NHS and Social Care: Staffing
Baroness Blackwood of North Oxford Excerpts(4 years, 11 months ago)
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Baroness Watkins of Tavistock (CB)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In so doing, I declare my interests as a nurse, as set out in the register.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, patient safety is paramount. We expect health and social care providers to deploy sufficient numbers of suitably qualified, skilled and experienced staff at all times. The NHS People Plan aims to ensure a sustainable overall balance between supply and demand across all staff groups. This Parliament will see the people plan deliver 50,000 more nurses by 2025, a further 6,000 doctors in general practice and 6,000 more primary care professionals, all of which will support safe staffing and better care.
Baroness Watkins of Tavistock
I thank the Minister for her reply and particularly commend the NHS People Plan, yet evidence suggests that urgent action is needed to address the shortages in social care as well as healthcare. Many older people with dementia are failed by our social care system, in part due to costs and the availability of suitable staff. It is vital that the Government resolve the future of social care funding. Without certainty on funding, employers cannot invest in and plan for the future workforce. Dignity in care will be achieved only with rapid, proactive planning. Can the Minister explain the potential delay to the cross-party talks about funding for social care and what approach will be taken to ensure that proper staffing in social care is available during this Parliament?
Baroness Blackwood of North Oxford
I thank the noble Baroness for her question and pay credit to the work she has done in this area. She is absolutely right that we have to make urgent progress in delivering a sustainable social care solution. In the first instance, we have given councils up to £3.9 billion of additional funding in 2019-20, and the Prime Minister has been clear that he wants to see cross-party consensus on a sustainable way forward this year. I look forward to seeing progress made as swiftly as possible and hope that we will see work across this House on it, as I know this place takes the issue very seriously. In addition, we have run a national adult social care recruitment campaign to raise the profile of adult social care and encourage applicants. This has been successful; we have seen a 23% increase in the number of vacancies advertised on the DWP’s “Findajob” platform, which is improving the situation in the short term.
Baroness Walmsley (LD)
My Lords, there are particular shortages of nurses in certain specialties such as children’s palliative care, children’s mental health and learning difficulties. What will the Government do to improve the situation in those very important and sensitive areas?
Baroness Blackwood of North Oxford
The noble Baroness is quite right that we want to target recruitment towards the areas with the greatest shortages. That is one of the reasons why, when we announced the new non-repayable funding, we also announced a top-up for targeted specialties struggling to recruit. It is also why we have announced the availability of placements which can enable nurses to develop experience in specific specialties, which make it easier to recruit and retain those nurses in very rewarding and sometimes hard to recruit specialties.
Baroness Thornton (Lab)
I am sure the Minister will understand why the House might be slightly sceptical of “as soon as possible” promises, given that we are still waiting for a Green Paper that was promised almost two years ago. A date would be a good idea here.
Do the Government intend to follow the example of the Welsh and Scottish Parliaments and introduce safe nursing staffing legislation? Does the Minister agree with me—and with UNISON, which has 450,000 health workers in its membership—about the ever increasing importance to the NHS of recruiting nurses from overseas? How can the Government justify increasing the health tax, which applies to overseas nationals and will surely make it harder to recruit and retain nurses? Will the Minister suggest to the Treasury that the Government should in fact drop that planned surcharge?
Baroness Blackwood of North Oxford
The noble Baroness will know that appropriate staffing levels are already a core part of the CQC’s registration regime and that the law already requires hospitals to employ sufficient numbers of suitably qualified, skilled and experienced staff at all times. It is also mandatory for staff to provide monthly reports on the average number of care hours per patient per day, which is considered a better measure than staff numbers. However, we recognise the proposals that have come forward regarding staff safety and legislation; they are being considered at the moment.
The NHS surcharge is being considered to make sure that it is at an appropriate level to ensure that we continue to recruit at an appropriate level. At the moment, the rate of recruitment from non-EU countries has increased significantly by more than 150%.
The Lord Bishop of London
My Lords, I am sure the Minister knows that safety is about not just numbers but the continuing development and supervision of nurses and midwives. Can she comment on what the Government are doing to ensure that both nurses and midwives are funded properly for clinical supervision and professional development?
Baroness Blackwood of North Oxford
The right reverend Prelate is quite right. Ever since the tragic events in Mid Staffordshire, the NHS and our nation have been on a journey to make sure that the NHS is one of the safest healthcare systems in the world. This is based broadly on three policy strands: better regulation; greater transparency; and a culture of learning. HSIB is part of that. We hope to move forward in putting legislation in place to ensure that there can be learning without blame, and we hope to ensure that the appropriate training is in place. The people plan, which the noble Baroness, Lady Harding, is in the process of finalising, will ensure that specific proposals on how that will be delivered come forward imminently.
Lord O’Shaughnessy (Con)
My Lords, the Government are to be commended for wanting to raise the number of staff in the NHS and social care. In the near term, it is equally important that we make sure that we use the staff we have as efficiently as possible, and that we give them the tools and skills to be as productive as they can, including through the use of technology. To what extent will the digital tools that already exist and are on the market feature in the people plan?
Baroness Blackwood of North Oxford
My noble friend is a great advocate of investment in innovation and technology—and for good reason. One of the health infrastructure plan’s key priorities is ensuring that we bring forward the data and digital transformation solutions that will enable staff to spend more time on caring and less time on administrative and repetitive tasks that could be much better undertaken by some of the digital solutions that are now available. Some of those solutions would manage rotas more effectively and others, such as those being delivered by the £200 million AI hub, will enable, for example, AI solutions in radiology and pathology, which could lead to much earlier and more effective diagnoses in areas such as cancer.
