Health and Social Care Update

Baroness Merron Excerpts

Monday 10th October 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, it may have been some weeks since this Statement was made in the other place, but its subject matter is as relevant today as it was when it first saw the light of day. The big questions remain: among them, where are the costings and how will it be funded?

The NHS is facing the worst crisis it has ever seen, with patients waiting longer than ever in A&E, stroke and heart attack victims waiting an hour for an ambulance and some 378,000 patients waiting more than a year for an operation. Those figures date back to the summer—before we even get to the winter and the challenges winter always brings.

At the time of the Statement, the NHS Confederation’s verdict was that

“these measures will not come close to ensuring patients who need to be seen can be within the timescales set out … they will have minimal impact on fixing the current problems that general practice is facing over the winter”.

But has not the situation got even worse since this Statement was first heard? The scale of the challenge faced by our health and social care services, the people who work in them and the public who rely on them has worsened as the state of the economy worsens. The country is now experiencing spiralling inflation which far exceeds the assumptions on which budgets were set, while those who work in the health and care services are struggling with the cost of living. What will be the response to this? How and where will the so-called efficiency savings demanded by the Treasury be found?

What we do know is that the impact will not be equal. As the right reverend Prelate the Bishop of London addressed at the weekend, it has been reported that the Government’s long-promised White Paper on health disparities has been dropped. Can the Minister confirm this? If that is not the case, can he advise on when can we expect this crucial plan to narrow the widening inequalities in health outcomes between the poorest and the wealthiest, between white and black, Asian and minority-ethnic people and between those in the north and south?

The Statement says that patients will be able to get a GP appointment within two weeks, but let us remind ourselves that, prior to 2010, the guarantee of an appointment was within two days, not merely an expectation of two weeks. Can the Minister provide more detail as to how the two-week expectation will be met? I ask this in the context of the record numbers of GPs indicating that they will be retiring or leaving the profession, where burnout and low morale are at an all-time high. How will the numbers stack up when 4,700 GPs have been cut over the past decade, and the long-promised 6,000 GPs are not on course to be delivered? With 330 practices having closed in just the last three years, where will these appointments take place? Are there plans to open new practices?

The gaping hole at the heart of the Statement is, as we know, the lack of a workforce strategy. In the ABCD plan presented by the Health Secretary, the only reference is under D, which refers to doctors and dentists. They are important—there is no doubt about that—but what about the nurses, paramedics, technicians, care workers, cleaners and caterers? Without a plan to tackle the whole staffing crisis, there is not a plan for the NHS.

What are the Government going to do about the staff shortages of 132,000 in the NHS today? This cannot be overlooked. Earlier today, the Minister told your Lordships’ House that there were 200,000 more staff in the NHS than 12 years ago. Perhaps he could elaborate further. Are these full-time equivalents? Where are they and what roles do they perform? Crucially, does the Minister accept that there still needs to be a fully costed plan to deliver the workforce that we so desperately need?

The Statement refers to some £500 million to speed up delayed discharges. Can the Minister help with some more detail on this? Is it a new investment or a re-announcement? How will it be funded? It is indeed right to say that if patients cannot get out through the back door of the hospital because care is not there in the community, we get more patients at the front door and more ambulances queuing at the front. That is exactly the situation we see today. The crucial point is that unless the Government act on care workers’ pay and conditions, employers will not be able to recruit and retain the staff they need. What is the plan to address this?

Finally, can the Minister reassure the House and patients across the country that the response to the crisis in the NHS will not be to lower standards for patients but to raise performance instead? I am sorry to say that this Statement misses the target. I hope the Minister will reflect on the points that I have raised, and other noble Lords will undoubtedly raise, and take the opportunity to use his new and important position to make proper change and improvement.

[Baroness Brinton (LD)]

My Lords, I echo the comments of the noble Baroness, Lady Merron, about the nature of the plan. It is full of warm words and aspiration, light on detail, especially on funding, and seems to disregard the reality on the ground at the moment. I also echo her concern about the rumours of the White Paper on inequalities being shelved. That is really important. Many of us spent a lot of time in your Lordships’ House during Covid hearing about the problems of people with Covid, particularly those from ethnic minorities and deprived backgrounds. There is a lot of data to say that those people have really struggled.

The workforce plan is something else that from these Benches we asked for consistently long before work started on the Health and Care Act, but absolutely consistently since then. Turning to the plan itself, on ambulances, the announcement in July was welcome but three months on—and this was an emergency announcement—it feels as if nothing has changed. The number of delayed discharges remains stubbornly high, and we know that there is a new wave of Covid rising: the ZOE study figures today suggest around 230,000 new daily cases and 2.2 million active cases. That is going to continue to rise: all the medical experts in this area say we are now definitely at the beginning of this wave.

