Health: Pelvic Mesh Implants

Baroness Jolly Excerpts

Tuesday 6th February 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend makes an excellent point. This is one procedure, and for some women it can be positive and life-enhancing. But we also know that it carries a risk of complications. That is one reason why we wanted to carry out the audit, because it will look not only at areas and procedures where there have been problems and complications but at where it has been successful, so that we can have a proper understanding of what the complication rate is and therefore what the safety concerns are.

[Baroness Jolly (LD)]

My Lords, the NICE guidelines that the Minister just referred to conclude that:

“Evidence of long-term efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research”,


as he said. But will he tell the House how confident we can now be that that is the case and that the information has been effectively disseminated? What is the mechanism for informing clinicians and women about this NICE guidance?

[Lord O’Shaughnessy]

The noble Baroness is quite right to say that it is not just about having the guidelines but making sure that clinicians follow them. Professional standards demand that clinicians do follow them, and indeed a clinician would need to be strongly justified in using mesh implants outside of the guidelines. They include things like gaining consent, providing information and registering operations that have been carried out. The guidelines are very strict and we expect clinicians to follow them.

NHS Winter Crisis

Baroness Jolly Excerpts

Monday 5th February 2018 Lords Chamber

[Lord O'Shaughnessy]

My Lords, I thank the noble Baroness for her questions. I agree with her that we are all proud of our NHS, on all sides of this House, and I am sure that we all have great pleasure in stating that through whatever means we are required to. I also join with her in paying tribute to the staff, who do such a fantastic job, often in challenging circumstances.

She asked first about urgent operations. It is clear in the guidance that they should not be cancelled when it would negatively affect patients’ outcomes. If that has happened, NHS England is investigating and reinstating those operations. The guidance is quite clear and NHS England has followed that up.

As for A&E targets, we know that they have not been achieved recently. It is important and instructive to look at the extraordinary increase, not just in winter but overall, in the number of episodes that are happening. They really are increasing at a very high rate. Demand is very high—higher than I think could have been anticipated—and it is a credit to the NHS that it has produced the performance that it has. The aim now, with funding given at the Budget, is to get us back to the four-hour target that we all agree ought to happen. That is what will be happening over the coming year.

[Baroness Jolly (LD)]

My Lords, this morning I visited a suburban hospital in London, with an almost brand new A&E unit and a well-managed winter crisis. But despite all that, it has still had to face a bed occupancy rate of 97% on several days, which is stretching its ability to make this work. Money was clearly an issue—the hospital was quite anxious about what its end of year accounts might look like. Today, the Liberal Democrats launched a report looking again at a different way of funding the NHS through the creation of an office of budget responsibility for health and care, long-term health and care funding, and a ring-fenced tax to replace national insurance. Also, there is a clear need for some sort of short-term fix, and we have suggested that £2 billion should be raised by adding a penny to our income tax. Has the Minister looked at this report and will he agree to meet with me to discuss it?

NHS and Social Care: Winter Service Delivery

Baroness Jolly Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, this has been an interesting debate. There are many experts and much experience in this House. There is also a great deal of passion and it is not surprising that there is a lot of agreement.

I start by thanking all care workers who, on low wages and often with little thanks, do a splendid job, day in and day out, whether in a hospital, residential or nursing home, or in a domiciliary setting. There are 1.4 million people employed in social care roles, caring for more than 1 million adults. The winter period is often challenging. Certainly in the rural area where I live, these people have to cope with bad weather, dark morning starts and dark evening finishes, and, invariably, with clients who are less well.

The other unsung heroes in the world of care are the carers. I echo the call of the noble Baronesses, Lady Pitkeathley and Lady Wheeler, for the carer strategy and the action plan, long promised and long overdue. These carers are selfless family members or friends, who often work without help, payment or support, rarely getting respite.

The carer’s allowance, for those who take it—a lot of people are not even aware that there is an allowance that carers can take—is £3,260.40 a year. The winter bit is that there is a £10 Christmas bonus. I wonder: do we value our carers? Your Lordships will know, because the noble Baroness, Lady Pitkeathley, reminds us on a regular basis, that were this huge army of carers to be paid just the living wage, it would cost the Exchequer much the same as the annual national health and social care budget. That is their value, but what are they worth?

