Urgent and Emergency Care Recovery Plan

Baroness Masham of Ilton Excerpts

Thursday 2nd February 2023 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, what are the government plans for long-term rehabilitation? We need more physiotherapists and occupational therapists. There is an idea of getting people out of hospital quickly, but some of them need confidence and ongoing care.

[Lord Markham (Con)]

That is absolutely right. The figure that struck me on one of my many hospital visits was that apparently people lose 10% of their muscle mass each week they are in hospital, making it harder for them to look after themselves. The noble Baroness, Lady Merron, mentioned that we need to make sure the resources and investment are in the right places. All too often, hospitals become the place of last resort, when we all know that it is much better to put resources into the primary care at the front end or the social care and domestic help for physios who can visit homes at the back end. Central to the plans of my colleague, Minister Whately, is recognition that we will solve this in the long term, as all noble Lords want, only if we invest those resources in the right places.

National Health Service Pension Schemes (Member Contributions etc.) (Amendment) (No. 3) Regulations 2022

Baroness Masham of Ilton Excerpts

Wednesday 11th January 2023 Lords Chamber

I commend the Government on what they have done so far, but I also regret that there is not enough movement or radical change to allow the NHS Pension Scheme to stop discouraging senior and valuable staff from leaving and stop interfering with and undermining the morale of the staff that we have.

[Baroness Masham of Ilton (CB)]

I thank the noble Lord, Lord Davies of Brixton, for this regret Motion. This is an important matter, because we are losing some of our experienced consultant doctors because of this pension scheme system. We cannot afford to lose these doctors early—they are so valuable. Surely this is something that the Government can put right. This is urgent, and I hope that the Minister will have some good news tonight. If not, people will continue to be worried.

[Lord Allan of Hallam (LD)]

My Lords, regrettably I do not have an interest to declare in respect of the NHS Pension Scheme. I say regrettably because I was an NHS employee during much of my 20s but foolishly opted out of the pension scheme. Older me would have words to say to younger me about the lack of foresight in that decision, because the NHS pension was and is an excellent support in retirement, as the noble Baroness, Lady Altmann, has pointed out. If only I had had someone like her to advise me back then, I would be in a better position today.

Apart from that reminder of personal grief, I am grateful to the noble Lord, Lord Davies of Brixton, for enabling us to have this debate today, as it allows us to return to a key topic that we rightly discuss regularly in this House—the issue of staff shortages in the health and social care sector. He and the noble Baroness, Lady Altmann, have described some of the really quite profound structural challenges related to NHS pensions and taxation, and I hope that the Minister will agree to look at them in some detail.

On the narrower subject of the regulations themselves, the response to the consultation on this instrument is enlightening in describing the nature of the staffing pressures that the NHS faces, which brought around the original changes made in the Covid legislation that have then been prolonged in a series of statutory instruments, and especially in describing those that relate to staff sickness absence rates. I note that the consultation response was written last autumn but accurately predicted the fact that those staff sickness absence rates would continue through the winter. If anything, they have been worse than anyone anticipated, through the combination of Covid and flu. That makes the case for us not disincentivising experienced staff who are past retirement age from returning to help us out at a time of national crisis. It is of special note that, in this consultation, 98% of respondents said that, yes, this should go ahead and we should continue to offer some relief to those who are coming back into work, with only 2% against. That is quite a majority for any consultation.

If the consultees had any criticism, it was that the easements did not go far enough. I note that the Government have agreed to remove the 16-hour rule permanently from 1 April this year, and I hope that the Minister will confirm that this is the case. It was the pension scheme board itself that said that there was no rationale for requiring people who agreed to work past retirement to stick to a 16-hour limit.

The response also goes into some detail about the position of special class status members who can retire at 55, and what happens if they return to work before the age of 60. It included a graph that showed how much a nurse in this category could work before abatement applied. I understand that the word “abatement” in this case means that there is a limit to the number of additional hours that a nurse could work before losing, pound for pound, some of their pension entitlement. In other words, if they work past that amount of time, effectively they are working for free. The Minister may correct me if I have misunderstood, but the chart implied that there would be a straightforward loss.

