Children in Care: CAMHS Waiting Times

Baroness Tyler of Enfield Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I have some personal experience in this area, so I agree that we need to see people as quickly as possible. On the investigation, we have recently undertaken a call for evidence, which closed in July with 5,000 responses that we are going through. I think that our response to that will answer many of the questions, but I would be happy to meet the right reverend Prelate and discuss this further when we have those results.

[Baroness Tyler of Enfield (LD)]

My Lords, the Select Committee looking at the Children and Families Act 2014, which I have had the honour to chair, is publishing its report tomorrow, and the frankly dire state of children’s mental health services runs through it like a stick of rock. Our inquiry received harrowing evidence of waiting times of up to two years for children already in crisis; specifically, we heard that there are very long waiting lists for post-adoption trauma support. What are the Government doing to improve mental health support for this particular group of children?

[Lord Markham (Con)]

I will need to write to the noble Baroness to give a specific response in that case. It is an area of concern where I think we are increasing awareness, and any diagnosis needs to start with awareness. By definition, that means that more people are diagnosed or come forward, which is a good thing, but it then means that often it takes longer to see those people—I do not say that as any sort of excuse but just as an explanation. As we increase our understanding in this area, and I think that we would all agree that over the last 10 to 15 years there has been a huge increase in understanding, that means that more people are coming forward, but it means also that we need up our game in terms of supporting them.

Abuse and Deaths in Secure Mental Health Units

Baroness Tyler of Enfield Excerpts

Wednesday 9th November 2022 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I thank the noble Baroness. I first want to apologise for the failings in the care that Christie Harnett, Nadia Sharif and Emily Moore received. My thoughts, and I am sure the thoughts of this whole House, are with their families and friends. The death of any young person is a tragedy, all the more so when they should have been receiving care and support in a safe place.

The Minister in the Commons is looking much more towards a rapid review rather than a public inquiry, as the feeling is that rapid action is needed. We have seen some good examples of that recently, with Dr Bill Kirkup. It is very much at the top of the agenda and I agree with the noble Baroness; this is the third time I have spoken on similar incidents in the short time I have been here. We clearly need to make sure the proper action is in place to identify these issues.

[Baroness Tyler of Enfield (LD)]

My Lords, when this Question was answered in the other place on 3 November, the Minister said that

“staff shortages often contribute to some of the failings we have seen.”—[Official Report, Commons, 3/11/22; col. 1021]

These are some of the most horrific cases of abuse and death in so-called secure mental health units I have ever seen. Can the Minister say what emergency intervention funding will be made available, as happens with maternity services put into special measures, to ensure that every mental health patient in a secure unit is in a safe place?

[Lord Markham (Con)]

I agree, and I have been asking similar questions around whether we should be looking for a special measures-type regime in this space. To be fair to the new CEO, who has come in from 2020, he has set out a plan and progress is being made on many steps. It is the focus of the Minister to see whether that progress is quick enough. We understand that staffing is a key issue. We have increased the number of staff by 24,000 since 2016, and almost 7,000 in the last year alone. Clearly, part of this rapid review needs to be around staffing.

NHS: Discharge to Assess Policy

Baroness Tyler of Enfield Excerpts

Tuesday 8th November 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, the recent survey conducted by Carers UK, which has already been alluded to, found that 63% of carers disagreed that they had been asked about their ability to provide care. Indeed, the report is littered with harrowing examples of carers who felt that the discharge of the person into their care had happened too quickly, as a result of which their condition got worse and they had to go back into hospital. Can the Minister say how the NHS will collect both qualitative and quantitative data at the point of hospital discharge to ensure that undue pressure is not being placed on families?

[Lord Markham (Con)]

As mentioned, the Carers UK report and its findings made for sobering reading. It clearly shows why it was right to delay the guidance until we had that input; again, that will be followed up at the conference on Thursday. I think we all agree on the premise that we want to discharge people into their home quickly because that is the best place they can be, provided that they are medically able to be there. It is then in their home that the assessment takes place. Clearly, that must happen in a timely fashion and with the carer’s involvement but, again, the survey showed that that is not being done quickly enough in many cases. I accept that there are many things we need to learn from this but I think we can all agree on the direction: it is right to discharge people quickly provided that back-up and support are there to ensure that they have what is needed.

