NHS: Targets

Baroness Watkins of Tavistock Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the noble Lord, Lord Hunt, for securing this debate. It is a pleasure to follow other noble Lords, who have made very cogent arguments for change, and in particular the maiden speech of the noble Baroness, Lady Wilcox of Newport; it seems like nirvana to think we might have to pay only £90 a week to many people in England.

Clearly we want to reform health and social care to best serve the health and well-being of people in England. I declare my interests as outlined in the register, particularly as a registered nurse, president of the Florence Nightingale Foundation and a former sister in accident and emergency.

At the heart of the issue is whether the NHS should reform the A&E four-hour waiting target a decade after its inception. The national medical director of the NHS considers that a change to the four-hour target and some cancer treatment targets may, based on sound data, serve the population more effectively. I will concentrate on the A&E target and delays to patients’ transfer of care from acute hospitals to their own homes, nursing homes and registered care facilities.

The NHS is piloting a new A&E scheme entitled “rapid care measures” with 14 trusts. The new standards include the rapid assessment of all patients in A&E, coupled with faster life-saving treatments for those with the most critical conditions, including sepsis, heart attacks, strokes and acute psychotic episodes. The initial results are promising, with the number of patients spending over 12 hours in A&E falling faster than in control groups. There appears to be broad public support for these measures. It is vital that any change to targets are clinically appropriate and supported by evidence-based healthcare interventions, which the proposed changes reflect.

Therefore, unlike many in this House, I urge the Government to revise the A&E targets in this way and set clinical teams free to work in a more independent, evidence-based approach focused on individual patient need rather than keeping to a four-hour target set in stone. This is likely to enhance staff morale and improve time from attendance to treatment for those most critically ill. It may also reduce the number of people attending A&E for very minor problems as they may have to wait longer than four hours. We know that many people go to A&E for health problems much better suited to community-based services because they have difficulty accessing a GP or community nurse. The need to increase the number of GPs is essential, but so too is developing and enhancing the role of other healthcare practitioners in the community if we are really serious about system redesign in the NHS and social care.

In the US there has been an increasing focus on systematic change associated with the affordable health care Act, which elevated the role of both physicians’ assistants and nurse practitioners. I have witnessed the positive effects of the introduction of these roles in Washington State, particularly in supporting people with multiple physical and mental chronic health conditions in community settings. An analysis of US census data published this week shows that the number of nurse practitioners has grown at an unprecedented rate across the USA, from around 91,000 in 2010 to 190,000 in 2019. These practitioners are filling a primary care void, particularly in rural areas. A professor of nursing at Montana State University estimates that there will be two nurse practitioners for every five physicians by 2030, compared to one in five in 2016. Will the Government look at this research and investigate whether one way of improving primary care and reducing A&E visits would be to invest more significantly in a range of advanced roles for community healthcare practitioners?

The Government intend to publish plans to reform the social care system this year. That is essential because it will improve people’s lives and, we hope, reduce delayed transfers of care from hospital to the community. Will the Minister please note my support for altering the four-hour A&E targets in the light of the results from the pilot sites? I urge her to ask the noble Baroness, Lady Harding, to work further on the NHS people plan in the way outlined by the noble and gallant Lord, Lord Stirrup, and to consider piloting the NHS funding care packages for a fixed period on discharge for those due to leave hospital, in the way so ably outlined by the noble Lord, Lord Turnberg.

Coronavirus

Baroness Watkins of Tavistock Excerpts

Monday 3rd February 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord will not be surprised to hear that it is important to put the public health response first and foremost when it comes to a risk of this kind, and that is exactly what is happening in this case. The actions that the UK has taken in this regard have been appropriate, proportionate and commensurate with the data and evidence that have come forward, and they are based on clinical evidence. Having said that, he is absolutely right that an economic impact as a result of quarantine measures taken by China and others cannot be avoided, and it is right that we should consider the impact for UK businesses. I am sure that consideration will be given to what can be done about that.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister define what she means by mainland China? I asked a question about Hong Kong last week and I note from the Foreign Office website that the Hong Kong Government have announced that all border crossings with mainline China will close at midnight tonight, Hong Kong time, which is an excellent idea in terms of containment. I am also aware that people who work for international companies in Hong Kong have been told to work from home for a minimum of two weeks from last Friday—three days ago. What will we do about people coming to our borders from Hong Kong in the immediate future?

