NHS: Health and Social Care Act 2012

Baroness Armstrong of Hill Top Excerpts

Thursday 8th September 2016 Lords Chamber

[Baroness Armstrong of Hill Top (Lab)]

My Lords, it is a pleasure to be involved in today’s debate, although it is a troubling area of policy. The Minister has heard me on this before. The introduction of this legislation and the way that things have gone have not been a happy tale for the National Health Service—and, most importantly, for too many patients who look to the National Health Service and rely on it.

We know that one of the biggest challenges facing the NHS is the change in the nature of the population. Those changes in the population, and therefore the patient profile, were not addressed in this legislation, which was about structures. I am the last person to say that structures do not matter, but in the National Health Service people work with what they are given. They have to spend so much time trying to sort out what the legislation means in terms of structures and who is responsible for this, that and the other that they have not been tackling the issues that really affect patient care.

I am concerned particularly, as the Minister will not be surprised to hear, about the integration of the different sectors—the integration of the National Health Service with social care—which is one of the real priorities at the moment. They are two totally different systems and the changes in the Act have not enabled and helped those two systems to work more closely together. It is a real problem. There are many other problems but I am leaving it to other people to talk about them. I will concentrate on this issue.

What has happened is that there has been a greater concentration on trying to sort out hospital provision, and subsequent government policies have added to the total inability properly to deal with social care. It is social care that is absolutely critical to hospitals in terms of bed blocking, but also to the most vulnerable: the elderly and people with disabilities. Their voice is not as loud as other people’s in the system—it would not be, for obvious reasons—and their ability to have choice and quality of care differs hugely across this country.

I could weep over the Government not having worked more effectively across government on this issue. The idea that 40% cuts in local government—when so much of local government money is spent either on the elderly or on children—would not affect social care and not have consequent effects on the NHS, and not to have worked that out before the Government initiated certain policies, is risible.

As I uncovered in written PQs, the position is particularly difficult in the north-east—I suspect the Minister knows what I am going to say. I applaud the Prime Minister’s ambition that no area should feel left behind and that no individuals should feel that they do not have an equal opportunity to prosper. But look at what has happened and what is happening in the north-east. The actions that the Government have taken have exacerbated the problems and not eased them.

Poverty affects health. We should not need to say it but we still need to. The incredible reports from Marmot and so on show us just how much they affect health. In the north-east we have many more people who do not have the financial means to assist their own healthcare, so we have a much higher proportion of the population who are dependent on public subsidy in social care. As the Minister knows, I uncovered through these Parliamentary Questions that we have the highest proportion of people who are reliant on public funding for their care needs and the lowest ability to raise money in council tax because of the low value of housing.

The Government took a decision that one of the main ways of further funding social care would be through a 2% levy. When that happened, not a single authority in the north-east gained sufficient money from the 2% levy even to meet the rise in the minimum wage that the Chancellor announced on the same day. Whereas some authorities—I am told—have as a little as 1%, 2% or 3% of their social care users who are reliant on public funds, in South Tyneside, as one example, 89% of those who are dependent on social care rely on public funding. That authority got some £794,000 from the 2% increase and it nowhere near covered the costs in the social care sector of the minimum wage.

There is also, as the Minister knows, a crisis among the private sector providers of residential social care because they are not getting enough money. The Government have made a small attempt to alleviate that. But I am saying to the Minister that he really has to persuade his colleagues that if they want to get anywhere near meeting the Prime Minister’s ambitions, there has to be an urgent national review of how they fund social care and not to push it on to impoverished people in local authorities that have taken the cuts and do not have the council tax base that other parts of the country do. This is unfair, it is unequal and it has to change.

Health: Adult Psychiatric Care

Baroness Armstrong of Hill Top Excerpts

Monday 22nd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, if we can improve home treatment and crisis resolution at home it will free up in-patient beds and solve the other problem as well, as people will have to travel less far. That is absolutely critical. I cannot tell the noble Baroness today what NHS England is proposing to do with financial incentives, but I can reiterate that treating more people outside hospital, at home, is a priority for the Government.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, does the Minister realise that there are real problems in many regions? I chair a charity which deals with the most vulnerable—people with complex needs. We have evidence that the number of people whose mental health needs have increased has risen significantly over the past five years, and yet three centres in Tyneside—both residential and day care—which deal with the mentally ill are closing this year. How will we meet those people’s needs in such circumstances?

[Lord Prior of Brampton]

My Lords, reading the noble Lord’s report, I was struck that he said in the foreword that he went through times when he was very depressed and times when he was deeply impressed. In a way, that sums up the mental health system—it is fragmented, and there is a high level of variation. We provide fantastic care in one place but terrible care for somebody else, and very often it is not related to cost. I do not know about the particular instances that the noble Baroness has referred to, but I can fully understand that in certain areas it is much worse than in others.

Sex-selective Abortion

Baroness Armstrong of Hill Top Excerpts

Monday 7th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I have a long list of stakeholders, which covers all the usual suspects in this area, if I can put it like that. In the way that the methodology was developed to assess whether there was a population basis for gender abortions taking place, we took advice from the Office for National Statistics and a number of the royal colleges.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, has the Minister yet had the opportunity to consider the judgment made last week about abortion in Northern Ireland? What advice and work are the Government going to do with the devolved Administration to ensure that women in Northern Ireland get the same human rights as women in the rest of the United Kingdom?

[Lord Prior of Brampton]

My Lords, it is a devolved matter for the Northern Ireland Executive and not really for me or for us.

General Practitioners

Baroness Armstrong of Hill Top Excerpts

Monday 22nd June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness will know that NHS England recently published its Five Year Forward View, which is a five-year plan for the future. It will encourage much more care, delivered outside hospitals, in the community, and that will require larger input from general practice. I am very pleased to tell the noble Baroness that we are committed to 5,000 more doctors working in general practice.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I, too, welcome the Minister to the Dispatch Box. I wonder whether he agrees that the Government are being very complacent on this issue. I passed my GP surgery in a small ex-mining town in the north-east this weekend. On the door I read that there were 11 or 12 sessions in the next month when the GP practice would not be open—that is, from Monday to Friday. Is it not true that the model is broken and that young doctors coming into GP practice do not want to be partners and have the responsibility of running a small business as well? Is not the model broken? When we look at what is going on in areas where health outcomes are poorer, is it not urgent that the Government pay more serious attention to that?

[Lord Prior of Brampton]

The noble Baroness speaks a good deal of truth. The model that we have been working with since 1948 in this country is largely broken. We have to deliver more care through vertically integrated units of care, not just independent hospitals. Over the next five to 10 years we will see a huge consolidation of primary care. The old cottage industry model of general practice is probably broken. The Five Year Forward View recognises that and the Government have committed £8 billion to see that forward view put into practice.