Cost of Living: Public Well-being

Baroness Tyler of Enfield Excerpts

Thursday 20th October 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

I congratulate the noble Baroness, Lady Drake, on her excellent opening speech and refer to my relevant interests in the register.

As we speak, we are witnessing political turmoil of a kind I have not seen in my lifetime. Frankly, we are a laughing stock on the world stage. All of this makes me very angry because it is ordinary people who will pay the price, and that is what we are debating. On 23 September we were already in a cost of living crisis, with the highest inflation in 40 years and the nightmare of out-of-control energy prices. Events since then have caused massive further anxiety, fear and distress for millions of our fellow citizens. The cost of living crisis we are experiencing and the impact on public well-being is simply dire. All the research on well-being shows that not being able to meet basic needs has a negative impact on well-being individually, as families, communities and as a nation.

How did we reach this parlous state? It just does not wash to blame it all on Ukraine and other international factors. The market’s response to the so-called fiscal event of 23 September—the completely unfunded and by far the largest giveaway Budget in 50 years—was instant, brutal and devastating, both for the UK economy and us all as individuals. Sterling plunged; gilt yields rocketed; mortgage rates rose by well over two percentage points; and major players in the pensions market came close to insolvency. The outgoing Prime Minister’s much-lauded but quickly junked growth plan led to the UK losing overnight our much-cherished global reputation for fiscal probity and sound financial management.

Instead of it being a case of going too far too fast, the truth is that the growth plan did not survive its first contact with economic reality. The immediate result was to crash the economy. It is ordinary citizens—particularly the most vulnerable and the lowest paid—who are going to pay the highest price. Fast forward a few weeks: the IFS and others estimate that there is a remaining black hole of around £40 billion still to be bridged in the Chancellor’s Budget on 31 October. The Chancellor has said that he will be identifying a mixture of further extraordinarily painful cuts in public expenditure, together with increases in taxation. No matter what the Chancellor does, however, the UK will be paying a significant political risk premium to lenders not just for months but for years to come. One very visible effect of this is that millions will be paying higher mortgages and rents of several hundred pounds a month for years to come. It is no wonder that people are anxious, and public well-being has nosedived.

Jeremy Hunt has stated that he will be keeping the most vulnerable at the centre of his attention, which is clearly right. However, he is still refusing to confirm that universal credit will be raised next April in line with an inflation figure of well over 10%. The energy price guarantee—which, of course, was very welcome—has now been reduced from two years to six months. History will judge both the politics and the economics, and will allocate blame for the mistakes made on 23 September and subsequent events. Today, however, we are focusing on what we can do to support the millions whose already fragile sense of personal well-being has been further battered by all this turmoil and to protect them from the worst effects of that £40 billion of further cuts and tax increases still to come.

The context is not promising. Inflation is at 10%; food inflation is at 14% and real wages for many are at a 40-year low. According to a recent British Psychological Society survey, 55% of people feel more anxious about being able to pay their bills than they did this time last year; more than a quarter said that worrying about money was making them feel depressed; only 27% felt confident that they will get by financially this winter, and 52% said they were concerned about not being able to afford food. Other recent surveys have shown an estimated 11 million people feeling unable to cope. Anxiety about the rising cost of living is estimated to be affecting half the population; 50% of the population report that they have had to reduce expenditure on essentials—food, toiletries and petrol—over the past few months. Use of food banks, as we have heard, including by people in full-time employment, is skyrocketing. Millions are extremely anxious about how they will be able to feed their families and children. An estimated 1 million children are in food poverty and not receiving free school meals. Fuel poverty is estimated to have tripled, with many saying that they feel too scared to open their energy bills.

