NHS: Dementia Commission Report

Debate between Lord Markham and Baroness Watkins of Tavistock

Thursday 22nd February 2024 Lords Chamber

[Lord Markham (Con)]

We have set out a dementia good care planning guide to exactly those commissioners because, as ever, we need uniformity in these areas. Part of the strength of ICBs is that they have freedom to deliver local services, but we have to make sure that they are always achieving at least the minimum levels that the noble Lord referred to. That is what the guidelines are about, and we are setting monitoring against that to make sure that they are delivering on it.

[Baroness Watkins of Tavistock (CB)]

My Lords, I have two questions. First, I understand that NICE will review rather than approve the drugs in question. Secondly, it appears that they extend life but that the end of life is still very similar, so what do the Government intend to do to ensure that carers have sufficient respite and that there is a standard ratio of Admiral nurses to support families, certainly for the next decade until science gives us the answer?

[Lord Markham (Con)]

The noble Baroness is correct that the science is unfortunately not there yet. That is why we are investing £160 million a year in research, because more needs to be done. In the meantime, and I suspect for ever, we will need to make sure that support networks are around this space, and the voluntary care sector, for want of a better phrase, is a vital part of that. We are making moves towards it; we are giving respite care and making some payments. I freely admit that there is more we could be doing in this space, but we have done quite a bit as well.

Adult Social Care: Staffing

Debate between Lord Markham and Baroness Watkins of Tavistock

Tuesday 12th December 2023 Lords Chamber

[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.

[Baroness Watkins of Tavistock (CB)]

My Lords, does the Minister accept that many delayed transfers of care from hospital are associated with difficulty in getting social care in people’s own homes? In rural areas, we are still not paying for time spent travelling. Surely there is something we could do much more quickly, before the training certificate, to employ local people in a fair way to provide care in people’s homes, particularly in rural areas.

[Lord Markham (Con)]

The noble Baroness is correct about that; it is a key pillar of this reform. This is why we have tried to learn one of the main lessons from last year, by putting the £600 million discharge fund out early, so we can get those sorts of measures in place. That is why we have expanded the virtual care ward network to 10,000 beds, with the idea that people can be cared for in their own home but with support from the staff there. That is absolutely the direction we are moving in.

Mental Health Act 1983

Debate between Lord Markham and Baroness Watkins of Tavistock

Tuesday 21st November 2023 Lords Chamber

[Lord Markham (Con)]

Yes. I have tried to get into this further, and my understanding is that lot of the trouble is that there is often a fear from black and ethnic-minority people of the existing institutions that can help people early on. As we all know, with mental health difficulties, we have to act quickly. A lot of this is about getting everyone in society open to the idea that the earlier they can go to these sorts of places, instead of trying to brave their way through, the better. That is one of the key things to do to make sure that we do not then see problems down the pipeline, including the disparity whereby a black person is 11 times more likely to have community reviews and the disparity in detentions.

[Baroness Watkins of Tavistock (CB)]

My Lords, I think that other noble Lords will welcome the idea of sitting down at a round table to look at the future. In particular, what do the Government intend to do to invest in children’s and adolescents’ mental health services to make them accessible in schools? Early intervention will prevent a high proportion of people needing to be sectioned later on.

[Lord Markham (Con)]

The noble Baroness is absolutely correct. With the mental health units to detect problems early, we are now at around 35%; last year it was only 25% but in the next 18 months or so we should be at 50%, which is higher than ever before. I freely accept that 50% is not 100% but it is clearly a step in the right direction. The £2.3 billion investment we are putting in means 350,000 extra places for young people as well.

Suicide Prevention Strategy

Debate between Lord Markham and Baroness Watkins of Tavistock

Thursday 26th October 2023 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister assure us that DWP staff are being trained properly in recognising the suicide risk of such claimants? One of the most important things is that people largely want to work and getting rejected following job interviews is a huge risk for that particular population.

