NHS England: Waiting Lists

Lord Young of Norwood Green Excerpts

Tuesday 16th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the right reverend Prelate for that question. Unfortunately, I do not have the statistics with me, but I shall write to him.

[Lord Young of Norwood Green (Lab)]

My Lords, will the Minister tell the House whether he is encouraging the use of best practice, including new technology, between hospital trusts? There are still many examples where there is good practice out there, but it is not being spread.

On a point that we touched on last night, in relation to A&E, we have a serious problem. Paramedics are waiting for significant periods of time, which means that they are not getting out on the road to treat other patients. We really need to bring in some drastic measures to ensure that we create a new system. We cannot leave it for months and months because, if we do, the impact will mean that people’s lives will be lost. What measures does the Minister have in mind to deal with this problem?

[Lord Kamall (Con)]

The noble Lord made a very perceptive intervention last night when asking us to think outside the box, and I gave an example of someone who I know suffers from asthma and forgot to take his blue inhaler with him to another city. His wife went to a number of places to try to get an inhaler from the pharmacy and from A&E, while telling him to stay in his hotel room. In the end, he was told that the only way to get an inhaler was to call the ambulance. We need to think outside the box and be more creative about when those situations occur—it is not necessarily political, but we need to be creative.

On technology, one of my jobs is Minister for Technology, Innovation and Life Sciences. I have been forceful, when talking to the NHS, that we have to digitise and share data. I accept that there are some concerns over sharing data, but the way to have an NHS that is fit for purpose is to make sure that we digitise and share data.

Covid-19

Lord Young of Norwood Green Excerpts

Monday 15th November 2021 Lords Chamber

[Lord Kamall (Con)]

A lot of investment has gone into making sure that there is ventilation in schools. I will talk to my counterpart in the Department for Education to see what more can be done, but I know that the department is very aware of this issue and is looking more into it.

On the noble Baroness’s first question, we want to be clear and not confuse the message: vaccinations work and are our best line of defence. We do not want people to get a false hope that there are other ways to protect themselves. Not all people who do not take the vaccine are anti-vaxxers: some of them think that just wearing a mask may well protect them.

We want to focus on this message: get vaccinated; if you have been, get your booster; and if you have had your first vaccine, get your second one. There is nothing to fear from getting vaccinated. We are not only sending that message out but actively looking at different campaigns to reach those difficult-to-reach individuals in many communities.

[Lord Young of Norwood Green (Lab)]

My Lords, on the importance of vaccination, what are the Government doing to combat the anti-vax message? My second point is on the terrible situation in hospitals, where paramedics are forced to stay and wait with patients. There must be something that we can do to alleviate that situation until there is a long-term solution. Have we identified best practice? The Government ought to be thinking outside the box about what we can do to stop paramedics being trapped in hospital, denying them the ability to deal with other urgent cases.

[Lord Kamall (Con)]

I am sorry, but my memory has gone. What was the noble Lord’s first question?

[Lord Young of Norwood Green (Lab)]

It was on anti-vaxxers.

[Lord Kamall (Con)]

The issue of anti-vaxxers is very difficult in a society where we believe in freedom of speech. Clearly, if they are impeding people from attending school, going to certain places or getting vaccinated, that is obstruction. However, if they are saying that they do not believe that the vaccines are safe or whatever, it is really difficult and we have to get that balance right. We are clear that we want people to be vaccinated but, at the same time, we believe in freedom of speech. Quite often, if you really believe in freedom of speech, you have to allow people to say things that you disagree with, I am afraid. However, where they are actively blocking people from getting vaccinated, I think we have work to do.

As for thinking outside the box, we are looking at a number of different areas. For example, the other day I heard a case of someone who had forgotten his asthma inhaler. His partner told him, “Stay here, I’ll get you another one from the all-night chemist”. The all-night pharmacist said, “I can’t administer that”. She then went to A&E with her partner’s details. A&E said, “No, he has to come in here”. In the end, when she went back to the hotel, the hotel said, “We’ll have to call the ambulance”. All that could have been avoided had there been a way for the person who had forgotten his inhaler simply to get another one, rather than having to call in paramedics. Therefore, there are a number of different ways that we can think outside the box to make sure that we do not put undue pressure on the NHS at this time.