This cost of living and well-being crisis requires an urgent and meaningful response. This toxic cycle of mental health problems and money worries demands immediate action from the Government, regulators, employers and firms to stop the cost of living crisis becoming a mental health crisis. Many charities, think tanks and external commentators are generating policy responses and ideas. Foremost among these are: raising all benefits, including universal credit and disability benefits, in line with inflation on 1 December; reviewing and then revising in line with inflation all benefits, not only every 12 months but every six months, starting from next April; moving all children from families living in food poverty into free-school-meal programmes; providing further targeted cost of living payments to vulnerable groups still falling through these new safety nets; strongly encouraging mortgage providers and landlords to restructure payments for those struggling with payments, with a view to minimising home possessions and evictions; requiring the appropriate regulators to work with the energy companies to ensure that they make all possible efforts to secure payment restructuring for bill payers and provide a compassionate response to customers; ensuring energy companies make further financial contributions to the financing of the energy price cap; and ensuring—this is very important—provision of adequate and accessible debt advice services and debt relief schemes to prevent people from spiralling ever further into debt.

Finally, it is vital that the Government commit to funding mental health services, as set out in the NHS Long Term Plan, and publish the promised 10-year cross-government mental health and well-being plan and the health disparities White Paper. I hope that, when the Minister winds up, he can assure me that the measures I have highlighted, and others that we will no doubt hear about today, are being urgently considered.

Finally, there is a time when you have to say, “Enough is enough”. So could the Minister also say when this Government will finally do the decent thing and call a general election?

Health and Social Care Update

Baroness Tyler of Enfield Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

On the 15 trust areas, I will need to get back to the noble Baroness on whether it is down to demographic factors. I wish to dig into it more and will look at a number of things. I have been told anecdotally that the day of the week makes a big difference to performance and wait time, so that is another area I want to get underneath. In terms of retaining people, as an entrepreneur who has started up many businesses, I know the importance of motivating a workforce. Clearly, if work does not pay—for want of a better word—there is not much motivation to put in the extra hours we require. I will come back to the noble Baroness with more information on that.

[Baroness Tyler of Enfield (LD)]

My Lords, I welcome the Minister to his new role and declare an interest as a non-executive director of the Royal Free London group of hospitals, which includes Chase Farm. I would like to pursue the points made by both the noble Baroness, Lady Merron, and my noble friend Lady Brinton about health inequalities. With an almost 20-year gap in healthy life expectancy between the most and least deprived areas in London, could the Minister say if and when the Government are planning to publish the health disparities White Paper?

[Lord Markham (Con)]

I thank the noble Baroness for reminding me that I failed to reply to that point earlier and for giving me the opportunity to do so, but I will need to investigate further. As I say, I do not have immediate knowledge of this issue, but I undertake to come back to the noble Baroness with a reply.

Draft Mental Health Bill

Baroness Tyler of Enfield Excerpts

Tuesday 28th June 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an incredibly important point. We have seen the impact that the pandemic has had on mental health across all age groups. During the Health and Care Bill, the noble Lord and many others raised the issue of parity between mental health and physical health, and I thank him for that. That brought home that the current legislation is out of date, which is why we really need to update it. I also thank noble Lords who have spoken so far for agreeing that this is not a party-political issue at all. We all want to address this issue, and maybe the issue of funding will come up. The Government remain committed to achieving parity between mental and physical health services to reduce inequalities. We are making good progress; investment in NHS mental health services continues to increase each year, from almost £11 billion in 2015-16 to £14.3 billion in 2020-21. We expect all current CCGs—and ICBs once operational —to continue to meet the mental health standard, and we have made a number of amendments. We are investing more than £400 million over the next four years to eradicate mental health dormitories. Clearly, as we go through the Bill, there will be financial implications, which will be considered as we debate it. I cannot give a clear pledge on which measures will be implemented until we have seen the Bill. Clearly, however, we understand that a lot of this is long overdue, so the quicker we can get this done and come to an agreement satisfactory to all sides of the House, the sooner we can get on with implementing it.

[Baroness Tyler of Enfield (LD)]

My Lords, I welcome many of the proposals contained in the draft Bill, particularly those that give people affected by the Bill more say over their treatment and care. However, as others have said, the Bill is currently worryingly silent on workforce issues, and I think we all agree that they will be critical to the successful implementation of any reforms. My specific question to the Minister is: what assurances can he give that children and young people aged 18 and under will benefit from the reforms at least as much as adults and, specifically, will they be able to access the same treatment safeguards as adults?

