NHS: Better Care Fund
Lord Turnberg Excerpts(9 years, 11 months ago)
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Lord Turnberg (Lab)
My Lords, there is no doubt that care in the community is grossly underfunded. There are too many elderly people living alone and in need of care that they are being denied. We know that social services are now only able to provide care for urgent cases and then often only a quite inadequate 10-minute visit to help those people get dressed, bathed or fed. We know, too, that GP services are extremely stretched in many parts of the country. I do not think the BMA was simply crying wolf in its recent pronouncements when it said that it is having great difficulty coping with its growing workload. On top of that I hear it is having problems recruiting in general practice, especially in the north.
Now we hear from the Local Government Association that its budgets will have been cut by 15.5% by next year and that it is looking at a black hole of a £5.8 billion deficit by then. It is against this background that we see this inexorable rise in demand for both acute and longer-term care. On the one hand, the increase in numbers of those aged over 80 is heartening and is a tribute, at least in part, to modern medicine, but equally it is troubling that we have to cope with them accumulating multiple illnesses and disabilities. The prospect of dealing with more than 1 million people with dementia by 2030 is not exactly comforting either.
It is irrefutable that social care services need more funding and the Government’s response has been to rob Peter to pay Paul by taking this £3.5 billion out of the NHS and handing it across. Social services certainly need it and the rationale for doing so might seem reasonable on the face of it. After all, the budget for the NHS is so much bigger at more than £100 billion a year and, of course, we know that our hospitals are full of patients who would be much better off at home if care could be provided there. Some 30% of beds are said to be blocked in this way. So let us shift money across. However, that ignores the extreme financial stress that already exists in the NHS, where talk of a looming financial cliff edge in 2015 is commonplace. The impact of the Nicholson challenge with £20 billion savings already made, largely by short-term measures such as wage restraints and redundancies, and predictions of even more stringent savings of some £30 billion by 2020, is sending shivers down the spine of many a trust chief executive when 40% of them are already said to be running a deficit.
I hope the noble Earl will forgive me for introducing a note of aggression in my talk. He knows my normal benign nature does not allow for much aggression but I feel quite strongly about this. There are those who say that we should close some beds or whole hospitals and money will be freed up. That may be true—money will be saved, but at what cost to patient care? We have already heard of the stresses placed on hospitals by rising demands for acute care—that is acute care, not the care of longer-term patients within hospitals. It is the rising tide of acute emergency cases that is taking its toll now on hospital services that is so difficult. These demands are being made now, in the summer, when we have approaching 88% bed occupancy rates. Incidentally, we have the lowest number of beds per head of population in Europe and the shortest length of stay, so we are already pretty efficient.
Of course we should do more to improve efficiency. We should continue the process of focusing specialised services in fewer major centres; we should merge services between small, relatively inefficient hospitals; and of course we should be looking at better models of integrated care across the health and social care divide—that is essential. Today’s publication by the NHS Confederation and the Local Government Association is a step in that direction.
There could be more efficiencies, too, in the bureaucratic machinery that we have set up to run the service. I am struck by the fact that we removed two layers of administration, the SHAs and PCTs, and replaced them with four. We have NHS England with its large staff, the 40 outposts, 27 area teams and of course the 211 CCGs. That says nothing about the clinical senates, of which we hear so little, and the complex network of clinical reference groups. Instead of the promised bonfire of bureaucracy, we have had an explosion of bureaucrats. We could save money here with a closer look at all this superstructure but that is not going to happen any time soon.
Meanwhile, the cash-strapped NHS is being taxed again by the better care fund. To expect to be able to run an acceptable level of integrated care between hospital and community by shifting limited resources from one to the other may be expecting just too much. Yet we are a wealthy country: the fourth wealthiest in the world, according to the ONS, and with more billionaires than anywhere else. In spite of that, we have cut the proportion of GDP that we spend on this from around 8.2% in 2009 to about 7% now, and we are predicted to cut that proportion to about 6% by the end of the decade. I can well understand the Treasury wanting our services to be more efficient, but I cannot see what justification there can be to cut the share of the national cake for the care of our population to just 6%, which is so clearly well behind other OECD countries. The contrast between reports of a country said to be doing so well economically with those that show that at the same time it is starving our vital services is, I find, just too much.