Recent research shows that more than half of us believe that we do not know a single family member or friend who cares, while as many as three in five believe that they do not know any work colleagues who help look after a loved one. In reality, one in 10 people in the UK are carers and one in nine people in the workforce are juggling their paid job with unpaid caring. I remind the House that the Care Act calls for carers’ needs to be assessed alongside the needs of those they support. Could the Minister tell the House when the most recent report on this was published? Is this being met right across local authorities? When would he expect the next one, so we can measure improvement?

The solution to many problems is more money. More money can mean more staff and new preventive ideas. It could ease the way for primary care and community care to work more coherently with local social services. I acknowledge that more money has been made available to the care and health systems over the winter period. The better care fund increased social care funds by £4.4 billion over three years, as well as the adult social care support grant of £240 million in 2017-18. But work needs to be done in many parts of the country to improve existing systems—to look into data sharing between health and care as a matter of urgency, for example.

Before I address delayed transfers of care, I will talk about the reduction in social care support. Social care budgets have seen an estimated loss of more than £6 billion since 2010. Between 2010-11 and 2014-15, spending on social care fell by 7% even as demands increased over the same period. The social care precept allowed local authorities to raise council tax by up to 2%, and in December 2016 this was raised to 3%, but, as my noble friend Lady Pinnock and the noble Lord, Lord Smith of Leigh, explained, this tax is inherently regressive in its structure. Local councils in poorer areas are not able to levy an effective council tax as easily to meet social care demands.

Cuts to local authority funding, rationing and a reduction in the level at which support is available have reduced the number of care packages. This will invariably increase the likelihood that someone will become frail and so, when falling ill, will need hospitalisation. If care packages can enable someone to look after themselves, they often avoid going into hospital. Ironically, often self-funders fail to pay for as much support as they need. They can find themselves less able to self-manage and find themselves admitted.

There are financial and physical costs of the delayed transfers of care. The estimated annual cost to the NHS is around £820 million each year and the loss of 1.15 million hospital days in acute treatment—up 31% compared with 2013. There are physical costs. Each additional day in hospital is a higher risk of infection and rate of readmission. The amount of strength lost per day in hospital—I am talking about muscle strength of an elderly person—is up to 5%. Delayed transfers of care seem to hurt twofold: once on the bed shortage, but again on muscle loss. If elderly patients lose up to 5% of their muscle mass daily and constitute the majority of patients under delayed transfers of care, the NHS could indirectly be contributing to a number of falls and hip fractures in the long run.

A lot of delays are attributable to the NHS, with 58.3% of all delays in November, compared with 34% to social care, and 7.6% jointly, with social care’s share slightly falling over the last year. The noble Baroness, Lady Watkins of Tavistock, spoke about the primary reason for social care delays—35.4%—being due to patients awaiting the care package in their own home. Will the Minister explain why there is not enough capacity in the system? Could this be due to a fall in private investors who no longer see this as a good investment? What is the solution? We all know that local authorities have responsibility for market shaping, but what if the market does not wish to be shaped? Where do we find ourselves then?

I shall put in a plug for the local community hospital. Those in my own backyard in Cornwall, having been saved from cuts in 1996 in advance of the 1997 general election—I remember Frank Dobson coming down and waving his magic wand—are now coming into their own as a safe place to transfer patients to when they no longer need medical care but do need nursing and rehab. Additionally, they are a resource for the GP, who can admit a patient for as short a time as a few days to see them over a crisis, rather than have them go into the local acute hospital.

Integration of health and social care is the holy grail of care. We watch with interest devo-Manc, where there is a commitment to integration of health and care, and Cornwall, where there is a move to make the CCG a department of the council. We should also note that Torbay has been working for years like this, now under the auspices of the Torbay and South Devon NHS trust, which states that it provides acute health services, community health services and adult social care. It is not rocket science; others have done it.