[Lord Kamall (Con)]

When I was having initial discussions on the various parts of the Bill, children and young people’s mental health clearly came up. The statistics are staggering. Some 420,000 children and young people were treated through NHS-commissioned mental health services in 2021. That is an increase of 95,000 in just a few years. That is still without us being aware of everyone who needs access to the system, or young people and their parents and families being aware of what support is available.

We are continuing to increase investment into mental health services by at least £2.3 billion a year by 2023-24, as set out in the NHS Long Term Plan. There is also the extra money in response to the pandemic, which saw extra demand. We have 287 mental health support teams in place in around 4,700 schools and colleges across the country but, once again, more needs to be done. It is one of those issues where demand outstrips supply.

We now have mental health support teams covering 26% of the country a year earlier than planned, but we hope to increase this progressively over the years so that as many schools as possible are covered. We have delivered 7 million well-being for education recovery programmes. We understand the tensions and workforce issues that will inevitably arise. The Health Education England review and the Government’s strategic review are considering all the changes in healthcare overall; all the technologies and ways of delivering services; and the change from secondary to primary and down to the community. We are working out in the response what workforce we need for each of those changes.

Nursing: Staffing

Baroness Tyler of Enfield Excerpts

Thursday 16th June 2022 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment they have made of the report by the Royal College of Nursing Nursing Under Unsustainable Pressures: Staffing for Safe and Effective Care in the UK, published on 6 June.

[Baroness Tyler of Enfield (LD)]

My Lords, I am very pleased to open this important debate on the pressures facing the nursing workforce, who play a critical role in our overall healthcare system. Throughout the Covid pandemic, nurses constantly went the extra mile, and more, often at great personal cost. Indeed, I want to pay tribute to all health and social care workers who toiled through the pandemic with great self-sacrifice. We should never forget their heroic and unstinting labours. I refer to my declared interests in the register, particularly as a non-executive board member of the Royal Free London NHS Foundation Trust.

Last week, the Royal College of Nursing published Nursing Under Unsustainable Pressures: Staffing for Safe and Effective Care in the UK. It reported on the results of the RCN’s March survey, which asked staff about their last shift—that is, the last time that they were at work—and compared the results with earlier surveys from 2017 and 2020. It makes for salutary reading. The report states that recent events, including the UK’s exit from the EU and the pandemic, have highlighted and worsened long-term problems with workforce supply in health and social care. The findings highlight starkly the impact of growing staff shortages and rising demand on the ability to deliver safe and effective care.

To give a brief flavour of the report’s findings, only 25% of respondents said that their last shift had had the full number of planned registered nurses; 75% of respondents reported a shortfall of at least one registered nurse on their shift; and four in five respondents felt that patient care was compromised by not having enough registered nurses on the shift—these figures had all gone up since the previous survey. Also, only around one in five respondents agreed that they had enough time to provide the level of care which they would like.

There is a lot more besides, but these findings give us cause for real concern, in terms of morale and staff retention and in the impact on patients and their safety. Frequently, nurses felt that the quality of care that they were providing was compromised, ranging from basic personal care, such as helping patients going to the toilet, through to severely ill patients getting treatment late and, sometimes, medicines not being given at all.

It is also worth looking at the key figures from the Nursing and Midwifery Council’s annual registration report. It is clearly good news that the number of nurses, midwives and nursing associates on the register has grown to more than 758,000 given the pressures of the last two years. Almost half of newly hired nurses were recruited from abroad. Of course, international nurses and other professionals make a welcome and vital contribution to the NHS, but it raises ethical and sustainability issues when so many are coming from poorer countries that often are experiencing staff shortages in their own healthcare systems. Alarmingly, however, over 27,000 nurses left the register, a sharp rise on the previous year.

