NHS England Update
Lord Turnberg Excerpts(1 week, 2 days ago)
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Baroness Merron (Lab)
It will not affect commitments to women’s health. As we have said, women’s health remains a priority. The noble Baroness will know that there are some 600,000 women already on the gynaecology waiting list; that is far too long for women to wait. Women’s health hubs are part of the solution, and I continue to champion those with the integrated care boards.
Lord Turnberg (Lab)
My Lords, I am delighted to support the direction of travel towards patients first. I wonder if there are savings to be made. We can concentrate on the gap in social care, where I suspect much of the NHS is so interdependent. Social care is so badly funded, and we need to do something there.
Baroness Merron (Lab)
As we discussed earlier, the provision of social care and housing has a huge impact on quality of life and discharge from hospital. As my noble friend will be aware, the noble Baroness, Lady Casey, will be commencing her look into social care, to report to us all on the immediate and long-term changes that are needed and to build cross-party consensus.
Primary Healthcare Facilities
Lord Turnberg Excerpts(1 week, 4 days ago)
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Baroness Merron (Lab)
I certainly agree and can reassure the noble Lord that this is the case. I know that your Lordships’ House will have heard me speak previously about the very considerable investment that the Chancellor committed to in the Budget to provide adaptions for people’s houses in order that they could be cared for at home. I also say to the noble Lord that integrated care systems infrastructure strategies have been developed, which will create a long-term plan for future estate requirements and investment, while community health services also provide for planned and urgent care close to home, including clinics, care homes and, to the point raised by a previous noble Baroness, community hospitals.
Lord Turnberg (Lab)
My Lords, the biggest problem is the shortage of GPs. We are losing them faster than we are recruiting them. What plans do the Government have to increase the number of general practitioners?
Baroness Merron (Lab)
I am glad to say that recently, as my noble friend will be aware, we concluded the annual consultation on the GP contract and the committee voted in favour of the contract for the first time in four years. That will provide a way forward in terms of strengthening provision, prevention and the integration of services, which I hope will lift morale and the attraction to being a GP. We want to see consistent growth. There are now over 1,000 more full-time equivalent doctors working in general practice compared with January 2024. We have committed to training thousands more GPs across the country and recruiting over 1,000 newly qualified GPs through an £82 million boost to the additional roles reimbursement scheme.
Adult Social Care: Long-term Workforce Plan
Lord Turnberg Excerpts(2 months, 2 weeks ago)
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Baroness Merron (Lab)
I can give that assurance to the noble Lord, and I am glad he has identified to your Lordships’ House the wide range of circumstances in which the workforce might be. For the benefit of your Lordships’ House, I should add that, in their manifesto, the Government made a commitment to
“ensure the publication of regular, independent workforce planning, across health and social care”.
We are currently developing advice on the options about how to fulfil this commitment for adult social care, which will take account of the point the noble Lord made.
Lord Turnberg (Lab)
My Lords, one of the major problems is that most care workers are employed by privately owned care homes, both large and small. Many of these employees are on zero-hour contracts—it is a mess. How does one ensure that we have a national workforce plan if we have all these workers in various organisations? We must bring them all together and have a centrally regulated qualification that is nationally recognised. I hope I am not boring my noble friend by asking the same question: when are we going to get a nationally recognised qualification and registration?
Baroness Merron (Lab)
My noble friend is never boring and certainly does not bore this Minister. I very much take the point about the difference between the social care workforce and the NHS workforce, because the majority of the jobs in social care, as my noble friend says, are in the independent sector and the Department of Health and Social Care does not have the levers to ensure a development pipeline. However, this is a challenge for us to meet, not something to turn away from: it is a matter of working across the whole of the workforce, no matter where they are from.
On professionalisation, I agree that we need to enhance skills, because care needs to be of the right quality. I mentioned earlier the development of the care workforce pathway, which is a new career structure, and also that the level 2 adult social care certificate qualification has been confirmed.