[Lord Markham (Con)]

Absolutely. It is my understanding that all front-line DWP staff have two days of mental health training in precisely this area. Also, their stated objective is to support people in what they can do and support them into work based on their abilities. We all know that work gives people a big feeling of self-worth and confidence and is a key to both physical and mental health.

NHS Long-term Workforce Plan

Debate between Lord Markham and Baroness Watkins of Tavistock

Tuesday 4th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. He is quite right to say that we need to check against delivery and he is quite right to hold us to account on that. Personally, I am happy to commit whatever time we need to debate this because I completely agree on how important it is. As I say, it is quite sobering when you think about the figures: as we said, we expect one in eight school leavers to go and work in this sector, so we almost cannot spend too much time on that.

As I say, the dental plan will be published shortly, and making sure that the balance is right, and that it is seen as an attractive option to be an NHS dentist versus working in the private sector, is absolutely an important part of that as well.

[Baroness Watkins of Tavistock (CB)]

My Lords, I very much welcome this plan and in particular the fact that we will start to deliver more homegrown healthcare workers; in fact, the WHO has applauded us for these moves because there is such an international shortage, not because overseas workers are not welcome here.

I want to ask one question. I very much support the concept of apprenticeships, but professional workers on registers, be that nursing, medicine, physiotherapy or paramedicine, expect apprenticeships to be degree-level apprenticeships, accepting that the entire workforce will not be graduates but that registered clinicians should be. Can the Minister please clarify that issue?

[Lord Markham (Con)]

I thank the noble Baroness. The whole idea of the apprenticeship is that the standard that you are training to is absolutely the same, albeit obviously you are getting there via a different route. However, as regards the capability, training and knowledge of that person, clearly, whichever route they have come from, they need to be at that same required level. That is why the royal colleges have been such an important part in the development of this whole plan.

Mental Health In-patient Services: Improving Safety

Debate between Lord Markham and Baroness Watkins of Tavistock

Monday 3rd July 2023 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I welcome the Statement, but I will raise two issues. First, it seems that several different bodies will look at what the problem is, yet the ombudsman has just said that it is absolutely imperative that

“The Department of Health and Social Care should commission an independent review of what an effective set of patient safety oversight bodies would look like”.


Could the Minister comment on how that will be considered in tandem with the proposals outlined in the Statement?

Secondly, will the proposals look at a safe staffing model for all in-patient mental health services? In fact, in-patient services are really looking after only those people who have severe mental health problems; they are almost the equivalent of an intensive care unit in a general hospital. Increasingly, staff do not have time for proper continuity of handover when they leave shifts, and that needs to be examined. It is relatively easy to describe somebody’s blood pressure and blood stats in an intensive care unit as you hand over in a general area, but to describe the complexities you have been working with, for example with somebody who has severe schizophrenia and is deluded and paranoid, takes a good 10 minutes in a handover. I would welcome the Minister’s comments on how we will look at ensuring that that is considered when measuring safe staffing.

[Lord Markham (Con)]

I thank the noble Baroness. The points she rightly makes are exactly what we believe is the remit of the new HSSIB review starting from October. One of the specific points is about developing safe therapeutic staffing models for all mental health in-patient services. I think and hope that the exact points raised by the noble Baroness will be addressed by the review.

Dementia Palliative Care Teams

Debate between Lord Markham and Baroness Watkins of Tavistock

Thursday 15th June 2023 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw noble Lords’ attention to the recent research report from King’s College London about better palliative care and end-of-life care for those affected by dementia. It shows clearly the cost-effectiveness that can be achieved and the reduction in the use of in-patient hospital beds. I declare that I am on the NHS Executive and am pushing for this. What can the Government do to ensure that ICBs actually take this forward?

[Lord Markham (Con)]

As I said, we think that the ICBs are the right place to manage this at a local level, but it is our responsibility from the centre to make sure they are delivering on that. I personally have seen good examples: my father was cared for at home, with palliative end-of-life care, and I know how happy he was to be able to do that, so I totally agree.