When asked in the NMC’s leavers’ survey why they left, many said that their main reasons included too much pressure and poor workplace culture. More than a third of respondents said that Covid and feelings of burnout influenced their decision to leave. Some said that they were worried about their own health, while others struggled with increased workloads and a lack of staff, reinforcing the findings by the Royal College of Nursing.

What needs to happen? As the Minister will no doubt remind us, the Conservative Party pledged in its 2019 manifesto to deliver 50,000 more nurses, and progress is being made against that target, which I welcome. However, as the Chief Nursing Officer for England, Ruth May, said recently, while the pledge was welcome, it falls short of what is needed. Analysis from the King’s Fund also supports the view that the target will simply not be enough, saying that at a national level

“recruitment is having no clear impact on actual vacancy numbers or on the shortfall of nurses in the NHS”.

It went on to explain that the underlying cause of nursing shortages was that demand for nurses was increasing more quickly than supply, for reasons that it described as “complex, longstanding and varied”. However, it cited the pandemic and new targets to increase diagnostic and elective activity, which have created new demands and exacerbated workforce shortages that long pre-date Covid-19. The King’s Fund recommended a regular assessment of demand for and supply of nurses in the NHS over the next five to 10 years as the only way of tackling the backlog of care and dealing with these shortages and with rising patient demand, now and into the future.

Workforce planning is clearly crucial, and we need to see an emphasis on university nurse training programmes and the very welcome degree apprenticeship scheme, but so is a strong focus on retention, with so many nurses experiencing burnout and significant numbers intending to leave. Unfilled vacancies increase the workload pressure on staff, and it quickly becomes a vicious cycle leading to high levels of stress, absenteeism and turnover. As we know, reliance on bank and agency staff as short-term stopgaps has huge and unsustainable costs.

What is needed for nurses to make them want to stay? Clearly, pay is critical, but my view is that the NHS must focus on becoming a more attractive employer. This means tackling head on concerns expressed about bullying and discrimination, offering more opportunities for flexible working, and strengthening more people-focused and inclusive leadership. It must also include more black and minority-ethnic nurses in senior positions. In short, it requires a fundamental change in the culture to create an environment in which staff want to work and make their careers.

In talking to front-line nurses during the pandemic and more recently, I have been struck by a simple message of “We just need to get the basics in place”. While well-being support and initiatives are welcomed, the nurses I spoke to said they just wanted to know that there would be somewhere they could sit and recover at the end of a long shift, that hot food and drinks would be available during the night when many catering services are closed, that there would be someone to speak to in a non-judgmental way after dealing with difficult cases, that leave could be taken, that there would be flexibility around rotas to help with family responsibilities and support with childcare, and that they would not have to pay an extortionate amount for car parking. I think we all agree with that.

Are these things too much to ask for the nurses who look after us and our families when we are most vulnerable? In short, it means working with nurses on what really matters to them. The nurses I spoke to said that nursing can be a great job and a highly rewarding profession, but we must get the basics right so that they feel they are valued and properly supported.

Finally, I want to turn briefly to wider workforce planning issues. Like many other noble Lords, I was bitterly disappointed when calls, supported by many inside and outside Parliament, for independent, long-term workforce projection data to be routinely published went unheeded in our lengthy debates on the Health and Care Bill earlier in the year. Like many others, I believe this modelling is key to putting the workforce back on a sustainable footing, ensuring safe staffing levels and supporting more strategic spending decisions. Given this glaring gap in the Health and Care Act, it is ever more critical that workforce planning is properly addressed in the forthcoming long-term NHS strategy.

The Secretary of State for Health recently told the Health and Social Care Select Committee that while the strategy is expected to include data on workforce requirements by speciality and to provide a gap analysis to inform training plans, he could guarantee only that the conclusions would be published. He said the plan may not be published in full, including the workforce projection data. He also told the committee that the number of people waiting for NHS care stands at 6.7 million. Surely we need to know whether the NHS will have sufficient staff to meet growing demand and how many more professional staff will be trained, along- side plans to create new roles and use technology to work in different ways. Is the Minister able to explain why it may not be possible to publish the workforce plans in full, and can he confirm the dates for the publication of Health Education England’s updated Framework 15 document, looking at long-term strategic trends and drivers in healthcare, the update to the 2019 NHS Long Term Plan and the 15-year workforce strategy setting out the number of staff the NHS will need?