Flu Vaccination and Blood Test Cancellations

Lord Young of Norwood Green Excerpts

Tuesday 14th September 2021 Lords Chamber

[The Deputy Speaker (Lord Brougham and Vaux) (Con)]

I call the noble Baroness, Lady Stuart of Edgbaston.

[Lord Young of Norwood Green (Lab)]

My Lords—

[Noble Lords]

Oh!

--- Later in debate ---

[Lord Young of Norwood Green (Lab)]

After my unfortunate trans moment, I shall now ask my question in all seriousness. Does the Minister recognise that this winter it is particularly important that we get the maximum number of flu vaccinations in this round? It is important every winter, but this winter somebody contracting flu and then Covid is in serious danger.

[Lord Bethell (Con)]

My Lords, I reassure the noble Lord that we have strained every sinew to deliver the most impactful flu vaccination programme in the history of the country. We have expanded the range of the flu vaccination and the number of vaccinations available. The NHS depends on us keeping people out of beds. That is why we are highly focused on this.

Women’s Health Outcomes

Lord Young of Norwood Green Excerpts

Thursday 8th July 2021 Lords Chamber

[Lord Young of Norwood Green (Lab) [V]]

My Lords, I, too, thank the noble Baroness, Lady Jenkin, for this debate and for her thoughtful and informative intro. She pulled no punches—rightly so—in her description of the often painful lifelong journey of women and girls. I welcome the statement by Nadine Dorries, the Minister for Patient Safety, on the government-led women’s health strategy—the first one.

In May 2020, in response to a Written Question on whether hospitals were required to provide single-sex services, including spaces for patients, the noble Lord, Lord Bethell, said that the revised guidance on delivering same-sex accommodation published by NHS England and NHS Improvement stated that

“providers of National Health Service-funded care are expected to have a zero-tolerance approach to mixed-sex accommodation, except where it is in the overall best interest of all patients”.

Many NHS trusts interpret that in a number of ways that are not always conducive to the health and treatment of women and girls as patients. As many noble Lords have said, we should be listening to patients and seeking examples of best practice. Women often favour single-sex wards for good reason. Rates of sexual assault are far higher in mixed-sex wards. In 2009, Channel 4 discovered that almost two-thirds of sexual assaults by patients occurred in mixed-sex wards.

The Minister stated that there were

“no plans to withdraw the guidance.”

Can I suggest to the Minister that he reconsider this whole issue? He also stated:

“NHS trusts have not been asked to provide the information required to make an assessment of the impact of allowing patients to self-identify their gender and there are no plans to ask them to do so.”


There are many examples of assaults on women in mental hospitals and other areas. Surely we recognise that, when women enter hospital, they do so to experience a calm, safe and non-threatening environment. I ask the Minister to meet Peers concerned about this issue.

NHS Digital: Primary Care Medical Records

Lord Young of Norwood Green Excerpts

Tuesday 8th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, engagement with the Royal Colleges, the BMA and GPs on a one-to-one basis has brought about a system that has a national data opt-out and a tier 1 opt-out with GPs. This is fully explained in all our materials and there has been a campaign to raise awareness among patients. We are taking a brief pause to ensure that patients have almost as much time as they could possibly have to make the decisions they would like to make. That is a wise decision in the circumstances.

[Lord Young of Norwood Green (Lab) [V]]

My Lords, by coincidence, I received a text from my GP surgery yesterday inviting me to click on a link if I wished to opt out of having my data shared. I do not. Does the Minister agree that data sharing plays a vital role in advancing diagnosis and cures for a range of diseases and illnesses? Of course we need to ensure that there is public trust on anonymity. Can he give us more information on that and on cybersecurity?

[Lord Bethell (Con)]

I am grateful for the noble Lord’s anecdote. It is no coincidence that he got the text yesterday. We have energetically promoted this opportunity to patients and we are grateful to those who have engaged. He is entirely right. Patient data played a critical role in the development of the shielding list during Covid, in the recovery clinical trials programme and in the vaccine priority list. Clinical data is essential for patient safety. That is why we are modernising the system by which we access it.

