NHS: Winter Staffing Levels

Lord O'Shaughnessy Excerpts

Thursday 26th October 2017 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have to increase staffing levels in the National Health Service to meet anticipated demand during the forthcoming winter period.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)]

My Lords, providing appropriate staffing over winter is essential. NHS England and NHS Improvement have worked together to make sure that every major consultant-led emergency department has a robust plan to meet demand. This includes necessary staffing levels. In addition, the department has provided £100 million to relieve pressure on urgent and emergency care specifically to allow primary care streaming and improve patient flow in A&E departments.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his reply. Those are soothing words, but I am afraid not really matched by the reality on the ground. It is clear that we face a dire prospect this winter on account of the Government’s poor labour planning over the years they have been in power. We know that we are 40,000 nurses short, GP numbers are tumbling and adult social care staff numbers have fallen from 70,000 to 48,000 in four years. Last year, 45% of the consultant posts advertised were not able to be filled. We really are in a very difficult position.

I ask the Minister a very specific question: is it true that the Government have given the go-ahead for vulnerable patients who are not fit to be discharged to their home to be discharged to third parties? They will be allocated to homes where the hosts have no medical expertise and for which they will get paid £1,000 a month.

[Lord Clark of Windermere]

This is my final question. Will the Government not listen to medical opinion and drop this preposterous scheme?

[Lord O’Shaughnessy]

The noble Lord knows that winter is always a more difficult time for the NHS. I hope he also knows that there are 11,000 more nurses on wards than there were in 2010. Indeed, I was looking at the data on doctors. There has been a 30% uplift in emergency doctors in that time as well. So there are more staff in the NHS—but, of course, there is much more need for winter preparedness. The NHS feels that it is better prepared than ever for winter.

On the issue that the noble Lord refers to—I assume he is talking about the story in the press today—that is, I stress, a local pilot that is being explored. I do not think it is even under way. It is being proposed by a local doctor—indeed, an emergency registrar. For it to go ahead, it is clear that any such pilot would have to abide by the very strict rules that exist on safety, safeguarding quality and so on for any care setting. The head of Age UK said that any new innovation—I think we want to encourage innovation—needs to pass the mum or grandma test. I think that is a very reasonable test to apply to something such as this.

[Lord Ribeiro (Con)]

My Lords, the only way in which to increase staffing levels in anticipation of the flu epidemic is through agency staff, which is going to cost a huge amount of money. Surely, the better thing to do would be to ensure that all health staff are vaccinated so they are at least healthy when the epidemic hits us—if it does.

[Lord O’Shaughnessy]

My noble friend talks with great authority on this issue and he is quite right. The NHS is offering all front-line health staff free vaccinations. NHS England has confirmed that it will also be paying for care workers in social care settings to get free jabs. Furthermore, we are now, for the first time, inoculating in school children aged between two and eight, who are sometimes known as “superspreaders”. This is to ensure that, if such an epidemic were to happen, we would be as well prepared as ever.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister join me in acknowledging the stance being taken by the NMC in seriously considering changes to the English language test to make it more relevant to nursing practice, while maintaining patient safety? This has the potential to increase significantly the recruitment of overseas nurses in the UK. I also seek assurance that the Government will not cut investment in district nurse training.

[Lord O’Shaughnessy]

I am grateful to the noble Baroness for raising this. We have discussed a number of times the impact of the test on recruitment from countries other than the UK. It is entirely sensible for the NMC to look at this. On nurse training, I hope she will have been reassured by the announcement from my right honourable friend the Secretary of State for Health at the Conservative Party conference that we will deliver a 25% increase in nurse training places from 2018-19 onwards.

[Lord Rennard (LD)]

My Lords, is not part of the problem for the NHS, and for hospitals in particular, during the winter that so many people have difficulty in accessing their GP? The number of GPs has fallen by 3% over the last two years. Is it not, therefore, counterproductive that the Government have been cutting funding for community pharmacies when many more people should be seeing their pharmacist and not seeking to see their GP or even turning up at A&E units?

--- Later in debate ---

[Lord O’Shaughnessy]

We recently debated community pharmacies. Reforms have ensured that most people—more than 80%—are within a 20-minute walk of a community pharmacy. As a consequence of these reforms, there has been no decrease in the number of community pharmacies in England.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the case raised by my noble friend relating to Essex goes to the heart of the problem of discharging patients from NHS hospitals because of the lack of support in the community from social care and the reduction in nursing home places during the last four years. Is the Minister as surprised as I am that, despite this, up and down the country the NHS, through its sustainability and transformation plans, is putting forward proposals to cut out community hospitals and community hospital beds? Will Ministers issue an instruction to the NHS so that this will not be allowed to happen?

[Lord O’Shaughnessy]

We have discussed the issue of nursing home beds. We also know that there has been an increase in the provision of domiciliary care packages which reflects people’s changing care needs. Figures published yesterday show that social care spending has risen by £500 million during 2016-17. I am sure this will be warmly welcomed across the House. On community beds, noble Lords should know that, in addition to the usual four tests for reconfigurations, last year Simon Stevens, the head of NHS England, said that there is now a fifth test—the bed test. There must be robust evidence that any proposed reduction in beds is because of a reduction in demand and not the other way round.