As we all know, the NHS faces many acute pressures and challenges such as GP recruitment, which is well off track against the target, ambulance waiting times—we heard the appalling case in the news this morning of a 94 year-old gentleman who waited five hours after a bad fall and it tragically proved fatal—building new hospitals, unacceptable A&E and cancer treatment waiting times, delays in discharging patients due to lack of social care, and the list goes on. Having the right highly skilled, dedicated and motivated workforce, both clinical and managerial, lies at the root of them all. I very much look forward to hearing contributions to this debate from other noble Lords and the Minister’s response.

Health and Care Bill

Baroness Tyler of Enfield Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

I ask the Minister to please give this resolution godspeed and bring the clause into action as soon as he can. Let us try and move this forward so that—maybe by the time we have gone a year or 15 months from now—we have a real opportunity of making a change which will benefit many parents, and which will not produce adversity but help produce consensus by giving parents a real say in the level of treatment.

[Baroness Tyler of Enfield (LD)]

My Lords, I wish to comment extremely briefly on Motion E, in relation to unpaid carers and hospital discharge, and to ask the Minister one question. I want first to pay tribute to the noble Baroness, Lady Pitkeathley, for her unstinting leadership on this issue. I very much welcome the amendment in lieu which the Government have brought forward to ensure that carers and patients are properly involved in discharge decisions.

My one point is that the cost of living crisis is a reality and life is getting tougher for many people. Involving carers at the point of discharge gives them the opportunity to say that they are unable to care, or unable to get the support they need for caring because they are juggling work and care—for example, if it is impossible for them to give up work fully because they need to feed the family or pay the bills. Can the Minister give me assurance that carers’ needs to juggle work and care will be both properly covered and explored in the guidance which I know that the Government are committed to producing, and which I am very much looking forward to seeing?

[Baroness Walmsley (LD)]

My Lords, I shall make a few brief comments about Motions A, E, G1, L1 and Q. On Motion A, we very much welcome the Government’s amendments in lieu, to make it clear that no commissioning organisation within the ICS can have a member appointed to it who could reasonably be regarded as undermining the independence of the health service because of their involvement in the private sector. The Government have listened to the concern expressed by the noble Lord, Lord Hunt of Kings Heath, whom I congratulate for spotting the loophole, and that is very good and welcome.

On the matter of carers and safe discharge in Motion E, we on these Benches were concerned that unpaid carers would not be sufficiently consulted and their own health and well-being might not be sufficiently taken into account. I am grateful to the Minister for spelling out, at my request, how the impact on carers will be assessed before a patient is discharged into her or his care. However, at the moment, when there is an outbreak of Covid-19 in a hospital ward, the carers are not allowed to visit the patient. Therefore, those conversations are not taking place. I should be very interested to know what the Minister will suggest about how those conversations can take place in that situation.

It is very important that appropriate action is taken to address the carer’s needs as well as those of the patient. Indeed, if those needs were not addressed, it would affect the ability of the carer to look after the patient, so both would suffer. I know this is a big responsibility for local authorities, which are strapped for cash, but it is vital that these needs are catered for, especially in light of the fact that those many thousands of unpaid carers save the public purse a massive amount of money, as well as looking after their loved ones with the loving care and attention that it would be very difficult for professionals, however dedicated, to give.

On Motions L and L1, I have listened carefully to the concerns of the noble Baroness, Lady Finlay, and she is quite justified. Governments have a habit of promising action but then moving on to something else, so we on these Benches, like the noble Baroness, will be looking out very carefully for the results of the review and the actions which we hope will follow.

We very much welcome Motion Q and congratulate the noble Lord, Lord Bradley, on achieving what he has. We particularly welcome the mention in the amendment in lieu of the word “prevention” of mental ill-health, as well as diagnosis and treatment.