Covid-19: Government’s Publication of Contracts

Lord Young of Norwood Green Excerpts

Thursday 11th March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful for my noble friend’s remarks. Absolutely—the public expected us to act, not to push paper. I pay tribute to officials from the Department of Health and in particular from the Crown Commercial Service and the MoD who stepped forward in unbelievably difficult circumstances, particularly around PPE, to transact on a very large amount of extremely complicated and very difficult procurements that ensured that our front-line healthcare workers were safe.

[Lord Young of Norwood Green (Lab) [V]]

My Lords, I declare an interest as I am on the advisory board of a local clothing manufacturing company in Haringey in an unremunerated capacity. Can the Minister explain why a high-quality SME capable of supplying reusable, RFID-tagged PPE gowns which can be laundered 70 times at a cost of 80p per wash—compared to disposable gowns which cost £10—and which are better for the environment and support local employment has not been given a contract?

[Lord Bethell (Con)]

My Lords, I personally share the noble Lord’s frustration over the subject of reusable gowns. It strikes me as sensible and good for the environment for us to be able to use reusable gowns wherever we can. However, those who do the procurement understand fully what is required of a fully sterile gown and, unfortunately, with the amount of moisture and liquids that are involved in operations and in the front-line healthcare service, quite often it is not possible to have reusable protocols in place. That is why we use so much disposable PPE kit. It is a huge regret to me, and I share the noble Lord’s frustration. If he would like to write to me with details, I would be glad to pass them to the right people.

Puberty-blocker Drugs

Lord Young of Norwood Green Excerpts

Thursday 10th December 2020 Lords Chamber

Asked by

[Lord Young of Norwood Green]

To ask Her Majesty’s Government what assessment they have made of the administration of puberty-blocker drugs to children under the age of 16.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, the Government are committed to providing the best possible care for children and young people accessing gender identity services. Earlier this year, the National Institute for Health and Care Excellence was asked by NHS England to undertake a thorough review of the latest clinical evidence on the use of puberty suppressants and cross-sex hormones. An independent group, under the chairmanship of Dr Hilary Cass, will make recommendations about the existing clinical policies based on this evidence.

[Lord Young of Norwood Green (Lab) [V]]

My Lords, I wish to make my position clear: I am opposed to all forms of transphobia and transgender discrimination, but this should not override the rights of women as defined in law. I welcome the Minister’s statement on the guidance and the research, and I am sure he agrees with me on the importance of the NHS guidance. Does he also recognise that this needs to be ported? What actions will the Government take to ensure that local services, such as CAMHS, are sufficiently resourced to provide psychological support to all children and young people with gender-related distress?

[Lord Bethell (Con) [V]]

My Lords, the noble Lord puts his point extremely well. I share his concern for those with trans or gender concerns of any kind. I reassure him that provision of gender identity services at all levels is an absolute priority for the NHS. In the recent court case, we have seen a clarification of the guidelines attributed to some of those services, but it in no way mitigates against or suggests a lack of commitment on the part of the NHS to such services.

Covid-19 Update

Lord Young of Norwood Green Excerpts

Monday 21st September 2020 Lords Chamber

[Lord Bethell (Con)]

It is a war, that is why we are focused on how we manage extra resources such as the Nightingales. We have put in new systems and artificial intelligence for algorithms to help us with our triage. We have invested £450 million in A&Es, which will include building new holding bays. As my noble friend rightly points out, these need development. We have invested in 5,000 DnaNudges and other point-of-care devices to give front-line care workers the diagnostic help they need.

[Lord Young of Norwood Green (Lab) [V]]

My Lords, I welcome the statement from the Minister, but to be candid, when I hear talk about Moonshot, I will believe it when I see it. What members of the public want is the ability to access Covid tests in places such as Bagshot, or Aldershot, or any other testing centre. The reports we get are that they cannot get appointments. Schools are closing because they cannot get test results, classes are being sent back; therefore, it is not just the number of tests, it is how long they are taking to turn around. To say we are surprised by the surge, when we were opening schools, does surprise me.