Health: Vaping
Baroness Blackwood of North Oxford Excerpts(4 years, 11 months ago)
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Baroness Redfern
To ask Her Majesty’s Government what assessment they have made of the effect of vaping on public health.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, despite reductions in smoking rates, smoking remains the leading cause of preventable death in England. E-cigarettes are not risk free but are less harmful to health than smoking tobacco. Each year, more than 50,000 additional people who would not have quit through other means quit smoking through e-cigarette use. We continue to monitor the evidence base on e-cigarettes. The next Public Health England annual review is due in February 2020.
Baroness Redfern (Con)
I thank the Minister for her response. Does she agree that people who vape and struggle to quit should be given the same support and access to NHS services that is offered to regular smokers?
Baroness Blackwood of North Oxford
The Government have consistently highlighted that quitting smoking and nicotine use completely is the best way to improve health. Although they are not risk free, research shows that e-cigarettes are effective in helping smokers to quit. That is why we committed in the long-term plan to roll out “stop smoking” services in the NHS, to support improvements even on our smoking cessation rates—smoking is now at its lowest level on record, down from 18.4% in 2013 to 14.4%.
Lord Hunt of Kings Heath (Lab)
My Lords, does the noble Baroness agree that, looking back over the past 10 or 20 years, apart from the ban on smoking in public places, vaping has been the most successful intervention to reduce smoking? Does she therefore agree that we need to be cautious before we rush into trying to ban or overregulate its use, as some campaigners want?
Baroness Blackwood of North Oxford
As I said, more than 50,000 additional people quit smoking through e-cigarette use each year. We see e-cigarettes as an effective and safer route to quitting smoking than other routes. However, we understand that, at the moment, there is no evidence on the impact of long-term vaping, which is why Public Health England continues to update and publish the evidence base on e-cigarettes annually. We will continue to monitor the impacts of that use.
Baroness Meacher (CB)
My Lords, modest process changes could be made to enable patients who need medical cannabis to gain access to it. This is the most effective way of reducing public use of cancer-inducing cigarettes and vaping, which I understand is not risk free, although we do not know all the results. Will the Minister agree to meet me to discuss these process changes, which really could make a big difference and save people?
Baroness Blackwood of North Oxford
The noble Baroness is an avid campaigner on this, and I commend her on the work she does on it. I would be delighted to meet her to discuss this, of course, but I am also pleased with the progress we have made in bringing forward clinical trials to improve the evidence base around medicinal cannabis.
Viscount Ridley (Con)
My Lords, my noble friend will be aware that this week sees the centenary of the prohibition amendment in the United States, a policy that resulted in disastrous health outcomes and a huge increase in criminality and was repealed within 10 years. Does she feel that history is being repeated with America’s policy of prohibiting vaping but not regulating it for product safety, resulting in a number of deaths caused by the illegal use of substances in vaping—contrasted with this country, where product safety regulation has enabled us to do safe vaping?
Baroness Blackwood of North Oxford
My noble friend has asked a comprehensive and pointed question. It is notable that e-cigarette use among young people in the United States has increased dramatically— 78% in high-school students and 48% in middle-school students. We have not seen that in the UK because of the very effective and tightly regulated methods we have brought in around advertising and access for under-18s, which have borne fruit. I am proud of the way in which we have managed that in the United Kingdom.
Baroness Janke (LD)
My Lords, is the Minister aware that smoking has again become much more normal, and indeed quite fashionable—particularly in the form of e-cigarettes, among not just smokers but young people and people who have never smoked? Does she consider that this risks growing nicotine use and dependence? If so, what is being done to monitor and evaluate in health terms the increased use of e-cigarettes?
Baroness Blackwood of North Oxford
I am not quite sure I agree with the fundamental hypothesis of the noble Baroness’s question. If the normalisation hypothesis were true, we would not have expected to see smoking rates continue to decline as they have. Since 2013 smoking rates have fallen from 18.4% to 14.4%, and among young people regular use is very small. It is at 2% for those who have never smoked and is very rare or less, at 0.5%, for 11 to 15 year-olds.
Lord Brooke of Alverthorpe (Lab)
Will the noble Baroness be good enough to check the facts and assertions made by the noble Viscount, Lord Ridley? The facts are that during prohibition in the States, health improved and did not decline. Will she check that and give him the correct facts on it? Also, will she make sure that before we make any great changes on cannabis, we look very carefully indeed at what is happening in those states in America where cannabis is freely and openly sold for recreation purposes, and check on the number of people now dying from accidents and a whole range of associated problems? True, it is raising tax, but it is also raising many social problems.
Baroness Blackwood of North Oxford
I assure the noble Lord that when it comes to questions around medicinal cannabis and smoking, one of the reasons the UK is successful is that we approach our policy based on the most excellent evidence base. We are world-renowned for the approach we take to using evidence and putting it into policy most effectively. We are considered the European leader in smoking policy, in particular when it comes to our most recent tobacco control plan, and we will continue to be so.
Lord Vaux of Harrowden (CB)
My Lords, the noble Baroness has mentioned that smoking among children is relatively low, but it is growing fast: it has more than doubled in the last four years. I strongly urge her to speak to schools. My own conversations suggest that in the last year and a half to two years it has increased more than fivefold. Does she agree that flavours such as gummy bear, twister lollipop, jelly babies, pixie tarts and unicorn milk are quite clearly aimed at children? It really is time that we looked at the rules around this.
Baroness Blackwood of North Oxford
The noble Lord is absolutely right: there must be no complacency when it comes to any kinds of illicit drugs or substances aimed at children. We have very active policies, led by the Home Office in partnership with the department of health, to ensure that we keep up with all these substances. On smoking and the use of e-cigarettes, my figures are slightly different from his, and I am very happy to discuss this with him after Questions.
Young Carers: Health and Well-being
Baroness Blackwood of North Oxford Excerpts(4 years, 11 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what plans they have to ensure that young carers receive the social care, family, mental health and financial support they need to ensure their own health, development and well-being.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, we are committed to supporting young carers to ensure that they maintain their health and well-being and have the same life chances as their peers. We will continue to carry out the commitments made in the Carers Action Plan. These aim to increase the identification, support and recognition of young carers. This year, we will publish reports on young carers identification and work on carers from seldom-heard groups.
