NHS: Neurology Care

Baroness Fraser of Craigmaddie Excerpts

Monday 26th February 2024 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. I had the opportunity to join the Neurology Alliance forum today, which was quite timely. I think its approach is entirely right in looking at what we can do to help people get on with an active life and back into the workforce, understanding that the economic impact of that is key. We have set up the neuroscience transformation programme, which the Neurology Alliance is on board with, which we think will tackle many of the issues that the noble Lord mentions.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I declare an interest as chair of the Scottish Government’s advisory committee on neurological conditions and as chief executive of Cerebral Palsy Scotland. People with neurological conditions are faced with navigating a very complicated maze of services straddling primary care, secondary care and social care. Some conditions have well-defined pathways; many other conditions, such as cerebral palsy, do not. If the Government are not going to look at an overall neurological strategy such as the one that we have in Scotland, what practical steps will they take to help people with neurological conditions navigate these confusing services, so that they get the right support at the right time?

[Lord Markham (Con)]

My noble friend is correct. The important step towards this was our appointment of the first national clinical director of neurology over the last year. The task force put out a progressive neurological conditions toolkit which sets out the pathways exactly as my noble friend mentions. It shows the treatments for over 600 conditions. This is a complex area so it is vital that the pathways are understood in each area and patients can understand how to navigate them.

Adult Social Care (Adult Social Care Committee Report)

Baroness Fraser of Craigmaddie Excerpts

Monday 16th October 2023 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I was privileged to sit on the Adult Social Care Committee, which was so ably and sensitively chaired by the noble Baroness, Lady Andrews. I thank her for her comprehensive introduction to the debate.

I found it incredibly hard to think of what to say; it has all been said many times. We know what needs to be done. I pay tribute to my noble friend the Minister for his work and perseverance in this area, because I know that he knows what needs to be done and that he understands this sector, but we do not seem to be moving the dial one iota for people.

I travelled down from Scotland this morning, and our experience of attempts to create a national care service is not one I wish to recommend to the House. So far, its development has cost £1.26 million in engagement, £1.38 million in staff costs, an accountability agreement with local authorities and the NHS and an inadequate skeleton Bill that has been delayed three times. As Scotland illustrates, the top-down approach does not work. It is expensive and futile and, despite all the time and money spent on it, not one person’s care in Scotland has been improved.

For me, the Government’s People at the Heart of Care is based on very sound conservative principles, but we will not enable people to have choice and control unless plans are backed up by funding and action. Our committee’s report illustrates how carers, paid and unpaid, are key to ensuring that those who draw on care can indeed lead a “gloriously ordinary life”.

We heard of the huge challenges experienced by people in being able to find good PAs. The Government acknowledged in their response to the report that personal assistants are “invaluable”, yet this crucial and apparently valued workforce is unregulated, too often paid only the minimum wage, on zero-hours contracts and not funded enough to be employed full-time, and has no access to ongoing training and no recognised qualifications.

The Government have promised to improve career pathways and opportunities for progression within the adult social care workforce, and have identified £250 million to do this. Can the Minister give us any details on how this is to be spent? How could it help more people access PAs? I have encouraged the Minister before to look at the charity ENABLE’s PA model in Scotland, and do so again to support this.

As the noble Baroness, Lady Andrews, said, unpaid carers carry a huge burden but are largely unseen, unappreciated and ignored. The Minister will not be surprised to hear me calling yet again for improved identification. The discrepancy in the estimated number of unpaid carers of between 2.4 million and 6.5 million in our report illustrates how woeful our ability to identify this key group currently is.

In May the Government updated their road map for better data for adult social care, which recognises that while a variety of various sources capture some information on unpaid carers, they lack consistency and coverage. As I understand it, a new regular survey focused on unpaid carers is to be created. Can the Minister give us any update on these plans?

The Government’s vision that data should be collected once and shared with those who need it is one of those common-sense statements that sound really simple, but that I know will be very difficult to achieve and implement. Who will social care data be shared with? Will people needing care and their unpaid carers have access to their data? There are examples given, such as GP records being shared with home care managers and authorised social care staff, but who is classed as “authorised” in this context?

