Brexit: Medicine Supply and NHS Staffing

Lord Clark of Windermere Excerpts

Thursday 5th September 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I do not believe that the noble Lord is presenting an accurate picture of the case. We have been very clear with the public, and a lot of information has been published on the MHRA website, on GOV.UK, on nhs.uk and in a number of other places, regarding the information about the analysis of the impact of no deal on patients and on the NHS. We have been very clear about the risks that we think there may be to the supply of medicines due to temporary disruption at the border and the mitigating measures that we have taken to ensure that the supply will continue uninterrupted to patients and to the healthcare system. If the noble Lord wishes to have more information, I am sure that he would be very happy to write to me, and I will place a copy of my reply in the Library.

[Lord Clark of Windermere (Lab)]

My Lords, the noble Baroness is aware that virtually every pharmacist and every GP is experiencing dire shortages of certain medicines already. If the Government have such a good alternative plan for a no-deal Brexit, why do they not bring forward those plans to deal with the shortage that patients are facing today?

[Baroness Blackwood of North Oxford]

At any given time, there are about 100 to 150 medicine shortages within our system. There is a team specifically set up in the Department for Health and Social Care to deal with these shortages. There is no evidence whatsoever that the shortages within the medicine system at the moment are related to Brexit. I work to respond to those shortages every day. The system that we have set up to respond to the potential risks of no deal—which we do not want to happen—is prospective. We are confident that it will be able to respond to any potential border disruption on the short straits.

NHS Dentistry Services

Lord Clark of Windermere Excerpts

Thursday 11th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord is quite right: prevention is always better than cure. That is why the programme for oral health improvement in both the NHS long-term plan and the dental contract being tested focuses on a more preventive approach to oral care. Water fluoridation is obviously a very effective way of improving oral health, particularly for children. According to the 2012 Act, it must be a local decision supported by Public Health England in the lead. We want to see more decisions. PHE’s guidance on delivering better oral health sets out clear expectations on this, but there are also other ways in which fluoride can get to children. One is through fluoride in toothpaste, which is now at effective concentrations; the other is that all dentists are expected to deliver fluoride to teeth directly, at clinically appropriate intervals, to all children in their care.

[Lord Clark of Windermere (Lab)]

Is it true that more than a million people were unable to get a dentist under the health service last year?

[Baroness Blackwood of North Oxford]

I do not have that figure in my briefing pack, but I am very happy to write to the noble Lord to confirm or deny whether that is the case.

National Health Service: Bullying

Lord Clark of Windermere Excerpts

Wednesday 3rd July 2019 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what assessment they have made of the level of bullying, harassment and abuse in the National Health Service in England.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the NHS staff survey shows that the level of bullying, harassment and abuse in the NHS is too high, so we are tackling these issues through the national Social Partnership Forum’s collective call to action; the interim people plan, which, through its new offer for our people, will create a healthy, inclusive and compassionate culture where bullying, harassment and abuse will not be tolerated; and our alliance of healthcare organisations, which is promoting civility and respect throughout the NHS.

[Lord Clark of Windermere (Lab)]

I thank the Minister for her Answer. As she said, the latest survey shows that over 25% of NHS staff had personally experienced bullying from fellow employees in the previous 12 months. Does she agree that that is appalling and intolerable, and that in most other organisations it would simply not be tolerated? I accept that the problem is exacerbated by the chronic staff shortages, but bullying can be reduced by firm and proper management practices. That is within the Government’s power, so will they get on with the action of reducing the intolerable level of bullying in the NHS?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question, which is a follow-up to a recent Question on this. This is exactly why the Government have brought out a manifesto commitment to tackle violence and abuse against staff, including legislation that has already brought forward one conviction. NHS Improvement and NHS England have reviewed what central support arrangements should be provided to support NHS organisations in their responsibility to protect staff from unacceptable violence and abuse. In addition, we are bringing forward a plan that will pilot and evaluate the use of body-worn cameras by paramedics, who experience the worst of the violence and abuse, so that we can ensure that they have evidence for prosecutions that is sadly often lacking for convictions where they are appropriate.

GP Services in Rural Areas

Lord Clark of Windermere Excerpts

Tuesday 2nd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I know that my noble friend, who comes from a family of GPs, has personal experience of this. She raises an important point. We are encouraged that, in the last year, 300 more doctors, 300 more nurses and 700 more staff with direct patient care responsibilities working in general practice have been recruited. HEE has recruited record numbers of doctors into GP training, but we recognise the challenge of recruiting in hard-to-reach areas. That is why we have put in place the targeted enhanced recruitment scheme and we are identifying ways to improve this, such as the under-doctored digital-first practice. We recognise that we need to do more, however, and I would be very happy to meet my noble friend to discuss ways in which we can do that.

[Lord Clark of Windermere (Lab)]

My Lords, the noble Baroness is aware that Cumbria is one of the blackspots for recruitment of GPs, with, in many cases, surgeries completely dependent on the odd locum and the good will of the general nursing practitioners. Bearing in mind that there are 19 million visitors a year to the Lake District and the national park, as well as the resident population, this is not a satisfactory situation. Is she prepared to look into the particular problems of GPs in Cumbria?

