NHS: Nurses

Baroness Watkins of Tavistock Excerpts

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

To be very clear, today, there are 29,000 extra, over the 2019 figures. That is more than half way towards the figure of 50,000. I will quite happily write to noble Lords so that they can see the figures clearly in black and white, but I can assure the House that we are talking about increases in nurse numbers. We have achieved a 29,000 increase on the 2019 levels.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a registered nurse and would like to follow on from the noble Baroness, Lady Chisholm. We must grow our domestic workforce in nursing. I do not dispute the figures the Minister has given, but any nurse earning more than £27,000 who trained recently is now repaying 9% towards their student loan, on top of the 20% tax they are paying. I accept that they get a £5,000 bursary a year, but they work extraordinarily long hours compared with ordinary students. It really is essential that we find a way to retain those young nurses who have just trained by doing a debt write-off of their loan after five or six years.

[Lord Markham (Con)]

I totally agree that retention and attracting people into the profession are key. I like to think that we are looking at all these things in the round, taking into account the £5,000 grant, the service they are giving, and their conditions and pay going forward. As ever, this is a moving feast, for want of a better term, so we will keep looking at it to make sure we continue to both attract and retain the domestic and international staff numbers.

Nursing: Recruitment

Baroness Watkins of Tavistock Excerpts

Wednesday 26th October 2022 Lords Chamber

[Lord Markham (Con)]

First, we are actually exceeding the number of leavers. There were 36,000 people who left last year and 45,000 who joined—a net increase of 9,000. That is not to say that we do not want to retain people. I absolutely accept the premise that we do, which is why we have a retention programme in place to ensure that we are able to do so. We also have a restart programme to help people who have left to get back into nursing in a quick and easy way. Overall, the main point here is that the number of joiners is exceeding the number of leavers. We are more than catching the number up; we are exceeding it.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as a nurse and the co-editor of the WHO report, State of the World’s Nursing. It is true that we have 9,000 additional nurses, but of the 48,000 who in the last year joined the register for the whole UK—for the four countries, not just England—more than half had trained overseas. Those nurses are very welcome here, but it illustrates that we are not encouraging people who wish to go into nursing to do so, beyond the 72,000 the Minister referred to. That is very much to do with student finance and the lack of apprenticeship opportunities for older people who want to go into the profession. Can the Minister look into increasing those opportunities?

[Lord Markham (Con)]

Indeed, and towards that aim we have set up the nursing associate role, which is a stepping-stone to allow people to ease in and have qualifications on the way to becoming a fully trained nurse. The overall point I make, as before, is that by putting in a £5,000-a-year grant for student nurses, we are recruiting the numbers. I reiterate that 72,000 is a big pipeline but also that it is an uncapped pipeline. The more we can attract, the merrier—whether domestically or, as in the fine tradition of the NHS, from overseas sources.

Health and Social Care Update

Baroness Watkins of Tavistock Excerpts

Monday 10th October 2022 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I welcome the new Minister and declare my interests, in particular that I share his interest in the nursing profession. I have two questions. One is about the 15 units where particular problems have been identified. Does he think that is to do with demography, particularly older populations, and that we have got the funding calculation right in those areas? Secondly, is he prepared to meet me to talk about retaining people who are currently qualifying who, if they do overtime, are being hit with the 9% repayment for their student loans? This means there is very little incentive for the younger generation to do overtime, despite their being the fittest and probably most able to do so.

[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.

Primary and Community Care: Improving Patient Outcomes

Baroness Watkins of Tavistock Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, it is a pleasure to follow the noble Baroness. I congratulate my noble friend Lord Patel on securing time for this important debate and support his proposal for a special committee. I declare my interests as a registered nurse and as president of the Florence Nightingale Foundation.

Other noble Lords have spoken about the medical workforce—in particular, general practitioners—and the need to invest in dentistry services. I will focus on the multidisciplinary teamwork in general practice and community care, with a particular emphasis on nurses, midwives and health visitors. In England, the primary care networks have enabled some community nurses and GP practices to work closely together at a local place level. This is building on a successful neighbourhood model that has been in existence for many decades. However, as briefing from the Queen’s Nursing Institute reminds us, a one-size-fits-all model does not apply because of the variety of geographical neighbourhoods—including rural and urban communities —and the different needs within those communities.