NHS National Health Inequalities Improvement Programme

Debate between Lord Markham and Baroness Watkins of Tavistock

Thursday 25th May 2023 Lords Chamber

[Lord Markham (Con)]

As mentioned previously, the review did not happen because of Covid, and it is very much within the plans that it is time to look at school standards again. Clearly, that is key to making sure that there is a healthy diet in schools, and of course that goes across the board.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister explain whether the Department of Health is working with other departments to consider funding families entitled to free school meals with additional allowances during the summer vacation in the light of the current cost of food and the need, as he has acknowledged, to provide adequate nutrition to promote health in young people?

[Lord Markham (Con)]

Yes. It is worth reiterating that the 37.5% free school meal level is an achievement, as is the fact that all infant schoolchildren receive free school meals—higher than ever before. However, the noble Baroness is correct in terms of what happens during holidays. That is why we have the holiday activity fund, which in the summer holidays, for instance, provides meals for four of the weeks, as well as for another week in winter. Clearly, we need to keep that under review to make sure that that is sufficient.

Mental Health Act Reform

Debate between Lord Markham and Baroness Watkins of Tavistock

Thursday 26th January 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct; these things do need resources. We have committed to £2.3 billion of extra spending next year and an increase of 27,000 in the number of mental health nurses; I am glad to say we are well on the way, with a 7,000 increase over the last year. This all comes back to workforce planning—I am sure I will be asked that question later. And, yes, we will publish our plan soon.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister comment on why it is 50 years since we have had a revision, and say whether in fact the Government are delaying this legislation because of the resources that will be required, as has just been referred to?

[Lord Markham (Con)]

No, I hope that all noble Lords will see that there is no sense of delay on this side—and we are not waiting for the legislation to introduce a lot of these measures. It is very important, and we are ready to push on as soon as parliamentary time allows.

Osteoporosis: Early Detection

Debate between Lord Markham and Baroness Watkins of Tavistock

Thursday 19th January 2023 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, could the Minister comment on whether the department of health is working with the department of energy to ensure that we can afford to heat our swimming pools? Swimming is a really good exercise and reduces the risk of falls, particularly in older people.

[Lord Markham (Con)]

As previously mentioned, prevention is always better. Exercise, as I have learned from my noble friend Lord Sandhurst, is a good way of preventing osteoporosis. Where we can find cost-effective ways of getting that exercise, such as swimming pools, we should be promoting them.

Care Homes: Staffing

Debate between Lord Markham and Baroness Watkins of Tavistock

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. I think that the House will recall that I have mentioned on a number of occasions that this is a critical part of the workforce plan. What has become clear, even in the short time that I have been at this box, is that social care is a vital cog in the whole chain, so to speak, which goes right back to ambulance wait times and A&E, because if we do not get the flow going out of the system, we have got problems there. So I can assure the noble Baroness that it is key to my thinking, and to all our thinking.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a future member of the NHSE board. I want to ask how we are going to monitor the advancement from care homes back into domiciliary care, in order to ensure that we do not just move the problem from the hospital to care homes so that, very quickly, there are no beds left in care homes to continue this transfer system. In particular, who is going to pay for the residents in those care homes, and for how long?

[Lord Markham (Con)]

The question is absolutely correct: as I said earlier, less than 10% of these 13,000 people need to be in care homes full-time. The danger is often that once you put them there, they remain. That is why the package is focused on stays of up to four weeks, and absolutely making sure that they are monitored through, because it is vital. It is a step-down situation to help people ease from the acute—where they need a bit of extra support—so that, most importantly, they can get back home as soon as possible.