Baroness Wheeler (Lab)
My Lords, there are now an estimated 800,000 young carers delivering care to family members, and there has been an alarming 83% increase in children as young as five, six and seven undertaking this role. Is it not clear that the Government’s continued failure to tackle the social care funding crisis means young carers having to undertake care and support, at great cost to their own well-being, education and mental health, that should be available in the social care system? In particular, short breaks for respite care funded by local authorities are vital for disabled children and their families, including their siblings, many of whom are young carers. What action are the Government taking to make sure that they fill the annual £434 million funding gap in local authority funding for social care for disabled children in England, identified by the Disabled Children’s Partnership?
Baroness Blackwood of North Oxford
The noble Baroness will know that we take with the utmost seriousness the need to put social care funding on a sustainable footing. I heard the serious debate about this that we had on Thursday in the Queen’s Speech debate, and took back the seriousness with which this place takes those issues. On carers’ leave, the Government want to combine rewarding careers and the education of young carers with being able to care, and do not want young carers to take on inappropriate levels of caring. Therefore, the Government have committed to supporting unpaid carers with a leave entitlement of one week per year, which will be taken up in the employment Bill. In addition, I take the noble Baroness’s point about respite care and I will provide her with further detail in a note.
Lord Mackay of Clashfern (Con)
The Minister referred to the recognition of children giving this care. What provision is there for finding out the children who are subject to caring for adults or siblings in their family?
Baroness Blackwood of North Oxford
I thank my noble and learned friend for his question. The Government changed the law to improve how young carers and their families are identified and supported, to simplify the legislation relating to this. In addition, in 2016 we funded the Carers Trust to develop and run the Making a Step Change project for young carers and their families. It was designed to embed best practice to champion and identify support for young carers and their families and to provide an effective and integrated way for voluntary and statutory sector partners to identify young carers. We are working even harder to make sure that GPs and other professionals do the best for young carers. NHS England has recently introduced a new framework of quality markers in when identifying carers for GP practices so that they can improve both their health and their well-being throughout the care pathway.
Baroness Pitkeathley (Lab)
My Lords, the noble Baroness will remember from her previous role at the Department for Health and Social Care that, when carers were consulted prior to the Carers Action Plan, 67% of young carers said that they were not receiving any support at all. Does she have any statistics to show that this situation is improving?
Baroness Blackwood of North Oxford
We have now delivered all 12 of the commitments and recommendations in the Carers Action Plan to improve the situation for young carers, but the noble Baroness is absolutely right that the way we will improve on that is by improving identification. As I have said, with support from the Carers Trust and the Children’s Society, we are focusing on making sure that we embed not only early identification but also the right support throughout our work with young carers. We know that we have further to go but we are determined to do so.
Baroness Brinton (LD)
My Lords, the Children and Families Act 2014 made a very clear link between the Department for Health and Social Care working with other government departments to ensure that young carers got support, specifically the Department for Education. Also in that Act is a young carer’s assessment that every young carer is entitled to. What are the Government doing to ensure that every school identifies such young carers and makes sure that a referral is made to other support mechanisms elsewhere, including health?
Baroness Blackwood of North Oxford
This is a hugely important point, because obviously sometimes young carers are not necessarily identified by health professionals. In 2019 the Department for Education carried out a review of the educational outcomes of children who need or have had need of a social worker, and obviously young carers are identified in that cohort, where they represent around 3% or 16,500 of them. The department has identified the barriers that they face and the best practice needed to help leaders and front-line practitioners overcome them. Work is ongoing in how we respond to that. In addition, the DfE has worked to improve information sharing to safeguard vulnerable children, which would include carers, to make sure that they are picked up and given the support they need and thus ensure that they have the best life chances.
Lord Watts (Lab)
My Lords, how do the school attendance records of children who are carers compare with the average?
Baroness Blackwood of North Oxford
The noble Lord has asked a specific statistical question which I want to provide an accurate answer to, so I will write to him.
Baroness Finlay of Llandaff (CB)
My Lords, do the Government recognise that the shortage of beds which is being experienced across the NHS is having an adverse effect on the ability to provide respite admissions when young carers find that they are literally at breaking point? Funded beds in hospices, nursing homes and other places can be essential to maintaining the cohesiveness of a family unit that is under extreme strain.
Baroness Blackwood of North Oxford
Obviously, pressure on the wider NHS and on social care can have a knock-on effect on unpaid carers who provide an enormous and valuable contribution to our health system, and also on those who care for them. I think that many of us in this Chamber will have personal and direct experience of that. That is why we have provided an extra £33.9 billion of funding for the NHS to ease those pressures, why we are working hard to find a sustainable solution to social care reform, and why we want to make sure that we provide carers of all ages with the support they need, first through identification and later by making sure that they have joined-up support right through the system.
National Health Service Infrastructure
Baroness Blackwood of North Oxford Excerpts(4 years, 11 months ago)
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Baroness Thornton
To ask Her Majesty’s Government what assessment they have made of the consequences for patient safety of the backlog of maintenance and repairs to National Health Service infrastructure.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, the Government recognise that the quality of infrastructure, including backlog of maintenance, can pose challenges to the efficiency, safety and quality of NHS services. That is why we have launched the Health Infrastructure Plan, which includes the biggest hospital building programme in a generation. This substantial investment will support many of the hospitals facing the biggest challenges from their estates.
Baroness Thornton (Lab)
I thank the Minister for her Answer. NHS Providers says that the cost of the backlog is now £6.5 billion, and last year 15,844 patient incidents and 4,810 clinical incidents were caused by estate and infrastructure failure, and there were 1,500 fires in which 34 people were injured. The backlog includes wet walls in wards preventing babies’ incubators being plugged in. This is extremely serious. Will the Government provide the necessary funding to catch up—I am not sure that it is available yet? What is the timescale for catching up with the backlog—not building necessarily the 40, or six or however many, new hospitals that have been tendered?