I was surprised, and then on reflection pleased, that the Department of Health was to be renamed the Department of Health and Social Care, despite the fact that the Secretary of State has always had responsibility for social care albeit with the support of a Care Minister. However, I am disappointed that, since Mrs May became Prime Minister, the Care Minister has not been a Minister of State—what message does that send us? That particular Minister of State historically has also looked after mental health. Those are two areas where you need somebody with a bit of oomph in the department.

In the first week in January, an article in the Financial Times written by Sarah Wollaston, was headlined:

“Only political courage can save Britain’s health service—It will take a cross-party approach and a willingness to put public interest first”.


Along with others, we on these Benches eagerly await the Green Paper on social care funding and ask the Minister what other topics will be in it. Will it become a portmanteau paper?

But do the Government have the willingness? My honourable friend Norman Lamb visited the Prime Minister along with Liz Kendall and Sarah Wollaston to ask for her support in this cross-party look at the issue. They also asked her to consider raising income tax by a penny in the pound, which would raise £6 billion, which is the gap between where we are and where we need to be financially. Indications suggest that the public would warm to the idea. They see the system creaking and feel it is the least they could do. Those of us on these Benches agree.

Public Health: Strength and Balance Programme

Baroness Jolly Excerpts

Thursday 18th January 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite right to point out the importance of preventing falls. Around 95% of hip fractures come about through falls, at particular cost and pain to the individual, of course, but also to the wider economy as a whole. I should point out that Public Health England supports a number of activities, one of which is a partnership with Sport England that has trained 5,000 health professionals in delivering physical activities, including strength and balance work. I agree that more needs to be done at local authority level, particularly as we have an ageing population, but there is good work going on at the local level.

[Baroness Jolly (LD)]

My Lords, in parts of Cornwall there has been real success with the strength and balance programme, with a huge reduction in falls. We all know that prevention is always better and cheaper than the cure. Can the Minister tell the House what work has been done to determine how much could be saved for the NHS as a result of a total rollout of this programme and why reductions to local authority public health budgets are jeopardising such programmes?

NHS: Nurse Retention

Baroness Jolly Excerpts

Wednesday 17th January 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom and experience. He is quite right about the need for long-term workforce planning. I hope that is why he will welcome the 10-year strategy that Health Education England is launching. It is looking at diversifying the working population—for example, through the growth in the number of nursing associate training places.

On the report, I can only apologise again for the delay. I hope that at least the noble Lord will welcome the fact that in the reshuffle the health department gained social care policy. That was one of the issues on which he wanted to promote greater integration.

[Baroness Jolly (LD)]

My Lords, in the past 12 months, more than 6,000 nurses have gone on long-term sick leave, related to stress. How are nurses being helped to cope by the occupational health departments of their employers, and do the Government acknowledge that the problem is exacerbated by a 1% cap on their pay rise?

[Lord O’Shaughnessy]

I acknowledge the importance of looking at pay, which is why it was so welcome that the issue was dealt with in the Budget, with the cap being lifted for nurses and other health professionals on Agenda for Change contracts. I agree that long-term sickness is a big concern and undoubtedly having an impact on some nurses leaving. That is why the return-to-practice programme that we have is so important. Several thousand nurses have been through it; it is about providing opportunities to come back into the profession in a supportive way for those who want to do so.

NHS: Winter Funding

Baroness Jolly Excerpts

Thursday 11th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I shall certainly take that interesting idea to the new Minister for social care. The noble Baroness will be pleased to note that the number of delayed transfers of care actually fell in the run-up to winter as a result of the extra money that went into social care. However, she has put forward an excellent idea and I shall certainly take it to my new colleague.

[Baroness Jolly (LD)]

My Lords, £100 million of the money announced by the Chancellor went into primary care streaming, which is designed to keep all but the most ill out of A&E. Some £55 million of that was handed out in April and £21 million in June. Can the Minister give an indication of the impact thus far of primary care streaming and tell the House where the other £24 million went?

[Lord O’Shaughnessy]

Nine out of 10 type 1 A&E departments now have streaming in place, so the money has gone into that. However, obviously we want to get to 100% so that is where the extra funding will go, but it is already having an impact. A full quantitative evaluation will take place at the end of the winter.