[Baroness Blackwood of North Oxford]

The noble Baroness asked that question last time and I did not forget. At the moment, Foreign Office travel advice is that anyone who has travelled to the UK from anywhere in China other than Wuhan or Hubei province, but not including Macau and Hong Kong, in the past 14 days and has developed symptoms should immediately self-isolate, even if symptoms are minor, and call NHS 111. Macau and Hong Kong are not included because those territories do not have evidence of sustained community transmission, as has been observed in mainland China, to date. They are therefore not currently included in the same travel advice as mainland China. However, the epidemiological situation in Hong Kong and Macau, as indeed in the rest of the region, is kept under constant review and will be considered in travel advice as we go forward, and reported to this House accordingly.

Wuhan Novel Coronavirus: UK Citizens

Baroness Watkins of Tavistock Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. At the moment, there are 5,974 cases in mainland China and 6,064 cases globally, and there have been 132 deaths. It is important to understand that coronavirus is a large family of viruses, ranging from the common cold to much more severe diseases, such as MERS. The data we have puts the mortality rate at about 3%, so the risk is comparatively low compared with SARS and MERS. I just want to say that at this point.

In terms of wider travel advice, the FCO is now advising against all travel to Hubei province and all non-essential travel to China, and is advising British citizens to leave if they are able to do so. Wider public health advice for those travelling around the region can be seen on the Public Health England website. It is very clear and detailed. Any further advice on travel can be seen on the Foreign Office website. We are co-ordinating very closely; indeed, there was a COBRA meeting on this issue just yesterday.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister clarify that Public Health England is working closely with the other three public health departments in the UK and is taking the lead on this for people who are returning? Further, what is our strategy for Hong Kong, where nurses have said today that they will go on strike unless the borders between mainland China and Hong Kong are closed in order to protect the population?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: all the public health authorities across the United Kingdom will work closely together to ensure clear co-ordination, as always happens on public health issues. On Hong Kong, we will be discussing those issues through the WHO, which met yesterday to consider whether WN-CoV should be declared a public health emergency of international concern. It did not declare a PHEIC yesterday, but it will meet again. If it does declare a PHEIC, we will of course review our recommendations. However, we should be confident about the actions that we have taken. They are measured, proportionate and based on the highest level of scientific and clinical advice available at this stage of the outbreak from the Chief Medical Officer and Public Health England. We will keep the situation under continuous review and report to the House as it develops.

NHS and Social Care: Staffing

Baroness Watkins of Tavistock Excerpts

Wednesday 15th January 2020 Lords Chamber

Asked by

[Baroness Watkins of Tavistock]

To ask Her Majesty’s Government how they intend to ensure safe staffing in social care and the National Health Service in this Parliament.

[Baroness Watkins of Tavistock (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In so doing, I declare my interests as a nurse, as set out in the register.

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

My Lords, patient safety is paramount. We expect health and social care providers to deploy sufficient numbers of suitably qualified, skilled and experienced staff at all times. The NHS People Plan aims to ensure a sustainable overall balance between supply and demand across all staff groups. This Parliament will see the people plan deliver 50,000 more nurses by 2025, a further 6,000 doctors in general practice and 6,000 more primary care professionals, all of which will support safe staffing and better care.