Baroness Blackwood of North Oxford
The department acknowledges that parts of the NHS estate do not meet the demands of a modern health service and that there is unmet need for capital within the NHS. That is why we announced £2.1 billion of capital for health infrastructure in August and a further £2.8 billion injection in September. This is to ensure that staff are safe to deliver the world-leading health service that they should in a modern, efficient environment. We are also going further by reforming the capital regime to establish a clearer set of capital controls and the right incentives for organisations in respect of their infrastructure. The Chancellor has also confirmed that DHSC will receive a new multi-year capital settlement in the next capital review. Backlog of maintenance across the government estate will be a key theme of the spending review.
Baroness Finlay of Llandaff (CB)
My Lords, I declare my interests in relation to emergency medicine. Will the Government undertake to look specifically at the problem for emergency departments, given that many of them do not have enough cubicle space for the number of ambulances that arrive and the number of patients who are blue-lighted in? Staff do not have enough space to take a short break from the front line of some of the most harrowing cases that they have to deal with.
Baroness Blackwood of North Oxford
The noble Baroness is very expert in this area, and she is absolutely right that the NHS estate must prioritise areas of most need. This is why we have put in a serious amount of investment. NHS Improvement is also conducting a backlog review to understand where the areas of greatest need are and to assist NHS trusts in prioritising capital spending over the next few months and years.
Baroness Jolly (LD)
My Lords, equipment such as CAT scanners also comes from this source of income. Many are now not operating properly or are out of action awaiting repair. How many days of treatment are lost each year as a result of this?
Baroness Blackwood of North Oxford
Data on the proportion of capital equipment that is out of action or on days lost is not currently collected and the responsibility for that is with local NHS organisations, but the Government have recently supported investment in new diagnostics. As outlined in our Health Infrastructure Plan, we have invested £200 million to deliver new state-of-the-art diagnostic machines, such as MRI machines, CT scanners and breast-scanning equipment, to 78 trusts. We recognise that we need to improve the number of scanners that are younger than the “golden rule” of 10 years old.
Baroness Manzoor (Con)
My Lords, I welcome the Government scrapping car parking charges, which will support people who are caring. I also welcome the new money that will be put into the infrastructure project, which is vital, as the noble Baroness, Lady Thornton, has pointed out. Can my noble friend say, however, whether AI and new technology will be used, and whether funding will be put in place to help carers and people living in their home?
Baroness Blackwood of North Oxford
I thank my noble friend for her question. She is absolutely right that we want to prevent people from going into hospital in the first place. We have made a £200 million investment in the AI lab to reduce the burden on doctors in the first place and to make use of the benefits of AI in diagnostics. A number of centres up and down the country are trialling this to reduce the burden on clinicians so that they can become more human and work on their caring responsibilities. We are also trialling a dementia care test bed, so that there is support for carers and so that people with dementia can remain in their own home. This is going on in Surrey and has been hugely successful; it is a very exciting development.
Lord Crisp (CB)
My Lords, given that the NHS is seeking to shift to being a more community and primary care-based organisation, can the Minister say more about what investment is going into community and primary care in capital terms?
Baroness Blackwood of North Oxford
We have been looking at providing additional funding and support to councils to meet the rising demands and to continue to stabilise the social care system. We announced access to an additional £1.5 billion of funding for adults and social care, and we will be considering this further in the spending review.
Baroness McIntosh of Hudnall (Lab)
My Lords, the noble Baroness will be aware that there was a spike in the incidence of flu just before Christmas; I do not know whether it has diminished, but it certainly was quite high. As a consequence, a number of people who perhaps would have much preferred not to go to hospital were forced to do so. She might like to know that, in one London hospital to which one of my family was obliged to go, the queue for A&E was out into the street. Many of those people were ill and should not have been outside in the cold. The reason for it was partly to do with availability of staff but more to do with the availability of chairs. Does she understand that hospitals need capacity beyond what their expectation might be of how many people will turn up, precisely to cope when there is a spike of this kind?
Baroness Blackwood of North Oxford
The noble Baroness is right that there has been a significant increase in demand over recent years. That is partly why we have secured the significant funding increase from the Treasury of £33.9 billion, which we will be enshrining in law for the first time to give certainty to hospitals. It is why we are increasing the capital investment, which will address some of the challenges that she has raised, and it is also why we have run a vigorous flu vaccination programme to prevent people from getting into that problem in the first place. We recognise that we need to reduce the demand from those going into A&E unnecessarily and to support those very hard-working staff who were in those situations over Christmas and the new year. We thank them for their hard work over that period.
Queen’s Speech
Baroness Blackwood of North Oxford Excerpts(4 years, 11 months ago)
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Lord Lamont of Lerwick
That an Humble Address be presented to Her Majesty as follows:
“Most Gracious Sovereign—We, Your Majesty’s most dutiful and loyal subjects, the Lords Spiritual and Temporal in Parliament assembled, beg leave to thank Your Majesty for the most gracious Speech which Your Majesty has addressed to both Houses of Parliament.”
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, it is a great honour to open this debate on Her Majesty’s gracious Speech. I am delighted to be joined by my noble friend Lord Younger, who will, I know, brilliantly close what I am sure will be a constructive and lively debate. We will consider in detail the Government’s proposed approach to economic affairs, business and public services. The key theme linking all those areas is the overarching objective to invest in our future prosperity. Given that, I am sure that there will be unanimous support for that priority across the House, and I look forward to hearing your Lordships’ expert contributions on its implementation.
There is no question but that the gracious Speech sets out an ambitious agenda for reform. There might be some who will be tempted to give an opinion on that but I will not apologise for what is a challenging and bold approach and for a Government who are restless for opportunity and renewal. This is a Government who are re-energised, reinvigorated and refocused on the right priorities, with a driving purpose to deliver real change for British people up and down this country.