NHS Winter Pressures

Debate between Lord Markham and Baroness Watkins of Tavistock

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

As with my answer to the previous question, I look forward to that meeting and learning everything we can. I will repeat the statistics on that subject that struck me most: of those 13,000 people who are fit to be discharged, we think that only 3% need to be in social care in the long term; 97% could be at home, which is the best and most cost-effective place for them. We need to ensure that the support is in place to ensure that that option exists.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as a nurse and as a new appointment to the NHS England board as a non-executive director. There are two things missing from this discussion. First, there has been no reference to people waiting for mental health support. How can we ensure that people in mental health crisis are moved rapidly out of busy A&Es to be supported in quieter environments? There is a very good example across the road, at St Thomas’ Hospital, which is helping the A&E. Secondly, it is high time that we seriously consider giving full-time contracts to care workers in domiciliary services, because, as soon as somebody goes into hospital, the care worker’s hours are cut and, although they know that individual, they very rarely get reallocated to them when they are transferred back out of hospital. The lack of continuity of care often results in readmission, so what will the Minister do to ensure that, in the way that the noble Lord, Lord Turnberg, just outlined, we improve the lot of those particular care workers?

[Lord Markham (Con)]

First, I welcome the noble Baroness to the NHS England board, with high expectation of the value that she will add to it. I am very interested to understand her point further; I will speak to Minister Whately about that and respond to the noble Baroness in writing. Where people have knowledge of a patient at home, they can add that to their care when they come back out again.

Social Care Sector: Staff Shortages

Debate between Lord Markham and Baroness Watkins of Tavistock

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the right reverend Prelate for the passion that she clearly displays in this field. As I mentioned in my Answer to the Question, we have a national recruitment campaign, and looking at the staffing plan for allied health professionals and what needs to be paid to recruit people in the right areas will be part of that. The national living wage is a start, but clearly we need to make sure that this is an attractive career that people want to join and stay in.

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw attention to my interests in the register. Recently, the coroner in Cornwall ruled that some deaths in the county are probably attributable to delays in ambulance services, which are in turn associated with delays in transfers of care from acute services to care homes. There has been a reduction of more than 600 care bed places in Cornwall in the past four years. This is an example of the challenge that we face. Does the Minister accept that the Government’s objectives for the NHS will never be effectively achieved without resolving the social care challenges, and that the difficulty of recruiting from overseas, particularly in rural areas, should be acknowledged?

[Lord Markham (Con)]

I agree and have often made the point that solving this part is key to the flow and to getting people through discharge quickly, which has a knock-on impact on A&E and ambulance wait times. That is why I was delighted to hear the Chancellor recognise this specifically and mention £2.8 billion of funding in 2023-24, which will account for 200,000 new care packages in this space, as well as £4.7 billion in 2024-25 to resolve the exact problems that the noble Baroness brings up.

Ambulance Delays

Debate between Lord Markham and Baroness Watkins of Tavistock

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

The noble Lord is referring to the whole-system issue here, which I mentioned before. There is a £450 million investment to increase capacity in A&E facilities; that has already worked to upgrade 120 trusts to enable them to offload quickly. There are also 7,000 extra beds, and the £500 million social care discharge fund is all about freeing up more beds so that ambulances can discharge quicker.

[Baroness Watkins of Tavistock (CB)]

My Lords, I must declare that I am a former deputy chair of an ambulance trust that was an exceptional performer but is no longer, associated with the fact that, in some circumstances, it cannot get patients admitted to two of its largest local hospitals in under four hours. The problem is social care, not increasing the number of ambulances on the roads. Will the Government consider much more innovative approaches to respite care support for people who are ready to leave hospital and whose families cannot afford to leave work to look after them but, with incentives, probably could do so? That would be a practical way of moving the system forward at the moment.

[Lord Markham (Con)]

I agree with the noble Baroness that social care is a key solution to all this. As I said, that is what is behind the 13% of beds that are currently blocked and the £500 million spend in this area. However, we can be more innovative. That is what the virtual ward initiative, which I saw working so well in Watford, is about; it has reduced reattendance rates after 90 days from 46% to around 8% for COPD patients. This is an area where we need focus and innovation, and which is very much top of my agenda.

