National Health Service: Nurses

Baroness Gardner of Parkes Excerpts

Wednesday 22nd February 2017 Lords Chamber

[Lord O'Shaughnessy]

I am sorry that the noble Lord takes such a negative view of the changes we are making. There are actually 6,500 more full-time equivalent nurses and health visitors than there were in 2010. There has been a 15% increase in the number of training places and of course, through our reforms which he just mentioned, we are taking the cap off the amount of training places that can be offered.

[Baroness Gardner of Parkes (Con)]

My Lords, can the Minister tell us how the apprenticeship scheme is going, because a lot of damage was done when Tony Blair said that you had to have five A-levels to become a nurse? We hope that this apprenticeship scheme will counteract that.

[Lord O'Shaughnessy]

I am grateful to my noble friend for mentioning the nursing degree apprenticeship, which was announced at the end of last year. The first nurses should be in place from September of this year. Once established, this apprenticeship route could allow up to 1,000 additional nurses to join the NHS every year.

Hospital Beds: Availability

Baroness Gardner of Parkes Excerpts

Thursday 9th February 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is quite right to raise the issue of mental health. I do not have the specific figure with me but I will write to him with it. We know that there has been a historic disparity between the two services. This was recognised by the Prime Minister in a very important speech she gave a few weeks ago, setting out some of the ways in which the Government are doing more on this. However, there is clearly a lot more to do.

[Baroness Gardner of Parkes (Con)]

What is the situation of people providing care at home on behalf of councils? Many carers I know are called out at 10 or 11 at night to receive someone who has just been sent home from hospital. However, they are not really trained themselves; they are trained only by the care agency. Is it not time that we provided them with proper training, particularly as so many of them have come from the Philippines and other such places and we are not sure what the future holds for them?

[Lord O'Shaughnessy]

My noble friend is quite right that there has been an increasing prevalence of domiciliary care, which involves carers caring for patients in their own homes. Making sure that those patients can get home at a good time that works for them and those who support them is clearly a critical part of dealing with this delayed discharge issue.

Health Workers: Training

Baroness Gardner of Parkes Excerpts

Wednesday 18th January 2017 Lords Chamber

[Lord O’Shaughnessy]

I do not recognise the description of “slagging off”. We know that GPs do a fantastic job and we are recruiting more of them—5,000, as the noble Lord said. More money is going into general practice as part of the five-year forward view. The Prime Minister in her statement paid tribute to the work that GPs do and said that there were obligations around extended hours and the provision of out-of-hours healthcare—and it is quite right, with the pressures we face, that every part of the healthcare system steps up to fulfil its responsibilities just as others are doing, in order to meet the pressure we are under.

[Baroness Gardner of Parkes (Con)]

My Lords, in the past I have raised the issue of the standard of training for nurses and the fact that they have to have five A-levels to get in. The answer from the Government is that they are about to introduce training that will not require five A-levels and therefore will produce many more nurses. Can the Minister tell us what is happening with that and whether there is any real progress?

[Lord O’Shaughnessy]

There are two routes into nursing. One is the university route, and because of the changes we are making, there will be the possibility for universities to recruit up to 10,000 more nurses. That is why we are removing the cap. We have also introduced an apprenticeship route, which does not involve going to university but follows the apprenticeship route practised in other fields. That will have 1,000 places in its first instance.

NHS: Community Pharmacies

Baroness Gardner of Parkes Excerpts

Tuesday 6th December 2016 Lords Chamber

[Lord Prior of Brampton]

The pharmacy access scheme is being set up to deliver exactly what the noble Baroness is asking for—that rural pharmacies and those in very deprived areas will receive greater payments than others. I am not quite sure what report she is referring to. I will have to look at her question afterwards and write to her.

[Baroness Gardner of Parkes (Con)]

My Lords, are not people more willing to go to pharmacies for immediate help with dental conditions in particular because otherwise, they have to pay to have someone look at their mouth, and instead they can go in and ask for some sort of treatment if they have a pain? The pharmacist can diagnose at a very early stage any form of oral cancer—and indeed other conditions—which would otherwise not be noticed until perhaps too late.

Social Care

Baroness Gardner of Parkes Excerpts

Thursday 1st December 2016 Lords Chamber

[Baroness Gardner of Parkes (Con)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, on securing this topical debate and am very aware of the many years that she has devoted to this field. To say, as everyone has, what challenges there are is a complete understatement. It is in such a state at the moment that it is very difficult to know where to go and how to deal with it.