[Baroness Watkins of Tavistock]

I thank the Minister for her reply and particularly commend the NHS People Plan, yet evidence suggests that urgent action is needed to address the shortages in social care as well as healthcare. Many older people with dementia are failed by our social care system, in part due to costs and the availability of suitable staff. It is vital that the Government resolve the future of social care funding. Without certainty on funding, employers cannot invest in and plan for the future workforce. Dignity in care will be achieved only with rapid, proactive planning. Can the Minister explain the potential delay to the cross-party talks about funding for social care and what approach will be taken to ensure that proper staffing in social care is available during this Parliament?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question and pay credit to the work she has done in this area. She is absolutely right that we have to make urgent progress in delivering a sustainable social care solution. In the first instance, we have given councils up to £3.9 billion of additional funding in 2019-20, and the Prime Minister has been clear that he wants to see cross-party consensus on a sustainable way forward this year. I look forward to seeing progress made as swiftly as possible and hope that we will see work across this House on it, as I know this place takes the issue very seriously. In addition, we have run a national adult social care recruitment campaign to raise the profile of adult social care and encourage applicants. This has been successful; we have seen a 23% increase in the number of vacancies advertised on the DWP’s “Findajob” platform, which is improving the situation in the short term.

NHS: Nurses

Baroness Watkins of Tavistock Excerpts

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

I always take very careful note of proposals from my noble friend. At the moment, that is not under consideration, but it will certainly be looked into. As the entry salaries rise, it is more likely that student loans will be repaid, but what is important at this stage is that we attract the most nurses into the profession. At the moment students are able to access student loan funding for maintenance as well as the non-repayable funding from the DHSC, which means that we will meet our target of 50,000 more nurses by 2025, which is what we need to be able to deliver a sustainable NHS.

[Baroness Watkins of Tavistock (CB)]

My Lords, could the Minister provide an estimate of the number of people the Government expect to recruit from countries where the nurse-to-population ratio is already inadequate? If this is morally right and what we need to do, how can we ensure that some of our overseas aid budgets through DfID are used to increase nurse training in countries that we will recruit nurses from?

[Baroness Blackwood of North Oxford]

The noble Baroness is very expert in this area. I cannot give her specific numbers on specific recruitment from individual countries; I do not know which specific countries she is asking about. I can tell her that the recruitment of nurses from overseas non-EU territories has increased by 156% in recent years; as the daughter of a South African nurse, I can also tell her that this is a long-term pattern and has been good for the NHS. However, we must also make sure that we invest in many of those nations as we do through the overseas budget, which is part of the department’s healthcare priority. I would be happy to write to her with details.

Queen’s Speech

Baroness Watkins of Tavistock Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register. It is a pleasure to follow the speech of the noble Baroness, Lady Tyler, because I have had to cut my own considerably so that I might contribute to this debate on the gracious Speech not only on my own account but to some extent on behalf of my noble friend Lady Emerton, of Tunbridge Wells, who has given notice of her retirement from 1 November. I am glad that I might be given a few extra seconds as a result. She very much wanted to be here today but is unable to be so. I want to acknowledge her extensive contributions to the nursing profession over the past six decades, and particularly the distinction with which she has served this House for the past 20 years.

On a more personal note, her encouragement, mentorship and support to me as a “fellow nurse” has been exemplary since my appointment to this House four years ago. I wish my noble friend a happy retirement and I am fully aware, having spoken to her on the phone this afternoon, that she is following my contributions in the House now and will do so in future. I can only hope that, with further experience, I will live up to at least some of her high expectations.

I welcome the new laws that the Government intend to bring forward to assist in the implementation of the NHS plan in England, in particular the £33.9 million per annum increase in the budget by 2023-24. However, how do they intend to ensure that the appropriate workforce will be available to deliver the plan? The recent NHS people strategy outlines the challenges that we face in this domain. Is it not time for the Government seriously to consider writing off student debt for healthcare professionals who work in the NHS and state-funded social care roles for three to five years after graduating from university? Providing “golden hellos” to recruit to hard-to-fill roles, including learning disability and mental health nursing, podiatry and some areas of medicine, should be seriously considered. Having investigated the Army support structure for attracting nurses, it is clear to me that there are established successful schemes of this kind in the UK public sector. Why cannot this approach be adopted more widely? We will not be able to provide safe staffing in the NHS unless we recruit and retain excellent healthcare professionals.