I have a number of questions for the Minister. How is it intended that the money from the NHS will be used for care in the community? Is it to be ring-fenced? Will there be true integration between the NHS trusts and social services in the way that it is spent? Have the Government any plans to encourage recruitment into general practice, particularly in the north, and for A&E consultant posts, two key services at the interface between community and hospital?
Have they given any thought to their predictions for the future funding of health and social care beyond 2015? I know that the Minister will say that future spending plans will have to wait for the next spending review but I fear that the crunch will come rather sooner than that, and probably far sooner than the election. The department must be making contingency plans now about how the service will cope over the winter; I would be surprised if it was not. I wonder if the Minister would be willing to share some of that with us. I look forward to his response.
Health: Multiple Sclerosis
Lord Turnberg Excerpts(9 years, 12 months ago)
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Earl Howe
My Lords, I am pleased to say that the number of specialist nurses for multiple sclerosis in the UK has risen from 80 in 2002 to 245 currently. I hope that my noble friend will agree with our view that local healthcare organisations, given their knowledge of the healthcare needs of their local populations, are the people best placed to determine the workforce needed to deliver safe and effective patient care within the available resources. However, it is of interest that NHS England’s service specification for specialised neurology does specify that nurse specialists should be involved in the care of people with multiple sclerosis.
Lord Turnberg (Lab)
My Lords, 11 drugs are now available for remitting and relapsing multiple sclerosis, three or four of which have been approved only in the past two or three months, which is great news. Is there any chance that these new drugs will be included in the risk-sharing initiative with industry?
Earl Howe
My Lords, I think that the answer is almost certainly no because the risk-sharing scheme initiated under the previous Government is quite complex to administer and we would need to be persuaded that the administrative burdens associated with it were worth while. Now that we have the NICE process, it is probably best that NICE should look at these drugs in the context of its new clinical guideline, which is what the stakeholder groups thought was preferable.
Health: Rheumatoid Arthritis
Lord Turnberg Excerpts(10 years ago)
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Earl Howe
My Lords, I pay tribute to the National Rheumatoid Arthritis Society, which is organising Rheumatoid Arthritis Awareness Week this week, between 16 and 22 June. I am aware that Public Health England has run early diagnosis campaigns, which up to now have focused largely on cancer. However, I understand that a broader focus on earlier diagnosis is currently being considered. What might be done to tackle other conditions or symptoms has yet to be decided, but I will keep the noble Baroness informed of developments.
Lord Turnberg (Lab)
My Lords, one of the problems is that there are still far too many single-handed general practices, which have great difficulty providing a full range of services. Are the Government doing anything to try to bring them into bigger groupings?
Earl Howe
My Lords, we are encouraging single-handed practices not to disband but to federate themselves—if that is a good word—with other practices in the area, and certainly to seek the support of their clinical commissioning group. That would ensure that the range of professional training available is utilised and that there is peer support where appropriate. Therefore, while many single-handed practices do a very fine job, there is scope for them to collaborate with their colleagues in the local area.
National Health Service: Hospital Beds
Lord Turnberg Excerpts(10 years ago)
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Lord Turnberg (Lab)
My Lords, is the noble Earl aware that we have one of the highest rates of bed occupancy in the EU, approaching 90%, and yet we have the lowest average length of stay? All this makes it extremely difficult to think about reducing bed numbers still further.
Earl Howe
In fact, average annual bed occupancy rates have been stable at around 84% to 87% since 2000. Of course, that rate goes up and down. We know that winter sees greater pressure on bed occupancy, but the NHS has long experience in managing peaks in demand, particularly over the winter. We do not set optimum bed occupancy requirements on the NHS. As the noble Lord knows well, that is a matter for the local NHS to manage.
Elderly People: Abuse
Lord Turnberg Excerpts(10 years, 1 month ago)
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Lord Turnberg (Lab)
My Lords, I, too, am grateful to the noble Baroness, Lady Cumberlege, for raising this important issue. We cannot say we have not been warned about abuse of the elderly. Numerous detailed reports have been published over many years, and we have not neglected to talk about it in your Lordships’ House either. The Government’s response to the Francis report on the Mid Staffs affair was well meant and the Care Bill we passed last week is very helpful, but to my mind, neither of them is aimed at the right targets, nor are they sufficient. They both place far too much emphasis on inspection and punishment for wrongdoing, which of course is essential, and far too little emphasis on measures to prevent bad behaviour happening in the first place.