I attended a meeting which the noble Baroness held recently for carers. It was interesting because I tend to think of carers as people who work in the care industry, and her people were alarmed that someone such as me was there, who was interested in people who are working as employees in the care industry. There has to be closer liaison between these two groups. Voluntary carers are fantastic in all they do, but I remember knocking on doors and speaking to people who said they were completely worn out and did not know how much longer they could continue because they had been looking after their elderly mother and were already pretty elderly themselves. That is when the care worker comes in to give respite care or to help out on some occasions. The two need to work together: the huge number of individuals related to people or caring for them voluntarily and the other side.

One problem that stunned me in the meeting was that when people in ordinary employment went to their employer and said that they now had to take on a caring responsibility for a relation, their employer did not want to know them much longer, because they thought it would interrupt their work. I could understand it because, from running a dental practice, I know that if someone goes on maternity leave and you have only two people, you are in a difficult position while one is away. You wondering whether she will come back; you have to hold the vacancy for a long time; and then she decides not to come back after all that. It is not easy. Nevertheless, there must be a change of attitude of firms so that they can make provision for their staff to be able to help a family member who really needs it.

Care workers usually work in what is run as a business and acts as an agency for a local authority, but whoever is doing the work shares the same aim, and respite care is important. The loss of cottage hospitals means that there is now no interim stage: people have to go from a hospital where they are pushed out, often in the middle of the night, when care workers are often the only people who can be there to receive them at home and see that they are safe.

We must be quite sure that the care industry is working correctly. I spoke to one person who was with her friend and someone was due to arrive to give her lunch at 12 o’clock. There was no sign of them, but the one due at 2.30 or 3 arrived and gave her lunch. Then the other one turned up and said that she had just come to sign to say that she had given lunch. Then they said, “What do you mean: you have given lunch? The next person has given the lunch”. That must be checked on.

When I was chairman of social services on a local council, we checked on those things. Someone dropped in at random to check whether you were actually on the job. It is important to ensure that one carer does not come in to find that the other has left someone in an appalling state and done nothing that they were meant to do. That is very unfair and random checks would deal with it.

People want to live independently and they want to die in their own beds. This was said to me by Essex County Council, which sent us a very good paper. I followed up and spoke to Councillor Madden, who was very interesting. He said that they had developed what is called a “good life” conversation. First, they ask: “What can you still do for yourself and what help do you really need?”. Then they look at what they can do to help them get back to where they were, if there is a prospect of that. Otherwise, they just have to go on with it.

I have no time to say more, but much more could be said. I hope that we will hear many other points brought out by other speakers this afternoon.

Nurses: Training

Baroness Gardner of Parkes Excerpts

Tuesday 22nd November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there were 3,500 more nurses working in the NHS in 2015 than there were in 2010. In retrospect, we did not anticipate in 2010 the Mid Staffordshire crisis and the Francis report, which led to a very substantial increase in nursing levels after about 2013. The noble Lord is right; we were short of nursing throughout that period. We are addressing that now with a 15% increase in nursing places and we expect that by 2020 there will be 40,000 more nurses than there were in 2015.

[Baroness Gardner of Parkes (Con)]

My Lords, is the Minister aware of the fact that the Blair Government introduced only one standard for nursing? You had to have five A-levels and take a university degree. The abolition of the state-enrolled nurses, who would have made—and did make—a marvellous contribution, has been very retrograde. Now we are dependent on a large number of foreign nurses. In every hospital that I have visited, we rely on them completely. Why can we not have that intermediate level of training back?

Cataract Operations

Baroness Gardner of Parkes Excerpts

Wednesday 16th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there is evidence of variation around the country, of that there is no doubt, although overall, the waiting times for cataract treatment are no longer than for other procedures. The RNIB has identified two issues of concern: second eye operations and follow-ups. We have asked NICE to bring forward further guidance in 2017 so that there is a proper evidence base for the threshold for cataract operations. As the noble Lord referred to in his Question, we are developing opticians in the high street to help do the follow-up consultations.

