NHS: Targets

Baroness Watkins of Tavistock Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the noble Lord, Lord Hunt, for securing this debate. It is a pleasure to follow other noble Lords, who have made very cogent arguments for change, and in particular the maiden speech of the noble Baroness, Lady Wilcox of Newport; it seems like nirvana to think we might have to pay only £90 a week to many people in England.

Clearly we want to reform health and social care to best serve the health and well-being of people in England. I declare my interests as outlined in the register, particularly as a registered nurse, president of the Florence Nightingale Foundation and a former sister in accident and emergency.

At the heart of the issue is whether the NHS should reform the A&E four-hour waiting target a decade after its inception. The national medical director of the NHS considers that a change to the four-hour target and some cancer treatment targets may, based on sound data, serve the population more effectively. I will concentrate on the A&E target and delays to patients’ transfer of care from acute hospitals to their own homes, nursing homes and registered care facilities.

The NHS is piloting a new A&E scheme entitled “rapid care measures” with 14 trusts. The new standards include the rapid assessment of all patients in A&E, coupled with faster life-saving treatments for those with the most critical conditions, including sepsis, heart attacks, strokes and acute psychotic episodes. The initial results are promising, with the number of patients spending over 12 hours in A&E falling faster than in control groups. There appears to be broad public support for these measures. It is vital that any change to targets are clinically appropriate and supported by evidence-based healthcare interventions, which the proposed changes reflect.

Therefore, unlike many in this House, I urge the Government to revise the A&E targets in this way and set clinical teams free to work in a more independent, evidence-based approach focused on individual patient need rather than keeping to a four-hour target set in stone. This is likely to enhance staff morale and improve time from attendance to treatment for those most critically ill. It may also reduce the number of people attending A&E for very minor problems as they may have to wait longer than four hours. We know that many people go to A&E for health problems much better suited to community-based services because they have difficulty accessing a GP or community nurse. The need to increase the number of GPs is essential, but so too is developing and enhancing the role of other healthcare practitioners in the community if we are really serious about system redesign in the NHS and social care.

In the US there has been an increasing focus on systematic change associated with the affordable health care Act, which elevated the role of both physicians’ assistants and nurse practitioners. I have witnessed the positive effects of the introduction of these roles in Washington State, particularly in supporting people with multiple physical and mental chronic health conditions in community settings. An analysis of US census data published this week shows that the number of nurse practitioners has grown at an unprecedented rate across the USA, from around 91,000 in 2010 to 190,000 in 2019. These practitioners are filling a primary care void, particularly in rural areas. A professor of nursing at Montana State University estimates that there will be two nurse practitioners for every five physicians by 2030, compared to one in five in 2016. Will the Government look at this research and investigate whether one way of improving primary care and reducing A&E visits would be to invest more significantly in a range of advanced roles for community healthcare practitioners?

The Government intend to publish plans to reform the social care system this year. That is essential because it will improve people’s lives and, we hope, reduce delayed transfers of care from hospital to the community. Will the Minister please note my support for altering the four-hour A&E targets in the light of the results from the pilot sites? I urge her to ask the noble Baroness, Lady Harding, to work further on the NHS people plan in the way outlined by the noble and gallant Lord, Lord Stirrup, and to consider piloting the NHS funding care packages for a fixed period on discharge for those due to leave hospital, in the way so ably outlined by the noble Lord, Lord Turnberg.