My worry is that social care provision is still far too far down the priority list. At the recent party conferences, neither the Prime Minister nor the leader of the Opposition spent any time discussing social care. Even the Minister for Social Care spoke about integrated healthcare teams and community health services, not social care. She spoke about how we continue to look at health and care through the prism of the NHS, saying:

“It often feels like the acute hospital is like the sun in the NHS solar system with everything else spinning round it. But it doesn’t have to be that way”.


She is right. I agree with her, but until we turn the telescope around and focus on enabling people to lead a gloriously ordinary life, social care will always lose out.

National Health Service: Major Conditions Strategy

Baroness Fraser of Craigmaddie Excerpts

Monday 18th September 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. The Government, and in particular my noble and learned friend Lord Bellamy on behalf of the whole MoJ team, fully support the noble Viscount’s remarks on the Powers of Attorney Bill and warmly thank him, Stephen Metcalfe MP and all the others for their efforts on the Bill.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I congratulate the Minister on concentrating on the importance of person-centred care, particularly for people with long-term conditions. I declare an interest as chief executive of Cerebral Palsy Scotland. Cerebral palsy is a good example of this, because we actually have very good NICE guidelines for the treatment of adults with CP but there seems to be nothing we can do to ensure that integrated care boards around the country follow those guidelines. Can the Minister explain why?

[Lord Markham (Con)]

My noble friend is absolutely correct, in that we are setting out the whole emphasis of what we are trying to do here. It is really ingrained in those pathways. It is about culture and behaviour as a whole, rather than a silo-based scheme, looking at the whole patient. Once we have got those pathways set up properly, it is Ministers’ job—I have mentioned before that we each look after six or seven ICBs—to hold them to account and make sure they are following those pathways.

Mental Health Services: Huntington’s Disease

Baroness Fraser of Craigmaddie Excerpts

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

The plan with the neuroscience transformation programme is to give that pathway to every ICS, which it should follow and commission to, to make sure that specific treatment is in place. It is a complex area, as we all know. Again, as I understand it, there are more than 7,000 rare conditions. I want to be open about the ability to put in place a specific individual care co-ordinator for every one of those, but we need to make sure that ICSs have enough skills in their locker—for want of a better word—so that they can recognise the situations and make sure they are commissioning to the plan.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I declare my interests as chair of the Scottish Government’s neurological advisory committee and a trustee of the Neurological Alliance of Scotland. This is an issue not just for people with Huntington’s disease but for people with other neurodegenerative conditions, such as Parkinson’s. NICE standards for people with Parkinson’s recommend the prescription of Clozapine for hallucinations or delusions, but only psychiatrists are enabled to prescribe it; therefore, people with Parkinson’s do not have access to this treatment because neurologists cannot prescribe it. Will the Minister look at this? Maybe this is one way to ensure that people get the treatment they need.

[Lord Markham (Con)]

Yes, I think is probably the best answer I can give in the circumstances. I will absolutely do that and will write to my noble friend.

Adult Social Care: Challenge Procedures

Baroness Fraser of Craigmaddie Excerpts

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

First, I take issue with the inadequacy comment. Some 89% of people expressed a high level of satisfaction with the social care provided, which, although not 100%, is pretty good, as I think everyone would agree. As I said, the workplace plan has been drafted. I am afraid I cannot give an exact date of publication—I believe there are local purdah issues now—but I can say that it will be soon.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, one of the things this House has heard about many times is our reliance on unpaid carers and the important role they play in helping people who draw on adult social care to navigate the system. The 2014 Care Act put a duty on local authorities to identify unpaid carers, but that is not happening. What can the Government do to identify unpaid carers, so that we can support them more readily?

[Lord Markham (Con)]

I thank my noble friend for that question. The Government absolutely recognise the role that unpaid carers play—I have fulfilled such a role myself for a number of years—and it something we are working towards. We have introduced the leave provisions and a certain level of payments for them; that may be modest but it is a step in the right direction. Again, the whole idea of getting the CQC in this space is that it can start monitoring local authority provision and ensure that it is identifying unpaid carers, among other things.

Social Care

Baroness Fraser of Craigmaddie Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I, too, start by thanking the noble Baroness, Lady Andrews, for securing this debate today, for her very sensitive chairing of the Adult Social Care Committee, on which I was privileged to serve, and for her tireless commitment to improving the landscape of care, which is a real conundrum of our time. We must “reimagine” it, as the most reverend Primate urges, and, while many have claimed that they will fix it, it remains unfixed.

