Asked by: Lord Smith of Leigh (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the social and economic determinants of health inequalities identified by the Marmot Review, Fairer Society, Healthy Lives, published in 2010.
Answered by Baroness Blackwood of North Oxford
Fairer Society, Healthy Lives - the Marmot Review - provided a comprehensive analysis of the state of health inequalities in England, their causes, and evidence-based recommendations for action on social determinants of health. These are the conditions in which people are born, grow, live, work and age. These conditions are, in turn, shaped by political, social and economic forces.
The Marmot Review concluded there is a social gradient in health whereby the lower a person’s social position, the worse his or her health with people in more deprived areas having shorter lives and fewer years lived ‘in good health’ than those in less deprived areas. The Government has fully assessed the report, and it continues to inform our approach to reducing health inequalities which is now underpinned by legal duties.
Public Health England monitors the indicators on the social and economic determinants of health, identified by the Marmot Review, in its wider determinants of health web tool. In addition, through its Long Term Plan, the National Health Service has committed to all major programmes and every local area setting out specific measurable goals and mechanisms to reduce inequalities over the next five and 10 years. The NHS will also take action to cut smoking in pregnancy, provide outreach to homeless people and help people with severe mental illness find and keep a job.
The Mission in the Ageing Society Grand Challenge, announced by the Prime Minister last year, is to ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest.
This underpins the Department’s prevention vision published in November 2018 - Prevention is better than cure: our vision to help you live well for longer. In it, the Secretary of State for Health sets out our mission to improve healthy life expectancy so that, by 2035, we are enjoying at least five extra years of healthy, independent life, whilst closing the gap between the richest and poorest. A copy of the report is attached.
Asked by: Lord Smith of Leigh (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what percentage of NHS staff, per region in England, are citizens of other EU member states; and what assessment they have made of the impact of Brexit on those employees.
Answered by Baroness Blackwood of North Oxford
NHS Digital publishes Hospital and Community Health Services (HCHS) workforce statistics. These include staff working in hospital trusts and clinical commissioning groups, but not staff working in general practitioner surgeries, local authorities or other providers.
The following table shows the percentage of HCHS staff that are known to have an EU27 nationality in England and by Health Education England region, as at 31 October 2019, headcount.
| Percentage of HCHS staff with an EU27 nationality |
England | 5% |
Of which: | |
Health Education East Midlands | 3% |
Health Education East of England | 7% |
Health Education Yorkshire and the Humber | 2% |
Health Education Wessex | 7% |
Health Education Thames Valley | 9% |
Health Education North West London | 10% |
Health Education South London | 10% |
Health Education North Central and East London | 11% |
Health Education Kent, Surrey and Sussex | 7% |
Health Education North East | 2% |
Health Education North West | 3% |
Health Education West Midlands | 3% |
Health Education South West | 5% |
Source: NHS Digital
These figures are based on nationality data held on the Electronic Staff Record. It is self-recorded, so can differ from an individual’s citizenship or immigration status.
The Government is committed to ensuring that the over 63,000 European Union nationals that work in the National Health Service not only stay in the United Kingdom after we leave the EU, but feel welcomed and encouraged to do so. Part of this commitment is mitigating against any potential impact that EU exit might have on EU citizens in the UK. To help achieve this, the Home Office has opened the public testing phase of the EU Settlement Scheme. All EU nationals are eligible to apply to the scheme’s public testing phase. Furthermore, to help facilitate as many applications as possible, the Prime Minister announced on 21 January 2019 that, as of 30 March 2019, all applications to the settlement scheme will be free. Additionally, where individuals have applied, or do apply, before that date, and are charged an application fee, then this fee will be refunded.
Asked by: Lord Smith of Leigh (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what plans they have to compensate hospices in order to ensure that the recent NHS pay rise and proposed pension changes do not adversely impact those hospices' ability to fund activities.