I was a member of the pre-legislation scrutiny committee for the Health Service Safety Investigations Bill, ably chaired by Sir Bernard Jenkin MP, a strong advocate for the Bill. As others have outlined, the Bill will transform the way in which patient safety incidents in the NHS are investigated. Investigations would be for the purpose of learning and not to attribute blame or fault, thus improving patient safety by encouraging staff to identify areas of concern and to be candid in the information they provide to the investigatory body. I fully support this approach, while recognising that the Bill requires proper debate and amendment, as other noble Lords have outlined. I hope that we might be able to do this in what might be a very short term after what has happened today.

My noble friend Lady Emerton has been a champion in promoting high standards of community-based, individualised care for people with a learning disability. On behalf of us both, I ask what the Government’s plans are for finally replacing inappropriate, institutionally-based services with more suitable provision. This issue appears notably absent from the gracious Speech.

It is essential that the proposed Mental Health Act reforms are initiated. This will require additional investment in mental health services, as others have outlined, yet the NHS long-term plan, with investments relating to 40 new hospitals, makes no mention of new community mental health facilities. The Royal Colleges of Nursing and Psychiatrists call for an end to dormitory provision in mental health wards; a fleet of vehicles to transport people having a mental health crisis to a care facility, rather than using police vehicles; and the provision of more appropriate assessment space in emergency departments, in particular therapeutic calming spaces. Can the Minister outline whether any such investment is planned?

It is acknowledged by the King’s Fund that the NHS plan will not be achieved without further investment in social care, as was far more ably outlined by the right reverend Prelate the Bishop of London. The Government intend to bring forward the Green Paper proposals to reform adult social care to ensure dignity in old age. This is urgent. What is the planned timetable for this legislation? It is unacceptable in 2019 that dignity in old age should be a vision for the future rather than a right today.

Health is adversely affected by poverty. Barnardo’s, the Trussell Trust and many other bodies estimate that Brexit will create inflationary pressures that will hit the poorest in our society the hardest. Will the Government commit to providing a hardship fund for those on universal credit if there are sudden increases in food prices? If so, can they guarantee that such a fund would provide grants and not loans? Reducing food poverty and investing in public health measures, including health visiting services, particularly for children, may do more to improve the nation’s health than the proposed hospital building programme. We need a rounded approach.

It has been a pleasure to contribute to this debate. I look forward to the Minster’s responses to the issues that I have raised. Finally, I wish on behalf of the nursing profession to thank other noble Lords for their appreciation of my noble friend Lady Audrey Emerton’s public service contributions and her long and distinguished service in nursing, the NHS and this House.

[Noble Lords]

Hear, hear!

NHS: Bullying

Baroness Watkins of Tavistock Excerpts

Wednesday 5th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My noble friend is right that we must ensure that bullying, wherever it comes from, is reported. It is just as unacceptable that bullying should come from managers and senior people as from those below. As I said in my Answer, the reported level of bullying from managers is 3.2%. This is one reason why we have introduced the “freedom to speak up” guardian, so that NHS workers are free to speak up and feel that they can do so in a safe space.

[Baroness Watkins of Tavistock (CB)]

My Lords, the interim report by the noble Baroness, Lady Harding, on NHS staffing highlights persistent shortages of staff, particularly of registered nurses, in many parts of the NHS. To what extent does the Minister believe that bullying is associated with managers focusing on NHS targets without sufficient staff to deliver high-quality care?

[Baroness Blackwood of North Oxford]

The Interim NHS People Plan identified bullying and violence in the workplace as a key challenge that must be addressed, and identified some measures to address them. However, the noble Baroness is absolutely right that an underlying challenge is staffing, which is a major concern for the NHS workforce. The plan looks to address them in a serious and concerted way by recruiting more staff, retaining existing staff, and looking at innovative ways to entice former staff back into the NHS so that we reduce the pressure on the entire system. She will know that the plan includes commitments to recruit 40,000 more nurses over the next five years and to reduce the vacancy rate to 5% by 2028, down from the current 8%, and reiterates the commitment to recruit 5,000 more GPs on top of the 20,000 extra support staff to be recruited in the coming years.