The chart tells us that the most experienced nurses, those with 35 years of pension entitlement, would be able to work around 0.5 of a full-time equivalent before the pension ceiling kicked in. The Government in their consultation, because they were not lifting the abatement permanently, put a glass-half-full spin on it, saying, “Look, these people can come back and work half time”. But of course there is a glass-half-empty angle on it as well, which is that we are potentially losing half the time that those experienced staff could give to us if they did not feel that, by working those extra hours, they would lose out on their pension entitlement. I note that the abatement for this group has been extended to 2025, acknowledging that concern, but that there is still no permanent solution. Again, I hope that the Minister today has some ideas for how we may go further and ensure that the NHS can persuade retired staff of all classes to put in as many hours as they feel fit to do. We do not want to be in the position whereby someone is willing to work more but, purely for financial reasons, feels unable to do so.

I am sure that we will return to the theme of the impact of NHS Pension Scheme rules on staffing levels over the coming months. As the noble Baroness, Lady Altmann, pointed out, it is clear that there are unforeseen and unwelcome consequences of some of these rules, which I suspect is because they were crafted in a different climate for NHS staffing, at a time when people would retire and plenty more people were coming in. Today we are in quite a different situation where, frankly, we are desperate for those people who can still work, who are at retirement age, to postpone in many cases well-earned retirements to come back and assist us. In that climate, it is essential that the Government commit to revising rules where that would make a material difference to staffing levels and therefore to the health of the nation.

Long Covid

Baroness Masham of Ilton Excerpts

Thursday 17th November 2022 Lords Chamber

[Baroness Masham of Ilton (CB) [V]]

My Lords, I apologise for having to be virtual this week. I thank the noble Baroness, Lady Thornton, for this debate, with a very special “thank you”.

I am a member of the All-Party Group on Coronavirus. On several occasions we have taken evidence on long Covid. On the last occasion, three ladies gave us evidence—a doctor, a teacher, and a train driver. All would like to be working, but it was impossible. Long Covid had struck them so badly that they were unable to leave their houses and fatigue and brain fog had taken over their lives. One of the ladies said, “We are the forgotten”. I said, “No, you are not forgotten”. That is why my “thank you” to the noble Baroness, Lady Thornton, for having this debate, is so special.

Recently, I met a doctor at a BMA dinner who is doing research on long Covid in Birmingham. I asked him how he found long Covid, and he wrote to me, stating:

“I have been reflecting on the challenges I am facing in both my roles as a clinician and researcher in long Covid. One of the biggest issues for me personally is the definition of long Covid. It is necessarily broad, given that we do not fully understand it, but it includes such a heterogenous group of patients that the diagnosis has limited use for patients. As a result, it is also very difficult to design studies to understand it better. Funding for specific research to address this would benefit the community greatly.


Pragmatically, my experience of the long Covid services has been good, though I should emphasise I only have experience with one centre, and I am fully aware that across the country services are patchy. We have been fortunate locally to have rehabilitation experts who have joined the team and made a positive contribution”.


Services are patchy across the country in respect of so many health issues. People living in rural areas should not be forgotten, as the right reverend Prelate the Bishop of Exeter said. The key messages from the APPG on coronavirus are that long Covid is having and will continue to have a significant impact on both the UK’s health and economy, that Covid-19 must be recognised as an occupational disease, that a compensation scheme must be put in place for key workers living with long Covid, and that a comprehensive long Covid care system must be established to tackle the significant burden that it will continue to place on the NHS.

Long Covid impacts significantly on the UK population and will continue to do so, including on the UK workforce in both public and private sectors. Many of those living with the acute health challenges presented by long Covid were initially infected as a result of work they did during the pandemic on the front line—caring for patients, educating children and continuing to provide vital transport services—yet support from employers and indeed the state is hugely variable.