I have two other points on which I would welcome a response from the Minister. One, raised by noble Baroness, Lady Barker, is about domiciliary care. It is essential that PPE is available. It must be the right quality; we have had examples where large batches have been ordered from Turkey and China and they have been no good. We want quality PPE that is available.

[Baroness Penn (Con)]

Could the noble Lord address his question to the Minister now?

[Lord Young of Norwood Green (Lab) [V]]

I am addressing all these questions to the Minister. My last point is this: will there be testing capacity in general practice surgery?

[Lord Bethell (Con)]

My Lords, we are introducing a new scheme for bringing testing capacity straight to the desks of general practice, and the results from that initiative are promising.

NHS: Targets

Lord Young of Norwood Green Excerpts

Thursday 6th February 2020 Lords Chamber

[Lord Young of Norwood Green (Lab)]

My Lords, I congratulate my noble friend Lord Hunt on giving us the opportunity to debate this issue and on his tour de force contribution, giving us the benefit of all his vast experience.

I declare an interest: like many, I am a frequent user of the NHS, which gives you an opportunity to observe first-hand the range and quality of service that you get. I echo my noble friend Lady Crawley in saying that in most cases it is very good. I am also a member of my GP’s patient care committee. The practice has nearly 8,000 patients but operates in what is an extended semi-detached house. For the past five years or more we have had plans for a nice brand new medical centre offering a good range of services, but that was suddenly scrapped. Quite apart from the £1 million or so wasted in the planning, you can imagine the frustration and demoralisation in our practice as well as the impact on the local A&E. I would welcome a comment from the Minister on why essential schemes such as this are suddenly scrapped.

I declare another interest: our daughter Laura, an ex-paramedic, is now a trainee advanced clinical practitioner in A&E, working at a local hospital, so I hear some of her first-hand experiences.

I, too, congratulate my noble friend Lady Wilcox on a superb maiden speech that drew on her vast experience in local government. I am sure it was the first of many great contributions.

It is national apprenticeship week. Your Lordships will not be surprised that, as an apprentice ambassador, I will refer to staffing and skills, of which we all know there are vast shortages in the NHS. We should be ashamed of our need to poach highly trained medical staff from countries that desperately need their services. Year after year we fail to train enough people. Worse still, and a great example of the law of unintended consequences, the Government previously decided that they would scrap free training for nurses and introduce a bursary—a really smart idea. That is irony on my part. I am glad to say that they have restored it, but it did not help.

Unfortunately, the NHS cannot make full use of the apprenticeship levy because of the need to find replacement staff for apprentices’ study time. Again, I hope the Minister will take away that point to see how to improve that situation. If she wants some good advice, may I suggest that she goes to the Open University, which is heavily involved in nursing apprenticeships?

We are supposedly in the middle of the fourth industrial revolution, yet the use of new technology in the health service is patchy, to say the least. Recently, somebody told me, “We can’t even transfer patient details electronically between hospitals.” This is in theory the 21st century, yet we still cannot make use of that technology.

I enjoyed the Panglossian contribution to the debate made by the noble Lord, Lord Bates. We should pay tribute to the good work done by NHS staff in a very challenging day-to-day situation, as he acknowledged. However, all is not for the best in the NHS world, as the Government acknowledge in their funding proposals. May I suggest that the Minister looks across the NHS for examples of best practice? My noble friend Lord Turnberg gave us an example. That is not the only hospital trust that is using that, but why does it not spread? It takes far too long. I predict that a lot of the Government’s proposed funding increases will be wasted unless best practice of providing good services and keeping to budgets is looked at. I hope that the Minister will take that as a constructive contribution. It takes far too long for best practice to permeate through the NHS, and unfortunately bad practice can be tolerated with disastrous consequences for far too long, as we heard on the Paterson report. Paying billions in compensation is disastrous. There are examples of no-fault liability schemes that would encourage responsible whistleblowing and save that huge waste of NHS money.