No one chooses to be cared for, or to become an unpaid carer. If the noble Lord, Lord Laming, was here, he would tell us that either could happen to any one of us at any time. But, as our report points out, both are invisible. This invisibility leads to confusion around what social care is and who delivers it. While the NHS is there “from cradle to grave”, individuals who do not currently need care cannot imagine they ever will and therefore fail to plan for such a time.

I draw your Lordships’ attention to my interests as laid out in the register, in particular my work as chief executive of Cerebral Palsy Scotland and also with people with neurological conditions. My lived experience says that we must not view social care through the prism of the NHS. Many of the people I work with are neither ill nor old; they just need help to be able to live what our committee’s report called

“a gloriously ordinary life”.

I know people who choose to study with the Open University and miss out on all those extracurricular experiences that I am sure many of us look back on with fond nostalgia, because they cannot be confident that they will be properly supported to get around campus and get to lectures like their contemporaries. I know parents who have to give up their own professional lives when their adult child leaves formal education because the system assumes that they will; and I know people who remain living with elderly parents because there is no suitable accommodation for people under the age of 65. Our committee heard from many witnesses who were not ill or old but could not get the right support. Worse than that, they were worried that, if they contacted their local authority for a review, the support they did have would be reduced.

For many of working age, what they want and need are good PAs, personal assistants. These are professional enablers who help you do what you want, whether it is getting to work, feeding you, taking you to the pub or, in a case highlighted to us during the course of our inquiry, enabling someone to pay their respects to Her Majesty Queen Elizabeth II at the gates of Balmoral—something that could never be assessed as an outcome by a local authority care package.

Yet there are not enough PAs. You are really stuck if your PA is ill or does not turn up, and the challenges of becoming an employer and dealing with recruitment, PAYE and pensions too often just puts people off. We heard evidence in our committee from Enable Scotland, a charity which works with local authorities across Scotland delivering their PA model of care, where the charity deals with all of those employer issues and provides a personalised service to people who want it. I encourage the Minister to look at this model.

For too many, as we have heard, contact with social care services is forged in crisis and fraught with difficulty. The providers of last resort are family and friends, who are thrust into roles they neither sought nor are supported to fulfil as unpaid carers. I believe the Minister himself has been a carer and appreciates the challenges. He has called unpaid carers

“the backbone of the system”—[Official Report, 20/2/23; col. 1434.],

but I am afraid that, despite warm words, unpaid carers continue to be taken for granted.

As the noble Baroness, Lady Andrews, pointed out, carer’s allowance is the least generous benefit and considerably less than the minimum wage. There is little respite, little support and severe financial implications, but too many families feel they have no other options.

If we do nothing else in the Government’s forthcoming social care plan and future work, I urge the Minister to improve identification of unpaid carers, including children who care. Self-identification is not working and neither are the formal systems set out in the Care Act. There are still so many gaps. We heard about the No Wrong Door initiative successfully employed in Liverpool. How can the Minister ensure initiatives such as this are more widely adopted?

As others, particularly my noble friend Lady Shepherd, have said, over the years, Ministers have been given a veritable shopping list of solutions. I hope these two reports and our debate today can add to the impetus the Minister needs within government, because the last thing people who rely on care want is yet another plan that fails to be backed up with action.

Adult Social Care

Baroness Fraser of Craigmaddie Excerpts

Monday 20th February 2023 Lords Chamber

[Lord Markham (Con)]

Again, I would like to say that the big increases in funding—the 20% increase that we are talking about in two years’ time—are very much an acknowledgement that there is a demographic issue here, where more and more people are going to be coming into this situation. That is why we are putting those plans in place and working on the workforce; we are already seeing thousands of people being recruited every month to assist with capacity in the system. So we are putting in place the plans to address that.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, one of the issues identified in the report of the Adult Social Care Committee, on which I had the privilege to serve with the noble Lord, Lord Laming, was the invisibility of unpaid carers. What are the Government doing to support services to identify unpaid carers, and what more targeted support can we give this vital population—more than just one week of carer’s leave?