Agency Nurses

Baroness Jolly Excerpts

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is quite right that we need sufficient staff. He will know that when the Government came to office in 2010 difficult decisions needed to be made about the funding of all public services, because of the economic situation at the time. It is worth pointing out that, since that time, there are over 10,000 more nurses on wards, which is obviously particularly important at this time of year. In terms of the future figures, I hope he will be aware that there will be an increase in the number of training places for nursing—£5,000 a year. Indeed, Health Education England, which is responsible for workforce planning, will deliver a long-term plan to make sure that we can tackle this issue, which has been a long-standing problem for the NHS.

[Baroness Jolly (LD)]

My Lords, the Royal College of Nursing surveyed its members on this issue and two key things came out. One was that they wanted flexible working hours and the other was that they wanted the ability to choose a ward or specialty. It is clearly better for nurses to be employed by their trust rather than through an agency, so what are NHS trusts doing to accommodate nurses’ desire for flexible working patterns and a choice of where they work?

[Lord O'Shaughnessy]

On the issue of flexible working there is an important distinction between agency working and bank working. Bank working provides a degree of security and familiarity, in that the nurses employed by nursing banks often work in the same hospitals. That is one of the most important ways that we can provide the flexible working which, as the noble Baroness quite rightly said, nurses want.

NHS Winter Crisis

Baroness Jolly Excerpts

Monday 8th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I am not in a position to say whether they should have a second inoculation, but there are still a number of people who have not had that inoculation. Those vaccines are available in GPs, surgeries, and we absolutely encourage all groups to have at least a first one.

[Baroness Jolly (LD)]

My Lords, it seems as if a winter crisis, year on year, is totally predictable. I cannot remember a year when there was not one, but I echo the Minister in paying tribute to those NHS staff, right across the system, who have worked flat out 24/7. Part of the problem is that the social care system and health system are not properly integrated—although I note from Twitter just now that Secretary of State Hunt has responsibility for social care, with immediate effect. Can the Minister tell me whether there are hospital beds occupied by people who no longer need them but are unable to return home? Can he give me an indication of the shortfall in accommodation or beds in the public, private and not-for-profit sectors in nursing and care homes? What gives the Government confidence that the £335 million in the autumn Budget will help, and can he give us some clarification on how that money is to be distributed?

[Lord O’Shaughnessy]

First, I join the noble Baroness by reiterating on a personal basis a tribute to the staff who have worked so hard over this period. I think we all know many of those people, and they do an extraordinary job. Social care is clearly a really important part of the picture because it is not just the flows into hospitals but the flows out. A lot of that is to do with delayed transfers of care. That is one reason why additional funding has been going in—I think it is £1 billion this year. It is important to point out that all local authorities have now signed up to plans to reduce what are called DToCs, in the jargon. DToCs have been falling, which means that there is the opportunity to get people out of hospital. That could be into a care home or residential care or it could be to their own home.

Health: Atrial Fibrillation and Stroke

Baroness Jolly Excerpts

Tuesday 12th December 2017 Lords Chamber

[Baroness Jolly (LD)]

My Lords, regular checks of the pulse rate can help indicate whether someone has atrial fibrillation. These should be carried out at the five-yearly general health check that GPs offer to those aged between 40 and 74. Could the Minister tell the House how many GP practices routinely call patients for this health check, whether they are paid to do so and how many patients take up the opportunity? I declare an interest as I am in this age range and have never been offered a health check.

[Lord O'Shaughnessy]

I too am in that age range. I am afraid I cannot tell the noble Baroness what the global figures are, but I shall write to her to do so.

Social Care

Baroness Jolly Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her response and her questions; I will deal with them in order.

First, she asked about funding. She is quite right to point out the £2 billion of extra funding that was announced in the March Budget; of course, we have had two Budgets this year, so extra funding was included in a Budget this year. I should also point out that that was the latest tranche of additional funding, which totals over £9 billion over three years, taking into account the additional funding announced in recent financial Statements. The precise purpose of the funding is to address the fact that we have a growing and ageing population. The number of people requiring care packages is rising, and often the complexity of those packages is becoming more acute—hence the need for more funding, as we all recognise.