The Fuller stocktake report referred to by other noble Lords gives good examples of where services work closely together, successfully emphasising that the focus in both community and primary care should be on good outcomes for patients, not a one-size-fits-all approach for the sake of administrative uniformity. It is for that reason that the local integrated care boards should ensure that local practitioners, in partnership with the people they serve, are closely involved in determining the shape of local community services. It is widely recognised in government that there is a significant workforce shortage in the NHS, including in primary and community care. Yet everything points to the need for more care to be delivered in patients’ homes and in community settings, and this must be considered in workforce planning.

It is particularly vital that we educate more qualified specialist district nurses to lead and manage teams in the community. This in turn links to patient safety and quality outcomes. Similar investments are necessary in the mental health and learning disability community nursing services. Our extremely esteemed colleague my noble friend Lord Kakkar, who is a surgeon, defined this very accurately in his speech, so it is a pleasure to agree with him. There is significant untapped potential in the nursing workforce and many other healthcare professions including, for example, physiotherapy and occupational therapy. All healthcare professionals should be encouraged to use the skills and knowledge they have to the highest level of practice for which they have been educated. Instead, many feel frustrated that they are not enabled to work to their maximum potential. We need to be clear about career development for healthcare professionals working in community settings. This would aid retention and develop more independent and professional practice, meaning that many patients with long-term conditions would need to be seen by GPs only when their healthcare status changed significantly.

It is argued that the first 1,001 days from pregnancy to the age of two are a period of unique rapid development which lays the foundations for a child’s lifelong mental and physical health. Midwives, who lead interventions, including support with breastfeeding, smoking cessation and parental emotional well-being, have a positive and far-reaching impact on a child’s subsequent health development and life chances. The reverse is also true, and it is often during pregnancy that families get locked into the intergenerational cycles of inequality. For example, babies born to families on lower incomes are significantly more likely to be born underweight, have higher risks of mortality and experience of developmental problems.

The latest NHS workforce figures for England show that there were 541 fewer midwives in June 2022 compared with 12 months earlier. The drop in numbers was particularly pronounced in the north of England—evidence of the need to level up. The most recent Office for National Statistics figures show that 11,000 more babies were born in 2021 than in the previous year, so we have fewer midwives yet more births. The Institute of Health Visiting estimates that there is a shortfall of 5,000 full-time equivalents in England—a loss of over a third since 2015. It is worth noting that there were 536 child serious harm events in 2020-21 including, sadly, some child deaths. This was an increase of nearly 20% on 2019-20.

The health visitor performance matrices from August 2022 show that the lowest-performing local authorities had 4.2% of new birth visits within 14 days and 5% of two to two-and-a-half-year reviews, against the highest-performing local authorities, where the figures were 99.3% and 100% respectively. This means that, in some parts of the country, almost all children receive a two to two-and-a-half-year review whereas, in others, fewer than one in 10 children is assessed by health visitors for what are deemed to be mandated contacts. This kind of postcode lottery should be of significant concern to us all. Health visitors make a difference through improved identification of children with developmental delay and vulnerabilities by supporting families through early intervention and thus improving outcomes.

Does the Minister agree that it would be helpful to harness the skills and experience of all clinicians in the delivery of public health and to locate health and care services in easily accessible and prominent community facilities? This would enable healthcare teams to work closely together and make preventive care easily accessible to all. Early intervention is not only crucial to the health and well-being of families and children but good for community cohesion and economic productivity, as well as leading to savings in the cost of unemployment, crime and mental illness.

Finally, I turn to information from the Royal College of Nursing. In June this year, it reported that over half of nurse respondents in primary care said that there were insufficient nursing staff to safely meet the needs of their patients, and two-thirds said that the skill mix was not appropriate to meet the needs and dependencies of the service users and patients effectively. With advanced skills, registered nurses in primary and community care should be able to lead care for patients who have received accurate diagnosis and treatment plans from GPs and/or hospital consultants. Safely delivering high-quality care improves patients’ outcome and reduces readmission to hospital.