I have come to the end of my time. Again, I thank my noble friend Lord Hunt for the opportunity to contribute to this debate.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank all noble Lords for an expert and robust debate on a very important issue. In the time available, I shall do my best to respond to as many of the points raised as possible. I particularly thank the noble Lord, Lord Hunt, for, as ever, a robust contribution on a very important issue and for allowing us to have this debate. I also pay tribute to the noble Baroness, Lady Wilcox, for a formidable maiden speech. It is clear that she has deep personal experience and a straight-talking character, which means that she will make a considerable contribution to this place. I look forward to many future debates and interactions with her on the issues she has raised today and many others.

Like my noble friend Lord Bates, whom I can see in his place and who made an outstanding speech, I start by thanking the hard-working staff in our health and social care services. These services face unprecedented demand, with an ageing population and the challenges of winter placing a particular strain on them. In that context, the staff are doing a quite extraordinary job. As was mentioned by the noble Baroness, Lady Crawley, we all have our love letters that we can speak of, based on our own experiences. They demonstrate when the staff go far above and beyond to make sure that we come out on the other side in one piece.

I have listened very carefully to the concerns raised today about NHS performance, the pressures on our social care system and the impact on patients. Noble Lords are absolutely right to expect the Government to be restless in pursuing higher quality and in supporting the NHS so that it can be there for each and every one of us when we need it most. Today, I will outline the steps that the Government are taking to help address those concerns and will bring noble Lords up to date as much as possible.

I turn, first, to performance. As I have already mentioned, the NHS and social care system faces unprecedented demand. A number of noble Lords mentioned the figures. I will not go into too much detail as I would like to answer as many specific questions as possible. However, I should like to note that the most recent figures available for December 2019 show that there were over 2 million attendances at A&E—6.5% more than in December 2018. That means attendance by over 70,000 people every day—the highest ever for the month of December. Hospitals have also delivered 2.4 million more operations and almost 13 million more consultant-led out-patient appointments than in 2009-10. That is an extraordinary achievement.

However, I recognise, as was mentioned by the noble Lords, Lord Hunt and Lord Turnberg, the noble Baroness, Lady Pinnock, the right reverend Prelate the Bishop of Carlisle and many others, that in addition to the pressures on the health service, we are seeing increased demand in the social care system. We must put social care on a sustainable footing, with everyone being treated with dignity and respect. It is one of the biggest challenges that we face as a society. As my noble friend Lord Bates rightly said, we must resist the temptation to treat it as a political football. The Prime Minister has been clear that this Government will deliver on their promises and bring forward a plan for social care this year, as was specifically requested by the noble Baroness, Lady Brinton. I am quite sure that she will hold us to account very firmly on that commitment.

It is expected that there will be 1.5 million more over-75s in the next 10 years and we have to find a way of caring for them. As the noble Baroness, Lady Wilcox, rightly pointed out, there has also been a significant growth in the number of working-age people with disabilities who need care at a younger age. We need a system that gives every person—old and young—the dignity and security that they deserve.

The noble Baroness, Lady Wilcox, was right that these are complex questions which require not only difficult decisions to be made but the establishment of a sustainable settlement that will provide certainty for generations to come. That is why we will seek to build cross-party consensus, but we have been clear on two points: that everyone will have safety and security, and that nobody will be forced to sell their home to pay for care. The noble Baroness, Lady Thornton, asked me to predict both the Budget and the outcome of these negotiations. I am afraid that I will not be able to do that today but I am very touched by her thought that I would be able to answer those questions immediately at the Dispatch Box. However, I would like to update the House on what we have been doing to try to reduce pressures in the meantime.

To help address the increases in demand, last year we committed to £33.9 billion more funding a year by 2023-24. We are now enshrining that in law, and I know that we will have a significant debate about what that means for the NHS. As my right honourable friend the Secretary of State for Health and Social Care announced, this is a significant cash settlement for the NHS, and it means that we are already delivering on our manifesto commitments. We are also committed to delivering 40 new hospitals over the next decade, 50,000 more nurses, 6,000 more doctors in primary care and 50 million more GP appointments. As requested, I will update the House on the specific questions on that.