If we put aside for just one moment the small matter of Brexit, noble Lords will not be surprised to hear me say that there can be no higher priority than the NHS. It is therefore my pleasure to open this debate by updating the House on the Government’s plans for improving healthcare.
As noble Lords will no doubt be aware, we have already committed to increase NHS funding, amounting to an extra £33.9 billion in cash terms annually by 2023-24. This is the single largest commitment to the health service ever undertaken by a peacetime British Government. Furthermore, in the first 100 days of this Parliament, we will bring forward legislation to enshrine this multiyear funding settlement in law. This is the first time that a Government have delivered such a commitment in legislation and its purpose is to give unprecedented financial certainty and to allow the NHS to plan with security for years to come.
The NHS long-term plan has been drawn up by those who know the NHS best, so that we can guarantee that it is not just about money but about how we spend it effectively. It has been drawn up by health and care staff, and patients and their families, along with experts in their fields. It sets out an approach for making sure that this extra funding goes as far as possible, ensuring that every pound is invested in the things that matter most.
Supporting the NHS in delivering the long-term plan is a priority for the Government and we are carefully considering options for targeted legislation to enable this. These targeted changes will reduce bureaucracy and improve collaboration across the NHS, ensuring that it evolves to meet the challenges of prevention, integration and technology, and enabling local partners to work together to deliver a healthier nation where we can care for people throughout their lives.
A key part of this strategy is, as we have debated many times in this place, fixing our social care system, which is clearly under pressure and which, in turn, contributes to the unprecedented demand on the NHS. To meet this rising demand, we are already providing councils with access to an additional £1.5 billion for social care next year. This comprises an additional £1 billion of grant funding for both adults’ and children’s social care, and a proposed 2% to enable councils to access a further £500 million from 2020-21. Of course, this is not only about money. We are determined to find a long-term solution to meet the challenges in social care to ensure that every person is treated with dignity and offered the security that they deserve. Therefore, alongside the additional funding, we will seek to build cross-party consensus to bring forward the necessary legislation to implement social care reform. For the avoidance of doubt, we have pledged that these reforms will ensure that no one needing care will be forced to sell their home to pay for it.
Furthermore, the Government have promised to put mental health on an equal footing with physical health. As the Mental Health Act is nearly 40 years old, modernisation of this Act is critical. Therefore, we will publish a White Paper early this year, setting out the Government’s response to Simon Wessely’s independent review and our vision for wide-ranging reform. We will then bring forward a new mental health Bill to amend the Act. This work is important but it is also complex. Given our experience—in this place particularly—with the Mental Capacity Act, I think we can all agree that it is right that these long-term changes are made with care and consensus. Through these reforms, we hope and intend to empower patients and remove inequalities in our mental health system.
In my role as a Minister for Health, I have particular responsibility for promoting innovation across the industry. We all have reasons to be grateful for the medical innovations that have become available through the NHS over its 70-year history, from the first clinical trial into scurvy, to proton beam therapy and mass vaccination programmes. The Medicines and Medical Devices Bill will give us the necessary powers in UK law to update the current regulatory systems for human and veterinary medicines, clinical trials and medical devices. The Bill will enable us to cement our position as a world leader in the licensing and regulation of innovative medicines and medical devices after we leave the European Union, and will ensure that we have a regulatory system with robust standards and patient safety at its heart. The Bill is very much part of our agenda to modernise regulation, supporting early clinical trials and the production of personalised medicines but also the development of ever more sophisticated and safe medical devices.
I am proud to say that Britain is a nation of innovators, with many world-changing innovations and inventions pioneered here in the United Kingdom. The Government are committed to continuing to push the frontiers of science and technology via boosting R&D funding and developing proposals for a new, high-risk funding body to ensure that we remain at the forefront and competitive globally. We are equally ambitious in the scale of our commitment to the environment. We are the first country to legislate for long-term climate targets; we are world leaders in offshore wind and green finance; and there are now nearly 400,000 jobs in low-carbon industries and their supply chains. We will continue to lead the way in tackling climate change, encouraging new industries that will boost our productivity and growth as an early supplier of new, low-carbon technologies globally.
Our future, though, depends on the strength of our great cities. We have promised a White Paper on devolution, and I think all of us in this place agree that there is a powerful case for empowering every region and levelling up opportunity across every corner of this country. To unleash the potential across city centres in England, Scotland, Wales and Northern Ireland, we need to invest in the factors that contribute to economic growth: a strong labour market, education, land for housing, infrastructure and more.
Our labour market is in its strongest position in years, with a UK employment rate of over 76%, almost three-quarters of which is in full-time jobs, but we are committed to going even further. This Government are determined to make the United Kingdom the best place to work in the world. Through the employment rights Bill, we will continue to deliver on our pledge to bring about the greatest reform of workers’ rights in 20 years. The gracious Speech confirms the Chancellor’s promise that the national living wage will increase and that, provided economic conditions allow, it will reach two-thirds of median earnings within five years. Also, within five years, the Government plan to expand the reach of the national living wage to everyone aged 21 and over. Taken together, we expect these changes to benefit 4 million low-paid workers. As assured in our manifesto, the Government will also increase the national insurance threshold to £9,500 next year—a tax cut for 31 million people, with a typical employee paying around £100 less in 2020-21.
Record numbers of people are now working and saving for retirement, with 87% of employees saving into a workplace pension in 2018, an increase of 55% since 2012. This shows that people are preparing for their future but, even with this success, we know that we must do more. Everyone in this place has commented on this in my hearing. That is why the Pension Schemes Bill will put protection of people’s pensions at its heart and sets out the next phase of pensions reform, building on consensus across the pensions industry and the political spectrum. On a personal level, I also very much welcome the urgent review undertaken by the Department of Health and Social Care and HM Treasury into the annual allowance taper to fix the pensions system so that senior clinicians can take on extra shifts without the fear of an unexpected tax bill.