Key to patient outcomes are the structure and processes of health and social care services—and, I would add, housing. Investment is urgently needed to improve the digitalisation of patient records and test results in primary care. Patients want effective healthcare delivered by compassionate, professional, trained staff and to understand their treatment, which assists them in adhering to their own personal care plans. The latest idea in general practice is to be told, “You’ve had this blood taken, but if you don’t hear from us then everything is fine.” None of us trusts it, to be honest.

Local integrated care boards should be involved in planning the most appropriate structures and processes of services to meet their local need, but must also be mindful of ensuring uniformity of access to NHS-funded services in England; I recognise that not all services have to be delivered directly by the NHS. Access to community-based physical and mental health services is as important as the right to an operation or emergency care following an accident. Can the Minister assure the House that this aim will be supported by the Government to improve patient outcomes and reduce the disparity of access to primary and community services in England?

Disabled People: Personal Assistants

Baroness Watkins of Tavistock Excerpts

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an important point about who should be in that room when we are talking about all these issues. Generally, across government, there are a number of joint initiatives in terms of ensuring that we hit our target of equality for disabled people, but as other noble Lords have pointed out, this issue falls between DWP and DHSC. I was surprised when I was briefed on this about where it fell. It clearly must be people in the same room.

[Baroness Watkins of Tavistock (CB)]

My Lords, it was a pleasure earlier to hear the new Health Secretary say that this is the kind of example that she would want to resolve—she did not use a particular one. Could the new integrated care boards not be the trusted sponsor for such personal assistance in each area? It would be straightforward and simple to introduce.

[Lord Kamall (Con)]

On the face of it, that sounds a very sensible suggestion, so let me take it back to the department, and if I am still here, I will respond.

Cannabis: Medicinal Use

Baroness Watkins of Tavistock Excerpts

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

I do not know how to respond to that. All I will say to the noble Baroness is that nothing could be further from the truth. This is clearly an issue based on medicinal cannabis. The noble Baroness will know that my party is a coalition; there are quite a number of libertarians in my party who would take a very different view on banning these issues. What is really important is that, to be licensed as a medicine, it has to be approved by the MHRA; to be approved by the MHRA, except in very exceptional circumstances, you have to go through trials. These companies make a lot of money; they can afford to go through the trials; they are just choosing not to.

[Baroness Watkins of Tavistock (CB)]

My Lords, NICE has actually supported the limited use of medical cannabis. It has, over many years, supported the limited use of novel drugs in cancer and heart disease, which have been readily available. Does the Minister agree that it is a national scandal that we are discriminating against some of the most vulnerable people with severe epilepsy in our country by not providing this in limited forms on the NHS pre further clinical trials?

[Lord Kamall (Con)]

What I would say is that it is left up to the doctors, who are able to ask for it to be prescribed on the NHS. In some cases, that has clearly not been accepted and that is why people have to go privately, but the best way to solve this problem is for the industry to come forward and go through trials. The offer is open, the NIHR has money available, but for some reason the companies prefer to sell it unlicensed.

Polio

Baroness Watkins of Tavistock Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

Vaccination is already part of a national plan. People should be vaccinated at certain ages—I think it is in the first few months, and then in preschool and then at about the age of 14, when they get their booster at school. A couple of things could have happened. Someone may have travelled overseas, had the oral polio vaccine and then excreted it into the system—and it has happened on more than one occasion. On top of that, the important message is: check your records and make sure that you are vaccinated. It is not a matter of trying to get a new vaccine; it is already part of NHS routine. We encourage more people to come forward.

[Baroness Watkins of Tavistock (CB)]

Can the Minister clarify further what we will do to encourage vaccinations, while schools are still open, for 14 year-olds and for the 11% of under-twos in Greater London who are not vaccinated at the moment?

[Lord Kamall (Con)]

Part of the public health message has been focused on making sure that people come forward, even before this was detected in the sewage works. One thing we saw as a result of lockdown was that some parents in some areas had not taken their young children to their doctor to have the vaccine. Let me be clear: at eight, 12 and 16 weeks, a child gets a 6-in-1 vaccine; at three years and four months, as part of the 4-in-1 preschool booster, they get it; and at 14 years they get one at school as a teenage booster. Some of those are pre school. We are encouraging people to check their red book, check their vaccination record and make sure they take their child in for their vaccine.

