from their commitment, they display enormous skills, day in and day out, and people at the end of their life are dependent upon them?

[Lord Kamall (Con)]

I am sure all noble Lords will agree with those sentiments, and that is why we have published the White Paper on social care. We are investing an additional £5.4 billion over three years and we want to make sure it is a career that people feel valued in. We also have £3.6 billion to reform the social care charging system, to make sure that all local authorities can move towards paying care providers a fair rate for their care, and a further £1.7 billion to begin major improvements across the whole social care system in England.

HIV and AIDS

Lord Laming Excerpts

Wednesday 1st December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for making that very important point and for stressing that this should be seen not just as a gay disease but as a disease that heterosexual and other people also suffer from. One of the issues in the HIV plan has been to ensure that those communities which maybe have a macho approach to a number of these issues are addressed, particularly at the local community level. It is very difficult, and we have to tread carefully, particularly with some of the ethnic minority communities, so that we are not seen to be stigmatising that community or blaming them but getting the right balance. The fundamental point that my noble friend makes is very important and we should repeat it: HIV does not affect only gay people—it also affects heterosexual people and younger communities.

[Lord Laming (CB)]

When coronavirus struck us, within a year, remarkably, a number of vaccines had been produced, to huge effect. Does that not stand in marked contrast to what has happened with HIV/AIDS? Is it not amazing that 20 years after the noble Lord, Lord Fowler, did so much to establish a proper response to HIV/AIDS, we still have do not have the medical support that we need for it? Can the Minister take this back to the department and see what more can be done to improve the situation?

Public Health Grant to Local Authorities

Lord Laming Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

It is true that some of the allocation for the National Health Service is being used for public health spending, but we want to make sure that across the health system the NHS not only focuses on prevention and therapeutics but works in partnership with the public health authorities.

[Lord Laming (CB)]

My Lords, the good news is that in the Budget last week, it was announced that local councils are to receive £1.6 billion in grants for each of the next three years. The bad news is that that does not take them close to what the councils were receiving and spending in 2010. Will the Minister do all that he can to press for adequate funding, especially for the public health services but also to meet today’s needs and not those of a decade ago?

[Lord Kamall (Con)]

There are many bodies tackling public health and raising awareness of some of the worst health problems we have—not only the Office for Health Improvement and Disparities and public health officials in local authorities but the NHS, which wants to move more towards prevention because in the long term that saves money.

NHS England Funding: Announcement to Media

Lord Laming Excerpts

Tuesday 26th October 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness refers to what she sees as the workforce shortage. The Government are fully committed to supporting our health and care professionals and to making sure that we have the right number of people with the right skills to deliver excellent patient care and support the increased elective activity committed to under Build Back Better: Our Plan for Health and Social Care. The Chancellor will confirm to the House our three-year settlement for wider health budgets at the spending review on Wednesday, which will support the NHS to undertake long-term planning for the workforce and elective recovery. I will write to the noble Baroness on specific staff numbers for A&E.

[Lord Laming (CB)]

I wonder whether the Minister would agree that the NHS cannot succeed without adequate social care. In the last seven days we have had two reports that show just how vulnerable the social care system is. Can the Minister sign up to a new agreement to protect the NHS by supporting social care? That was absent in this statement.

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion. We see social care as incredibly important, which is why we will soon have before the House a health and social care Bill to make sure that we look at both health and social care, from birth all the way through one’s life.

Social Care: Family Carers

Lord Laming Excerpts

Monday 13th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the maths that my noble friend has done is a little bit premature. The White Paper will come out later this year; it will spell out the precise financial arrangements, and I am looking forward to that.

[Lord Laming (CB)]

My Lords, the Minister has already indicated an understanding that many carers sacrifice a huge part of their lives in trying to care for a loved one. Many of the community support services that used to be available are no longer available. When these arrangements break down and a crisis occurs, it is understandable that the only option left is to call an ambulance, which places increased pressure on the health service. Will the Minister champion a new approach, which is this: “Protect the NHS by supporting carers”?

[Lord Bethell (Con)]

Yes, I would endorse that sentiment. That has been one of the learnings of the pandemic. It is instinctively true in any case, and the evidence base during the pandemic was quite right. They are interlinked; that is one of the reasons we are bringing forward a Health and Social Care Bill that brings both services much closer together and brings a responsibility on the ICSs to combine health and social care at the same time. Our population-wide measures will try to bring those care responsibilities much closer together, as the noble Lord suggested.

Residential Social Care: Staff

Lord Laming Excerpts

Monday 6th September 2021 Lords Chamber

Asked by

[Lord Laming]

To ask Her Majesty’s Government what steps they are taking to improve the (1) training, and (2) remuneration, of staff in social care residential services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, we are incredibly proud of our health and care staff. As a nation, we are indebted to their selfless dedication, particularly over the last 18 months. The Government fund a range of training opportunities to support the development of care staff, including through a core workforce grant of £23.47 million. However, the vast majority of care workers are employed by private sector providers, who set their pay independently of central government.

[Lord Laming (CB)]

My Lords, I am grateful, but the Minister will understand that, very often, the impression is given that the only qualification needed by these splendid staff is that of a kind heart. This is despite the fact that they are caring, day by day and hour by hour, for the people in our society with the most profound needs. Does the Minister accept that, in these circumstances, it is remarkable that the median pay for these staff is £8.12 per hour? Is it any wonder that there are 112,000 vacancies in this field? Could the Minister say whether the Government have any plans to support these staff with professional training and give them a fair salary?

[Lord Bethell (Con)]

My Lords, I endorse the noble Lord’s key point, which is that value is seen not through salary but through the skill, love and determination of our social care staff to do a fantastic job. We are extremely proud of the service that they provide. The provision of care in this country is being looked at in the spending review settlement, and the need to support the sector will be addressed in that.

Covid-19: Care Homes

Lord Laming Excerpts

Thursday 17th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, PHE has published a report on that. It calculates that around 1.6% of the deaths in care homes were directly attributable to discharge. That number is very sad, but it is a relatively low proportion. This will, of course, be a subject covered in the government inquiry that the Prime Minister has already announced.

[Lord Laming (CB) [V]]

My Lords, I feel sure that the Minister will agree that it was extraordinary that, when relatives were prevented from visiting their loved ones in residential care, and many of the residents could not understand why they had been abandoned, at that very time patients were being admitted from hospital without having been tested for this virus.

[Lord Bethell (Con)]

My Lords, I completely sympathise with the point on those in care homes receiving a very tough challenge when they have been prevented from seeing loved ones. We have had to take extremely severe infection control measures, many of which are still in place for the reasons that have been discussed in this Chamber before. But I challenge the noble Lord’s point on testing. We brought in testing when asymptomatic infection was recognised and when the capacity was available.