Nursing: Staffing

Baroness Merron Excerpts

Thursday 16th June 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I start by thanking our nursing workforce and, indeed, the whole health and social care team. I congratulate the noble Baroness, Lady Tyler, on securing this important and very timely debate, and thank her for the way in which she set out the issues. It is important that we are considering them today, given this report. I also thank the Royal College of Nursing for this comprehensive report, which I believe shines a real light on the realities that are being experienced by the nursing team and patients. It produces a very loud red flag for the future, which I am sure the Minister will address. The Nursing and Midwifery Council also helpfully shared its annual registration data, cited in the report. I shall refer to that later.

The key message coming through from this debate, as has come through so many times, is the question of whether the Government have it right on workforce. I am sorry to say that, on this occasion as on previous occasions, the answer is no. This is about having the workforce to do the job. It has been debated numerous times in your Lordships’ House and in the other place. Your Lordships’ House made its view known very clearly that any organisation worth its salt—that certainly includes our National Health Service—would undoubtedly have in place a workforce plan for now and for planning ahead, looking at retention, recruitment and training, and all the many complexities involved. Yet within the Health and Care Act we did not have that commitment.

I will refer to the survey findings, which come in the context of record waiting lists and 50,000 registered nurse vacancies. The report refers to the fact that the UK’s exit from the EU and the Covid-19 pandemic have both highlighted and worsened long-term problems with workforce supply in health and social care. However, the report also says that this is nothing new. For many years, nursing staff have been shouting about the impact of growing staff shortages and the rising demand on their ability to deliver care that is safe and effective. The report argues that the impact of these pressures is now “beyond concerning”, with patient safety, care outcomes, staff retention and staff well-being affected.

On this point, I was glad to hear from the right reverend Prelate, who spoke of her experiences of talking to nurses and rightly reminded us of the positive side: nurses’ passion for improvement and service, and their commitment to delivering for patients. The right reverend Prelate also rightly spoke about the pressure on nurses. I wonder whether the kind of commitment shown to us by nursing teams means that their situation is constantly overlooked. I believe that there is a great tendency for them to be taken for granted because, as the right reverend Prelate said, they will always deliver.

From the report, we know that

“staffing levels are compromising care”

and

“that there are not enough registered nurses on shift”.

There is also a greater intensity of nursing care required by patients. This highlights that we have a worsening situation, not one that is static. This once again makes the case for proper workforce planning that can move with the times. I anticipate that the Minister will refer to the pandemic as being one of the greatest pressures. While that it is true, the report also said:

“Going into the … pandemic … 73% of nursing staff surveyed … said that staffing levels on their last shift were not sufficient to meet all the needs of the patients safely and effectively. In 2022, this has risen to 83%.”


This is not a new problem; it has been exacerbated but it would not be right to refer solely to the impact of the pandemic.

We have heard a number of the key findings, but the one that really strikes me is this:

“Only 25% of shifts had the full number of planned registered nurses on shift.”


Linked to that, 81% of those surveyed

“felt that patient care being compromised was due to not having enough registered nurses on the shift”,

and yet one in five said

“they felt unable to raise their concerns.”

This is a very dangerous cocktail to which I hope the Minister will have a response.

The report makes a number of recommendations, and we have had a number of proposals in the debate today. I am interested to hear the Minister’s response to the recommendations of the report and the points raised within this debate.

As we know, the Government have announced an increase in the number of nurses, and that can be tracked back to a 2019 manifesto pledge. In addition to providing us with an update on this situation, it is worth reiterating the point made by the noble Baroness, Lady Tyler, on the comments of the Chief Nursing Officer for England, Ruth May, who said that while she welcomed the pledge, it fell short of what was actually needed. This will be the case because recruitment on its own is not the point; it is also about the vacancy numbers, the shortfall and the numbers of nurses that are leaving.

On that point, I refer to the information from the Nursing and Midwifery Council. When asked why people had left, they said the main reasons were too much pressure, poor workplace culture, struggles with increased workloads and a lack of staff. Could the Minister give us more information on when he will be able to share the 15-year plan for the workforce? When will it materialise, and how will it take all of these matters into account?

The report calls for a “credible, costed long-term” health and care workforce strategy. A nursing team is at the heart of this. I hope that the Minister will hear the points made in today’s debate, but also the previous calls for a proper workforce plan, which will be the only way we can meet the demands upon us.

