NHS: Long-term Sustainability

Baroness Chisholm of Owlpen Excerpts

Thursday 18th April 2024 Lords Chamber

[Baroness Chisholm of Owlpen (Non-Afl)]

I congratulate the noble Baroness, Lady Ramsey, on a very moving and brilliant speech. I also thank my noble friend Lord Patel for bringing this timely debate to us today. As he mentioned, community will play a vital role in the future sustainability of the NHS. I will speak briefly on community nurses, who deliver, along with the help of care assistants and families, bespoke care to individuals in their homes and the community. It is not unusual for these professionals to live in the area where they carry out their work, leading to—I feel this is a key point—them having the added advantage of often being aware of the families’ circumstances, bringing the continuation of information, relationships and management. They foster an organic connection for patients and their families—care that is delivered to the community from birth to death.

We all know that primary prevention avoids the manifestation of disease, improving health through information and lifestyle behaviour, which includes dietary and nutrition interventions along with vaccinations, strategies to promote sexual reproductive health, family planning and mental health well-being. If this healthcare can be provided in the community in family hubs, schools, the workplace, medical centres and homes, it obviously frees up hospital beds and unnecessary GP appointments.

However, from what I have read, 4,000 district nurses are providing care for a population of around 55.8 million. That is one nurse per 14,000 people, whereas there is one GP per 1,600 people. The fall since 2010 equates to almost half of NHS community matrons and district nurses, and 29% of health visitors. Health equality is achieved when everyone has a fair and just opportunity to be as healthy as possible. Community-based nurses are well positioned to play an important role in addressing the underlying causes of poor health.

We are all well aware that it is vital that we move from concentrating solely on treatment and management of disease to prevention and social needs. Embedded within the community, community professionals are well positioned to build trust. They see first-hand the limitations associated with those they are involved with, be it in housing, family, mobility, transportation or dietary issues, to mention just a few. They connect and engage with partners from across social, health and other services. That is the ideal, but without the professional numbers required to carry out this vital work and giving them time with their clients, along with time to report back to the multidisciplinary team, none of the above can be achieved.

It is an attractive career that provides flexible working and a diversity of roles as an autonomous and independent practitioner. With the use of modern technology, there should be more productive time with clients and less paperwork. But a survey done by The Queen’s Nursing Institute in 2022 found that, in practice, the application of digital technology is poor. The survey pointed out that poor user experience appeared to be around design and function rather than a lack of computer literacy or enthusiasm. It went on to highlight problems with unsuitable hardware and software, lack of integration and repetition of data entry, as well as a lack of compatibility between different computer systems. That is disappointing. Can the Minister tell us what has been done in this regard and what is being done to raise the level of community nurses and encourage nurses to go into this genre of nursing?

In conclusion, over the past few weeks we have had a record fallout of the workforce due to long-term illness. Community nursing enables patients to remain independent in their homes with bespoke care, which is obviously beneficial to their health, economically beneficial to the NHS and beneficial to the productivity of the country. I have rather rattled through this, but as with sustainability of the NHS, time is of the essence, and it is the same in this Chamber.

Children’s Cancer Services

Baroness Chisholm of Owlpen Excerpts

Wednesday 20th March 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord makes some very good points. Following the NHS review and the evidence put forward, specific cancer treatments will take place at University College Hospital London, which has two particular benefits for patients: radiotherapy and proton beam technology. Ministers want to understand and make the points the noble Lord has made, and to see whether this is a decision we are comfortable with. As I said earlier, since January 2024 we have had the power to call in a decision in exceptional circumstances.

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, we have heard a lot in this House about joined-up thinking, but this is not joined-up thinking. Instead, we are thinking of fragmenting a service which works very well. Co-location is important, in order to enable experts to talk, research and take decisions together. Can the Minister do everything he can to change the decision?

[Lord Markham (Con)]

I am happy to go through the facts. I hope noble Lords know me well enough to know that I like to look at all the evidence, and, clearly, we are at that stage. I saw an excellent example just the other day in Cambridge, where we are building a new centre to put research and treatment under one roof. That, of course, is what the Royal Marsden has for children’s cancer, so I am aware of the benefits and they will be at the front of my mind.

Social Care: Integrated Care Systems

Baroness Chisholm of Owlpen Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

First, I think we can all agree on the necessity of making sure that these are integrated and the vital role that social care plays in all this. I must say, my experience from the places I have visited is that they are well integrated, but I will take that point back and would be pleased to look at any particular examples of where we feel that is not the case because, as I think the whole House will agree, it is vital that they are completely integrated.

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, I believe that six integrated care boards have been selected as national front-runners on innovations that will help move patients from hospital to their home. Can my noble friend the Minister confirm that these are going ahead, give examples and reassure us that they will be properly monitored, with data being collected? I have just realised that I called the Minister “my noble friend” but, due to my new role, all noble Lords are now my noble friends.

