Brexit: Health and Social Care Workforce

Debate between Lord O'Shaughnessy and Lord Laming

Thursday 13th December 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her question. First, we want to ensure that EU staff working in Britain are able to do so, and course that is why the EU settlement scheme pilot is so important. The social care workforce in this country has increased a lot, with a mixture of domestic and foreign staff. One of the ways in which we are increasing the attractiveness of that profession is by increasing the living wage, which has benefited so many staff in social care. Of course, many of them are highly skilled, and we want to ensure that we continue to be able to attract such skilled staff. We continue to discuss with the Home Office exactly what the right thresholds are for our future immigration system so that we do not lose out on these kinds of staff.

[Lord Laming (CB)]

My Lords, does the Minister agree that the problem is caused primarily because of the low esteem given to social care staff? This is extraordinary because most people who find themselves dependent on those staff value their contribution enormously. Would it not be helpful if the Government attached greater importance to those staff, not only through reward but through training and proper support?

[Lord O'Shaughnessy]

The noble Lord is absolutely right. The Government certainly do not hold those staff in low esteem—quite the opposite. As we know, we need increasingly to think of health and care staff as one workforce and ensure that professional paths lead through all those professions. I am sure he will be aware of the work being done by Skills for Care, which provides the overarching policy in this area, has made recommendations about pay and helped to inform our increase in the living wage, and is providing better training facilities for those staff.

Domestic Abuse: General Practitioner Charges

Debate between Lord O'Shaughnessy and Lord Laming

Thursday 15th November 2018 Lords Chamber

[Lord O’Shaughnessy]

I do not think that it is an issue of staffing per se, because it is not only doctors but other healthcare professionals who are able to provide letters of this kind. The evidence that has been gathered through consultation and indeed through the progress of the secure tenancies Bill is that the charges for these letters act as a barrier. That is the issue we are trying to address.

[Lord Laming (CB)]

My Lords, does the Minister agree that evidence of domestic abuse is important not only in respect of the adult who is the victim but also in respect of the children? It is the children who are often the most innocent victims in these situations. Given that, GPs have an important role to play in producing evidence of the well-being of children in these households.

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom on this subject. That is precisely why the domestic abuse Bill is looking to provide stronger sentences where a child has been involved or has witnessed this kind of abuse, and why some of the money I mentioned earlier, around £8 million this year, has been put aside to support children in these situations.

NHS: Staff

Debate between Lord O'Shaughnessy and Lord Laming

Tuesday 13th November 2018 Lords Chamber

[Lord O'Shaughnessy]

I am grateful to my noble friend, who set the foundation for this long-term workforce plan—indeed, the long-term plan for the NHS. He is right. It is not just a workforce plan for health workers but also looks at care workers. We need more staff, and that decision will be taken at the spending review, but it does have the highest priority.

[Lord Laming (CB)]

My Lords, does the Minister agree that the concerns expressed in this Question apply equally or even more to social care services? Unless social care is adequately staffed, the rebound on the health service will be enormous. I hope that, in future, social care will be given priority along with the health service.

[Lord O'Shaughnessy]

I agree. Indeed, my Secretary of State has made workforce one of his top priorities. We are responsible for health and social care, and the Green Paper we will publish this autumn will contain more detail on the social care workforce plan.

NHS and Social Care Services: Parity of Esteem

Debate between Lord O'Shaughnessy and Lord Laming

Thursday 5th July 2018 Lords Chamber

[Lord O'Shaughnessy]

I join the noble Baroness in paying tribute to staff, not just across the NHS of course but across all the caring professions. We published the draft strategy and will publish a joint strategy for the health and care workforce precisely for the reasons that she set out. We need to make sure that there is joined-up care across all sectors. That means that we need extra funding—a sustainable funding solution—for the social care sector. We have put in an extra £9 billion over the course of this spending review since 2015 to provide a short-term solution. The Green Paper is about providing a long-term solution. Some of the principles in the Green Paper emphasise the importance of this integration, delivering quality and integration, a valued workforce and sustainable funding. Those are the conditions necessary for what she wants to achieve.