Vaccinations

Baroness Merron Excerpts

Wednesday 15th June 2022 Lords Chamber

[Lord Kamall (Con)]

I am afraid I am not aware of the details to which my noble friend refers, but I would be happy if he wrote to me. I will then take that back to my department.

[Baroness Merron (Lab)]

My Lords, more than one in 10 children are not fully protected against measles by the time they start school, and research shows that many parents are unaware that it can lead to serious complications, such as pneumonia and brain inflammation —or, indeed, that it can be fatal. With the major focus on Covid vaccinations over recent years, what assessment has been made of the effect on the uptake of routine vaccinations, including MMR? What steps are being taken to restore any affected vaccination levels?

[Lord Kamall (Con)]

The noble Baroness raises a very important point. We have to recognise that the UK has one of the most comprehensive childhood and adolescent immunisation programmes in the world. We have seven national childhood immunisation programmes, three adolescent programmes and two elderly programmes. Vaccine uptake in the UK remains high overall, but there has been some decline in routine childhood vaccines—so we have been looking at school-based immunisation programmes, some of which were clearly interrupted due to Covid. At the same time, from October to December 2021, the coverage of childhood vaccination programmes actually increased.

Defibrillators

Baroness Merron Excerpts

Wednesday 15th June 2022 Lords Chamber

[Lord Kamall (Con)]

All I can say is that I hope so. I will try to find out and commit to write to my noble friend.

[Baroness Merron (Lab)]

My Lords, with Travelodge, Tesco and Royal Mail all announcing that they will participate in the British Heart Foundation use training pilot, will the Minister undertake to look at the potential impact of this training on saving lives and work with his ministerial colleagues across government to encourage such training on defibrillator use by other companies, the public sector and other organisations?

[Lord Kamall (Con)]

If noble Lords will excuse the pun, one of the heartening things in answering this is that, when I received briefing on this, it is really important and interesting how we are working across government. It is not only in the Department of Health; we are working with the Department for Transport on transport locations, DCMS on sports grounds, the Department for Education on education settings and other departments. This is really a cross-government initiative.

Personal Protective Equipment: Waste

Baroness Merron Excerpts

Tuesday 14th June 2022 Lords Chamber

Asked by

[Baroness Merron]

To ask Her Majesty’s Government what assessment they have made of the expenditure on unusable and excess Personal Protective Equipment (PPE), and the reasons for the waste.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

We have delivered over 19.8 billion items of PPE to keep front-line staff safe. Facing a dangerous virus, and against the background of no vaccine, as well as rising demand, market disruption and panic buying, we procured as much PPE as possible rather than too little. Only around 3% of PPE that the department purchased is unusable, and we are working with waste providers to dispose of unusable stock in the most environmentally friendly and energy-effective way.

[Baroness Merron (Lab)]

My Lords, £9 billion was wasted on PPE due to obscenely inflated prices, irregular payments to intermediaries and faulty kit which is now poised to go up in smoke, along with nearly one in four of the contracts in dispute around products which are not fit for purpose or where allegations of slavery have been made. We know that the Government were responding to an unfolding crisis, but how was this shameful episode allowed to go unchecked and why has the department been allowed to establish a track record for not following public spending rules?

[Lord Kamall (Con)]

We have to go back and remind ourselves of the situation in 2019 and 2020. We have to remember that, at the time, there was no vaccine and the whole market suddenly panicked—people were competing with each other to buy equipment. We heard stories of government officials sitting in factories with suitcases of cash, trying to make sure that they could buy material at the best possible prices, and at the same time we saw containers being redirected at sea and people being gazumped. We therefore made the decision at the time, without being accurately able to predict how much PPE equipment we needed—no one could have done so—to procure as much as possible.

Health and Social Care Leadership Review

Baroness Merron Excerpts

Thursday 9th June 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank everyone who works in the NHS for their continued dedication and skill. We owe them our gratitude. I also put on record my thanks to General Sir Gordon Messenger and Dame Linda Pollard for leading this very important review.

We know that we are at the foothills of a huge programme of NHS reform and reorganisation, which your Lordships’ House carefully scrutinised during the passage of the Health and Care Act. It came through loud and clear that the healthcare system requires proper leadership and a workforce that has enough staff to do the job, something that we know is not the case at present nor is suitably in the pipeline.

