Health and Social Care: Winter Update

Debate between Baroness Brinton and Baroness Merron

Tuesday 21st January 2025 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I want to echo the comments of the Secretary of State in the other place about the appalling treatment of Achamma Cherian, who was stabbed in the Royal Oldham Hospital last Saturday. It is absolutely intolerable for any member of NHS staff to be treated in this way. Can the Minister reassure your Lordships’ House that staff in A&E especially are protected, but also throughout our NHS?

I want also to start by thanking our NHS and social care staff for their remarkable effort. One of the problems that our NHS and social care staff have faced is total exhaustion since the winter of 2019-20. Immediately following the winter pressures, we were faced with a pandemic. Everybody in the NHS is now saying that this winter feels much worse, simply because it is yet another year of winter pressures.

Ambulance services have had to change their advice across the country to warn of being overstretched. A leaked memo from the West Midlands Ambulance Service says that patients who had collapsed with abdominal pain and vomiting, which are category 3 and 4 calls, and even, in the periods of highest demand, with heart attack or stroke, which is category 2, were told, “We don’t have an ambulance available to respond to you and it may be hours before one is available. Is there any way you can arrange safely to get to a hospital emergency department?”

I am minded to tell the House that, when I got a bus the other day that passed University College Hospital at Warren Street, a number of people got off who were clearly extremely unwell and being taken to the hospital by their families. What are the Government planning to do to support patients who need urgent ambulance services that are not available—for reasons that we understand are often to do with backlogs in A&E, queues and so on?

The Statement says that the experience of patients this winter is unacceptable, and we on these Benches agree. It is the opposite of a vicious circle: it is a circle of hell, not just for patients but for staff. I note that the Secretary of State commented in the Statement on what he saw when he was visiting, but worse is to come. We know from the Royal College of Nursing survey published earlier this week that we have patients dying in corridors, with nurses feeling absolutely unable to provide support for them.

It is not just 14 years of underinvestment; frankly, we are now seeing the problems of the wrong reforms that happened some years ago now. That has resulted in particular in pressure on primary care. The Statement focuses on hospitals but does not address the real crises that are going on in primary care.

In addition to the issues of funds and the planned extra doctors, who will take a while to come in, what are the Government planning to do to prevent hospitals constantly referring patients back to primary care when they need just an X-ray or a test, rather than being dealt with by the doctor they are seeing in hospital?

The emphasis of the Statement is obviously on the current high level of infections. It comments on the more than 5,000 patients in hospital beds with flu, but it does not say that we need to add to that RSV, pneumonia and Covid. The problem is that there is no weekly data from the UKHSA, which no longer collects and publishes such data. I hope the Government are prepared to consider reinstating that. An interesting graph on social media about two weeks ago set the peaks and troughs of all these infection spikes over the last three years against the increasingly long absences of NHS staff due to extended sickness, and they mirror exactly. I ask the Minister—who will remember that when she was in opposition, I asked this of many Ministers—what is happening in hospitals to encourage staff, when facing infection spikes, to wear masks and to encourage others to do so? This is about getting the basics right.

The Chancellor has made an investment this year. Compared to past winter investments to cover the winter crisis, how much is going to be there for the long term—or, by the time we get to March, will it all have been sucked up by the current winter crisis?

The Statement says that it is not too late to get yourself vaccinated. I have to tell noble Lords that, if you are a clinically vulnerable patient—and I count myself in that category—it is. GP services keep being given deadlines, which they pass on to patients. Patients then discover that they cannot get the vaccines at their local surgery. If they are inspired to go and find help elsewhere, that is fantastic. However, I suddenly got lots of texts from my surgery saying, “You haven’t been vaccinated yet. Go and get vaccinated”. I had been vaccinated. The problem is that the pharmacy database does not relate to the GP database. When will that be remedied? I have been going on about this problem for well over a decade. It is ridiculous that I have to intervene and say, “Actually I have had it—at your request”.

I have talked before about primary care, and it is shameful that the previous Government did not provide enough vacancies for newly qualified GPs last year. I credit this Government for providing some support and money this year to make sure that is happening. Will this continue to happen in future years or is it one-off, one year’s money? While the extra funding for general practice is welcome, it is not enough without the contractual change between primary care and secondary care. Have the Government taken account of that? It is not solving the real problem, which is that GPs and their staff are facing phenomenal pressure in their systems.