NHS: Nurses

Debate between Lord Markham and Baroness Watkins of Tavistock

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

To be very clear, today, there are 29,000 extra, over the 2019 figures. That is more than half way towards the figure of 50,000. I will quite happily write to noble Lords so that they can see the figures clearly in black and white, but I can assure the House that we are talking about increases in nurse numbers. We have achieved a 29,000 increase on the 2019 levels.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a registered nurse and would like to follow on from the noble Baroness, Lady Chisholm. We must grow our domestic workforce in nursing. I do not dispute the figures the Minister has given, but any nurse earning more than £27,000 who trained recently is now repaying 9% towards their student loan, on top of the 20% tax they are paying. I accept that they get a £5,000 bursary a year, but they work extraordinarily long hours compared with ordinary students. It really is essential that we find a way to retain those young nurses who have just trained by doing a debt write-off of their loan after five or six years.

[Lord Markham (Con)]

I totally agree that retention and attracting people into the profession are key. I like to think that we are looking at all these things in the round, taking into account the £5,000 grant, the service they are giving, and their conditions and pay going forward. As ever, this is a moving feast, for want of a better term, so we will keep looking at it to make sure we continue to both attract and retain the domestic and international staff numbers.

Nursing: Recruitment

Debate between Lord Markham and Baroness Watkins of Tavistock

Wednesday 26th October 2022 Lords Chamber

[Lord Markham (Con)]

First, we are actually exceeding the number of leavers. There were 36,000 people who left last year and 45,000 who joined—a net increase of 9,000. That is not to say that we do not want to retain people. I absolutely accept the premise that we do, which is why we have a retention programme in place to ensure that we are able to do so. We also have a restart programme to help people who have left to get back into nursing in a quick and easy way. Overall, the main point here is that the number of joiners is exceeding the number of leavers. We are more than catching the number up; we are exceeding it.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as a nurse and the co-editor of the WHO report, State of the World’s Nursing. It is true that we have 9,000 additional nurses, but of the 48,000 who in the last year joined the register for the whole UK—for the four countries, not just England—more than half had trained overseas. Those nurses are very welcome here, but it illustrates that we are not encouraging people who wish to go into nursing to do so, beyond the 72,000 the Minister referred to. That is very much to do with student finance and the lack of apprenticeship opportunities for older people who want to go into the profession. Can the Minister look into increasing those opportunities?

[Lord Markham (Con)]

Indeed, and towards that aim we have set up the nursing associate role, which is a stepping-stone to allow people to ease in and have qualifications on the way to becoming a fully trained nurse. The overall point I make, as before, is that by putting in a £5,000-a-year grant for student nurses, we are recruiting the numbers. I reiterate that 72,000 is a big pipeline but also that it is an uncapped pipeline. The more we can attract, the merrier—whether domestically or, as in the fine tradition of the NHS, from overseas sources.

Health and Social Care Update

Debate between Lord Markham and Baroness Watkins of Tavistock

Monday 10th October 2022 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I welcome the new Minister and declare my interests, in particular that I share his interest in the nursing profession. I have two questions. One is about the 15 units where particular problems have been identified. Does he think that is to do with demography, particularly older populations, and that we have got the funding calculation right in those areas? Secondly, is he prepared to meet me to talk about retaining people who are currently qualifying who, if they do overtime, are being hit with the 9% repayment for their student loans? This means there is very little incentive for the younger generation to do overtime, despite their being the fittest and probably most able to do so.

[Lord Markham (Con)]

On the 15 trust areas, I will need to get back to the noble Baroness on whether it is down to demographic factors. I wish to dig into it more and will look at a number of things. I have been told anecdotally that the day of the week makes a big difference to performance and wait time, so that is another area I want to get underneath. In terms of retaining people, as an entrepreneur who has started up many businesses, I know the importance of motivating a workforce. Clearly, if work does not pay—for want of a better word—there is not much motivation to put in the extra hours we require. I will come back to the noble Baroness with more information on that.