NHS Long Term Plan

Baroness Jolly Excerpts

Thursday 31st January 2019 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I draw attention to my interests as declared in the register. It is worth mentioning that the noble Baroness, Lady Browning, is the only Peer to have mentioned people with learning disability and autism. In 2015, following the Winterbourne View scandal, there came the Transforming Care programme. Can the Minister outline in a letter or, if there is time, at the end of the debate what progress has been made and whether local authorities received the budgets required to match the services they are delivering?

I thank the noble Lord, Lord Hunt, for calling this debate. The long-term plan is detailed and forward thinking, but without supported staff, sufficient resources and consideration of social care, it is difficult to see how the Government can achieve the comprehensive and integrated health system to which they aspire. The long-term plan is a positive step forward, but it is defined as much by what it omits as what it contains. Without a workforce strategy, the social care Green Paper and involvement of local authorities and not-for-profits, the plan is incomplete.

We have 100,000 vacancies in our health system. The 3.4% uplift in long-term funding for the NHS does not cover key areas of health spending, and uptake of innovation is patchy. By 2030, we could have a quarter of a million vacancies in our NHS, including in key areas such as nursing. We are already suffering from the loss of 5,000 mental health nurses since 2010 and a 50% drop in the number of district nurses in the same period. The number of health visitors is down by 4,000, which does not bode well for children’s services and a healthy early start. My key concern is that, while the long-term plan recognises the workforce crisis, there is no magic bullet. Without solving staffing problems, many of the goals in the plan will go unfulfilled.

The crisis is exacerbated partly because workforce planning in England has become increasingly fragmented and incomplete. Six years on from the introduction of the Health and Social Care Act, it remains unclear who is accountable for workforce strategy and investment. Can the Government confirm where the buck stops for workforce planning for nurses, doctors and care staff? What timeline can we expect for the release of the workforce plan, which will provide more detail on strategy? Is the March date given to the noble Baroness, Lady Harding, realistic? A “quick and dirty” piece of work will give us a picture of what is happening, but it is the resulting timelines for all the strands of this work that will shape the workforce of the future.

I hope that we will see health and social care considered together in the workforce plan, as many other noble Lords have said. Integrating health and social care would, for instance, strengthen our ability to support individuals with multi-morbidities, an area that was relatively neglected in the plan.

The rollout of the “enhanced health in care homes” model, which strives for co-ordination and co-operation between care homes and the NHS, is an encouraging commitment in the plan which recognises barriers to good health and attempts to overcome silos. Overcoming silos can also mean broadening skill sets.

One headline in the plan is the greater focus on training “generalist” doctors. This is a good idea; we should not neglect encouraging broad skill sets at all levels of health and social care. Can the Minister expand on this proposal for generalist doctors? It would require reinvestment in training. In 2006-07, the training and education budget was 5% of the NHS’s total budget, but that has now fallen to 3%. It would cost £2 billion to put the budget back to 5%, but the returns may be far greater, so for the Chancellor it could be a good deal.

Retention of staff is a problem. It is such a waste if trained staff leave for a better-managed, better-paid role elsewhere. A start might be to look at rostering. Complaints about inflexible rosters from nurses, but also of late from junior doctors, make for a culture of stress, leading to staff opting for agency or bank work, where choice or control is possible for the individual but not, of course, for the hospital. Some hospitals do this successfully; others need to copy what is done.

To retain experienced staff, could the Government also encourage employers to pay a living wage to social care workers? This could form part of the social care Green Paper when it arrives. Currently, many in our community are being served by staff who are overstretched and underpaid. Social care staff in hospitals, care homes and the community are the glue that keeps the system together, that prevents admissions from the community and that speeds patients home.

In the past, key medical innovations tended to be within the realms of big pharma. Now innovation appears in the form of med-tech, robotic surgery and other surgical improvements such as delivering TAVI heart valves through the groin. Under a local anaesthetic, this achieves today what before required open heart surgery, with all the risks that entailed. This is not only a surgical improvement; patient stays are hugely reduced and outcomes often immediate.

In the long-term plan, there is a laudable focus on digital health to bolster access to services, which, if carefully implemented, may increase patient satisfaction and help to minimise wasted resources. Some surgeries do this better than others. I had to cancel a doctor’s appointment to take part in a debate tomorrow—I sent a text; they confirmed with a reminder text; all I needed to do was type “absent”, and they cancelled the appointment. Innovation in staff rostering can improve staff and ward morale and allow a better work/life balance.

I have a couple of questions for the Minister, which I am happy to wait for. What support are the Government giving to innovators and early adopters of technology designed for use in operations and other clinical interventions? What changes need to be made to commissioning to accommodate and support innovation?

Looking at the speakers’ list, it is no surprise that this has been an interesting and well-informed debate—it is always going to be the way. There is much and varied experience in your Lordships’ House, and I thank the noble Lord, Lord Hunt of Kings Heath, for tabling the debate.