[Lord Markham (Con)]

Again, as I said before, they are the backbone of the system; some of my personal experience attests to that. So I hope that what we were talking about will be seen as the start, rather than the end, of what we are trying to do. But we recognise that it is a decent start, because this issue has been out there for many years and we are starting to address it. Obviously, forums such as these make sure that it is something that more people are aware of. I accept at the same time that a week a year is a start in terms of a break; it is not the end of the situation.

Neurological Conditions

Baroness Fraser of Craigmaddie Excerpts

Thursday 9th June 2022 Grand Committee

[Baroness Fraser of Craigmaddie (Con)]

I thank the noble Lord, Lord Dubs, for securing this important debate. It is, unfortunately, late on a Thursday afternoon, but as he said, it coincides with the publication of the joint patient experience survey, undertaken for the first time by all four Neurological Alliances from across the UK. I declare lots of interests: I am a trustee of the Neurological Alliance of Scotland, I am chief executive of Cerebral Palsy Scotland and I chair the Scottish Government’s National Advisory Committee for Neurological Conditions.

As part of that, this debate and survey took me back to work undertaken in 2018 with the Scottish burden of disease study, which highlighted not only the invisibility of neurological conditions but, to use the not very good language of the study, the “burden” of living with a long-term, complex condition, and the burden that already places on health and care services. This population live for a long time and are already using health and care services, but are invisible. Improvements are therefore difficult to make because of that invisibility. The conclusions and recommendations of the Neurological Alliance survey illustrate how services are patchy and fragmented, but they give us a barometer for where to concentrate action. I have three areas for action that I would like to highlight.

First, we have to better understand prevalence. Data on numbers of all neurological conditions remains woeful. The data we do have is mostly estimates. We seriously underestimate prevalence due to the inaccurate and inconsistent way that neurological conditions are recorded across all healthcare settings. We have to look at the system of coding: how do we make it simpler?

At Cerebral Palsy Scotland, we have campaigned for the development of a national cerebral palsy register, building on existing work from Queen’s University Belfast, supported by the Northern Ireland Government, and work undertaken by the Welsh Government. Working on the principle that if you are not counted you do not count, part of ensuring better services is to prioritise reliable data in order to plan not only for future services but for future workforce needs.

Secondly, we have to deliver seamless care between the different parts of the system and to take a more holistic view of the workforce. It is important to look beyond neurologists. People with neurological conditions come into the NHS through numerous routes. That is part of the problem. The role of the consultant neurologist is to exclude conditions and to provide a diagnosis. It is important that this should be achieved as quickly and as efficiently as possible. However, since people with neurological conditions can live for many years post a diagnosis, the important question is: who will deliver their care? It will not be the neurologist.

As the noble Lord, Lord Dubs, outlined, clinical nurse specialists are key to managing care for some conditions, MS being one of them, but sadly too many other conditions do not have clinical nurse specialists and are therefore left out. We need to be more imaginative about roles and responsibilities in multidisciplinary teams and in planning for future workforce needs, and perhaps to work more collaboratively with other areas, such as MSK and stroke services.

The majority of health and care services required by this population are provided by primary and community care services and by AHPs. People with cerebral palsy, for example, rely on regular access to physiotherapy to prevent further deterioration and to stay well, but access to neuro physios and other rehabilitation services is completely inadequate and comes nowhere near the standards and guidelines set by NICE for adults with CP. It is the same for many other neurological conditions.

The Question refers to services covering the whole of health and care. As the noble Lord, Lord Dubs, also mentioned, this is Carers Week. Carers are an integral part of this workforce too. But I believe that anybody—health, care or social workers—who has any input into delivering care for someone with a varied and complex condition must have access to information and training about that condition. Far too often, it is left to the third sector to pick it up in a piecemeal and underfunded way that cannot hope to reach all those in need.

Thirdly, support for mental health needs to be provided at diagnosis. It has to be an integral part of condition management for children and adults. Too many people, children in particular, report that their mental health needs are not being met at all. If raised with professionals, their concerns are dismissed as being just a part of their condition that they have to live with. There are, in theory, a range of mental health services that can be accessed by people with neurological conditions but, again, there are huge variations in equity of access, both geographically but also for the different conditions.