Our nation’s productivity is no more and no less than the combined talents and efforts of people up and down this country. Therefore, the next part of our plan to make Britain fit for the future is to improve the quality of our education system. Importantly, the OECD’s PISA results show that the UK already outperforms the OECD’s average for reading, maths and science, and that performance has recently improved significantly in maths. It is especially welcome that this has been driven by improvements for lower-attaining pupils. However, our work is far from finished. That is why we have announced a cash boost to schools of £2.6 billion next year, rising to an additional £7.1 billion in 2022-23. This means that per-pupil funding in every school will increase in cash terms, and it will rise higher than inflation in most schools. The settlement underlines our determination to recognise teaching as the high-value prestigious profession that it is. It ensures that pay can increase for all teachers, with teachers’ starting salaries increasing to £30,000 by 2022-23. That represents an increase of up to 25%. On further education, we have already introduced the first part of the national retraining scheme and we will invest an additional £3 billion in the National Skills Fund, which will build on existing reforms to ensure that British workers are equipped with the skills they need to thrive and prosper for a lifetime in work.
Key to ensuring a lifetime of prosperity, to recruitment and to raising the productivity of our country is building more homes and creating a fairer property market. We know that this is true. In the last year, therefore, we have delivered over 241,000 additional homes. That is the highest level in over 30 years. During this Parliament, we will implement measures to encourage shared ownership, help local families on to the housing ladder and speed up the build of affordable housing. This Government are working to deliver a rental system fit for the future, which is why we are introducing the Renters’ Reform Bill to protect tenants and support landlords to provide the good-quality homes that we know this nation needs. It is also necessary that we undertake urgent action to respond to Dame Judith Hackett’s independent review of building regulations and fire safety. Working together to learn the lessons of Grenfell, we will bring forward a building safety Bill and a fire safety Bill as soon as possible. I know that the House understands the urgency of those steps.
Turning to transport, Her Majesty’s gracious Speech contained a series of measures to tackle urban congestion and transport links—it is no good trying to boost productivity if people cannot get to work on time—both here in the UK and with trading partners around the world. Our ageing airspace system has not been updated since the 1960s, so the Air Traffic Management and Unmanned Aircraft Bill will bring forward measures to modernise airspace, making flights faster, cleaner and quieter and giving the police greater enforcement powers to effectively tackle the unlawful use of unmanned aircrafts, including drones.
Earlier this year we successfully brought home 150,000 Thomas Cook passengers stranded overseas in the largest ever peacetime repatriation. But that operation was complex and costly, so we will bring forward a number of reforms to deal with airline insolvency that will provide oversight of airlines in financial trouble and help passengers to return home speedily and efficiently. Furthermore, we are determined to protect passengers from the misery of transport strikes, so we have announced plans to keep a minimum number of services running during transport strikes, ensuring that unions can no longer hold the travelling public to ransom. We will also implement widespread reform to the rail industry, following the Williams review, to improve performance and reliability, simplify fares and ticketing and introduce a stronger railway commercial model.
This Government are steadfastly committed to a path of budget responsibility in the context of what I have outlined as an ambitious reform agenda. Our economic plan will be underpinned by a responsible fiscal strategy, investing in public services and infrastructure while keeping borrowing and debt under control. As a country we are in a strong position, not by accident but by design. The International Monetary Fund forecasts that this year the UK economy will grow faster than those of France, Germany, Italy and Japan. The deficit has reduced by four-fifths since 2009-10. We have seen the economy grow every year since 2010. There are 3.7 million more people in work now than there were in 2010, and the proportion of low-paid jobs is at its lowest in 20 years.
All this is good news that I am sure will be welcomed by every Member of this House, and thanks to this we can now invest more in growing our economy and public services. That is why this Government are proposing a step change in infrastructure investment to deliver sustainable and inclusive growth. We will implement an infrastructure revolution, helping to ensure that productivity and opportunity are spread to every part of this country. That is why the gracious Speech has confirmed plans to publish a national infrastructure strategy, which will act as a blueprint for the future of infrastructure investment across the whole of the United Kingdom. It will examine how, through infrastructure investment, we can address that most critical and pressing of challenges—decarbonisation—and set out plans to turbocharge gigabit-capable broadband rollout and improve energy and transport infrastructure.
In closing, it is my fervent belief that Her Majesty’s gracious Speech affirms our commitment to invest in an ambitious agenda and level up opportunity and quality of life in every corner of the United Kingdom. We will invest to reform education to deliver social mobility. We will invest to build homes, infrastructure and economic opportunity to help raise living standards. We will invest in our NHS to make it the most sustainable and high-quality healthcare system in the world. I know that as legislation comes forward there will be expert and challenging debates in this place in which the collective wisdom and experience of the House will be called on to the full. I also know that in this place we share a common commitment to a fairer, more innovative and prosperous Britain. I look forward to delivering on that with each and every Member in this Chamber.
Lord Davies of Stamford (Lab)
My Lords, before the noble Baroness sits down, following her remarks on the NHS, can she tell the House whether the Government propose to leave the European Medicines Agency? If so, will pharmaceutical companies registering a new compound, having gone through the procedure with the European Medicines Agency, have to replicate the process and cost by going through the same procedures here? Or will the Government accept the EMA’s registration, even though we no longer have any influence over the management, policies or strategy of the agency?
Baroness Blackwood of North Oxford
I apologise, but I think the noble Lord slightly missed his moment and I had sat down. However, I know my noble friend Lord Younger will respond in his closing remarks.