[Lord Markham (Con)]

Replying on behalf of all noble friends, let me say that I am particularly pleased to see this scheme go ahead. Just yesterday, Members of the House were talking about whether we should have full-time contracted dom care people because they know their patients best. That is exactly what these front-runner pilots are designed to do: to try out these new ways of working and heavily invest in areas, which you probably cannot justify on a national level until you know that it really works. Leeds, for instance, is developing a transfer of care hub, while the Northern Care Alliance is focusing on dementia. This is all about seeing what works and then, when we know what works, scaling it up very quickly.

NHS Waiting Times

Baroness Chisholm of Owlpen Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. With reference to past performance, that is what the spending increases were all about. They were an acceptance that we need to do more in this space, and we are doing more. The pandemic clearly brought unprecedented circumstances and that is why we have announced more funding to get on top of that in the next few years, tackling all the areas that the noble Baroness mentioned in terms of A&E wait times, GPs and all the rest.

[Baroness Chisholm of Owlpen (Con)]

My Lords, we know that part of the problem is that ambulances are going to A&E departments but are not able to deposit their patients in A&E. We know that there is a blockage at the other end in social care, with people not being able to be discharged fast enough back into the community or into care homes. Until that is sorted out, I cannot see how we are ever going to sort out the waiting lists. Can my noble friend the Minister tell me what might happen that will perhaps make those problems better?

[Lord Markham (Con)]

I thank my noble friend. Adult social care, as many have heard me say before in this House, is a crucial part of this, because it is all about the flow. That is why I was delighted that, in addition to the £500 million discharge fund for this year, we have secured up to £2.8 billion of funding for next year. That is in addition to the 7,000 extra beds and the tailored help for the 15 worst-performing hospitals with the ambulances, so we have a complete answer to all these areas.

Ambulance Delays

Baroness Chisholm of Owlpen Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. I have been made aware of the TV series and it is on my watch list. I am looking forward to going out overnight on an ambulance control shortly to learn at first hand. Tomorrow, I am visiting ambulance response teams and leaders in the field in the Maidstone and Tunbridge Wells area. Ambulances are of key importance; they are the “A” in the ABCD plan, and that plan very much features in everything we are doing. We are active on that and will rightly report, as we are here, on a continuing basis, and, as the noble Baroness knows, regularly report the statistics to ensure that we are on top of the problem.

[Baroness Chisholm of Owlpen (Con)]

My Lords, the delayed response to category 1 incidents by ambulances is really due to a systems failure, whereby those who should be treated in the community are unable to be, and those who are in hospital blocking beds are unable to go back into the community, where they should be treated. I ask my noble friend the Minister what plans there are to improve social care. I also congratulate him on answering four Questions today. As a nurse, I prescribe a strong drink at the end of the afternoon.

[Lord Markham (Con)]

I thank my noble friend for probably the best advice and question I have received in my marathon series. I could answer her question at great length, because I agree that this is a whole-system issue and we need a whole-system response. I would happily talk about every aspect of that but I will pick up just a couple of the specific points that she made. Social care is clearly vital to this. That is what the £500 million discharge fund is for. We are all aware—noble Lords have probably heard me say it enough times—that 13% of our beds are occupied in this way. As my noble friend states, an ambulance will visit a home and 50% of the time will not end up conveying someone into hospital. Is having an ambulance there, with three people in it, the best use of our resources when perhaps a paramedic on a bike could solve it just as well? In a similar vein, my understanding is that roughly 50% of all A&E attendances are people who do not really need emergency treatment. Again, that goes to the point about making sure that they have opportunities to receive primary care appointments, which is what the pledge to increase appointments by 50 million is all about. This is a whole-system problem and something that we are working on with a whole-system approach.

NHS: Nurses

Baroness Chisholm of Owlpen Excerpts

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

With respect, the numbers I quoted are up to date. They take into account the overall increase. We saw 36,000 leavers and 45,000 starters in the last year, so that is an overall growth of 9,000, which shows that the work we are doing to encourage people into the profession is working.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I know how much I, the noble Baroness, Lady Watkins, and the right reverend Prelate the Bishop of London enjoyed our nursing careers; we all trained at the same place. Is there not some way in which we can encourage students to come forward to this fantastic profession so that we can make sure we have a sustainable domestic workforce here in this country?

[Lord Markham (Con)]

I totally agree. I am proud to say that we have 72,000 nurses and 9,000 midwives in training at the moment. There is no cap on the number of people who can join the programme, so that is very much the spirit of what we are trying to do. Key to that was a £5,000 grant each year for nurses to attract them into the profession. It is working.

Edenfield Centre: Treatment of Patients

Baroness Chisholm of Owlpen Excerpts

Thursday 13th October 2022 Lords Chamber

[Lord Markham (Con)]

My Lords, like the noble Baroness, I am aware that the White Paper is in draft, but I have not seen its latest status. I know it will address some of the issues that we all agree are not to our satisfaction. At the moment, I can undertake only to understand the position of the White Paper and come back to her, if I may.

[Baroness Chisholm of Owlpen (Con)]

My Lords, first, I congratulate the Minister on his position. It is a baptism of fire, but I know he is up to the role. Would it be better if we engaged with the CQC better, so that these issues did not arise, rather than leaving it to undercover reporters? Thinking outside the box a little, what about body cameras? The police have them, after all, and they can protect not only workers but those the carers are looking after.