To address the issues highlighted in the Neurological Alliance’s survey, we require leadership and vision. Will the Minister therefore commit not only to taking up the challenge of the noble Lord, Lord Dubs, but to developing an overall strategy to support people with neurological conditions? In Scotland, we already have the framework for action for neurological care and support, which I was involved in creating. The ambition must be that health and care services support people with neurological conditions to live well on their own terms, with access to the right person at the right time and in the right place. This is essential. I look forward to supporting the Government in achieving this ambition.

Health and Care Bill

Baroness Fraser of Craigmaddie Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Balfe (Con)]

My Lords, my only previous intervention on the Bill came about when I read the proposed clause, and in my capacity as a trained mediator I thought that the original proposed clause was not very sound. The proposed new clause is a huge improvement on that, and I hope it will be looked on with favour. As the noble Baroness said, it is about evening up the power relations.

If you are in a hospital and dealing with anyone who is ill, but particularly small babies, it can be a very difficult experience. My daughter-in-law had two very small twin babies. Gathered around the incubator were one PhD and three decent BScs, and we did not know what to do. We felt quite powerless, but we also felt that it was very difficult to get the doctors to tell us what the prognosis was. In fact, the prognosis was quite good—they recovered and are now both in the school football team—but at the time there was on our part a great sense of powerlessness and a feeling that the doctors did not feel they really needed to communicate with us. That level of powerlessness is what this aims to address.

It is about early access to independent mediation. The first qualification of a mediator is that independence. They will not get a result, and nor should they, unless they have the trust of both sides and unless both sides enter into it in a good spirit, looking for a solution. Finally, if they get a solution, it has to be one that sticks. That is why the amendment refers to

“the senior doctor with overall clinical responsibility.”

This cannot be a mediation where a junior member of the medical staff is sent along, where it has no binding effect and where the senior doctor looks at it and says, “I don’t like that; we’re not going to do that.” There has to be some sort of legislative backing.

However, as noble Lords will have seen, the amendment states:

“Where the authorities … become aware of the difference of opinion they must take … reasonable steps.”


It is all about getting consensus; it is about releasing medical data to both sides, and it is about ensuring that the doctors responsible for treatment are at least obliged to listen to any alternatives that the parents might wish to put forward.

When we last debated this issue, I advised—and indeed this has been done—that we knock out the financial provisions, because we thought that the Government would object and say, “We can’t sign a blank cheque.” However, clearly not all the people listened, because this very morning the Ministry of Justice released its Legal Aid Means Test Review, which states:

“We are proposing to increase significantly both the income and capital thresholds for legal aid eligibility, and remove the means test entirely for some civil cases. These include legal representation for children, and legal representation for parents whose children are facing proceedings in relation to the withholding or withdrawal of life-sustaining treatment.”


It rather shoots the government fox that was running around, does it not? It was said that mediation would encourage litigation, whereas now mediation will discourage litigation, because it will be in the interests of both the health service and the medical profession to make mediation work. In making it work, they will not have days and days in court, but they will have a chance of putting the case to a mediator—having been one, I can tell you that it is a lot cheaper than a barrister—and coming to an agreement without needing the great generosity of our Deputy Prime Minister, Dominic Raab, in offering to pay all these costs. I must say that I was surprised by that statement, but if anyone wants to read it, there are multiple copies in the Printed Paper Office, which is where I got mine.

I hope that the Minister will be able complement his colleagues in the Ministry of Justice by taking a positive attitude to curing this particular result. Otherwise, we will be in a position where the Department of Health and Social Care is saying no to mediation, but where we are now going to get free access to the law courts to run up huge bills. What the Ministry of Justice does not say is which departmental budget will pay for this concession. I would not mind placing a little bet as to which one it has in mind.

So I am asking the Department of Health and Social Care to save itself some money, thanks to the beneficent amendment proposed by the four noble Baronesses and supported by me. We are out to save the Government some money, to make it much easier and to build into the system a right for parents to have a more evenly balanced say in what happens to their child at what is a very difficult and distressing time for many of them.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I did not contribute to the debate on this amendment in Committee, but I did sit and listen to the contributions from around the House. What struck me was that in his characteristically sympathetic response, the Minister had not quite understood the purpose of the amendment and the problems it would solve. He stated that the amendment would place the views of parents and guardians above those of clinicians. I do not see that this is the case, especially with the revised amendment that we have before us. Unfortunately, it is a reality that parent-doctor conflict happens. I declare an interest as chief executive of Cerebral Palsy Scotland, and I have seen far too often the views of parents dismissed by clinicians. No matter how qualified parents may be, or what their role in life outside the hospital may be, they are consistently referred to only as “mum” or “dad”. Too often there is an imbalance of power with doctors, and too often parents are labelled as “difficult” or “sharp-elbowed”, as if wanting to do the best for your child is an irritant, and such parents should be grateful for what they get.