Health and Adult Social Care Reform
Lord Turnberg Excerpts(2 months, 3 weeks ago)
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Baroness Merron (Lab)
I am grateful to the noble Lord for welcoming many of the measures in this announcement. He referred to the £20 fee that will be paid to GPs to call the consultant where necessary. I understand the concern about increasing bureaucracy, but all these reforms are intended to work the other way. We will very closely monitor them and have very carefully considered them with all those who will be dealing with them. I am actually more than hopeful, because the intention is that allowing the GP, for example, to get further advice, and making sure that people are being seen in the right place, will save money. It will mean that people are not taking up a referral place and that they will be referred for the necessary tests, scans, et cetera without the middle bit, which is a very backward-facing way of dealing with things. We will continue to monitor that to ensure that we are reducing what is currently wasted clinical time, while also preventing unnecessary out-patient appointments. The monitoring should show all of that and I will be very happy to update the House on that. The fee is to ensure that it can happen and is an incentive to do so. Of course, the greatest prize is an increased and speedier service for patients.
Lord Turnberg (Lab)
My Lords, it is pleasing to welcome the proposals from the Government. It is also very pleasing to hear of the immediate things that can be done for social care, because we should not be waiting for the final report.
There are some more suggestions that we could make that do not require any money—that should be music to the Minister’s ear. We do not need more money to reduce the bureaucracy that people in the community are required to go through to gain admission to a care home. It is horrendous. They have a means test and a needs test serially, which can be very bureaucratic and time-consuming, and there are waiting lists. We must reduce that bureaucracy.
The second thing, which the Minister has already referred to, is the value that we place on care home workers. It is good to hear that they will get a rise in their money and that ideas will be put about on their careers, but, unless they have a recognised national qualification and registration of that qualification, career prospects will be limited. We must do more for them to allow them to see themselves in a career that could go on to nursing in the NHS. We must do more in that field if we are to retain these enormously valuable people.
Baroness Merron (Lab)
My noble friend, as always, makes very practical observations. I totally agree with the point about bureaucracy in terms of care homes. I have experienced that as I have power of attorney for an elderly friend, and I constantly wonder: if I am struggling with it, what would it be like for somebody who perhaps is not as used as I am to dealing with forms, organisations and, indeed, bureaucracy? It is extremely troubling. Yes, that will be part of what we will be looking at to improve social care—and also the discharge ability that we were talking about earlier. Valuing care workers, professionalising the service and recognising them are all key. I agree that it should be a natural move from being a care worker into a clinical setting, but we also need to recruit people to be care workers, retain them and upskill them, which is so important.
NHS Plan: Consultation
Lord Turnberg Excerpts(3 months, 3 weeks ago)
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Baroness Merron (Lab)
This is indeed one of the groups for whom we need to ensure absolute inclusion. As I mentioned, the work with integrated care systems will be particularly helpful in running the workshop. We train organisations to work with it, and it is designed so that it is easy to use. It can be used in events to reach the seldom-heard voices in communities, including those with learning disabilities. It is vital that we hear from them as we design an NHS fit for everybody for the future.
Lord Turnberg (Lab)
My Lords, one of the biggest causes of inequality is where you live in the country. If you live in the north-east or north-west, you live two, three or four years less than if you live in the south-west or south-east. Far fewer resources are available for people in those deprived areas: there are fewer doctors, nurses, physios, dentists and so on. What can the Government do to redress this gross imbalance?
Baroness Merron (Lab)
My noble friend allows me to say—and I hope your Lordships’ House will agree with this—that our approach will of course focus on addressing the social determinants of health. The goal will be to halve the gap in healthy life expectancy between the richest and the poorest regions. We are not just going to be moving from sickness to prevention as one of our three pillars, important though that is; we are also seeking, across government, to address the root causes of health inequalities. Again, that is being highlighted as part of the consultation.