I confirm that these Benches support the review’s seven recommendations and welcome that the Secretary of State has already agreed to implement them. However, the critical thing will be to see whether, when and how the proposals are implemented and we will keep a close eye on this. Regrettably, we have too often seen the commissioning of a review by Ministers only to see those same Ministers drag their feet on implementing the recommendations or shelve them completely. Will the Minister give us today a firm date for when he intends to publish the plan to implement the seven recommendations?

The social care survey from the Association of Directors of Adult Social Services shows that more than 500,000 people are waiting for a social care assessment in England, and we need swift action to alleviate this. Will the Minister explain why the review has not covered leadership in social care or primary care in sufficient detail? Is not this a missed opportunity?

Of course, this review is just one part of dealing with the crisis that the NHS faces. New staff getting an induction when they first join the NHS is sensible, but that is just a basic requirement of any organisation worth its salt. We all know that there are bigger, real mountains to climb. Waiting lists are at a record high: 6.4 million in the queue for treatment—nearly one in 10 people—patient satisfaction is at its lowest since 1997, and there have been longer waiting times for cancer treatment in every year since 2010. So it goes on.

There are currently 106,000 vacancies in the NHS, and staff are leaving in droves. In many specialities, they are leaving faster than they can be recruited to those vacancies. It remains to be seen how a shake-up for management will help our health outcomes and alleviate pain and suffering when there are not enough front-line staff. This has to be the Government’s focus.

Yesterday, the Secretary of State talked about the 15-year workforce strategy that he has commissioned. When can we expect it? It would be much appreciated if the Minister could put more flesh on the bones of this brief reference yesterday. Who will be leading this and what will be its terms of reference?

It would be negligent not to mention the role that managers played in the North East Ambulance Service cover-up. The Government are still considering whether to launch a review. Will the Minister provide an update? Surely, if management is to be improved, there is a need to learn from the times when it fails. The incidents at the North East Ambulance Service are a clear case in point.

Finally, it is regrettable that NHS senior leadership still does not represent the diversity of the population that it serves. How will the Government drastically improve equality, diversity and inclusion? And how will the best leaders—whether or not they have a so-called good network—be encouraged, prepared and brought into the most challenging roles where we need to see them?

These Benches welcome the review and its recommendations, but there are many outstanding questions while the NHS is in dire need of support and a workforce able to meet the demands and serve the people who need it.

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely and I now invite her to speak.

Children: Cancer

Baroness Merron Excerpts

Thursday 26th May 2022 Lords Chamber

[Lord Kamall (Con)]

I completely apologise to all noble Lords. It is important that we look at this issue; I am afraid I will have to write to the noble and gallant Lord with more detail.

[Baroness Merron (Lab)]

Following on from the question of the noble and gallant Lord about the matter of significant improvements being made in the lives of children with cancer by detecting cancer early and avoiding delays in care, there are of course three components to early diagnosis, with the first being awareness of symptoms by families and primary caregivers. Can the Minister tell your Lordships’ House what assessment has been made of the level of awareness and what is being done to promote that awareness among families and primary caregivers?

[Lord Kamall (Con)]

The noble Baroness raises an important point about how we raise awareness, and that goes right across not only the population but patients themselves. NHS England and NHS Improvement are developing plans for future phases of their Help Us Help You campaign to raise awareness of key cancer symptoms. To date, the campaign has contributed to the record high levels of urgent cancer referrals that the NHS has seen since March 2021.

Perhaps I may take the opportunity to address the question from the noble and gallant Lord. Covid clearly affected the backlog. One of the things about the waiting list is that now 80% of people on it are waiting for diagnosis. One of the issues we are looking at is how you push out more community diagnosis centres around the country, not only in hospitals but in shopping centres and sports arenas, so that effectively we go to the patient and detect as early as possible. We hope that all that, in conjunction with things such as blood testing and genomic sequencing, will lead to earlier diagnosis.

Sugar Reduction Programme: Bread

Baroness Merron Excerpts

Wednesday 25th May 2022 Lords Chamber

[Lord Kamall (Con)]

Right. I begin by thanking my noble friend for that very comprehensive question. As I said earlier, some sugar is needed in the process, but he makes an important point about how we reduce the unneeded additional sugar that is added. I have already given the reasons why there is some sugar, and no doubt the chemical processes will be improved over time: as mankind’s innovation and ingenuity increase, we will see more substitutes for sugar. I was also interested in the point made by the noble Lord about chapatis; next time I go to a restaurant I will ask about their sugar content.