[Baroness Gardner of Parkes (Con)]

My Lords, I declare an interest: I am sure I am one of many in this House who has benefited from cataract operations—I went to the Western Eye Hospital, which is part of the Imperial College system in London. Is the Minister aware of the huge change in life for people who have cataract operations now? My father had to travel from Australia to Vienna in 1938—in fact he was there when Hitler marched in; he got out as quickly as he could after that, but with his eye bandaged it took a bit of time. But that was because one of the only people in the world who could do cataract operations at that time was this surgeon in Vienna. We really do not value what we are getting now, which is done so well.

[Lord Prior of Brampton]

The cataract operation is remarkable; it can literally give back people’s sight in the course of a 10-minute operation. I think I am right in saying to the noble Baroness that the first cataract operation was done in 1787.

NHS: Cancer Patients

Baroness Gardner of Parkes Excerpts

Wednesday 9th November 2016 Lords Chamber

[Lord Prior of Brampton]

The new cancer dashboard has given us much more transparency around the country, so at least we now know where the problems are. The noble Lord is absolutely right that the critical area is early diagnosis, which is why one of the targets coming out of the new cancer strategy is that everyone should have a definite diagnosis within 28 days of an urgent referral. He is also absolutely right that one of the major constraining factors is workforce. We will be training an extra 200 non-medical endoscopists over the next couple of years, which should help considerably, but it remains an issue and Health Education England is due to report back in March 2017.

[Baroness Gardner of Parkes (Con)]

My Lords, can the Minister tell me whether we are now widely using the form of radiotherapy for cancer which is much less invasive? I think it is called IMRT and we have discussed it in this House before. Is it widely in use now in the National Health Service?

[Lord Prior of Brampton]

My noble friend is right; the use of IMRT has increased from around 10% to about 40% in the past year—so it is increasing greatly. There is much less collateral damage with IMRT. We have also, as my noble friend will know, commissioned two proton beam centres, at the Christie and UCLH, which will also make a difference. We have just announced a £130 million investment in new linear accelerator machines. Those three developments will, I think, greatly improve our ability to deliver world-class radiotherapy.

Children: Oral Health

Baroness Gardner of Parkes Excerpts

Monday 31st October 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the evidence for fluoride is incontrovertible: it is good for teeth. There may be other issues attached to fluoride, but in terms of dental health it is unquestionably a good thing. It is interesting to note that in Birmingham, which has been adding fluoride to its water for many years, the incidence of child tooth decay is 29% whereas in Blackburn it is 57% and in Hull, which is considering fluoridation, it is 37.8%. The evidence is very strong, but it is up to local authorities to decide.

[Baroness Gardner of Parkes (Con)]

My Lords, when I have asked Questions, as I have done repeatedly, mainly for Written Answer, about the difference in health between Birmingham and Manchester, with people in Manchester having the worst teeth in the whole of the UK—that was where the problem was with blocking hospital beds—the answer has always been that the only difference in health pattern is in teeth. I have had that point queried and asked what research the Government have done and whether they can really substantiate that fact. I am very much in favour of fluoridation, but I think that people are confused and want to be clear that there is no other health implication of fluoridation. I respect that view. What action will the Minister take to ensure that thorough, general health tests, as compared with the two arrangements referred to, are undertaken?

Medical Students

Baroness Gardner of Parkes Excerpts

Wednesday 26th October 2016 Lords Chamber

[Lord Prior of Brampton]

That is a very big question, which is hard to answer. My personal view is that I do not think that the training we give to our young doctors in management, leadership and how to structure new models of care is sufficiently broad. You could argue that the curriculum at medical school is too narrow and should be broadened.

[Baroness Gardner of Parkes (Con)]

Can the Minister tell me how many overseas doctors, particularly Commonwealth doctors—if he has a figure for that—are working in our National Health Service? On a separate topic, what can be done to encourage people to go into some specialties that we are told do not attract doctors, which is why there are not sufficient numbers in them?

[Lord Prior of Brampton]

My Lords, overseas doctors account for about 25% of the total number of doctors employed by the NHS, which is a very high number. I do not have the breakdown for the Commonwealth countries but it is an interesting question; I will research it and write to my noble friend. She is absolutely right that there are shortages in particular specialties. General practice and psychiatry are probably the two areas where there is the biggest shortage. HEE is determined to increase the intake in those areas. Certainly, the number of doctors going into GP specialty training this year is just over 3,000. That is an increase on last year but is still not enough.