By the time a family is faced with palliative care, they will undoubtedly have been through the care of many clinicians: specialist, community, hospital and, potentially, hospice teams. The parents are therefore often the one consistent factor, and they are especially important when the child is too young or too ill, or unable to voice their own views. It is when parents feel they have not been listened to by clinicians that they resort to formal complaints or litigation. It is a last resort, but too often it is the only resort that is open to them. This amendment seeks to address this by giving them space for a formal coming together of all interested parties at an earlier stage, and so preventing costly and lengthy legal disputes. It does not place one party’s views above others; it does not, as outlined in proposed subsection (3), require the provision of resources for any treatment or require a doctor to provide treatment not in the best interests of the child. It simply ensures that there is a clear framework in these tragic, difficult cases to guide what happens next.

This amendment is designed to solve a problem currently faced by families and clinicians at moments of crisis. I urge the Government to consider it, and I will listen carefully to the response of the Minister tonight.

[Lord Alton of Liverpool (CB)]

My Lords, the House will want to move on quickly, so I will not make the speech that I intended to make on this issue, but I would very much like to endorse what the noble Baronesses, Lady Fraser and Lady Stowell, the noble Lord, Lord Balfe, and my noble friend said in their earlier speeches. I know Connie Yates and Chris Gard, who are the parents of Charlie Gard, who died in 2017 of mitochondrial DNA depletion syndrome. Indeed, I have entertained them here in the House, arranged meetings for them and travelled with them. I entirely agree with what my noble friend is trying to do. This will make mediation work; it will create a proper balance and equality of arms. No parents should have to face litigation in these often tragic and troubling circumstances, so this is a good amendment and I hope the Minister will feel he can accept it.

Health and Care Bill

Baroness Fraser of Craigmaddie Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Lord Warner (CB)]

My Lords, I support Amendment 111 in the name of the noble Lord, Lord Hunt, to which I have added my name, and Amendment 80 in the name of the noble Baroness, Lady Cumberlege. On Amendment 111, I want to emphasise two points. First, GPs are and have always been the gatekeepers to the NHS. Without GPs, there is less primary care and less access to the NHS. Over 90% of patients access the NHS through their GPs and primary care. If you are unlucky enough to live in an area with a serious shortage of GPs, your access to NHS services is highly likely to be diminished and your health put at greater risk.

My second point is that it follows that a shortage of GPs is also likely to contribute to health inequalities, a topic much discussed during the passage of the Bill. In addition, this is likely to mean that you live in a place which the Government say they want to level up. So, if the Minister accepts the amendment of the noble Lord, Lord Hunt, he will be helping to deliver two government objectives: reducing health inequalities and levelling up. What’s not to like? Who knows—he might even get a promotion out of it.

I turn briefly to Amendment 80, which I support and will vote for if the noble Baroness pushes it to a vote. I want, however, to emphasise two points that follow on a great deal from what the noble Lord, Lord Lansley, said. For too long the NHS has relied on buttressing its inadequate system for training home-grown staff by recruiting from abroad. Brexit and tighter immigration policies have significantly reduced this supply line. It will take long-term planning and consistency of purpose over many years to rectify the health and care workforce supply problems.

My second and last related point on workforce is that the track record of the Department of Health on long-term planning is appalling. It is not just me saying that; it was made absolutely clear in the report by this House’s Select Committee on the Long-term Sustainability of the NHS and Adult Social Care, so ably chaired by the noble Lord, Lord Patel, who unfortunately, as we all know, is laid low by Covid. Those who support Amendment 80 should hear the arguments in the debate on Amendment 112, which would support its implementation. The noble and learned Lord, Lord Mackay, thought that something more elaborate than Amendment 80 was required. That may be the case, particularly for social care, but Amendments 80 and 112 complement each other. They are not rivals or alternatives; they put in place a structure thoroughly independent of government and which requires the Government then to pay attention to what has been independently provided.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, it is clear that there remain huge and serious concerns across the House and beyond regarding how the Bill addresses the chronic staff shortages in our health and care services. I say health and care services, because as we know, the staff shortages affecting the delivery of services are not just within the NHS but felt across the board, in health, care and public health services. While this is a current and urgent issue, future workforce planning will be the single most important factor in limiting our ability to deliver the ambitions we all have for the future of health and social care and importantly, the ambitions of the Bill.