Inflammatory Bowel Disease
Lord Turnberg Excerpts(10 months, 1 week ago)
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Lord Markham (Con)
For the benefit of the House, I would say they are often confused. Irritable bowel syndrome is suffered by about 10% of the population while inflammatory bowel disease—we are talking about Crohn’s disease and colitis—is suffered by less than 1% of the population. The key thing is trying to understand the difference between the two; as I say, we have this poo test, for want of a better word, which can do that. With people who test positive, you absolutely need to get them into that screening programme and get it right the first time, so you can pick up those problems and things such as cancer.
Lord Turnberg (Lab)
My Lords, more years ago than I care to remember, I was a gastroenterologist and saw many patients with inflammatory bowel disease. We were desperately seeking a cause or causes and we did research on infectious agents, unsuccessfully. Can the Minister update us on where research into the causes of these diseases is going? It has been going on far too long.
Lord Markham (Con)
The noble Lord is correct. This is an area where we still need more knowledge. We have spent about £34 million in research in this space over the last few years, but there is still a lot that we are learning. I can say freely that if there are good research projects there, the resources are available to make sure that they are funded, because we need to learn more in this space.
NHS: Long-term Sustainability
Lord Turnberg Excerpts(11 months, 1 week ago)
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Lord Turnberg (Lab)
My Lords, I too thank the noble Lord, Lord Patel, for his very wise words when introducing this debate; I would expect nothing less. What a pleasure it was to hear the maiden speech of the noble Baroness, Lady Ramsey; I am sure we will hear more from her.
The excellent Library report for this debate suggests that there may be little benefit in seeking new ways of funding and new systems of delivering the NHS. I was reminded of the economist Maynard Keynes, who said that any proposed change should not only produce improvement but be sufficiently better to make up for the evils of transition. We have seen plenty of evils of transition over the years. I will focus on one set of problems among the many which need attention.
The difficulties faced by patients coming to hospitals have been well rehearsed: crowded emergency departments, queues of ambulances waiting outside, long waiting lists for patients needing to be admitted, cancelled operations—the list is endless. I am acutely aware of them as someone who has spent most of his working life in hospitals. However, if there are to be any solutions, they must be found outside hospitals and in the community, where social, community and primary care are hardly coping under their loads.
This is where the problems for hospitals, and for everywhere else, arise. Age UK noted that 700,000 elderly patients were attending emergency departments because they could not get an appointment to see their GP. Over 15% of acute hospital beds are occupied by patients waiting, sometimes weeks, to get out of hospital. Some patients wait so long for care in the community that they are much more ill by the time they reach hospital. It is therefore little wonder that hospitals are overwhelmed. So, I make no excuse for focusing on the problems in the community, as other noble Lords have. They have been accumulating for many years. Local authorities’ funding has been squeezed to the point where they clearly are not coping. Because almost two-thirds of their budget is spent on social and community care, these are being cut to the bone.
We now have far too many vacancies for health visitors and district nursing posts. Meals on wheels has disappeared and support services are squeezed out completely. Yet demand for social care is increasing. There were almost 2 million requests to social care departments in 2023, and waiting lists are growing. Some wait many months for assessments and when they get to the front of the queue, they have to go through a tortuous and bureaucratic process that few can understand. As others have said, it is a two-stage system: an assessment of whether they really need support, and of whether they can afford to pay. Few can understand it, and few can pass.
Then, there is the problem faced by the very large number of people cared for at home by relatives and friends. Many such carers give up paid employment to look after their relatives. If they apply for help and if they can get through the mountain of bureaucracy, they may be able to receive £76.75 per week—ludicrously low recompense when it is recognised that this huge number of independent carers, several million of them, are saving the Exchequer vast amounts of money. Surely, we can do better than that.
Finally, I will shine a light on what is a disgrace in social care: the way we treat our social care staff. We treat all NHS staff badly, but care staff are at the bottom of the pile. Not only are they the poorest paid employees, who can earn much more in jobs outside caring; they are also treated badly for the vital role they play. They do not have a nationally recognised training programme or an approved and registered qualification. The lack of a professional qualification or the prospect of career progression causes many to leave caring within the first 12 months. Some 10% of jobs are vacant—approximately165,000 vacancies are currently advertised—and high sickness and absentee rates are far too common. The picture I have described has been creeping up for years.
