NHS: Seven-day Working

Baroness Manzoor Excerpts

Thursday 6th February 2014 Lords Chamber

[Baroness Manzoor (LD)]

My Lords, I, too, thank the noble Lord, Lord Ribeiro, for securing this debate. As other noble Lords have stated, the variation in outcomes and patient experience for patients admitted as emergencies at the weekend is evidenced in higher readmission rates, higher mortality rates, poorer patient experience and an increased length of hospital stays, while the availability of diagnostics such as imaging can be 40% lower. These facts are, on the whole, not in dispute so it is not my intention to mention the many excellent surveys and reports which evidence them. However, it would be remiss of me not to restate the importance of the report commissioned by NHS London in 2011, which concluded that increasing consultant cover in acute medical and surgical units at the weekends could prevent more than 500 deaths a year in London alone. The evidence clearly demonstrates the need for the NHS to take action.

Like other noble Lords, I applaud Sir Bruce Keogh’s report and its conclusions, except that it is rather disappointing that it took nearly a year to produce. I would like to hear what the Government are doing to ensure that the pace of change is rapid and that the report’s implementation programme is given greater priority. Quite rightly, there is much emphasis by the Government and NHS England on clinical outcomes and reducing inequalities in care, but NHS England will not deliver on its mandate should the current status of health services prevail at weekends.

While the £3.8 billion Better Care Fund which the Government have made available, pooled with local government, is also welcome, NHS England has yet to demonstrate how clinical commissioning groups are addressing the need for services at weekends and what support CCGs are giving to local authorities which support patients being discharged from hospitals and prevent unnecessary admission to hospitals, particularly as CCGs spend three-quarters of the £98 billion NHS budget. Indeed, I find it difficult to understand how the regulator, the Care Quality Commission, could have judged any hospital to be outstanding when such inequalities in care and service have existed in the NHS and been evidenced as such for at least the past 12 years. Perhaps the Minister can reassure the House that regulators will not be awarding outstanding status until a hospital is deemed to have improved its record of safety and patient care for patients at the weekend.

NHS England should also demonstrate how, as the commissioner of primary services, it is ensuring that it addresses and improves the variable quality offered by general practitioners. Although an optimist, I remain concerned by the slow pace of change. On the current evidence, NHS England cannot deliver on its mandate, and Public Health England will fail to close the inequality gap in social provision for some of the most vulnerable in our society, such as the elderly and people who need access to mental health services at the weekend. This is mainly because there is an absence or limited availability of consistent support services such as diagnostics, and a lack of community and primary care services which, if available, could prevent some unnecessary admissions and support the timely discharge of patients. It remains, as has been said, difficult to get routine blood tests, X-rays, MRI scans, pharmacy, physiotherapy and social services at weekends. Of course, I have already mentioned the variable out-of-hours primary care.

Sir Bruce is quite right when he advocates a whole-system approach to improve the current, unacceptable standards being offered in the NHS at the weekends. However, although I do not support yet another reorganisation of the NHS, with tight finance restraints, the Government may need to think further about simplifying the current and complex NHS system. They will also need to consider how budgets are shared and pooled between organisations, including with local authorities, and who will lead on this. The NHS is a great institution, and it is our duty to make it fit for the 21st century.