It is possible that we do not recognise often enough how difficult and taxing, both physically and mentally, the job of caring for elderly people really is. Quite apart from the nature of the job of feeding, toileting and cleaning physically disabled people, many of whom may be mentally disturbed and sometimes resistant or even aggressive, we have to face the fact that these jobs are spectacularly underpaid and underappreciated. They are not appealing jobs and they attract only very specific types of people: those who are dedicated to caring, angelic individuals who are devoted to looking after others. We are fortunate that there are many who fit into that category, but we should not take advantage of these remarkable people by giving them such poor recognition and little to bolster their self-esteem. No wonder there is a high turnover and absentee rate. Job satisfaction depends on being appreciated and there is no doubt that, where carers are appreciated, those who they are caring for gain the benefit. So what can we do to attract carers, and having done so, give them a sense of esteem and job satisfaction?
First, we must pay them better. Jobs in care homes are among the lowest paid anywhere. I fear that the profit motive of some care home operators may be just too strong and the low wages on offer will put off many whom we want to bring in. Also, local authorities are so cash-strapped now that, after a 30% drop in their funding, their services are clearly failing to keep up with rising demand. Poorly funded and understaffed services, leading to rushed overworked carers, are hardly conducive to the sort of care we aspire to.
Secondly, there is then the problem of a lack of professional training and qualification for care workers. We have gone some way along that route, with the help of the noble Earl and with a recognition that training should be an essential part of these posts. However, we are still some way off offering registration to allow care workers that self-satisfaction that comes with belonging to a qualified profession. We have been trying for some time in this House to correct this anomaly and I have no doubt that we will hear more about this topic.
Thirdly, there is the big problem of poor supervision in care homes and hospital wards. There seems little doubt to my mind that a well qualified, competent and active person supervising care at that level is of enormous benefit. These people are the key element in the mix leading to high-quality care. However, here again, recruitment to these posts and retention of people in them is dependent on making them attractive. Nursing sisters in charge of hospital wards should be recognised as having career-grade posts, so that these nurses are not attracted by the prospect of promotion off the ward after a year or so. They should be rewarded appropriately.
Finally, it is good to see in the Care Bill a duty on local authorities to investigate accusations of abuse. However, again, this is after any abuse has occurred and it is rather more important for those commissioning services to take greater care in ensuring that standards for the care that they commission are up to scratch. I look forward to the noble Earl’s response.
National Health Service: Nursing Staff
Lord Turnberg Excerpts(10 years, 1 month ago)
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Earl Howe
My Lords, as regards specialist nurses, the Government have supported the development of a range of specialist roles within the profession. In the end it is for local NHS organisations, with their knowledge of the needs of the local population, to invest in training for specialist skills and to deploy specialist nurses. We recognise that more could be done by some local healthcare organisations in this area, and Health Education England is able to support employers with continuing personal and professional development—but within clear limits. The planning process has created an opportunity for employers, through the LETBs—local education and training boards—to prioritise investment in this area.
Lord Turnberg (Lab)
My Lords, the number of nurses may have gone up a little, but the main problem is the marked reduction in the number of senior nurses on wards. These are the women and men who are in charge of a ward and make sure that care is properly delivered at the ward level. Does the noble Earl consider that this particular loss is because we do not reward and value these key individuals well enough to recruit or retain them?
Earl Howe
My Lords, as the noble Lord will be aware, finances in the NHS are tight. However, as I said earlier, there are now 5,100 more nurses on our wards than there were in May 2010. That must indicate that nursing is still an attractive profession for the brightest and the best of our young men and women.
Care Bill [HL]
Lord Turnberg Excerpts(10 years, 1 month ago)
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Lord Turnberg
“(b) biomedical and health research.”
Lord Turnberg
My Lords, I am grateful to the Minister for that full and helpful description of the background to this whole area of the use of confidential information. There is little doubt that public confidence in the uses to which their confidential information may be put has been badly shaken. For example, a number of recent revelations that access has been gained by one means or another by commercial organisations, insurance companies and so on has made the public—and many general practitioners—very wary and anxious.
That is why I want to put my own amendment, Amendment 45C, into the context of Amendment 45F, proposed by the noble Lord, Lord Owen, which emphasises a much stronger oversight by a statutory body: similar to, but stronger than, the Confidentiality Advisory Group chaired by Dame Fiona Caldicott, who commands such public respect and confidence. That is why I intend to support it if he moves it.