B stands for backlogs, and I am afraid that that is not really improving either. Although it is good to see that the two-year waiting list is reducing, the under-two year list continues to grow: 6.8 million at the end of last month. The plan talks about patients being redirected from hospitals, but our primary care system—GPs, community nurses, physios, speech and language therapists in the community, and especially social care—is already at breaking point. It is good to be offering Covid boosters, but why are under-12s excluded unless they are immunocompromised? Children at schools without proper ventilation were drivers of the last two waves of Covid, and it just seems ridiculous that they have not been included, because that would be an easy win.

In my question earlier today, I asked the Minister about care and particularly about virtual hospitals. It is good that the plan is picking up on some excellence in the NHS, and I am very proud of my local hospital for doing it, but the Minister did not actually answer my question, which was: given that this work of virtual hospitals creates more work for GPs, community nurses, physiotherapists in the community that in the past would have been done in hospitals, will there be extra resources for primary care? Without it, primary care is already at breaking point; they cannot just magic extra time and energy to do it.

The section about GPs is admirable in spirit, but doctors have repeatedly said that their main problem is a lack of doctors. We also know from the BMA survey back in the spring that GPs’ workload has increased by 30% on clinical administration alone. It is not Covid; it is mainly to do with digitisation and complex systems. It is all very well talking about getting administrators in to do it, but these are administrative tasks that doctors have to do themselves. Unfortunately, it is causing a problem, and I do not see any solution in the plan.

Whenever Ministers talk about doctors, they talk about the highest number ever—indeed, the Minister did so earlier—but there are two problems with that. There are more patients than ever, and that is never reflected in any comments by Ministers. Government funding for doctor training has not been sustained. This year, far too many—hundreds, just under 1,000—newly qualified doctors, fresh out of university, could not get training places because there was no funding for hospitals to be able to do it. The exodus of NHS staff was reported in the Times just last Saturday. The net change is not positive now; it is negative.

On dentists, it is very good news about the simplification of government rules regarding overseas dentists qualifying to work, and we look forward to seeing the regulation shortly, but the main problem is the drastic need to overhaul the government contract. While the Statement says first steps are being taken, I ask the Minister when the major work funding for it will be concluded. Will he also tell your Lordships’ House what provision there will be for the 3 million people who are either immunosuppressed or immunocompromised—for example, because of blood cancer or because of strong medication which has to suppress their immune systems? The government advice on the web page still says that people in this group should not mix with people who are not fully vaccinated or may possibly be brewing Covid, but a year ago all support to this group was ended. Along with other people in this group, because I am one of them, I am about to have my sixth Covid jab, but I have no idea how long I am going to be protected for—that is why I wear a mask a lot of the time in the Chamber. Half a million of the most severely immunocompromised people cannot make any antibodies in response to the vaccine. They were promised antiviral medication or Evusheld. Five million doses of antivirals were ordered, but only 50,000 were handed out, and the Government have just refused to allow Evusheld to be used. What will the Minister do to ensure that this group of people will be protected?

Finally, the Health Service Journal has said that two out of three integrated care systems have fallen off track on their financial plans because of the impact of inflation, Covid cases not being funded this financial year and higher spending on agency staff. This plan will not work if the new integrated care systems cannot work. It is vital that the Minister tells us what plans there are to make sure that ICSs will be supported properly.

The plan for patients has many warm words for delivery. I know this is something the Minister cares greatly for, and we will support him, but the words on their own will not do it. Our NHS and care sector are on their knees already. The Nuffield Trust report says that data shows that even without the pandemic, the backlog would have been well over 5 million. It says the NHS was already stretched. I look forward to hearing the Minister explain how the NHS and care sector will be able to deliver on this plan in their current state.

--- Later in debate ---

[Lord Markham (Con)]

As I mentioned, we have 3,500 more doctors, but the 50 million more appointments target, which we are well on the way to delivering, is from not just GPs but across the piece. It is also from nurses and community pharmacies. I think we would all agree that doctors are our most precious resource. Given the comments on not wishing to overburden them and the stresses of that, we need to make sure that their limited time is focused on the patients that most essentially need that time. We are expanding supply and spreading it among nurses—as I mentioned, from my experience with my mother, they are very capable and willing to pick up a lot—and among pharmacies as well.

[Baroness Merron (Lab)]

My Lords, I appreciate the answers that the Minister has given your Lordships’ House, but would he be good enough to write to address a number of the more detailed questions raised and give the information requested?