To conclude, most people are saying that this is the worst crisis we have faced in years. Unlike other parties, particularly the former Government, I am not prepared to blame the current Government for that. I credit the Government for the steps they are taking, but will they look at the longer-term issues that need to be dealt with to get our NHS back in a stable condition so that patients can rely on the service, from ambulances through A&E, general practice and hospital service?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I pay tribute to staff in health and social care for their commitment all year round, but particularly when the pressures are on us all in the winter. The noble Baroness, Lady Brinton, mentioned the nurse who was attacked at Royal Oldham Hospital. Our thoughts and prayers continue to be with her, her family and friends, and we wish her a speedy recovery. I can assure the noble Baroness and your Lordships’ House that protection of staff, and freedom to work and move around without abuse, harassment and discrimination, are all very important to us as a Government. There will be more about that as we talk about the workforce plan.

Let me make a few general points. I thank the noble Baroness and the noble Lord, Lord Kamall, for their questions and observations, all of which are important. As the Secretary of State said in the other place, it is crucial that we are honest, and I hope by now that your Lordships’ House will realise that we are, as a new Government, not frightened to say what the reality is, which is why the noble Lord, Lord Darzi, was commissioned to look into the state of the NHS. The noble Baroness, Lady Brinton, asked about long-term issues and that is exactly where we are.

I acknowledge the significant pressures faced by the NHS this year. However, cold weather, a sharp rise in flu and other infections, and other stresses and strains are not unusual, and we should not be surprised that winter comes every year. It is not acceptable to be going into a crisis every year. We have also taken immediate action. For example, beating the backlog of waiting lists is crucial, as is the 10-year plan because it will create an NHS for all year round. In addition, the emphasis is on getting social care into the right place, both in the immediate and the long term, because—as noble Lords regularly and rightly say—it is inextricably linked with the NHS.

Both Front Bench speakers talked about data and planning and preparation. There was a great deal of planning and preparation for what was then the upcoming winter, which we are now in, across health and social care. In the words of my right honourable friend the Secretary of State, we have been doing our best with the hand that we have been dealt. The noble Baroness, Lady Brinton, acknowledged that and I am grateful for her acknowledgement and her support. Annual winter pressures will always exist, but they should not automatically lead to an annual winter crisis.

These issues will not be solved overnight. It is going to take time, but we believe it can be done. That is why we are making investments—the noble Baroness asked about investment. The Budget committed an extra £26 billion to health and care—not as a knee-jerk reaction but to allow us to plan now and for the future.

On planning and preparation, I assure your Lordships’ House that the Secretary of State meets senior leaders in social care regularly. He also meets the UK Health Security Agency and NHS England regularly. Those groups are key to Ministers keeping on top of this.

We also have an excellent national operations centre, which I pay tribute to—that goes to the point raised by the noble Lord, Lord Kamall. The data available from it allows a focus on individual hospitals and individual patient waiting times. As of last week, we were down to one critical incident across the country, which compares positively with the 24 that were in place before.

The noble Lord, Lord Kamall, asked about lessons learned—if I might paraphrase it like that. I assure the noble Lord that before the spring we will set out lessons from this winter and the improvements that we will make ahead of next winter. For me, that is very welcome, because that is about acting as quickly as possible and looking to the future.

The noble Baroness, Lady Brinton, spoke about primary care, which is key to taking pressure off. I know that the noble Baroness is well aware of the three key pillars of the 10-year plan, which will be available in the not-too-distant future. I am sure that your Lordships’ House will want to discuss that at length, and I will be pleased to do so. To take the points from both noble Lords, that is all about the move from analogue to digital, from treating sickness to prevention, and from hospital to community. Those are not just words; they will greatly assist with the long-term planning that I know both noble Lords are seeking.

