Primary Care: Inequality

Lord Evans of Rainow Excerpts

Monday 19th June 2023 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what assessment they have made of the community health worker model in relation to reducing inequality of access to primary care.

[Lord Evans of Rainow (Con)]

My Lords, the Government have made no formal assessment of the community health worker model. However, they are supporting the development of models like the Brazilian one through the additional roles reimbursement scheme. We have delivered on our manifesto commitment to recruit 26,000 additional primary care professionals a year ahead of the March 2024 target. Our Delivery Plan for Recovering Access to Primary Care will also create a more equitable approach, regardless of patients’ routes to access.

[The Lord Bishop of London]

I thank the Minister for his answer. The community health and well-being worker model is widely used in Brazil and has proven extremely effective in improving health outcomes. In Brazil the model accounts for a 34% fall in cardiovascular deaths. In Westminster, the community health worker pilot in Churchill Gardens has been running for two years. Households that receive community health worker visits were 82% more likely to have received screening and health checks that they were eligible for, compared with households that had not received visits. In the light of the success of this pilot, will the Government consider rolling this scheme out, as they seek to reduce health inequalities?

[Lord Evans of Rainow (Con)]

My Lords, I am grateful to the right reverend Prelate for highlighting the benefits of this model, which is a great example of local innovation to tackle health inequalities. I pay tribute to her work as co-chair of the APPG on Rural Health and Care. I also congratulate those involved in rolling out this model in Churchill Gardens and other areas across the country. I understand that plans are under way to expand that further in Westminster. I shall follow the Brazilian model with interest, as I can see how it will work in urban areas. The challenge is to make sure that the model is scalable and able to work in rural and remote communities—a point raised regularly by the right reverend Prelate the Bishop of St Albans and Exeter.

[Baroness McIntosh of Pickering (Con)]

My Lords, how does my noble friend intend to reduce inequalities in rural areas? He just mentioned the difficulties of rolling out primary care in sparsely populated, deeply rural areas. Community health workers and care workers spend a lot of time on the road and have less time to spend with patients. This is something that I hope my noble friend will be able to address.

[Lord Evans of Rainow (Con)]

Our Delivery Plan for Recovering Access to Primary Care, published on 9 May, sets out our ambitions to reduce the number of people struggling to contact their practice and make sure arrangements are made for patients’ care on the day they contact their practice. This plan is committed to improving access experience and outcomes for all patients, including those in diverse groups and rural areas.

[Baroness Meacher (CB)]

My Lords, have the Government considered making it compulsory for every GP practice to have a physiotherapy and a psychological therapy service available in the practice? The numbers of hours, of course, would depend on the size of the practice.

[Lord Evans of Rainow (Con)]

The noble Baroness makes a very good point and she is absolutely right: GP practices are diversifying in the number of people and the types of services that they offer, including those she mentioned.

[Baroness Wheeler (Lab)]

My Lords, does the Minister agree, from the achievements of the scheme in Brazil and the impact coming through from the London pilot, that CHWs could prove particularly valuable in the management of people with multi-morbidities in their own homes? The CHW role of being the eyes and ears of the GP in the community and visiting people in their home the day after hospital discharge to make sure they are okay could be a tool for addressing the revolving-door hospital discharge problem and helping prevent unnecessary visits to A&E. Will the promised primary care emergency care funding be used to support this and the development of other important public health work?

[Lord Evans of Rainow (Con)]

The noble Baroness is exactly right, and that funding will be made available. There are currently four community health and well-being workers covering 500 households in the example I gave. My understanding is that they will not only help with healthcare provision with GPs and local hospitals but work with Jobcentre Plus so they can help people get work and access benefits, to help with mental health conditions and others.

[Lord Allan of Hallam (LD)]

My Lords, as well as the Westminster pilot, studies by organisations such as Imperial College have shown the potential for significant benefits to come from the community health worker model, yet the Minister said in his first response that the department had carried out no formal assessment of the model. Given the potential to improve health outcomes and make savings in acute services, does he agree that such a formal assessment would make sense? Is it something the department would like to do but has just not got round to yet?