The APPG has heard of long Covid’s devastating impact on children. Long Covid can have a significant impact on children’s education as a result of lost learning, and the level of support offered by schools to pupils and to parents of pupils living with long Covid is extremely variable. The APPG has heard that

“children experience a wide range of Long Covid symptoms, and that these symptoms can differ from those displayed in adults”,

yet there remains little research into treatment or specific care pathways for children. Without such research, long Covid will continue to impact the health and education of those children living with it.

There should be government guidance on long Covid across the country for GPs, employers, private and public services and the public at large. Some GP surgeries do not want to be involved, but patients only want to know where to go for help.

[Lord Davies of Gower (Con)]

I remind the noble Baroness of the six-minute limit.

[Baroness Masham of Ilton (CB) [V]]

I am just about to finish. They need directions—not to feel forgotten and not worth advising. Does the Minister agree?

We need compassion at this difficult time across the country. We need to solve the mystery of why some people develop long Covid and others recover without complications, and to take any similarities into consideration.

NHS: Backlogs

Baroness Masham of Ilton Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

We understand the importance of the programme, as I mentioned, and, in terms of the finances of the country, we have people in high positions who know its importance in the health debate. So the noble Lord can rest assured that it is top of our agenda, and we will be fighting hard to make sure that the capital programme is given the priority it needs.

[Baroness Masham of Ilton (CB)]

My Lords, would the Minister like to visit Masham GP surgery, where I live? He will find it is a GP surgery that needs updating. It was turned down, and one of the doctors left and went to Canada. It is now totally unsuitable for a growing population, for both patients and the staff working there.

[Lord Markham (Con)]

I do recognise the importance of primary care. We know that a lot of the people who turn up to A&E would be better served in the primary care system, so making sure we have good facilities in this place is vital, and again it is something that is part of our agenda. There was an excellent report in this space recently, and it is something we are working towards—so, yes, GP surgeries are very much an important part of this £10 billion programme.

British Heart Foundation: Tipping Point Report

Baroness Masham of Ilton Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

My noble friend is referring to the healthy eating agenda, which we very much support. It is a key component of health and enjoyment of life. The more we can do in that department, the better. We have taken some very solid steps on sugary drinks and, more recently, on the product placement guidelines, to show that that is central to our beliefs.

[Baroness Masham of Ilton (CB)]

My Lords, how much research is being done on Covid-19, specifically on long Covid and heart disease? Who would collect the data?

[Lord Markham (Con)]

I believe that extensive, detailed research is being done in those areas under the overall guidance of Sir Chris Whitty. We will share this when we have the results.

Nursing: Recruitment

Baroness Masham of Ilton Excerpts

Wednesday 26th October 2022 Lords Chamber

[Lord Markham (Con)]

That is an excellent point. One thing I probably should have said is that the number of 36,000 leavers includes people who have left NHS trusts and gone into community care, working in GP surgeries. We do not catch that number who come back in again, so the real number is less than 36,000, but the basic premise of the question—making sure we are attracting nurses to the right place—is absolutely the right one. I believe that is the plan in place, but I will check on that and make sure we are doing as requested.

[Baroness Masham of Ilton (CB)]

My Lords, would it be possible to make it quicker and cheaper to get visas to bring to the UK nurses from across the world who would like to work here? We can never have enough nurses without them, can we?

[Lord Markham (Con)]

I totally agree with the approach. I have declared a personal interest before in that my wife is a dentist from the Dominican Republic who came in exactly that way, so I completely support the intent.

Primary and Community Care: Improving Patient Outcomes

Baroness Masham of Ilton Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank my noble friend Lord Patel for this necessary debate, and I declare an interest. In November 1981, I was given an honorary fellowship award by the Royal College of General Practitioners, and I have been and am a user of the NHS, being a high-lesion paraplegic. I ask the Minister: how is the NHS going to be improved without an adequate workforce?

We have a growing elderly population, with many complex conditions, who need treating. I am absolutely perplexed that many well-qualified students with many A and A* exam results, and who would like to study medicine, are being turned away by universities because the universities do not have an adequate number of places or because they are too expensive to train. This seems ludicrous when there is such a shortage of GPs and specialist consultants. This is a frustrating situation. What can the Government do to rectify it? Should we not try to be self-sufficient for the future years by training our enthusiastic young people, not training just half of what we need? We must invest in our future.