The noble Baroness referred to primary care. We have committed to recruiting over 1,000 newly qualified GPs through an £82 million boost to the additional roles reimbursement scheme. The key thing about that is that it will increase the number of appointments delivered in general practice. If I might make another point to the noble Baroness, we recently made announcements about GPs being able to make a direct referral for tests and scans to stop the real “around the houses” of sending a patient to see a consultant, who then sends them away for the relevant tests and scans before they can see them in the round. That will do a lot to reduce waiting times and increase access.

The noble Baroness was right to raise corridor care. She will have heard the Secretary of State say that

“we will never accept or tolerate patients being treated in corridors. It is unsafe, undignified” ”.—[Official Report, Commons, 15/1/25; col. 364.]

He has also made it clear that he is ashamed of that situation. I say that in a spirit of honesty. That is a feeling I share. The Secretary of State also said that he could not, in all honesty, promise an end to corridor care by next year because, as he rightly observed, it will take time to undo the damage that has got us to this place. It will be through investment, reform and planning that we will be able to do that.

The noble Baroness also asked about winter funding. That is a very important point, because over many years we have seen last-minute winter funding arriving too late to make a difference, no matter the intention. This time, as I mentioned, the Chancellor allocated nearly £26 billion to the NHS for 2025-26 in the Autumn Budget. That means, in comparison with the funding that it would have got under the last Government, that the NHS will receive £2 billion more. For me, perhaps the most important point is the ability to plan ahead and factor in the need to support preparation for winter.

There are a number of other points that I could make and I am sure that noble Lords, as we move to further questions, will raise them. In the meantime, I thank both Front Benches for their interest and their questions, but also for their challenge.

First-cousin Marriage

Debate between Baroness Brinton and Baroness Merron

Monday 20th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I understand the point that the noble Lord is making, but this is a very complex topic in respect of which there is a great lack of reliable data. Any plans for any health information campaign anywhere clearly need to be considered carefully. Perhaps I can reassure the noble Lord that staff from the Genomic Medicine Service are already working with other national projects, such as Born in Bradford and Best Start for Life in Birmingham, to engage with the communities most affected by first-cousin marriage. Of course, any campaign plans for Shetland and Orkney will be a matter for the Scottish Government.

[Baroness Brinton (LD)]

My Lords, I am grateful to the Minister for referring to the Born in Bradford study because 18 months ago, it reported that over the last decade, the number of intra-cousin marriages in the Pakistani community had substantially fallen. The reasons for this were awareness of the risk of congenital abnormalities, young people staying in education longer, and changing family values. This is clearly a successful project. Is it being replicated elsewhere in the UK?

[Baroness Merron (Lab)]

The noble Baroness is right that consanguineous unions are decreasing. While it had the best data, the NIHR-funded study, Born in Bradford, to which the noble Baroness and I have referred, found that between 2000 and 2010, 39% of British Pakistani couples in Bradford were first cousins. However, that reduced by 27% by 2019, for the reasons suggested. Driving change across whole ranges of areas makes a difference, but it is important that we keep this in perspective and make any communications and support absolutely appropriate.

Hospice Funding

Debate between Baroness Brinton and Baroness Merron

Monday 6th January 2025 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

I thank the noble Lord for his good wishes and extend my new year wishes to everybody in your Lordships’ House.

To clarify the situation, this is the biggest boost for hospice funding in a generation. It is £100 million in capital, and there is no intention, as the noble Lord asked, to have any less engagement with the third sector—in this case, the hospice sector. The £100 million in capital is for adult and children’s hospices, and £26 million is confirmed for children and young people’s hospices. This has been widely welcomed. The decision in respect of national insurance perhaps would not have had to be made had the financial situation inherited by this Government been somewhat different.

[Baroness Brinton (LD)]

My Lords, I am grateful to the noble Baroness for explaining about the capital grant, but can she get the Government to commit to a long-term revenue funding formula for hospices for those services that are equivalent to those provided in the NHS, so that they are rewarded financially on the same basis as the NHS fairer funding formula?

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making, because planning ahead and certainty are key. I can confirm that my ministerial colleague, Minister Kinnock, will soon meet all major stakeholders to discuss long-term sustainability of funding. We are very aware of the difficulties that have been caused thus far and seeking a way forward.