[Lord Markham (Con)]

My noble friend is correct that these are the sorts of things that we need to think about in this situation. It is a complex situation because, of course, as well as the advantages of body cameras being able to pick up things like this, these are first and foremost patients in need of care and there are all sorts of privacy issues to take into account in such a situation. I think that what this shows is that more intensive dialogue and thought on this whole area is required. I do not believe that there is an easy solution such as body cameras; that might be one approach, but first and foremost I want to feel that these are places where patients feel that their privacy is respected.

What I would violently agree on is the need for further conversations with the CQC, so that it is aware of the need to do a review on this. We need to be looking at exactly these types of things to see if a more intrusive type of system is what is required to stop these sorts of things happening again.

Integrated Care Boards

Baroness Chisholm of Owlpen Excerpts

Monday 5th September 2022 Lords Chamber

[Lord Kamall (Con)]

As the noble Baroness will be aware, a lot of the work at the local level will be done by the ICBs, in partnership with others, under the ICS system. On the Government’s role on workforce, the department commissioned Health Education England to produce a report to look at the long-term strategic drivers to support long-term workforce planning. This work is nearing its final stages. We have also commissioned NHS England and NHS Improvement to develop a long-term workforce plan for the next 15 years. In addition, as the noble Baroness will know, Section 41 of the Health and Care Act 2022 gives the Secretary of State a duty to publish a report at least every five years.

[Baroness Chisholm of Owlpen (Con)]

My Lords, can my noble friend the Minister say whether the importance of civil society to these care boards is realised? It is often local charities that really know what is going on in a community, and it is really important that they are involved going forward.

[Lord Kamall (Con)]

My noble friend makes a really important point on this: if you look at the structure at the local level, you will see the ICBs, but they are in partnership with civil society organisations and others to form the ICP. The integrated care boards and integrated care partnerships together comprise the integrated care system locally. When looking at local health needs and the health of populations, particularly in deprived areas, it is really important that we work with local charities and civil society organisations; they are quite often trusted more by local people than professionals.

Draft Mental Health Bill

Baroness Chisholm of Owlpen Excerpts

Tuesday 28th June 2022 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, the noble Baroness, Lady Merron, talked about patients being detained for too long, particularly those who have been sectioned. My right honourable friend Jeremy Hunt MP, down the other end, talked yesterday about how it would be good to put something in the Bill to say that those who had been sectioned had to be re-evaluated fortnightly, or at least monthly. This is a very good idea, because we know that there are problems with people, particularly those in the autistic community, who are detained for far longer than need be. Could my noble friend the Minister make sure that this is brought up in Bill meetings? I hope that it could go in the Bill.

[Lord Kamall (Con)]

I thank my noble friend for the question and for raising this issue. I am aware that my right honourable friend the Secretary of State intends to meet Jeremy Hunt to discuss this in more detail. In my first week, or first fortnight, as Minister, one of the debates I took part in was led by the noble Baroness, Lady Hollins, about detention. That brought home to me at a very early stage in my ministerial career how shocking some of these events are and the way that young people, particularly those who are autistic or have other conditions, are being treated. My right honourable friend the Secretary of State will meet Jeremy Hunt to discuss this, and I hope that it will also be approached in the pre-legislative stage. If not, I am sure that it will be debated in this Chamber.

Defibrillators

Baroness Chisholm of Owlpen Excerpts

Wednesday 15th June 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble for raising the issue of this particular defibrillator. I am personally not aware of it, but I would be very happy if the noble Lord would send me more information on it—it sounds just up my street when it comes to innovation, as it were. We are working across the UK, with different sectors. In some ways, it is almost like a channel marketing campaign. How do we get defibrillators out to as many locations as possible? There is the Circuit and the National Defibrillator Database, and there will be an app that will allow people to find their nearest defibrillator. We are working with schools, educational institutions, sports grounds, transport, the Health and Safety Executive, the British Heart Foundation, Resuscitation Council UK and other partners.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I welcome the fact that there is a rise in the number of defibrillators across the country, but one of the problems is that a lot of people do not realise where they are located, particularly the emergency services and indeed the general public. My noble friend mentioned the national defibrillator network, known as the Circuit, but a lot of people are not aware of this—this is where outlets can register where their defibrillator is and the general public can find out where a defibrillator is when they need them. Is there some way that the department can raise the awareness of the Circuit so that more people are able to use it?

[Lord Kamall (Con)]

My noble friend raises a very important point, in her usual assertive manner. The British Heart Foundation, in partnership with Resuscitation Council UK, the Association of Ambulance Chief Executives and the NHS, has set up the Circuit, which is now live in 13 to 14 ambulance services across England, Scotland, Wales and Northern Ireland. In January this year, the BHF launched a website that will assist members of the public to locate defibrillators; it is also looking at apps so that people can find out where defibrillators are. We recognise that in some places people themselves are putting in their own defibrillators and we are trying to make sure that they are aware that they should be feeding into the Circuit, so that more people are aware of where they are.