NHS: Nurses
Baroness Blackwood of North Oxford Excerpts(4 years, 11 months ago)
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government when they expect to meet the Conservative party manifesto commitment to deliver 50,000 more nurses in the National Health Service.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, we expect to increase nurse numbers by 50,000 by 2025. Eligible preregistration students on courses at English universities from September 2020 will receive additional support of at least £5,000 a year, which they will not need to repay. Additional payments of up to £3,000 will be available for some students in regions or specialisms struggling to recruit and to help students to cover childcare costs. We encourage everyone considering this incredible career to apply before the deadline on 15 January.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the Minister, but the manifesto pledge and what she said today seem to me to have a whiff of fantasy, due to double counting, uncertain finances and a less than precise timetable. Of the 50,000 extra nurses, it turns out that only 30,500 will actually be additional nurses, of whom 12,500 will have to be recruited from other countries. Of the 18,500 that the Government are so magically going to persuade to stay on against the current trends, 12,400 were already pledged in the NHS plan published earlier in the year. It all seems to be on a bit of a wing and a prayer as to whether the Government will get anywhere near a net increase of 50,000. How can the Minister be confident that they are going to succeed when the student nurse attrition rate is at 25% and 14,000 qualified applicants were turned away from nurse courses last year?
Baroness Blackwood of North Oxford
My Lords, first, I thank the NHS staff who have worked so hard over the Christmas and new year period. I point the noble Lord to the recent record; the NHS now has over 20,300 more nurses on our wards than in 2010 and over 52,000 more nurses in training. We have increased our training places by 25% since September 2018 and made available 3,000 more midwifery places to ensure that we can achieve this outcome. We have put in place several actions on recruitment and retention, because we need to retain our extremely experienced and excellent nurses and to recruit more nurses to support them. That is why we have announced this new package, which will not only increase nurse payment by 12% but provide support for those in training, attracting more nurses in to support those already in place.
Lord Forsyth of Drumlean (Con)
My Lords, from the point of view of both retention and recruitment of nurses, would my noble friend not think it a good idea to allow student nurses who stay in the profession for a period of time to have their fees written off, given that because of their levels of pay they will not pay back the student loans required for the profession? That would save the taxpayer a good deal of money and encourage people to come into the profession.
Baroness Blackwood of North Oxford
I always take very careful note of proposals from my noble friend. At the moment, that is not under consideration, but it will certainly be looked into. As the entry salaries rise, it is more likely that student loans will be repaid, but what is important at this stage is that we attract the most nurses into the profession. At the moment students are able to access student loan funding for maintenance as well as the non-repayable funding from the DHSC, which means that we will meet our target of 50,000 more nurses by 2025, which is what we need to be able to deliver a sustainable NHS.
Baroness Watkins of Tavistock (CB)
My Lords, could the Minister provide an estimate of the number of people the Government expect to recruit from countries where the nurse-to-population ratio is already inadequate? If this is morally right and what we need to do, how can we ensure that some of our overseas aid budgets through DfID are used to increase nurse training in countries that we will recruit nurses from?
Baroness Blackwood of North Oxford
The noble Baroness is very expert in this area. I cannot give her specific numbers on specific recruitment from individual countries; I do not know which specific countries she is asking about. I can tell her that the recruitment of nurses from overseas non-EU territories has increased by 156% in recent years; as the daughter of a South African nurse, I can also tell her that this is a long-term pattern and has been good for the NHS. However, we must also make sure that we invest in many of those nations as we do through the overseas budget, which is part of the department’s healthcare priority. I would be happy to write to her with details.
Baroness Jolly (LD)
My Lords, many noble Lords will know that 2020 is the Year of the Midwife. I am delighted that the Minister was able to make an announcement on the number of midwives but I want to know by when they would be in post. I also want to know, as I am sure the House does, who is responsible for the delivery of those 50,000 new nurses.
Baroness Blackwood of North Oxford
The primary responsibility for their delivery will fall to the Secretary of State and NHS England but, obviously, it falls under the NHS people plan put together by Dido Harding —my noble friend Lady Harding of Winscombe—so it will be delivered through that programme.
Baroness Thornton (Lab)
My Lords, can we turn to the terrible situation facing nurses in Northern Ireland? Currently, there are 2,800 nursing vacancies, nurse pay has fallen by 15% in real terms in recent years, and nurses in Northern Ireland are the lowest paid in the United Kingdom. On 18 December, members of the RCN—the Royal College of Nursing—went on strike. That is absolutely unique. They plan to take further strike action on 8 and 10 January. Does the noble Baroness agree that this crisis cannot wait for the restoration of devolved institutions and that, given that he has the locus and power to do so, the Secretary of State should sort this out?
Baroness Blackwood of North Oxford
The noble Baroness raises an important issue. It is under active and serious consideration but, at this point, we are unable to give specific details about it. I will come back to the House on this when I am able to do so.
Baroness Manzoor (Con)
My Lords, I congratulate the Government on the new funding scheme for those wanting to come into nursing. Can the Minister say a little more about when this funding will be available?
Baroness Blackwood of North Oxford
The bursary will be available for new and continuing nursing, midwifery and allied health students for courses from September 2020. As I said, students will be able to access both student loan funding and this additional, non-repayable funding from the Department of Health and Social Care while studying. This means that students will have more cash in their pockets than they ever have before, which should attract them. It also means that we will be able to target funding to areas and specialisms that struggle to recruit, which we believe will definitely improve the sustainability of the nursing workforce and reduce its variability up and down the country.
Baroness Finlay of Llandaff (CB)
My Lords, I declare an interest as chair of the National Mental Capacity Forum. Do the Government recognise that we need to do more than just put more money into nursing for learning difficulties, given that there are now 1,000 fewer such nurses than there were four years ago and given that the mortality and morbidity rate in the population of people with learning difficulties is alarming, in that their life expectancy can be around 10 years shorter than that of the rest of the population? This area needs to be targeted. Given the stresses involved in this type of nursing, it takes more than money to retain people.