Will the Minister look again at how to make the careers of care home workers sufficiently attractive, so that we can retain as well as recruit them? Will he press for them to have professional qualifications after recognised training programmes, along with the prospect of career progression? Will he reduce the distressful level of bureaucracy faced by applicants for social care? If there is any more money—and quite large amounts were being bandied about last year that have not become visible on the ground—it should be focused where it would have most impact: on community and social care.
Pandemic Preparedness
Lord Turnberg Excerpts(11 months, 1 week ago)
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Noble Lords
Lord Turnberg (Lab)
My Lords, some years ago, when I was chairman of the Public Health Laboratory Service, we had 31 public health laboratories dotted around the country. Their role was to track and trace the sources of infections. We lost those in a review of the Public Health Laboratory Service, and I resigned as a result of that. What a loss that has been. What efforts are being made now to replace those laboratories which can do the track and trace that we desperately need?
Lord Markham (Con)
As the noble Lord mentions, one of the key pillars is having diagnostic capability. The noble Lord will be aware that, for the sequencing of all the different Covid strands, it was the UK that they were sent to because our diagnostic and sequencing ability is second to none. I am assured that that capability still exists and, with that, our ability to scale up diagnostic testing very quickly.
Cancer: Staffing
Lord Turnberg Excerpts(1 year ago)
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Lord Markham (Con)
As I mentioned, that was very much the big feature of the discussion that I had with the president of the Royal College of Radiologists just the other day. We have been growing the number of radiographers by about 3% every year, which is a good rate, and we look to increase that even further. The CDCs are about that. However, the actual demand is increasing by about 5% every year. Clearly, as well as recruitment, we need to make sure that we have effective diagnosis, and this is where the field of AI is very exciting. The radiographers are 100% behind it, because they really see the revolutionary effect it is bringing.
Lord Turnberg (Lab)
My Lords, we are certainly shortly of staff, and the problem is not increasing recruitment but enhancing retention. Staff are leaving because they are disillusioned and disaffected, and we do not treat them well enough. Any large business knows that, if you have a happy workforce, it will be productive. We certainly do not have that in the NHS. We certainly need to stop this dismissive attitude and enhance the conditions of their service, and it is not simply about pay. Does he agree?
Lord Markham (Con)
I totally agree that it is a range of things. I completely agree with the noble Lord that a good employer should be looking to make sure that employees have good working conditions and feel valued, and that there is an understanding culture in the workplace as well as decent pay. I say all this in the context that the workforce in the cancer space has actually increased by 56% since 2010, so it is not as if there have not been massive increases here. The actual number of treatments and diagnoses has gone up by more than 20% from pre-pandemic levels. So we are doing a lot in this space, but I agree with the noble Lord’s basic premise that we need to ensure that staff feel valued so they will want to carry on working.
Care Home Staffing
Lord Turnberg Excerpts(1 year, 2 months ago)
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Lord Markham (Con)
My noble friend is correct that the recruitment of personal carers is harder. I know that this is close to his heart. I can probably serve him best by giving him a written reply setting out the details of what we are doing.
Lord Turnberg (Lab)
My Lords, to make this an attractive job for a care worker, we have to not only give them a pay rise above the national living wage, which is their basic pay, but make this into a profession. If they are professionals, they will then have a career structure that is recognised nationally. Will the Minister encourage that development?
Lord Markham (Con)
Yes, I totally agree. That is why we announced this career pathway last week, to try to do exactly what the noble Lord is talking about. It has been welcomed; I quoted from ADASS, but a number of other bodies have welcomed what we are trying to do. We aim to do what the noble Lord said: to make it a profession that people really want to join. There are qualifications for it, advancement and apprenticeships, which are all part of setting up a career structure.