[Lord Evans of Rainow (Con)]

The noble Lord raises a good point. He is right that it is still relatively early days: we have to give it an opportunity to embed. I mentioned Churchill Gardens, but it is also happening in rural areas such as Cornwall, west Yorkshire and other parts of the country. We want to see how the scheme works out, because there will be similar results but with a different flavour depending on whether the area is rural, city, metropolitan or coastal.

[Lord Crisp (CB)]

My Lords, it is very good to see that this model is being copied elsewhere, as the noble Lord has just said, but what consideration are the Government giving to developing a new model of primary care that recognises the role that local people, such as these community health workers and, indeed local organisations, can play in delivering both care and support to people locally?

[Lord Evans of Rainow (Con)]

It is a proven case with primary healthcare provision at local level. The noble Lord mentioned local people: it is a combination of charities, friends, neighbours and, indeed, the local parish church, working together to help local people. It is not just a case of turning up at the GP practice; there is an awful lot of work that can be done before it gets to the GP.

[Baroness Blackwood of North Oxford (Con)]

My Lords, social prescribing is an important part of community health, because it acts directly on the social determinants of health. The long-term plan committed to 1,000 new social prescribing link workers in place by 2021, with the goal that at least 900,000 people will be referred to social prescribing by this year. Can the Minister update us on progress so far?

[Lord Evans of Rainow (Con)]

We know that the general practice services are still under huge pressure. I am grateful to the GPs and teams who are working incredibly hard to provide high-quality care in their communities. Our Delivery Plan for Recovering Access to Primary Care, published on 9 May, has shown a significant ability to increase appointments. In the 12 months up to April 2023, an estimated 346 million appointments were booked across all general practices in England, which was an increase of 38 million compared with the 12 months to April 2019. About 550,000 more appointments were delivered per working day in April 2023 than in April 2022 and 150,000 more per working day compared with April 2019. These figures show that we are making progress.

--- Later in debate ---

[Baroness Jolly (LD)]

Can the Minister clarify the difference in training for a community health worker and a community nurse? I declare an interest as I chair the NHS committee for community nursing.

[Lord Evans of Rainow (Con)]

I cannot say what the exact difference is, but I can say that they are very similar and overlap. I will write to the noble Baroness on the differences.

[Baroness Uddin (Non-Afl)]

My Lords, alongside all the good examples that noble Lords have mentioned, I draw the attention of the House to an excellent project developed over 40 years ago operating in the East End of London. It is a community health worker model that works specifically for women and children. It runs excellent services to this day, so the noble Lord might consider inquiring into it as a good model that is in operation. My question is: what progress has been made to address inequalities in leadership positions in the health service, as they impact all the other services that follow?

[Lord Evans of Rainow (Con)]

If the noble Baroness is talking about diversity and equality, the NHS has a fine record as an equal opportunities employer. On her invitation to inquire into the organisation she mentioned that is helping girls and women in her community, I am very happy to look into that.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I think the noble Lord did not quite answer the question from his noble friend on social prescribing. As I understand it, social prescribing is to do principally with non-pharmaceutical interventions which extend the reach of healthcare into areas that benefit, among other things, mental health. Will he have another go at answering it and see whether he can give us a slightly better account?

[Lord Evans of Rainow (Con)]

My Lords, I apologise to my noble friend for not answering her question fully and to the noble Baroness who asked it again. I am a big fan of social prescribing. If I could prescribe one thing to all Members of this House, it would be to take up parkrun, an excellent thing to do on a Saturday at 9 am in your local park. It is sponsored by the Co-op and its strapline is “Run, jog, walk, volunteer”. It is all-inclusive; everybody of any shape or size can turn up. That is a good example of social prescribing.