The noble Baroness, Lady Crawley, asked about the EU workforce. We have been clear that our priority is to ensure that the 181,000 EU staff currently working in the NHS and in social care are not only able to stay but feel welcomed and encouraged to do so. Since the referendum, we are pleased that 7,300 more EU staff are working in the NHS, including 900 more doctors. We are not only working to make sure that they are able to navigate their way through the EU settlement scheme easily and effectively; we will also introduce a new EU visa to make it easier for suitably qualified doctors, nurses and other staff to come and work in the NHS from overseas. We are working across government to make sure that this goes through smoothly.

In addition, a number of Peers, including the noble and gallant Lord, Lord Stirrup, and the noble Baroness, Lady Watkins, asked how we will go forward with the people plan, which will provide a constructive and holistic approach to our management of the framework for collective action on workforce priorities. This will be published in early 2020. It needs to take fiscal priorities into account, so there are questions around the Budget and the spending review. It will focus on growing and sustaining a well-skilled workforce across the NHS, particularly on creating healthy, inclusive and compassionate cultures. I know that this was raised by a number of Peers, including the noble Lord, Lord Turnberg.

To date, in addition, capital funding amounting to £2.4 billion has been provisionally awarded to over 150 STPs. I know that the noble Lord, Lord Hunt, has raised this on a number of occasions. This investment will modernise and transform NHS buildings and services, which the noble and gallant Lord, Lord Stirrup, asked about. The money will go towards a range of programmes across the country, including new urgent care centres, integrated care hubs that bring together primary and community services, and new mental health facilities. This money will be spent on upgrading facilities, increasing capacity so that more people can be treated and shifting emphasis towards prevention, making sure that we can deliver on the prevention Green Paper.

My right honourable friend the Prime Minister also announced a further £1.8 billion increase in NHS capital spending, which will deliver on 20 hospital upgrades so that they can come forward as soon as possible. This frees up the NHS to take forward and expand its existing plans for investment in infrastructure, and to unlock the delivery of commitments already made.

We have taken into account the questions about backlog maintenance and equivocal infrastructure asked by the noble and gallant Lord, Lord Stirrup. There has been a commitment that this will be taken into account as part of the spending review. It is recognised that, for too long, this has not been undertaken suitably strategically. I hope that that reassures him.

To respond to the noble Baroness, Lady Thornton, we have committed to growing the workforce by more than 600 doctors in general practice. NHS England and HEE are working with the profession to increase the workforce in England. This includes measures to increase recruitment, address reasons why doctors are leaving the profession and encourage them to return to practice. We have discussed this on a number of occasions. I am pleased to report that, last year, HEE recruited the highest numbers of doctors into GP training ever, at 3,540 trainees. We are moving in the right direction.

The noble Baroness, Lady Masham, rightly raised earlier diagnosis. We are committed to making sure that we drive forward on this. It is a crucial part of the long-term plan: as part of prevention, we also want to make sure that we are diagnosing earlier, reducing demand and pressures for patients and clinical trials. This is why we announced funding to replace outdated cancer diagnostics and treatment machines. Some £200 million, consisting of £100 million this year and £100 million next year, will be used to replace MRI and CT scanners or breast cancer screening machines that are more than 10 years old. I know that the Labour Front Bench wanted to be reassured about this so that we can ensure that we get earlier diagnostics and patients on the right care pathways as soon as possible.

The noble Baroness, Lady Gale, asked some specific questions about Parkinson’s. I hope to give her some helpful answers. In 2018-19, the NIHR clinical research network supported 323 dementia and neurodegeneration studies, 99 of which were new studies in this area. In addition, to address access to mental health support for people with long-term medical conditions such as Parkinson’s, we aim to increase access to psychological therapies for an additional 600,000 people each year by 2020-21. We have committed to ensuring that this will address care for patients, such as those with Parkinson’s. I hope that this answers some of the noble Baroness’s key questions.

In the short term, NHS England has prioritised funding to support performance for this winter. I know that this was raised by the noble Lord, Lord Hunt. Additional capital and revenue funding was made available to systems and trusts to support staff and bed capacity throughout the winter. This has allowed trusts to increase bed numbers and facilities to support better flow through the system. I am pleased that the NHS has reported that over 1,000 more hospital beds are open this winter than at the same time last year.