It is only against that background—of strong oversight and carefully controlled and limited access to such sensitive data—that we can even consider the very specific circumstances in which we can allow their use: not only legitimate use, but those uses which are vital for the benefit of the public and their health.
Lord Turnberg
My Lords, I was rather encouraged by the noble Earl’s initial remarks about strengthening Dame Fiona Caldicott’s committee and making clearer what role it might be able to play.
The problem I wanted to address in Amendment 45C is the uncertainty in the ways in which the words “promotion of health” may be interpreted. I know that the noble Earl has said that they cover research, for example. What about research that does not immediately seem to promote health? It is this rather vague term that I wanted to clarify. It is not about trying to unravel the legislation, as someone has suggested. It is about making it absolutely clear. I am afraid I was not very convinced by the noble Earl, and I beg leave to ask for the opinion of the House.
NHS: Bed Capacity
Lord Turnberg Excerpts(10 years, 3 months ago)
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Earl Howe
Yes, my Lords. As ever, the noble Baroness makes an extremely good point. It is heartening that infection rates have come dramatically down in hospitals over the past few years, but we can never be complacent and it is important that when a patient is moved the infection question is always considered.
Lord Turnberg (Lab)
My Lords, is it not the case that we have the lowest number of beds per head of population of any OECD country, bed occupancy rates of approaching 90%—a dangerously high level—and, despite all that, the shortest lengths of stay of any European country? Does the noble Earl agree that the idea of closing wards or hospitals can only worsen the situation, unless, of course, we are able to build up the community services before we do any of that?
Earl Howe
I agree with the principle that the noble Lord has articulated. Certainly, commissioners and providers of care should reduce beds only where it is clinically safe and appropriate to do so. The NHS is very experienced at flexing the number of beds it has available; it does this every year and every winter. As a principle, I would agree with the noble Lord but I come back to the point that bed occupancy rates have, in fact, remained stable over the past 10 years, fluctuating between 84% and 88% on average, and increasing slightly over the winter period.
NHS: Midwives
Lord Turnberg Excerpts(10 years, 3 months ago)
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Earl Howe
The noble Baroness is quite right. Helping commissioners to reduce unwarranted variation in service delivery is one of the key roles of the maternity and children strategic clinical networks, as I am sure she is aware, which are being established and supported by NHS England. Clinical commissioning groups are responsible for commissioning maternity services locally, but they work with local authorities and in conjunction with provider partners to give assurance that processes and service specifications are in place which ensure that midwifery staffing is appropriate for the locality.
Lord Turnberg (Lab)
My Lords, the number of births has gone up by 25% in the past 10 years. The vacancy rate among midwives is about 11%. That is the long-term vacancy rate. There seems to be a problem with recruitment and retention. Despite the figures that the noble Earl has cited, we are in some difficulty.
Earl Howe
The noble Lord is right. We recognised that issue at the outset of the Government, which is why we were determined that the number of midwives in training should be increased. It is now at a record number of 6,000. The number of trained midwives is increasing—that is, full-time equivalent midwives practising in the NHS rather than just on the register. We are heading in the right direction, but there is a long way to go.
Alcohol: Calorie Labelling
Lord Turnberg Excerpts(10 years, 3 months ago)
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Earl Howe
No, I do not, but it is worth noting that 49 businesses have signed up to the voluntary responsibility deal pledge on awareness of alcohol units, calories and other information. Those organisations have published calorie information on their websites about every single alcohol product. If one is buying online, it is possible to compare one product with another.
Lord Turnberg (Lab)
My Lords, is the noble Earl aware that alcopops are rearing their heads again? These sweetened drinks have sugar added to them to make them attractive, in a cynical attempt to bring the young on board to alcohol. They contain more than 170 calories a bottle—about the same as a sweetened chocolate milk drink—as well as the alcohol. Is there anything we can do to bring this to the attention of the supermarkets? I believe Sainsbury’s has alcopops on its shelves now.
Earl Howe
My Lords, in fact, sales of alcopops are in marked decline, to such an extent that the market for these products looks like disappearing in the next few years. Nevertheless, I take the noble Lord’s point. It is always a concern if people are putting their health at risk by drinking too much alcohol or consuming too much sugar. At the same time, one should not always assume that an alcopop is a high-calorie drink. For example, ready-mixed gin and tonic is technically an alcopop, but very often low-calorie tonic goes into it.