[Baroness Blackwood of North Oxford]

I am definitely happy to look into the situation in Cumbria, but this is one reason we have increased the funding specifically to primary and community care above the rate of the general increase to the NHS. It is also why we are bringing in incentives for GPs to work together at scale through the primary care networks and why there will be seven new service specifications for this. They will include enhanced healthcare in care homes, personalised care and supporting early care diagnosis, but also local action to tackle inequalities. This will be one of the specific areas for ICSs, which will lead the way we improve social care, as my noble friend Lord Young pointed out in his earlier answer.

NHS Long-term Plan

Lord Clark of Windermere Excerpts

Monday 1st July 2019 Lords Chamber

[Lord Clark of Windermere (Lab)]

We are very keen that the Government’s attempt to have a proper plan should work. The Minister knows that the staff are working under shortages of numbers and terrible shortages of finance. The Government go on and on about promised increased finance. According to the Health Foundation, funding for the wider health budget, which includes public health, will in real terms be £1 billion less in the next financial year. Are they right?

[Baroness Blackwood of North Oxford]

It is very important to pay tribute to the extraordinary work that NHS staff are doing across the system and in the wider healthcare system—we should thank them for that. The noble Lord is right that there is great financial stress in the system. A lot of work has gone into trying to alleviate it. That is why the NHS is one of the few parts of the public health system which received a significant increase in the £22 billion increase.

As for the public health system, training and the capital and social care investment, this will be part of the SR negotiations. I am sure the noble Lord will be aware that the Department of Health and Social Care will be making a strong case for increasing those parts of the system, because we believe it needs to increase just as much as he does.

NHS: Bullying

Lord Clark of Windermere Excerpts

Wednesday 5th June 2019 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty's Government what are the latest figures for bullying in the National Health Service; and what are their plans to reduce the level of such bullying.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government are committed to supporting NHS organisations in their responsibility to tackle bullying. Some 28.3% of staff responding to the 2018 NHS staff survey experienced bullying from patients, service users or the public, 3.2% from managers and 19.1% from colleagues. Through the NHS Social Partnership Forum’s collective call to action and commitments in the NHS people plan, the Government are working with these arm’s-length bodies, the royal colleges, the NHS national “freedom to speak up” guardian, NHS organisations and health unions to reduce levels of bullying for all staff, and they deserve our thanks for all their work.

[Lord Clark of Windermere (Lab)]

I thank the Minister for her Answer. As she indicated, the NHS depends entirely on the commitment and dedication of its staff. It is really appalling that 28% of them experienced bullying and harassment in the last year alone, as she said. Just 12 months ago, her predecessor as Minister told me that over 70,000 members of staff had suffered physical violence in the service, and those figures are three years old. That is indefensible. We need to protect these employees. Will she make it clear that physical attacks will simply not be tolerated? Will she upgrade the service’s register of violent and abusive patients, relatives and friends, and will she confirm that there will be zero tolerance against physical attacks on our NHS staff?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his Question and I share his outrage. We absolutely must have zero tolerance of violence against any NHS workers, wherever they work within the National Health Service. That is exactly why the Secretary of State made a commitment to the national NHS violence reduction strategy, which was launched on 31 October 2018. It will put in place arrangements to support trusts in their responsibilities to protect staff. The recommendations include improving governance, improving staff training and development, improving the work environment and better use of legislation, including the new Assaults on Emergency Workers (Offences) Act, which had its first conviction in November. That is a significant improvement, but we know that improving general morale and the workforce environment are important, which is why we published the people plan this week.

NHS: Shortage of GPs and Nurses

Lord Clark of Windermere Excerpts

Wednesday 8th May 2019 Lords Chamber

Tabled by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what is their response to recent reports that there is a serious shortage of GPs and nurses working in the NHS.

[Lord Clark of Windermere (Lab)]

My Lords, I beg leave to ask a Question of which I have given private notice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government recognise the pressure on the NHS workforce. The forthcoming NHS people plan will set out how we will attract more people into training and keep the workforce that we have in the NHS. In 2018, Health Education England recruited a record 3,473 junior doctors into GP specialty training—a 10% increase since 2017. Demand for nursing courses is strong: the latest data, published this February, showed a 4.5% increase in the number of applicants compared with 2018.

