NHS: Seven-day Working

Baroness Chisholm of Owlpen Excerpts

Monday 8th June 2015 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the impact of the current deficit position of NHS Trusts and NHS Foundation Trusts on the ability of the National Health Service to move to seven-day working.

[Baroness Chisholm of Owlpen (Con)]

My Lords, seven-day services will need to be implemented in an affordable way, focusing on both improving efficiency and delivering clear benefits to patients. We have increased the NHS budget by £12.7 billion over the Parliament and in some situations we have provided interim financial support—but this is dependent on trusts developing and sticking to a strong recovery plan. At the heart of all that, we are making sure that trusts continue to deliver safe and sustainable services within a balanced financial position.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Baroness for that response. Does she accept that you cannot achieve full seven-day working, including at the weekend, without employing more doctors, nurses and diagnostic staff? Given that NHS trusts are projected to have a £2 billion deficit this financial year, how will that be afforded? Can she confirm for me that the decision of NICE last week to pull work on guidance on nurse/patient ratios, which came out of the Mid Staffordshire situation, was the result of pressure from NHS England because of concerns about affordability?

[Baroness Chisholm of Owlpen]

My Lords, it is clear that the NHS faces significant financial challenges due to increasing demands. Seven-day services will need to be implemented in a way that is affordable and focused on both improving efficiency and delivering clear benefits to patients. The costs of the seven-day services will depend on many factors. We are working with NHS England to identify how to achieve the aim of providing seven-day services efficiently.

[Baroness Howarth of Breckland (CB)]

My Lords, would the Minister explain how a seven-day service would function when, at the moment, to gain a GP’s appointment people are waiting sometimes two weeks? It is about demand as well as timing. Some GP practices are needing to reduce the number of doctors because of a lack of finance in their budgets. Is this not going backwards, not forwards to a seven-day service?

[Baroness Chisholm of Owlpen]

My Lords, the Government are committed to improving access to GPs’ services, including delivering services seven days a week to ensure that people are able to access primary medical care when they need to. At present, £175 million, including £25 million from the £1 billion infrastructure fund, has now been invested in the GP access fund to improve access to general practice. The first wave was announced in September 2013 and the second in March this year. So there are now 57 schemes covering more than 2,500 practices, meaning that more than 80 million patients—one-third of the country—will benefit from improved access.

[Baroness Walmsley (LD)]

My Lords, in this as with many issues, one size does not fit all, so could the Minister say whether the Government are doing any research as to how their objective for a seven-day-a-week service can be delivered in different kinds of neighbourhoods? The solution for cities may not be suitable for rural areas or small towns, and there are probably many opportunities for innovation, such as near where I live in the small city of Chester, where the Countess of Chester Hospital has a GP unit. Could we not look at what the cottage hospitals and main general hospitals can do to assist general practices in providing this sort of service and keeping people out of A&E?

[Baroness Chisholm of Owlpen]

My Lords, certainly we are looking at all those ideas, and we will gather together all the data that we need before we go forward. But I feel that I should say that there are indicators for this service that cannot be measured, and one of them is quality of life. As a former nurse, at the forefront of my mind was always the question of whether my patient was getting the best care from me, from the specialist and from the hospital. In my book, a seven-day service goes towards achieving that goal.

[Baroness Armstrong of Hill Top (Lab)]

Is the Minister perhaps being just a little complacent about just how difficult things are? In the small ex-mining town where I live, in the north-east of England, I discovered on Friday that the GP practice that normally has seven to eight doctors now has three, two of whom are salaried. They are simply not able to offer any decent service, let alone a seven-day-a-week service, to patients in that small town and the surrounding villages. Does the Government not recognise that the model is broken and that they have to be far more urgent in addressing the issues that millions of people in this country face and that undermine confidence in the NHS?

[Baroness Chisholm of Owlpen]

My Lords, I think that the answer that I gave before about the GP access fund answers what my noble friend was saying. As we know, the Government are committed to ensuring that everyone can get the care that they need, seven days a week. Seven-day services are backed by senior clinicians, who recognise the vast improvement in patient care that can be achieved. We know that it reduces patient mortality. Expanding services to seven days a week has the potential to improve the patient experience, reduce the length of stay and chance of readmission and make better use of expensive resources such as staff and equipment.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chairman of University College London Partners. What assessment have Her Majesty's Government made of the potential impact of the European working time regulation on their aspiration to enhance seven-day working in the National Health Service?

[Baroness Chisholm of Owlpen]

My Lords, as outlined in the coalition agreement, the Government are committed to limiting the application of the working time directive in the UK.