NHS and Social Care: Winter Service Delivery

Baroness Watkins of Tavistock Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw attention to my interests as outlined in the register. I thank the noble Baroness, Lady Wheeler, for securing the debate on this important topic and for her excellent speech which, together with that of the noble Baroness, Lady Pitkeathley, and others, covered some areas which I will now not repeat. This topic should be of concern to all parties in this House, given the public’s expectation of access to high-quality provision, not only of healthcare but of social care.

Some 40 or 45 years ago, when I was at school, I read in a series of papers about the scandal in mental hospitals. It really encouraged me to go into mental health nursing and improve the lot of people who now no longer suffer in that way in institutional care. However, in the Times last week, there was the headline:

“A million lonely pensioners left to starve in their homes”.


A group of MPs from across all parties have talked about this. We are beginning to create what we had in institutional mental hospitals 40 years ago in people’s own homes, where they are even more isolated and alone than those who were in the system that I worked to change.

In all four countries in our United Kingdom, patients are waiting in ambulances or on trolleys in A&E prior to the full assessment of their conditions. One reason is that our acute hospitals are full, with bed occupancy rates of higher than 90%—completely different to the international recommendation that 80% to 85% is a safe way to practise. We know, as others have already outlined, that this is frequently because patients who are deemed fit enough for discharge are not fit enough to go home without significant levels of social support and care.

Rural England reported earlier today that, in Cornwall, there are on some days 60 people in hospital who are ready to go home, but part of the problem is that it is difficult to recruit home carers. Is that a surprise, when these carers are on less than £9 an hour and are not paid to travel, particularly in rural areas? At least when I was a district nurse I was paid for my travelling time. Patients are therefore held in ambulances, although with excellent paramedic care and support. Yesterday, South Western Ambulance Service NHS Foundation Trust told me that this costs about £66 an hour for individual ambulances and the clinical crew. Let us compare that to the £9 an hour for carers—if we could just turn the system around, could we not improve for the same amount of money? We know that people wait for long periods for discharge from hospital, which costs a minimum of £450 a day. We need a coherent total systems approach to health and social care. How can we do this? Well, is it not time for the Department of Health and Social Care to reimagine community services, as the recent King’s Fund report suggests?

As a short-term measure, we could set up some pilot sites, with acute trusts given the funds and authority to purchase and maybe even provide community support, including residential and nursing homes, for the first six weeks after discharge. Indeed, we could set up success measures to see whether we can reduce social isolation, enhance older people’s nutrition and thereby reduce admissions.

We need not only to remember that the current situation is affecting social care but to think about the perception of those whose planned operations have been postponed. These elective operations involve both young and older people, perhaps waiting for a simple hernia repair or orthopaedic operation. How do they feel about our NHS? Surely they would rather have innovative solutions than stay with the status quo. The issue of intergenerational fairness and a potential hypothecated tax was raised by the noble Lord, Lord Macpherson. We will turn the next generation off the health service unless we can provide the care they need as well as the care for their grandparents.

What plans are there to consider more innovative pooling of health and social care budgets, to provide the best seamless care for our people, and to reduce the stress caused not only to patients but to NHS and social care staff in our hospitals and community teams who—believe it or not—want only to provide high-quality services to those they serve? These are the questions that our staff want answered and we need to answer to encourage recruitment and retention in our vital services. I have given some of the simplest costs in financial terms that the public would understand, so surely a reorganisation with a community focus for older people’s care may enable better services for the same cost. This of course also includes suitable housing for frail elderly people and, possibly, NHS nursing homes.

Finally, does the Minister agree with a summary in a paper on economics from the BMJ last year, which concluded that spending constraints, especially for personal social care, were associated with a substantial mortality gap? The paper suggested that spending should be targeted on improving care delivery in care homes and people’s homes, and on maintaining or increasing nursing numbers.