Like many other noble Lords, I have the greatest respect for my noble friend Lady Cumberlege, and if she feels that the current duties the Bill places on the Secretary of State in Clause 35 to report at least every five years are inadequate, then I urge the Government to take note. As my noble friend said when she introduced her amendment, she is not alone: at least another 100 organisations are calling for this aspect of the Bill to be strengthened. I ask the Minister today, therefore: if the Government are not planning to accept the amendment, how do they plan to address the challenges of future workforce? How will they assess the future needs of health, social care and public health services? Previous work has not quantified the workforce numbers needed and we cannot wait for another review.

I have a couple of observations on the amendment itself, which I commend in that it does require the Secretary of State to report on this wider health, social care and public health workforce, unlike the current Clause 35, which refers only to the health service. However, I sound a note of caution, because if we simply assess vacancy rates, or get into the mindset of needing to replace like for like, role and service development, which will be essential to support future health and care services as they evolve, risk being stifled, as my noble friend Lady Harding referred to.

Those who hold much of the data on health and care professionals are not only the royal colleges, as the noble Baroness, Lady Finlay, mentioned, but also the regulators. I note that proposed new subsection (4) of the amendment does not mention health and care regulators, which I think should be consulted, in the spirit of my noble friend’s explanatory statement.

Finally, when describing the system in place for assessing and meeting workforce needs, as training and regulation are UK-wide, I hope there will be a spirit of co-operation between NHS England and the devolved nations to ensure that we are training the right people for the right roles across the UK NHS: this needs to be in any future workforce assessment as well. I also cannot understand why we do not accept that the royal colleges in Glasgow and Edinburgh can help us recruit. That seems completely bananas—that is the technical term. Will the Government accept that we cannot put workforce planning yet again into the “too difficult” box? We need to do more and go further, as my noble friend Lady Cumberlege urges. I accept there are no silver bullets, but the regular publication of independently verified projections of future demand and supply of workforce could, over time, create a sustainable model for improvement that would have a positive impact on both patient care and staff experience.

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Baroness, Lady Cumberlege, on the way she introduced Amendment 80—it was masterful. I point out that she took this amendment from the right honourable Jeremy Hunt, who unfortunately failed to get it through the House of Commons. In doing so, he expressed his regret that, when he was Secretary of State, he was not able to put in place a structure such as the noble Baroness proposes today.

The noble Lord, Lord Stevens, and the noble Baroness, Lady Harding, have both commented that it is self-evident that we need a workforce adequate to meet the demand. To do that, we need to anticipate increasing demand, changes in demographics, population growth and changes in practice. Crucially, we need to put in place resilience to health shocks. If we do not do that, we will continue to struggle to reach the OECD average of 3.7 doctors per 1,000 people, which is reasonable. To get there, we actually need 50,000 more doctors.

However, as the noble Baroness, Lady Jones, pointed out, this is not just about doctors. It is also about nurses and, as we have heard from the noble Lord, Lord Bradley, and the noble Baroness, Lady Whitaker, it is about allied health professionals. We need to train them all in a timely way, given, as the noble Lord, Lord Stevens, pointed out, how long it takes to train all these health professionals.

The Prime Minister claimed in the House of Commons recently that we have 45,000 more people working in the health service than before the pandemic. Unusually, that may be true, but it was not clear whether they were full-time professionals. However, that number bears no relation to the demand. There is no point in quoting raw figures if they are not related to the rise in demand. Moreover, there are fewer GPs than before the pandemic, and that is where people’s access to the NHS begins. If someone cannot get to see a GP, they cannot get a diagnosis or a referral, and their disease gets harder and more expensive to treat. Having too few GPs is not a cost-effective strategy, so I support Amendment 111, tabled by the noble Lord, Lord Hunt, and also his Amendment 168.