Finally, as my noble friend Lady Brinton said, we support Motion G1 from the noble Baroness, Lady Wheeler. I want to add just two comments to those of my noble friend. We should support the amendment because the government savings will be paid by the poorest and most vulnerable, and 80% of those with dementia who have very long-term caring needs will be worse off under the Government’s proposals, and that is not right.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, I rise very briefly to support Amendment D1, tabled by the noble Lord, Lord Blencathra. Last night I was part of a BMA web conference mounted by the Ethics Committee, of which I am an elected member, looking at the powerful evidence coming out of Xinjiang province in China. The concern is that, if we are purchasing products from there, we are complicit in the appalling human rights abuses that we were shown evidence of in this webinar. Therefore, I hope the House will support that amendment.

I return to the very important Amendment B1, tabled by the noble Baroness, Lady Cumberlege. This is not just a static situation. It is worsening. All that we have done is not just more of the same; we are actually sliding downhill rapidly. I want to give a little bit of data to the House to support that statement. There are now 1,565 fewer GPs than in 2015, meaning that there is a shortfall of 2,157 against the target that was set by the Government in their manifesto promise, in terms of where we are tracking to date.

The number of fully qualified GPs by headcount has decreased by over 600, so there are now just 0.45 fully qualified GPs per 1,000 patients in England, down from 0.52 in 2015. This means that each GP is responsible for about 300 more patients than previously. In terms of physiotherapy—I declare an interest as president of the Chartered Society of Physiotherapy—the model shows that 500 new physios are needed each year for multiple years to meet demand. There needs to be a trebling of the 6,000 NHS physio support workers. In nursing, the district nursing numbers have dropped from 7,055 in 2009 to 3,900 in 2021, which is a 45% drop. This is all going in the wrong direction. From the data that I could obtain, it looks as if three-quarters of nursing vacancies are filled by temporary staff.

This amendment, tabled by the noble Baroness, Lady Cumberlege, is crucially important. It would be a dereliction of our duty to ignore supporting that amendment, given all that we know and all the work that has gone on. That is not to be critical of the Minister and his team at all, because I am sure that it is not his personal wish that we do not have this in place—but we certainly do need a completely new approach to workforce planning.

[Baroness Tyler of Enfield (LD)]

My Lords, I wish to lend my support very briefly to Motion B1, moved so very compellingly by the noble Baroness, Lady Cumberlege. I simply wish to pick up and echo the telling point from the noble Baroness, Lady Harding, who I think broadly said that if you carry on doing the same thing, you are going to get the same results.

I have had a look over the last week at what results we are getting. We have had the frankly shocking revelations in the Ockenden review, highlighting the really severe implications for patient safety, particularly for women and babies, when there are just not enough suitably trained staff around to do the vital job that they are there to do. I looked at that review last night and found it truly shocking. In the last 24 hours, we have had a Care Quality Commission report looking at Sheffield Teaching Hospitals. It said that they lacked enough qualified clinical staff to keep women and infants safe from avoidable harm and to provide the right treatment. There is also today’s report—it may have been yesterday’s—from the Health and Social Care Select Committee, highlighting the critical NHS staff shortages affecting cancer services in England, meaning that too many people are missing out on that critical early cancer diagnosis which is so vital to their chances of survival.

I know those are the worst things happening and that there are lots of good things, but those things are not acceptable. Things like that are why public satisfaction in the NHS, as the noble Lord, Lord Stevens, said, is sadly going down. That is a real problem; it is the reason I so strongly support Motion B1 and why there is such strong cross-party support for it in this Chamber.

[Baroness Watkins of Tavistock (CB)]

My Lords, I support Motion B1 in the name of the noble Baroness, Lady Cumberlege. I will be brief and not repeat what others have said. However, it is worth noting that in the Statement on the Ockenden report, the Secretary of State for Health said:

“I am also taking forward the specific recommendations that Donna Ockenden has asked me to. The first is on the need to further expand the maternity workforce.”—[Official Report, Commons, 30/3/22; col. 819.]


That phrase could be repeated for every part of the NHS and social care workforce, so I believe that has changed the situation since the other House debated this issue.