[Lord Laming (CB)]

The Minister will know that in the social care field there are now numerous independent providers. What mechanism is there to ensure parity across the whole sector, including all aspects of social care?

[Lord O'Shaughnessy]

The noble Lord is right to point out that there are differences between the two workforces: clearly the NHS has a largely publicly employed workforce and social care has a largely privately employed one, so there will inevitably be some differences in form. We need to make sure that those workforces work together and are as attractive as one another, which is why finding a sustainable funding solution is so important so that those private contractors have the ability to pay what is necessary to attract the right staff.

Domiciliary Home Care Support

Debate between Lord O'Shaughnessy and Lord Laming

Wednesday 25th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for the opportunity to provide that reassurance for people using and benefiting from the care provided by Allied Healthcare. I want to reassure them that the Care Act 2014, passed by the coalition Government, gives local authorities responsibility for continuity of care if a business were to fail. Of course, we are not in that position with Allied Healthcare, because it still has to go through the CVA process. I can reassure people that the LGA has said that councils have “robust”—its word—plans in place to ensure continuity of care if that is required. I put that on record for those who may be worried about it.

We know that extra funding is needed in the sector. Over three years, through a number of means including extra money through the precept and direct funding to local authorities, the Government have increased by about £9 billion the funding available for social care, which we know is required. I also point out that, if you look at domiciliary care provider numbers, you will see that there are 50% more than there were eight years ago. We know that markets have entrants and that providers are exiting, but we have more providers in the market and more packages being delivered than ever before. Ultimately, the backstop is that local authorities have that responsibility to provide continuity of care.

[Lord Laming (CB)]

My Lords, does the Minister understand the importance of this Question? Imagine being a very vulnerable person living in a residential home with no alternative to go to or being dependent on a home help for the basics of daily living. Now imagine living under the shadow that the company that provides that service is going to go out of business at any time. Nothing could be more anxiety-provoking for these residents. The Care Quality Commission telling the local authority that there is a problem here is of no comfort. I hope that he will take this Question rather more seriously.

[Lord O'Shaughnessy]

I have huge respect for the noble Lord and his expertise in this area. I take this issue very seriously, which is why I used the opportunity in answering the noble Baroness to provide the reassurance that is in law. Local authorities need to step in to provide continuity of care with notice from the CQC, which now has a new responsibility to monitor the financial sustainability of providers and to make sure that that care is provided, whether it is delivered in-house or through contracts with other providers. That reassurance did not exist before it was introduced in the 2014 Act. It ought to provide a degree of reassurance among vulnerable people, who I accept will be anxious. That responsibility is in law.

NHS: Winter 2017-18

Debate between Lord O'Shaughnessy and Lord Laming

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree that those winter pressures are increasing. One reason that they are doing so, and throughout the year, is that we have a growing and ageing population, as we discuss a lot in this House. It is worth pointing out that the planning guidance for the NHS for 2018-19 talks about not only providing more surgeries but starting to stop the growth in waiting lists and reduce waiting times, as well as halving them for the longest waits. We are focused on this, supported by the extra money that was announced for the NHS in the Budget at the end of last year.

[Lord Laming (CB)]

My Lords, does the Minister agree that the structure of the GP service, settled decades ago at the beginning of the National Health Service, is no longer fit for the current demands on primary care services? Could that be looked at in a serious way?

[Lord O'Shaughnessy]

I think the structure of our GP service and primary care is envied around the world. It has many strengths, such as the partnership model being based in the community, but it is changing. For example, more GPs are employed in hospitals. There is a major programme of investment going into primary care, including new models of care around how GPs are structured, but the presence of primary care doctors in the community is one of the great strengths of the NHS.

Care Homes: Hospital Discharges

Debate between Lord O'Shaughnessy and Lord Laming

Monday 16th October 2017 Lords Chamber

[Lord O'Shaughnessy]

I am glad the noble Lord mentioned the number within a year. He will be interested to know, as other noble Lords will, that the number of delayed transfers of care went down year on year between August 2016 and August 2017. That is good news. That reduction has been caused by greater funding in that period and a greater focus on accountability, particularly for local authorities and trusts together. In terms of acute capacity, the number of beds has been relatively stable recently and NHS England has introduced a new test for any reconfigurations that adds a fifth category, looking at the number of beds available in any given area.