[Lord Clark of Windermere]

My Lords, I thank the Minister for her Answer and acknowledge her long-term commitment to the National Health Service. I shall not just swap statistics with her—that is easy—but I wish the Government would not keep repeating basic statistics. She talked about an increase in the number of GPs, but we have the lowest number of GPs for more than 50 years, with patients on occasion having to wait seven weeks for an appointment. We know that there is a 40,000 shortage in the number of nurses and that, according to the interim report that the Government have received and despite all their efforts, that figure could increase to 68,500. That report states that shortages in nursing are the single biggest and most urgent problem. Instead of playing around, will the Government seriously address the drastic situation that our NHS is in? We truly survive because of the efforts of the staff.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his Question and I echo his sentiments exactly in thanking GPs, nurses and all of our NHS workforce. Probably every noble Lord in this Chamber has a personal story of owing the NHS for personal service, as we do as a nation. That is exactly why the Government have put in a serious plan to address the challenges within the workforce. First, within the long-term plan we identified an increase in funding that is higher within general practice and community care than the wider increase in funding of £4.5 billion. Secondly, we have recruited the highest number of GP trainees ever. This is not swapping statistics, this is identifying the fact that we are being successful in recruiting into a challenging specialty. Thirdly, we are opening brand new medical schools to ensure that we have the capacity to increase training, while recognising that it takes time to grow a doctor. Fourthly, we are putting in place incentive programmes to make sure that the job is more attractive, so that we can retain those individuals.

Within the new general practice contract framework we have put funding in place for up to 20,000 more support and technical staff working in GP practices in order to relieve the pressure within that job. This will help bring down delays in getting appointments and make sure that the job is more attractive in itself. When it comes to nursing, we have put in place a pipeline, with new nursing associates and the new nursing degree apprenticeship, and we see this starting to pay off. So there is an improving picture, but there is still some way to go. We are making sure that we put in place a serious plan and we are determined to deliver on it.

Brexit: Counterfeit Medicines

Lord Clark of Windermere Excerpts

Thursday 7th February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her Question. As stated in the response to the MHRA’s recent no-deal consultation, it is expected that stakeholders would no longer be able to comply with the requirement to verify and authenticate medicines, so legal obligations related to this would be removed. In this scenario, we have committed to evaluate options for a future falsified medicines regulatory framework, taking into account investment made by stakeholders. It is important to note that the majority of the FMD was already implemented in 2013, and also that the MHRA has 30 years of experience as a world-leading regulator of more than 3,500 medicines. We expect that patients will remain safe and that there will be continuity of supply so that we can have confidence in medicines and safety for patients.

[Lord Clark of Windermere (Lab)]

My Lords, I congratulate the noble Baroness on her appointment. As she knows, the European medicines verification system becomes effective this Saturday, I believe. Is she confident that we have sufficient personnel and procedures to implement it immediately? Will she also say whether, if the Commons were to approve the Prime Minister’s preferred agreement, this protection would be included?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question. We are committed to meeting the 9 February deadline for the launch of FMD safety measures. We expect all stakeholders in the UK’s supply chain to be aiming to comply with the requirements. We know that much of the supply chain is already prepared, but it is a complex chain, setting up medicine supply across the EU. The main challenges concern error messages; several member states—including Denmark, Portugal, the Netherlands and Ireland—have noted, unrelated to Brexit, that there will be challenges in implementation. The MHRA has notified the supply chain that we will be taking a pragmatic approach to implementation. This is appropriate, to ensure patient safety and a continuation of dispensing.

NHS: Specialist Services in Remote Areas

Lord Clark of Windermere Excerpts

Tuesday 11th December 2018 Lords Chamber

[Lord O'Shaughnessy]

There are a number of schemes, as the noble Baroness points out. As well as the travel costs scheme, there is the low-income scheme. They are designed to help people with those kinds of costs. I do not have the specific numbers about take-up, but I shall certainly write to her with those.

[Lord Clark of Windermere (Lab)]

The Minister is correct to highlight the building of new hospitals, but these are no good if you cannot attract staff to them. Can he comment on the pilot scheme in west Cumbria which is training senior nurses to undertake the work of some junior doctors? How successful has that been, and how many students will take part in the second year of the course, which starts in January? What plans do the Government have to increase the number of staff right across the health service?

[Lord O'Shaughnessy]

I shall look at the scheme the noble Lord mentions and would be delighted to follow up with him directly on that. We need more staff; we have more NHS staff than we did in 2010, but nevertheless we need more GPs and nurses. Of course, we also need to diversify the workforce in new ways. One of the most exciting innovations in the workforce sphere recently is the creation of several thousand nursing associate posts to support nurses and doctors in a range of settings.

Domestic Abuse: General Practitioner Charges

Lord Clark of Windermere Excerpts

Thursday 15th November 2018 Lords Chamber

[Lord O’Shaughnessy]

I join the noble Baroness in condemning this type of crime, and it is disturbing that violence against older victims has risen. That is precisely the reason the Government have asked the Law Commission to look at the issue and bring forward suggestions on how to give the authorities greater powers to clamp down on those who perpetrate such crimes.

[Lord Clark of Windermere (Lab)]

My Lords, is the Minister concerned that the treatment of these abuse issues is under serious threat, given that many surgeries in the north of England no longer have a single permanent doctor?

[Lord O’Shaughnessy]

I do not think that it is an issue of staffing per se, because it is not only doctors but other healthcare professionals who are able to provide letters of this kind. The evidence that has been gathered through consultation and indeed through the progress of the secure tenancies Bill is that the charges for these letters act as a barrier. That is the issue we are trying to address.