Experts will be fully engaged in the Green Paper, providing advice to Ministers and supporting engagement. There is no point in having such an august group and not drawing on their expertise. I do not think that there is any contradiction in the way that I have described their role. We would not want to involve those people—and they would not want to be involved—if they were not going to be listened to.

On carers, I acknowledge the delay in the carers strategy and I understand that that must be frustrating for those who have invested so much time in it. I have two things to say in response. First, it is right that the position of carers is considered in the round, with care costs. Secondly, that is why the action plan is important: it provides a staging post between now and the intention to introduce fully fledged policy proposals in due course. I am afraid that I do not have a specific date or a funding package for that, but I will write to the noble Baroness with as much detail as I can find and place a copy in the Library.

[Baroness Jolly (LD)]

My Lords, I too thank the Minister for repeating the Statement. I declare my interest as chairman of a learning disability charity, providing services to around 2,000 adults in England.

On the long-awaited Green Paper, I welcome the Government involving independent respected experts in the field, including Andrew Dilnot, Kate Barker and Caroline Abrahams. However, we are sorry that the Green Paper will not have any element of care for working-age adults when published.

I want to raise a few issues that were mentioned by the Minister in the other place in her answers to MPs. She called for all party groups to be involved and said that there could be no change without consensus. That is exactly what I wanted to hear and it makes sense. The Minister knows our views on this.

On carers, in a debate earlier this week the noble Baroness, Lady Pitkeathley, talked about the worth of carers being equivalent to the NHS budget. I also praise carers and I am delighted that they will be involved in this review, but I am somewhat disappointed, along with the noble Baroness, Lady Wheeler. They went through quite a lot of consultation for the carers strategy and there is a certain amount of irritation that they might have to revisit all this work. If they have caring responsibilities, it is not always easy for them to get to a central place. I hope some mechanism can be found to ensure that that is captured, but also to see whether anything should be changed.

The Minister also agreed that health and social care cannot be considered independent of each other—another area of agreement. Will the Government consider introducing a statutory, independent budget monitoring agency for health and care similar to the Office for Budget Responsibility? This would report every three years on how much money the system needs to deliver safe and sustainable treatment of care. It could even be the first stage in the integration of health and care.

With the delay of the Green Paper, it is unthinkable that the Government are now leaving the social care sector in this state of uncertainty. They have completely failed to address the critical crisis in social care and now there are more than a million vulnerable older people without the support they need. With a funding gap, as we heard just now, of at least £2 billion by 2020, I wonder how much worse things will have to get before the Government will act. To put that in a more balanced way, does the Minister have any sense, whatever the outcomes may be from the Green Paper, of when we might want to see some of those becoming reality? Local authorities will also tell you that they are desperate for a solution. I echo what I said before: how long does the Minister reckon we will have to wait to see something change?

[Lord O'Shaughnessy]

Again, I thank the noble Baroness for those questions. I will try to deal with them in order. As I set out in the repeat of the Statement, there will be a parallel programme for working age adults. It is important to note that that feeds into the same inter-ministerial group. I emphasise that in terms of its profile in the overall work programme. It is of course separate from social care for older people, but it is a parallel programme.

The noble Baroness is quite right about the need to build consensus. We all know how much we need sustainable reform in this sector. Governments of all hues have tried it. We really do need to get there now. I cannot give her timings at this point of course, but it is becoming urgent as our population changes.

I completely agree with the noble Baroness on carers. I pay tribute to those carers of all ages, including young ones, who take on extraordinary responsibilities and dedicate their lives to caring for others. It is an amazing thing to do. I recognise her frustrations at the delay. I hope contributing to the Green Paper should not involve much additional work, although inevitably there will need to be some updating. As I said, I will write to noble Lords to give more details about the carers action plan, which is intended to be a bridge between now and the consequences of the Green Paper and the options it lays out.

Finally, we do not agree, as the noble Baroness knows, that there is a need for such a body on health and social care. She is of course right about integration. That is why metro mayors, such as the one in Manchester, are taking on these combined responsibilities. It is why integration is built into the better care fund. This is a direction we need to push down to provide proper, holistic, wraparound care for older people.