Baroness Blackwood of North Oxford
As ever, the noble Baroness raises a serious issue. We have introduced a targeted initiative for students who commence loan-funded postgraduate preregistration nursing courses particularly for those going on to work in learning disability, mental health and district nursing—to give them a golden hello, as it were. We have also introduced more clinical placements, where students can gain specific professional knowledge and be attracted into those very specialised and important areas of expertise.
Health: Eating Disorders
Baroness Blackwood of North Oxford Excerpts(4 years, 11 months ago)
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Baroness Parminter
To ask Her Majesty’s Government what steps they are taking following the reported rise in hospital admissions for eating disorders.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, the latest figures show that young people with an eating disorder are getting more of the support and treatment that they need than ever before. As part of the NHS long-term plan’s investment of an extra £2.3 billion a year by 2023-24, eating disorder services are being ramped up across England. This is on top of the £30 million each year announced in 2014, supporting 70 teams delivering care to thousands more young people with eating disorders.
Baroness Parminter (LD)
NHS figures show that 19,000 people required hospitalisation for eating disorders in England last year. That figure is more than double what it was a decade ago. With only 649 in-patient beds in the NHS in England to treat people with eating disorders, does the Minister agree that the resources to tackle this worrying mental health crisis are too scarce?
Baroness Blackwood of North Oxford
The noble Baroness, I know, has personal expertise in this area, and I thank her for her Question. As she knows, we have taken seriously trying to expand and improve eating disorder services in the country. We have invested the extra £30 million in community care and introduced the new waiting time standard, which we are on target to meet. But she is right to say that we need to improve in-patient care as well, and we are working hard to deliver on that.
Lord Lexden (Con)
My Lords, in view of the key role of schools in responding to mental health issues such as eating disorders, what progress have the Government made in giving schools the vital training support that they need in this area?
Baroness Blackwood of North Oxford
My noble friend is right that schools are important if we are to deliver on our commitment to the earlier diagnosis and prevention of mental ill-health, particularly in the area of eating disorders. We are introducing new school and college-based mental health support teams, the first of which are now becoming operational. We are also piloting four-week waiting times in 12 areas to improve access to children’s and young people’s specialist mental health services, which link to those schools, and we will evaluate performance on that.
Baroness Bull (CB)
My Lords, can the Minister confirm that in addressing the rise in eating disorders, sufficient consideration will be given to the intersection with the anti-obesity agenda? Measures to tackle child- hood obesity such as calorie counting or compensatory exercise are also symptoms of eating disorders, the very behaviours that treatment seeks to address. Many patients report that their illness started as a result of weight-related teasing, healthy eating advice or being praised for dramatic weight loss. Does the Minister agree that the solutions for eating disorders and obesity need to be considered in parallel to avoid the risk of one impacting negatively on the other?
Baroness Blackwood of North Oxford
Obviously we cannot ignore the obesity challenges that we face in this nation, and it is right that we take strong action to address them. But we recognise that this must be done in a sensitive way that also takes into account the potential consequences for those with eating disorders. We must strike a careful balance between informing and educating people about healthier choices and not negatively impacting on those with eating disorders, those in recovery from eating disorders or those who have the potential to develop them.
Lord Winston (Lab)
My Lords, the figures are, of course, of great concern but, as so often happens with many pathologies, sometimes the reasons for these sudden or increased rises are due to better diagnosis or increasing diagnosis, and, of course, greater awareness of the problem. Given that, can the noble Baroness say what plans the Government have to ensure that NHSX is fully supported in trying to help us to analyse these data to see just how important investment in this particular condition actually is, and others similarly that are on the rise?
Baroness Blackwood of North Oxford
The noble Lord, as ever, is quite right to delve into the detail of the 2017 survey into the mental health of children and young people in England. It found that eating disorders were identified in 0.4% of five to 19 year-olds—the spread was 0.7% of girls and 0.1% of boys—but it rose to 1.6% of girls aged seven to 19. Obviously, we want to understand what this rise in admissions means. There could be a number of reasons, which we hope are linked to earlier and better diagnosis, but of course we need to understand it better. We have a much better understanding of the data through the NHS mental health dashboard, which tracks down to CCG level what is happening with it, but we need to make sure that this work is properly funded and properly tracked in order to lead to better and more effective policies and provision of commissioned services.
Lord Lansley (Con)
Does my noble friend recognise that sometimes the point at which young people with severe eating disorders are able to meet the criteria for admission to an in-patient bed is so severe that some of the potential benefits from an earlier admission are lost? I ask my noble friend to return to the number of in-patient beds. We have a deficiency. What is the Government’s estimate of the extent of that deficiency, and what steps are being taken to commission additional in-patient beds?
Baroness Blackwood of North Oxford
We are increasing the number of commissioned in-patient beds up and down the country, but we are doing it in a way that recognises that it is better to have earlier diagnosis—prevention of the need to admit—and ensures that we do not wait until patients are at the stage where they need admission, which is the primary aim. My noble friend is absolutely right that we need to make sure that we have the right balance between those two. At the moment, we are doing a thorough assessment, and I will be happy to write to him on that issue.
Baroness Jolly (LD)
My Lords, the Minister has mentioned early diagnosis and treatment, which will help save lives, yet doctors receive less than two hours’ training on this topic. What pressure can the Government bring to bear to improve training for this deadliest of mental health illnesses?
Baroness Blackwood of North Oxford
My Lords—[Interruption.]
I am getting some help from the other side.
The noble Baroness is quite right on this matter. It is vital that professionals are trained to look out for potential signs. Obviously, with such a deadly mental illness—
I am not sure whether to stop or carry on.
Diagnosing eating disorders is an important area of mental health practice, so Health Education England is taking forward a significant package of work at the moment to review current education and training offered to identify gaps and ensure that not only junior doctors but general practitioners and nurses have the right kind of training.
The Lord Speaker (Lord Fowler)
My Lords, we now come to a number of First Readings. It might be helpful to the House if Members were kind enough to switch off their mobile phones before coming into the Chamber.