In addition, a further £240 million has been provided again this year for adult social care to help reduce delays in patients being discharged from hospital by providing social care support. The noble Baroness, Lady Brinton, was quite right to highlight the value that the better care fund has provided in integrating the links between adult social care and the NHS. She is quite right that this is a relatively short-term solution; we look forward to more sustainable long-term solutions from ICS and others. However, I am very pleased that we committed a total of £6.4 billion to the better care fund in 2019-20 and that further funding is committed for this year.

This is all in addition to winter funding that provided £145 million for hospitals last year and has gone up this year. It has also provided ambulance services with 256 new state-of-the-art vehicles and make-ready hubs, which shorten vehicle turnaround times. I know that the noble Baroness, Lady Masham, was concerned about this.

To support performance, the NHS has continued to focus on longer-term solutions. This means that, as we go on in years, we will not see the same performance challenges, transforming and improving urgent and emergency care services. The priorities are as follows.

The first is to increase the provision of same-day emergency care so that patients are seen quickly and not admitted to hospital overnight if that is unnecessary. We have seen some good progress here, with over 89% of hospitals now providing SDEC for 12 hours a day. Other priorities are: to reduce the number of patients who have unnecessary long lengths of stay of more than 21 days in hospital; to increase the number of urgent treatment centres delivering a standardised level of service to provide patients with an alternative to A&E; to continue to make improvements to the use of GPs at major A&Es, allowing less acutely ill patients to be streamed away from the emergency departments, and to consider the issues raised by the noble Baroness, Lady Watkins, about the higher training of GPs and other practitioners so that patients do not feel the need to go to A&E; and to enhance NHS 111 services so that people calling can receive a clinical assessment and be offered immediate advice.

To respond to the important point made by the noble Lord, Lord Young, about the spreading of best practice across the system, we have brought in very important measures recently—not only NHSX but Getting It Right First Time to support NHS Improvement’s work, as well as the Accelerated Access Collaborative to drive innovation and best practice across the system.

I turn to the questions about clinical waiting time standards. This review is being clinically led by Professor Stephen Powis, the national medical director of NHS England, to consider whether improvements can be made to access standards for urgent care, planned care, cancer and mental health treatment. It is not a question of abolishing or removing these waiting time standards.

I will briefly address the point made by the noble Lord, Lord Hunt, about the introduction of the four-hour waiting time and the Patient’s Charter. Let us remember that that was 15 years ago. Under this Government, last year, 1.7 million more patients were treated within four hours than in 2010, and hospitals delivered 2.4 million more operations. Let us not forget that, when the Labour Administration left office, over 18,000 people were waiting for more than 52 weeks to start elective treatment. It is now 1,400. I would like for us not to look with rose-tinted glasses and forget some of the challenges being faced then as now.

Regarding the questions on current A&E waiting times, the standard sets out a maximum four-hour wait from arrival to admission, transfer or discharge. The initial clinical review of standards report set out some key reasons why we should consider clinically whether there are better ways to deliver this care. First, the standard does not measure total waiting times or differentiate between severity of conditions. It measures a single point in what is often a complex care pathway, and there is evidence that hospital processes rather than clinical judgment are resulting in admissions or a discharge in the immediate period before a patient breaches the standard—in other words, perverse incentives.

In addition, since the introduction of the waiting time standards 15 years ago, practices in medicine and urgent care have naturally advanced, for example with the introduction of specialist centres for stroke care, urgent treatment centres, NHS 111, trauma centres, heart attack centres and acute stroke units, increased access to and use of tests in A&E and new ambulance standards, as well as the increased use of same-day emergency care to avoid unnecessary overnight admissions. This is all being led by clinicians on the best advice to improve the standard of patient care. Any changes will be reviewed only after full evaluation and clinical advice. I hope that that is reassuring for the House; I am sure that we will be robustly tested on it. I hope that it clears up some of the questions asked and responds to some of the points made by the noble Baroness, Lady Watkins.

I will close so that the noble Lord, Lord Hunt, has time to respond. I close by expressing the hope that I have reassured the House that this Government not only understand the importance of world-class health and social care provision but have made it our number one domestic priority. We are listening to the concerns raised regarding not only the quality of, and access to, NHS care but social care.