The public are asking what the national insurance levy is for if not to increase the number of professional staff in training. We are turning away people who want to be paramedics and nurses, as my noble friend has just said, who want to train locally. Of course we should undertake ethical overseas recruitment as well, but we need both. I firmly believe that this amendment needs the full support of this House.

Mental Health Services for Rough Sleepers

Baroness Tyler of Enfield Excerpts

Monday 21st March 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, the most common health problems among homeless people are substance abuse, as the Minister just mentioned, and mental health problems; often it is a combination of the two. Given this correlation, can the Minister say what the Government are doing to reconnect addiction services with health services in order to treat homeless people with multiple health problems? Does the Minister agree that specialist addiction services should be jointly commissioned by the NHS and local authorities to ensure full integration?

[Lord Kamall (Con)]

Like many other noble Lords, the noble Baroness has raised a very important aspect of this issue. She is absolutely right that people with drug addiction often have physical and mental health needs as well. Mental health problems and trauma are often central to an individual’s dependence on drugs, alcohol or other forms of abuse. As set out in the drugs strategy, we are working with NHS England to ensure that there is joined-up service provision between specialist mental health services and substance misuse services for people with co-occurring issues, including those who are experiencing rough sleeping. We are also going to make sure that the next phase of integrated care system development includes leadership on drugs and alcohol to integrate both physical and mental healthcare and substance misuse services.

Health Protection (Coronavirus, Restrictions) (Self-Isolation etc.) (Revocation) (England) Regulations 2022

Baroness Tyler of Enfield Excerpts

Thursday 17th March 2022 Lords Chamber

[Lord Hutton of Furness (Lab)]

My Lords, I have some sympathy with the arguments that the noble Baroness has just made, but I think this is probably not the time to have a general debate about the Government’s handling of the Covid-19 pandemic.

These regulations are fairly narrowly drafted and are designed to repeal the earlier regulations that required vaccination against Covid-19 to be a condition of deployment in the NHS. I support the repeal of these regulations. The Government have made a good case for the repeal in the Explanatory Memorandum, but none the less, it represents quite a significant and dramatic U-turn in government policy.

I do not think it made a lot of sense to require compulsory vaccination; there were other ways of ensuring the protection from harm of NHS patients. Of course, the loss of critical front-line NHS staff which the earlier regulations might well have produced would itself have represented quite a significant risk of harm to NHS patients.

Today, I have only one question I want to ask the Minister. Again, it is something that is contained in the Explanatory Memorandum. Paragraph 7.29 says that the Government will engage with NHS employers to review their policies on the hiring of new staff and the deployment of existing staff to take into account their vaccination status. I ask the Minister what the Government want to see change in NHS hiring and employment practices. Will new employees in the NHS, for example, need to have been vaccinated against Covid-19? What does this paragraph in the Explanatory Memorandum actually mean?

[Baroness Tyler of Enfield (LD)]

My Lords, I speak in support of the amendment from my noble friend Lady Brinton. One of the main reasons I am doing so is that I think the messaging being put over at the moment is entirely wrong and out of sync with where we are in this pandemic.

I watched a very short World Health Organization video this morning. It was only a minute long and it was called “Moving from Pandemic to Endemic”. The clear message was that endemic does not equal good. During an endemic, you actually require strong health control programmes if you are going to continue to reduce infections, hospitalisations and deaths—something I am sure we all want to do. In my view, there is a pressing need to maintain some of the public health measures that can help us control this virus as it becomes endemic. You can change the label but that does not change the challenges facing us, which, in my view, require sustained protections, particularly for the most vulnerable, and a very strong public health system.

Looking back at the Statement from the Prime Minister when the living with Covid plan was introduced, I was perplexed. He set out the rationale that cases were falling, hospitalisations were falling and the number of excess deaths from omicron was actually in negative territory. Were that still the case, I suspect I would feel quite a lot more relaxed than I do at the moment. This morning, I reviewed the figures and the latest stats from the ZOE study, the ONS and the Government’s own dashboard. Just on the Government’s dashboard we are seeing an increase of 52% in people testing positive over the last seven days and an increase of 18% in patients admitted to hospitals over the last seven days. That is not a virus in retreat.