Queen’s Speech

Baroness Walmsley Excerpts

Wednesday 3rd June 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, in stark contrast to its emphasis in the gracious Speech, the NHS was one of the biggest issues in the recent general election, with an auction of all sides promising increased funding. The Conservative Party promised to provide all the money the NHS needs to carry out its five-year plan and yet, as we have just heard, we have had no details of where this money is coming from and we still have not. This has to be the biggest question to be asked today and I hope the Minister will be able to answer it.

Our health service is the envy of the world and is precious to all of us. We on these Benches are proud of our record on health in government, in particular the contribution of Paul Burstow and Norman Lamb on mental health. I will leave further comment on that subject area to my noble friend Lady Tyler of Enfield. Suffice it to say that we will continue to scrutinise the Government’s plans in this Parliament.

The NHS is only as good as the quality of its staff and management and there are major problems ahead. Nigel Edwards, the NHS chief executive, recently said:

“The NHS needs to hit very ambitious efficiency targets, at the same time as fundamentally changing the way care is delivered and moving to a seven day service. That can only be done if it has the right staff in the right places. Yet there are not enough staff to fill gaps in key areas, and we are seeing clear signs of stress and disengagement”.

This must be addressed. There is a demographic time bomb waiting for us, with doctors, nurses and midwives nearing retirement without an adequate supply in the pipeline. It is all very well promising 24/7 GP services but there are not enough GPs now. Patients in some areas wait weeks for a GP appointment. No wonder they resort to A&E. How will the Government monitor how HEE plans to train the staff needed to fill this yawning gap?

Qualifications are also an issue, especially among care workers. The Liberal Democrat manifesto called for a Bill to regulate the qualifications of health and care professionals. This would improve patient safety as well as reduce the burden and cost of an outdated regulation regime. Does the Minister recognise the need for this and have the Government any long-term plans to address the issue?

The Conservative manifesto promised integration between health and social care and yet the gracious Speech was silent on the matter. The pressure on hospital beds has made this matter all the more urgent. The first section of the Care Act began its implementation last month. Can the Minister say whether it is going according to plan, and what are the plans to learn lessons to ensure that phase 2 goes well?

Every relevant patient has an entitlement to a care assessment but how portable are these across the borders between England and Wales and England and Scotland? I happen to be a resident of Wales and have in the past year had experience of the health service in both England and Wales. Although my own care has been good, it is horrifying for residents of Wales to read every week of the failings of the Labour Welsh Government and poor standards of care and extended waiting lists. We even have calls for the inspection system to be scrapped and a health board to be put in special measures because of terrible failings in the treatment of elderly, vulnerable people at the Tawel Fan unit. That is just the latest of many problems. This is of course a devolved matter but if the problem is funding the people of Wales will want to know if a fair amount of the proposed increased NHS funding announced by the Government will come to Wales. They will hold the Welsh Labour Government to account for spending it all on health and for spending it wisely.

There are serious cross-border issues which should be of concern to the Westminster Government as well as to the devolved Administration in Cardiff. The House of Commons Select Committee on Welsh Affairs rightly maintained that access to healthcare should be on the basis of need, not which side of a border you happen to live. Yet Welsh patients referred to English hospitals have had their treatment delayed, regardless of their clinical need, because the Welsh Government wanted to save money. That cannot be right. What assurance can the Minister give me that the Government will work with the Labour Government of Wales to prevent this discrimination against Welsh patients?

Of course, it is often wise to invest in order to reap rewards later and health is a very good example of the truth of this rule. Health promotion and sickness prevention programmes must go hand in hand with treatment of disease. Indeed, the undoubted pressure on the NHS could be alleviated if there was more focus on health education and on ensuring that everyone has a safe, warm home and access to good fresh food. Both of those are causes of ill health. These issues are now mainly devolved to Public Health England and local health and well-being boards. Will the Minister say how the Secretary of State will use his mandate to ensure that the NHS is a health service and not a sickness service?

There has been much talk in recent days about the use of agency nurses as part of the debate about privatisation in the health service. From my point of view, delivery of services to everyone free at the point of delivery is the absolutely top principle. In order to ensure the best interests of the patient, if this can be delivered in a small minority of cases by a private organisation, that is acceptable as long as it provides good value for the taxpayer and gives no advantage to the private company over NHS providers.

Agency nurses are not the answer and neither is a cap on their remuneration. To me, the crucial challenge is the quality of management and planning within the NHS, the public service. I was recently in a ward with two patients and nine members of staff. That was poor planning when the procedures concerned were elective and not emergency. At the same time, there were other wards where the staff were run off their feet. Hospitals which plan their staffing well make little use of expensive agency nurses. It is fashionable for some politicians to make a big thing about cutting managers and increasing the number of nurses and doctors but I believe we must not forget that good management allows the nurses and doctors to do their job better. That has to be our aim in the interests of the patients.