Personal Protective Equipment: Waste

Baroness Watkins of Tavistock Excerpts

Tuesday 14th June 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend is absolutely right that there has been an elective backlog. In analysing the backlog across the system we have found that about 75% to 80% of those waiting are waiting not for surgery but for diagnosis. This is why we have rolled out community diagnosis centres and will continue to do so, not necessarily in NHS settings but also in sports grounds, shopping centres, et cetera. On top of that, about 75% to 80% of those who require surgery do not require an overnight stay. We are trying to work through the elective backlog as quickly and effectively as possible.

[Baroness Watkins of Tavistock (CB)]

My Lords, what investment is being made to ensure that we can make our own PPE in this country in future, because the chief problem was that we were competing in an international market in a crisis?

[Lord Kamall (Con)]

I am not aware of detailed proposals on that but I know that there are many British companies who sourced from abroad and others that tried to manufacture. If you look at the relative costs and skills in the value chain, you will find that for many of the entrepreneurs in this country it is not cost-effective to manufacture here.

NHS Mental Health Patients in Private Hospitals

Baroness Watkins of Tavistock Excerpts

Thursday 28th April 2022 Lords Chamber

[Lord Kamall (Con)]

I begin, if noble Lords will allow me, by paying tribute to the noble Baroness for her doughty and robust opposition, but also for the advice when I was a new Minister suddenly thrown in at the deep end. It was very comforting to have one of the Opposition help me and give advice—I make no comments about the quality of the advice but I was incredibly grateful. I also pay tribute, to requote her words, to the perfectly formed shadow team. I thank them very much for all their holding us to account.

On the issue, when I was looking at the future of mental health, one thing we have to look at its granularity. There are different types of mental health; someone suffering from eating disorders, for example, will have a very different need from someone who is schizophrenic. It is really important that we do not just assume that everyone needs to be in a bed. Where appropriate, we should move people out to the community but make sure that they are supported there, not just kicked out the door and left to fend for themselves. We are looking at a massive programme of investment and at how we can have more targeted interventions for those suffering from different mental health issues.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as the recent chair of a major HEE review, recommending ways to improve and deliver the mental health nursing workforce, which was released on 20 April. Can the Minister really drill down on the extent to which the new ILATs will be accountable for both local provision of mental health in-patient beds—services are not enough and some people need admission and care in hospital—and the consideration of workforce needs, not only locally but for the services they purchase in the independent and not-for-profit sector?

[Lord Kamall (Con)]

The noble Baroness makes an important point about how we ensure that those who require services in their community receive them, while ensuring that we have the appropriate workforce. She will know that throughout debate on the Health and Care Bill, we have discussed the fact that Health Education England, as well as NHS England, is developing workforce strategies—as are local trusts at their level, which know their needs and requirements at the same time. In terms of the specific question, I shall have to write to the noble Baroness.

Health and Care Bill

Baroness Watkins of Tavistock Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[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.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Watkins, and to ensure that full support for Motion B1 has been presented from all round your Lordships’ House, including the Government Benches. The Green group also supports Motion C1 particularly strongly, and Motions D1, F1, G1 and L1, but I will speak briefly only to Motion B1 because it is so crucial.

In introducing this group the Minister spoke, as the Government often do, about the record numbers of staff in the NHS. I do not think anyone has yet mentioned the NHS staff survey conducted between September and November. Just 21% of nurses and midwives thought that there were enough staff in their unit to do their job properly and provide an adequate standard of care; almost 80% thought there were not enough. The noble Baroness, Lady Tyler, referred to the Ockenden report: that helped to highlight that, despite the fact that the Government have been trying to recruit more midwives, in the last year the number of midwives has actually gone down.

We really have to ask ourselves why the Government are so opposed to this amendment when there is such strong support for it around this House and among all the key bodies around the country. It may be that the Government have an ideological objection to the word “planning”, or that the Minister does, but this is about the future of our NHS and all the evidence says that this is an essential amendment. Surely the Government are not going to let ideology stand in the way of the future of our NHS.

I finish by commenting on the typically wonderful introduction to this group from the noble Baroness, Lady Cumberlege, who referred to the strong civil society campaign. The hashtag for it on Twitter is #StrengthInNumbers, and that says so much. We need the numbers and the facts so that we can get the numbers of staff in the NHS.