[Baroness Merron (Lab)]

My Lords, with the UK attending the 75th World Health Assembly in Geneva as we speak, it is concerning that the Government have delayed their planned measures to encourage a move away from foods that are high in fat, sugar and salt. To compensate for this, particularly for those who are experiencing higher levels of deprivation, can the Minister tell your Lordships’ House in what specific ways the Government intend to show the leadership that is so urgently needed?

[Lord Kamall (Con)]

I thank the noble Baroness for raising that point. Part of my role is in international health diplomacy, where other countries come to the UK wanting to learn from us. It is very interesting that a number of other countries are asking to learn from our sugar and salt reduction programmes, our alcohol and anti-tobacco programmes and our campaigns for healthy eating—not just telling people they should not do things but encouraging them to have a healthier lifestyle

NHS Dental Services

Baroness Merron Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Kamall (Con)]

On the face of it, that sounds a reasonable suggestion, so I shall take it back to the department and see if the people there agree.

[Baroness Merron (Lab)]

My Lords, reports of children who can no longer chew food normally and who have never seen a dentist are damning indictments of the lack of NHS dental services. With sugary drinks and snacks contributing to poor dental health, why have the Government decided to delay the introduction of restrictions on advertising unhealthy products? What assessment has been made of how this delay will affect children’s teeth and create additional pressure on the NHS?

[Lord Kamall (Con)]

I know the noble Baroness has been trying to get that question on the agenda as a Private Notice Question, so I congratulate her on asking it now. Clearly, it is right that we address this issue. The recent delay was only because of certain promotions, because we wanted to see this holistically with the cost of living crisis. Restrictions or a ban on, for example, where products can be placed will still go ahead in premier areas. Overall, it is right that we get balance to this, as any Government must. There are clearly concerns about affordability, which is why we have delayed those measures, but let us be quite clear that this is a delay; we are not kicking this into the long grass.

Long Covid

Baroness Merron Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

The NICE guidelines start with the definitions as I have laid out previously, and the NICE definitions are aligned with the World Health Organization. On the noble Lord’s specific question, I will have to write to him.

[Baroness Merron (Lab)]

My Lords, the Equality and Human Rights Commission made an announcement on Twitter that it recommended that long Covid should not be treated as a disability. That would mean that those suffering from the condition would have to take their employer to a tribunal if they felt that they were being discriminated against. Can the Minister tell your Lordships’ House what his view is on how reasonable or not this is? What steps are being taken to promote understanding by employers of this debilitating condition and to encourage and guide them to be open to making changes in the workplace to support sufferers in continuing to work?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. We are learning more about the different types of long Covid, how to treat them and what interventions they need. People will not always need to go to a primary or secondary care centre for their treatment; in fact, there is an app to help people who can be supported at home. In terms of general advice about disability or to employers, we are working across government as we learn more about this in order to give appropriate advice to employers.

North East Ambulance Service

Baroness Merron Excerpts

Monday 23rd May 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, human tragedy permeates this scandal, which has seen up to 90 unnecessary deaths, gross negligence, cover-ups and public money buying the silence of staff. Quinn Beadle, who was just 17 when she tragically committed suicide, died because an ambulance worker failed to perform proper resuscitation. In the report that was then made to the coroner, North East Ambulance Service managers removed this detail. The Secretary of State said today that this and dozens more injustices will be investigated more fully. Will the Minister confirm that this will take the form of a formal inquiry, as it surely must? Will questions be asked of the Care Quality Commission, which, despite being tipped off two years ago, failed to flag or even spot this outrage?

[Lord Kamall (Con)]

I thank the noble Baroness for raising those concerns. I completely agree with the sentiments she expressed; this is completely uncalled for. As I said previously, my honourable friend Maria Caulfield pledged that there would be an investigation into this. As to whether it will be a formal inquiry, it is too early for me to give a direct answer, but I will go back to the department and as soon as I have more information I will write to the noble Baroness. I understand that these are historic incidents and that the CQC has said that its service is improving, but as more information is still coming out—even today when I had the briefing, not all the information was there—I will of course commit to write to the noble Baroness.