Children: Gaming

Baroness Watkins of Tavistock Excerpts

Thursday 23rd May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the right reverend Prelate for his question. He is absolutely right that it is one of the issues that will be considered with the Online Harms White Paper. I encourage him and his colleagues to engage with the consultation. It is a very important part of that consultation and something we should consider very carefully.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Government carefully consider encouraging NHS innovation to invest, with other independent companies, in developing games to promote healthy lifestyles in children? In particular, there could be a game that would attract children who are prone to obesity associated with mental health problems to get them engaged in health promotion programmes and associated healthy activities—innovative action research rather than pure research.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right on that point. Emerging augmented reality and VR markets should be encouraged to offer these opportunities. Interesting evidence emerged from the AR game “Pokémon Go”, which encouraged many young people to go out walking and exploring, for example, and we have programmes that are investing in promoting exactly that kind of innovation. We also have the video games tax relief, which has benefited projects such as Eye Gaze Games, a series of games for children with mobility problems. We would like to continue investing in such programmes, which give the particular benefits that the Government would like encourage.

Mental Capacity (Amendment) Bill [HL]

Baroness Watkins of Tavistock Excerpts

Tuesday 26th February 2019 Lords Chamber

[Baroness Browning]

Is my noble friend able to define what the Government describe as “as soon as practicable”, which she said was going into the code of practice? Linked to that, how will it be defined for those people who will need the support of speech and language therapists, of an approved mental capacity professional or of an IMCA? It seems that we will need information to be provided at a very early stage, so that it can be considered and then decided whether there is a need for additional support. Can she give us some indication of how she is going to deal with that in the code of practice?

[Baroness Watkins of Tavistock (CB)]

My Lords, I welcome the Minister to her new role, and look forward very much to working with her. I also acknowledge that the Government have gone a very long way in responding to previous amendments in the name of Lady Hollis and myself with regard to the supply of information to the cared-for person and other relevant bodies.

I turn briefly to my Amendment 25A. While I fully appreciate that it is not always practicable for the responsible body to ensure that a copy of the authorisation record is given to the cared-for person and other bodies immediately after authorisation, as outlined, Commons Amendment 25 is not at all specific about the time limits. I believe this means that busy clinical staff may not always feel it necessary to chase up this issue and make time swiftly to explain issues to the cared-for person or the appropriate person. This needs to be done quickly enough in terms of ongoing deprivation of liberty safeguard orders for appeals or challenges to the authorisation to be made, if individuals so require.

--- Later in debate ---

Moved by

[Baroness Watkins of Tavistock]

25A: Line 10, at end insert—
“(1A) A record of any decision and justification for not immediately giving a copy of the authorisation record under sub-paragraph (1) must be kept.
(1B) If a copy of the authorisation record has not been given to those specified in sub-paragraph (1) within 72 hours, there must be a review of whether the lack of information was appropriate.”

Mental Capacity (Amendment) Bill [HL]

Baroness Watkins of Tavistock Excerpts

3rd reading (Hansard): House of Lords
Tuesday 11th December 2018 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful to the Government for adopting the principle of the amendment that we put forward on Report and for recognising its importance. I am glad to see that this will be in pre-authorisation reviews and to hear the assurances that it will act as a trigger for all types of reviews and will be put into the Bill when it goes to the other place.

I also recognise that the Minister has touched on staff induction, which will need to include training on liberty protection safeguards and cover when the review should trigger further action. However, I seek a categoric assurance from the Minister that the code of practice will state that staff will have the full protection of whistleblower legislation whenever they raise a concern, even if, for whatever reason, it does not proceed to initiating a review. I was grateful that during our meetings the Minister openly discussed the possibility of vexatious triggers, although I estimate that these would be very few and that triggers for reviews would involve legitimate concerns about a person’s welfare.

I also seek assurance that in its inspections the Care Quality Commission will be asked specifically to check that all staff know that they can request a review to be triggered and that they know that they will be protected. In addition, the responsible body, whenever asked to undertake a review, will need to keep a register of all such requests so that an emerging pattern of several requests coming from an institution will trigger a more major review into the type of care provided for everyone there.