Answered by Baroness Blackwood of North Oxford
In July 2018 the Department set out eligibility criteria for non-National Health Service organisations to apply for additional funding to implement the Agenda for Change (AfC) deal in 2018/19. The criteria requires non-NHS organisations, including hospices, to provide NHS services and employ existing and new staff on the AfC contract. In addition, that the NHS services they provided are funded by the Hospital and Community Health Services or Public Health Grant funding. Funding is linked to the direct costs of implementing the entire AfC pay deal which includes pay and non-pay reforms, not just headline pay.
For the final two years of the deal, 2019/20 and 2020/21, funding has been provided to NHS England as part of the Long Term Plan. While we cannot intervene in local contracting arrangements, we expect that commissioners and hospices will want to engage in conversations about how extra funding for the final two years of the deal might be passed on, on a similar ‘something for something’ basis which applies to directly employed NHS staff.
In addition to the long-term funding settlement for the NHS, HM Treasury committed to providing extra funding to meet the costs to the NHS arising from the ongoing actuarial valuation of the NHS Pension Scheme. Work is ongoing to ensure the additional cost to participating employers, including hospices, is appropriately funded. Discussions are underway with NHS England and NHS Improvement to determine the optimum method for distributing this funding to NHS commissioners and service providers. Arrangements will be confirmed in due course.
Asked by: Lord Smith of Leigh (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what support they intend to provide to hospices as part of the NHS Long Term Plan.
Answered by Baroness Blackwood of North Oxford
NHS England recognises that children’s palliative and end of life care has not kept pace with growth in clinical care cost or inflation. NHS England’s hospice grant programme currently provides £11 million a year for children’s hospices, helping to provide care and support to children and their families close to home in their final days.
As part of the NHS Long Term Plan, subject to clinical commissioning groups (CCGs) providing match funding, additional funding will be available each year for children’s palliative and end of life care services, with NHS England’s contribution increasing by up to £7 million a year by 2023/24. Therefore, if this is matched by CCGs, total funding will increase over the next five years to £25 million a year by 2023/24.
NHS England has also commissioned Hospice UK to undertake an evaluation of the cost effectiveness of hospice-led interventions in the community. Although there many such care models across England, there is insufficient data on what the most effective approaches are, making it difficult for CCGs to confidently commission these services. This project will examine hospice-led initiatives that appear to be having a positive impact on where people are cared for as well as where they die. The final results are expected for publication shortly.
Asked by: Lord Smith of Leigh (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what steps they are taking to support the greater provision of respite places and care homes in order to reduce problems of bed-blocking.
Answered by Lord Prior of Brampton
Local authorities are responsible for commissioning care and respite placements and for ensuring that the provision of care and support meets the needs of local people. The Department is supporting local authorities to improve commissioning and ensure that their local markets are effective.
Asked by: Lord Smith of Leigh (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether they have plans to introduce requirements for Clinical Commissioning Groups with patients in acute hospitals in other areas to prioritise those patients to prevent bed-blocking.
Answered by Lord Prior of Brampton
NHS England has advised that it does not currently have plans to introduce requirements on clinical commissioning groups to prioritise patients in one area over another.
However, NHS England is working to improve patient flow, for example through the Urgent and Emergency Care Review, which proposes a radical transformation in the way services are provided to deliver a more sustainable urgent and emergency care system, delivering care closer to home whenever it is safe and appropriate to do so.
NHS England has also recently published guidance on Transforming urgent and emergency care services in England to help frontline providers and commissioners deliver safer, faster and better urgent and emergency care to patients of all ages, collaborating in networks that cross traditional boundaries in order to deliver best practice. A copy of the guidance is attached.
Asked by: Lord Smith of Leigh (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what they estimate is the cost to the NHS of bed-blocking by patients who have received all their medical treatment; and what steps they are taking to reduce this.
Answered by Lord Prior of Brampton
The Department has made no formal estimate of the costs of delayed discharge to the National Health Service. It is recognised that such delayed discharges do use resource which could be deployed elsewhere, and all parts of the NHS and those with responsibility outside it, are continually looking for ways in which to reduce the number of delays.