Food and Drink Industry: Processed Sugar

Debate between Baroness Brinton and Baroness Merron

Monday 14th October 2024 Lords Chamber

[Baroness Merron (Lab)]

Taking on board the noble Lord’s point, I feel that it is important that we support people to make healthier choices. The noble Lord will be aware of—and I hope will welcome—the Government’s focus on moving from ill health to prevention. We want to make sure that people live well for longer. It is not only about making informed and heathier choices but about having the means to do so. That is why I particularly want to commend the fact that we will be introducing the restrictions on junk-food advertising to children on TV and online. That will make a major contribution.

[Baroness Brinton (LD)]

My Lords, the Food Foundation review in January this year noted that 41% of multibuys were still high in salt, sugar and fat, with only 3% on fruit, veg and staples. The Minister referred to working with the supermarkets and major manufacturers. Is this issue being raised with them as well? Particularly with the cost of living crisis, it would be extremely helpful if more multibuys were for foods that were good for people, such as fruit and veg, as well as basic staples and carbohydrates.

NHS: Independent Investigation

Debate between Baroness Brinton and Baroness Merron

Tuesday 8th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I agree with my noble friend. I am pleased to inform the House that just this week I announced a number of pilot programmes, through which maternity staff will be taught and supported to better identify the signs of a baby in distress in labour, so that action can be taken more quickly, and which will help staff deal with obstetric emergencies during caesarean sections. Such actions help to avoid preventable brain injuries and are right for the baby and the mother. We also need to tackle the issue of the more than £4 billion cost of the lawsuits that have been brought over a number of years.

I have seen good examples of teamwork in Bristol and Surrey, to name just two, and there are many things that can be learned. We know what strategies work—one of which is listening to women—but the challenge is, how do we roll out what is successful, including from the pilot programmes? Following the recent report, which showed a devastating situation in maternity and neo-natal care, that is a high priority for this Government.

[Baroness Brinton (LD)]

My Lords, the excellent report of the noble Lord, Lord Darzi, refers to the stress our GPs are under and how patients are no longer flowing through the hospitals as they should. One issue is that hospitals are constantly referring patients back to their GPs when they are still on the same treatment pathway. Recently, a member of my family was at a post-op review following a pacemaker operation that had gone wrong. Her heart was still giving her problems, and she was told she had to go back to her GP to start the whole process again. Many patients in hospital clinics are being told to go back to their GP to get a scan or an MRI—which is one of the reasons why they were referred to the hospital. This is not fair on hard-pressed GPs and, above all, patients. Can this practice be stopped?

[Baroness Merron (Lab)]

I am sorry to hear of the circumstance that the noble Baroness raises. I agree with her about the pressure on GPs who, of course, are working harder than ever. We know, not just through the Darzi report but through much evidence, that discharge into the community has to take place at the right time and with the right support, and that is not the case at present. I will certainly take up the specific thing the noble Baroness asks for and look into it in far greater detail, because this is clearly a practice, as she described, that is not supporting patients or GPs but working against them.

Palliative and End-of-life Care: Funding

Debate between Baroness Brinton and Baroness Merron

Wednesday 4th September 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is right in her observations, and we certainly recognise that times are difficult, particularly for many voluntary and charitable organisations including hospices, for example, due to the increased cost of living. We are working alongside key partners and NHS England to proactively engage with stakeholders, including the voluntary sector and independent hospices, because we want to understand the issues they face and to seek solutions to them.

[Baroness Brinton (LD)]

My Lords, the charity Together for Short Lives has found that the NHS local funding for children’s hospices has dropped by 31% in the last three years. Worse, the previous Government’s £25 million children’s hospices grant has been given to local integrated care boards, many of which have delayed distributing it. As a result, the children’s hospice movement is in real crisis. Please will the Government urgently review the funding that government has in the past put aside for children’s hospices, to make sure that they receive it?

[Baroness Merron (Lab)]

As the noble Baroness said, in 2024-25 the £25 million in funding from NHS England was distributed, for the first time, via integrated care boards. As I understand it from the previous Government, that was in line with NHS devolution. We will carefully consider the next steps on palliative and end-of-life care funding much more widely in the coming months and will take on board the comments of the noble Baroness and other noble Lords.