I bring to the notice of your Lordships and the Minister the situation of sick notes. It seems to be a difficulty for small businesses when an employee goes off sick and keeps getting repeat sick notes. Because of confidentiality, an employer cannot get advice from the GP. Are these repeat sick notes being given over the telephone, and for how long can they keep coming? Since the coronavirus epidemic, many GPs prefer telephone calls to face-to-face visits to surgeries. Small businesses need advice, as they have to put in staff to cover the absent staff who are off sick. At this difficult time, it may be the last straw which breaks the camel’s back.

Bed-blocking is well known and seems to be getting worse. This is not the fault of patients but it is very serious. Ambulances are being held up by multiple patients needing beds and waiting to get entrance to hospital. One of the main problems is that many elderly people have serious falls and cannot leave hospital until there is a care package in place at home so that it is safe for their return, otherwise they will be back in hospital. There is a desperate need for carers and a community team of physiotherapists, occupational therapists and speech therapists for patients who need to be safe at home. This does not come cheap. More funds are needed in both home care and hospital. It is no good robbing Peter to pay Paul; we need both.

My noble friend Lord Patel is asking for a House of Lords Committee on this important matter. It cannot wait: something should be in place before winter sets in. Whatever is set up needs to start the moment Parliament returns in October.

I end by saying that dentistry in the NHS is in crisis. Something must be done to save many people from agony and frustration. Dentistry has not caught up after the Covid epidemic. I have every sympathy with anyone who has toothache from an abscess, having had one myself last week. The conclusion is that reform of the dysfunctional NHS dental contract is now a matter of urgency. A reformed service will not work if there is no workforce left by the time it is finally introduced.

Thyroid Patients: Liothyronine

Baroness Masham of Ilton Excerpts

Wednesday 6th July 2022 Lords Chamber

[Lord Kamall (Con)]

I have had prior notice from other noble Lords about this issue and have organised meetings with my officials in the past on this—I am always happy to do so. Given the concerns about the lack of commissioning for people who have tried the first-line treatment and now want the second-line treatment, NHS England intends to revise its guidelines. It is sorry about the process, but it must consult before it can change those guidelines.

[Baroness Masham of Ilton (CB)]

My Lords, is this not a case of discrimination against those patients who need the drug?

[Lord Kamall (Con)]

The current advice is for them to try the first-line treatment and only if that does not work should they go for the second-line treatment which noble Lords are asking for. In some cases, there may be patients in the other direction, who could go on to the first-line treatment. NHS England clearly understands the problem and the concerns that many noble Lords have raised, and it is consulting on the guidelines.

Polio

Baroness Masham of Ilton Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes a really important about the future of the NHS and our health services. Last week, the Government published the Data Saves Lives strategy, which is what it says on the cover. One of the first issues we must tackle is digitising the NHS as much as possible. Digitisation is one of my three priorities, alongside sharing data. First, this will ensure that we can identify population health issues and patterns in conjunction with AI; secondly, giving appropriate access to researchers allows us to continue to be world-beating in identifying such issues. In future, it may well be that we can get a sample, use a bit of AI—thanks to other data sets—and locate more accurately. At the moment, we are really at the cutting edge of this. What will be vital to it is the digitisation, sharing of and access to data across the system.

[Baroness Masham of Ilton (CB)]

My Lords, is it known how many countries are using the live vaccine, which is different from the vaccine we are using?

[Lord Kamall (Con)]

I am aware that there are still some countries that use the oral polio vaccine, as opposed to the IPV we use in this country. I do not have the exact numbers with me. If the noble Baroness with allow me, I will go back to the department, see if that information is available and then write to her.

Vaccinations

Baroness Masham of Ilton Excerpts

Wednesday 15th June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Masham of Ilton.

[Baroness Masham of Ilton (CB) [V]]

My Lords, after having a coronavirus vaccine, for how long will a person remain protected? Do the Government propose a vaccine campaign next winter, and would it be possible to give the coronavirus and flu vaccines alongside each other to save administration and protect communities?