One of the difficulties I anticipate arising at the interface between the Mental Health Act and the Mental Capacity Act is over the principle of objection. Among this cohort of people, objection may not be active; it may be passive. Sitting quietly, being withdrawn and being unhappy should be enough objection for people to consider whether the person should have been placed somewhere different or whether the conditions of their liberty protection safeguards should be altered. I have the impression that the type of objection envisaged in the Mental Health Act review was much more active than this type of passive objection, which could be interpreted as consent.

The other worrying aspect relating to this Bill and to the entire mental health review is the acute shortage of accommodation for people, both in the short and long terms. There is a shortage of suitable accommodation for people in crisis and of long-term accommodation that can meet people’s needs. Some are therefore accommodated in places not really adequate for their needs, but there seems to be no other option.

I repeat my gratitude to the Minister for having listened and brought forward this government amendment, and for all the other amendments that have gone into the Bill and brought about substantive changes. I look forward to hearing those reassurances in his response.

[Baroness Watkins of Tavistock (CB)]

My Lords, I concur with what other noble Lords have said and ask the Government to take one more look at the remaining conflict of interest relating to independent hospitals. It appears they will be able to employ their own AMCPs and, as the responsible body, authorise the deprivation of liberty of people in the hospital. This could pose a huge conflict of interest. The team has taken a great deal of trouble to remove this in the care home setting, and it seems it would be relatively straightforward to do so for independent hospitals. I fully support the amendments outlined today.

[Baroness Barker (LD)]

My Lords, I too thank the Minister for bringing forward this amendment and for having taken the time and effort to discuss the thinking of the department with many of us. I pay tribute to him and to the noble Baroness, Lady Stedman-Scott. They were rookies—this was their first ever Bill—and they have done a tremendous job, not least because it is a fairly open secret that many of us think this is one of the worst pieces of legislation ever brought before this House. I seriously mean that; we have said it several times. Together, they have enabled all of us in this House to play a very responsible role in turning some very bad legislation into legislation that is still in many regards highly deficient, but not as bad as it was.

As the noble Baroness, Lady Murphy, said, inevitably we failed to see the wood for the trees. We were so busy dealing with big defects in what was presented to us that we did not really get the chance to stand back and look at what would be an efficient overall system. It is for people in the House of Commons to look at what remains to be done to improve the Bill as it comes to them.

Part of it is that we spent so much time looking at the role of care home managers, we did not get around to thinking about how AMCPs, IMCAs and appointed persons could work together more efficiently to ensure that the most vulnerable get the most attention. It is unfortunate that Sir Simon Wessely’s review came to us only last week, with, at its very heart, the important issue of objection, the implications of which we should have been able to discuss in this Bill. I am sure we will need to return to that.

On this amendment, I thank the Minister for widening the triggers to include the involvement of an AMCP. But I want to flag up to those who will look at this in future the change in the role of care home managers and the role they will continue to play in renewing deprivations of liberty for up to three years, which is a big concern.

I also want to return to an issue that has been raised before: why, in this Bill, do we continue to deploy the best interest argument when it comes to ensuring that somebody has an IMCA? Several times we have asked to see the evidence base for creating that hurdle to access an IMCA, and the Government have yet again not given us any. A lot of people, particularly older women with dementia, will not get an IMCA because they will not be deemed to be objecting.

Perhaps the Bill’s biggest deficiency, and one we have not discussed much, is that practically nothing is in regulation; large swathes of it will be left to a code of practice. If one goes back to the Mental Capacity Act, however, one finds regulations that relate primarily to those who will be enacting this legislation. Regulatory conditions are applied to those who can be an AMCP, and to what their training has to be, and to those who can act as an IMCA, and to their ongoing duties to maintain contact when people move and to step in when the appropriate person, for some reason or another, ceases to fulfil the obligations it was initially assumed they would.

I say to those who will look at this in the House of Commons: the Government must be required, apart from anything else, to come forward with a great deal more detail than we have been able to elicit from them. With that, I welcome what is before us today.