The measures I have outlined are helping to ease pressure on the health and social care system and to improve performance. The funding we have committed through legislation is intended to provide the certainty that the NHS needs to deliver the long-term plan and, with it, the world-class service that each and every one of us wants, so that clinicians, patients and the public can have confidence that they will always be able to find the right care at the right time, no matter where they live in the United Kingdom.

[Lord Young of Norwood Green]

The Minister has given a comprehensive response to a range of questions. Could she answer in writing the question on NHS apprenticeships? I would be grateful.

[Baroness Blackwood of North Oxford]

Yes.

Queen’s Speech

Lord Young of Norwood Green Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Young of Norwood Green (Lab)]

My Lords, I too welcome the Government’s commitment to education. In a report, The Queen’s Speech 2019, the Prime Minister says:

“we are going to level up with better education, better infrastructure and better technology. It is my abiding and unshakeable conviction that talent and genius are uniformly distributed in our country, but opportunity is not.”

I think that is a good summary of where we are now.

I will focus on apprenticeships, which will be a surprise to noble Lords. I declare an interest, because I am an apprenticeship ambassador. My starting point is to support the Government’s approach to apprenticeships. The Government recognise the importance of vocational education and, somewhat ambitiously, set a target of 3 million apprenticeships. Many noble friends warned the Government that the emphasis should be on quality and the need to convince parents, teachers and pupils that apprenticeships are a valid and quality alternative career path to university. They have a number of benefits, but “earn while you learn” is probably as good as any.

Therefore, I was somewhat concerned to read an article in the Times on 3 January headed “Fake apprentices exploit £3bn levy”, based on a report by an education and skills think tank. I do not agree with every bit of the article. It is critical of the fact that a significant number of apprenticeships are in middle management—supervisors and so on—but, given that for many years the Chartered Management Institute has said to us that one of the limitations on improving productivity is that only one in five managers is trained, that does not seem a bad use of apprenticeships. The article also seems to dislike degree apprenticeships but, again, I do not agree with that. However, it makes a worrying point about the quality of some apprenticeships. I think that it is focusing on levels 2 and 3, and I have some worries there. Although the DfE says, “It can’t be an apprenticeship unless it meets our standards”, that does not mean that that is what is taking place at ground level.

Another worry concerning the apprenticeship levy is that the number of starts in the 16 to 18 age group has fallen. Levels 2 and 3 apprenticeships are important. Not every child suits the academic approach. Surely we have to guard against increasing the number of NEETs—that is, young people not in education, employment or training—so we should not underestimate the importance of those apprenticeships.

The apprenticeship levy is a bit like the curate’s egg—it is good in parts—but we have to be careful that we do not throw the baby out with the bath water. However, it needs reform and it was supposed to have a review. I would welcome it if the Minister could give us the timescale for the reforms and review. It could probably do with involving more employers than is currently the case.

The average take-up of the apprenticeship levy is only 15% and it is seen somewhat negatively by some employers as an employee tax. We need to do something about that. We need more SME non-levy pay involvement. Employers have the ability to transfer 25% of their levy to SMEs, but we need other ideas to ensure that more SMEs employ apprentices. We will not hit anywhere near the target by relying on large employers.

The good news in the Queen’s Speech was the announcement of a national skills fund. There will be £3 billion over five years and another £2 billion to be spent on improving the estate, which I presume is on top of the levy. I would be interested to know exactly what will happen with the skills fund. I understand that there will be some consultation.

Many things need to be clarified in relation to vocational education. Another new qualification—the T-level—is being introduced but it is perhaps not getting the best reception at the moment.

There are a couple of points that I would like to end on. One is the question of student loans. Do we really believe that we are getting the best value for money from them? Billions of pounds a year go into student loans but some of the degrees are, quite frankly, hardly worth the paper they are written on. That is not to denigrate higher education, because there is a lot of good-quality higher education. However, are we really spending the money effectively? Could we have more two-year degrees? I think that we could. However, if I had to focus money on one area of education, it would be on early years learning. We know that, if we do not get it right there, that is where the trouble starts.