[Lord Laming (CB)]

Does the Minister agree that the position is likely to get more difficult as more care homes are saying that they cannot function on the level of fees being offered by local authorities? They are therefore withdrawing beds that are supported by public funds from this facility. Will the Minister look into that?

[Lord O'Shaughnessy]

I know of the issue that the noble Lord raises about withdrawing beds. As we discussed last week, there has been a small reduction in the number of nursing and residential care home beds. However, there has also been an increase in the number of domiciliary care packages. The noble Lord may also be interested to know that we are creating 6,000 new supported homes through the Care and Support Specialised Housing Fund. It is a changing market. I understand the funding pressures on local authorities, which is why we are putting in more funding.

Older Persons: Care and Human Rights

Debate between Lord O'Shaughnessy and Lord Laming

Tuesday 11th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I will read the report that the noble Baroness mentioned. She is quite right that integration of health and care budgets is the way forward, particularly as the burden of disease changes away from infectious diseases towards lifestyle and complex diseases of old age. The better care fund is beginning to start the kind of integration she is talking about, but of course we need STPs and accountable care systems, as set out in the five-year forward view. We feel there is, at the moment, the legislative freedom we need to move ahead with that.

[Lord Laming (CB)]

My Lords, the Minister will recall that last week there was a question about the number of residential homes for older people that were failing to provide adequate care. The temptation in some circles is simply to say that these homes should be closed down. The human rights of these very vulnerable people are bad enough when they are getting inadequate care; it is even worse when they are threatened with homelessness at this advanced stage in their lives. Will the Minister and his department give some thought to how failing homes could be tackled more effectively without creating homelessness for very vulnerable residents?

[Lord O'Shaughnessy]

The noble Lord makes an excellent point—and with great authority, as ever. The CQC report published last week indicated an improving picture, but clearly too much care is not up to scratch. One of its more heartening findings was that 80% of settings that had been deemed inadequate had improved by the time of the next inspection. It is clearly not right just to go in and start closing these homes: they need support to improve. As we are talking about care, it is worth bearing in mind also that the CQC report indicated that 98% of settings were deemed good or outstanding on caring. That goes to the heart of the fact that the people working in the care sector really do care and have been found to do so.

Mental Health: Children’s Services

Debate between Lord O'Shaughnessy and Lord Laming

Thursday 19th January 2017 Lords Chamber

[Lord O’Shaughnessy]

I thank the noble Lord for raising this important issue. I have looked at the YoungMinds research, and who could not agree that the money needs to get through to the front line? Its suggestion of maximising transparency is something with which we wholeheartedly agree. We do not think that ring-fencing is the right approach. It is right that we have a health service in which clinical commissioners, who know their local needs best, take decisions. As he knows, we are trying to redress an historic imbalance in both spending and parity of esteem for services. The approach that NHS England is taking about transparency is improving and working. I think that the YoungMinds research shows an improving picture year on year, although there is a lot to do. Indeed, that is confirmed by data from CCGs themselves on mental health spending, which shows an 8.4% increase year-on-year on money getting through to the front line.

[Lord Laming (CB)]

My Lords, do the Government accept that this is a subject of immense importance? Unless we identify young children with learning difficulties and other problems to do with eating disorders and self-harm, especially in the early years in education, and act quickly and robustly to meet their needs, it will be the beginning of a downward spiral. Society will pay a high cost in terms of both what happens to the individual in the impairment of their development and the costs for society in meeting their needs in their later life.

[Lord O’Shaughnessy]

I could not agree more with the noble Lord. It is significant that the Prime Minister made the announcement on mental health and committed herself to a big improvement in both the amount of funding and the services offered. Part of that is making sure that schools and health work together, with every secondary school in the country being offered mental health and first-aid training, but clearly there is much more to do.