NHS: Waiting Lists and Increased Spending
Baroness Merron Excerpts(1 year, 5 months ago)
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Lord Markham (Con)
I thank my noble friend. To be honest with him, I am hoping we can act quicker than that—that is absolutely the plan. I can tell him that we know the areas where they are performing and they are on the elective recovery plan, and we know those that are not. I do not need a royal commission to tell me that. To my mind, it is about understanding what those hospitals are doing well and putting in place focused action and support to help those that are behind the plan.
Baroness Merron (Lab)
My Lords, on an earlier Question, I and other noble Lords asked the Minister if the Government were still committed to their target of 18-weeks between GP referral and consultant-led treatment, and their other targets for A&E waiting times, ambulance responses and cancer treatment. I offer the Minister another opportunity to say to your Lordships’ House whether this is the case.
Lord Markham (Con)
I thank the noble Baroness. As I am sure the House is aware from the statements of the Chancellor and the Health Secretary, in a lot of areas we are trying to make sure that we place fewer targets on the health professions and GPs and allow them to manage. At the same time, we make sure that if they are not performing, action is taken, but generally we trust them to manage. The beauty of Google is that I have been able to check the 18-week target, and it is a statutory commitment, so I can give that assurance. However, on the others, we are making sure that we look at the performance measures that really matter.
Health: Pancreatic Cancer
Baroness Merron Excerpts(1 year, 5 months ago)
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Lord Markham (Con)
This is where we see the diagnostic centres being a key area in this. We have set up 91 community diagnostic centres. In addition, in 2020 we had only 12 non-specific symptoms pathways; we are now rolling those out to 96, so that 75% of the population will be covered by March 2023, with a target of 100% by March 2024.
Baroness Merron (Lab)
My Lords, the UK is lagging behind comparative European nations on cancer survival rates. In the landmark How Good is the NHS? report, the UK came last on pancreatic cancer survival rates. Could the Minister give a view as to why the UK compares so unfavourably to elsewhere? How will the recent comments of the Health Secretary about changes to national targets affect waiting times and survival rates for patients with pancreatic cancer?
Lord Markham (Con)
We are very clear on the need for speed in cancer treatment; that is one target that will not change, because we know its importance in all this. With pancreatic cancer, we are where we were with prostate cancer about 10 or 15 years ago, and I am glad to see that we have made great strides on that with initiatives such as the Movember campaign and the action on that. Candidly, we are not where we need to be on pancreatic cancer, and we need to adopt those sorts of awareness campaigns, as well as fast action on screening, to improve our performance.
GPs: Anti-depressants and Alcohol
Baroness Merron Excerpts(1 year, 5 months ago)
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Lord Markham (Con)
We all agree that GPs are best placed to do this. I think the House is aware of our commitment to increase the number of GP appointments by 50 million, and we are well on course to meet that target. At the same time, we have the independent review of drugs by Dame Carol Black, which looks at mental health, drugs and drink and how they are closely related, to make sure we have the best advice. First and foremost, I totally agree that the best-placed person is a GP talking to their patient.
Baroness Merron (Lab)
My Lords, the Joseph Rowntree Foundation reports that the number of anti-depressant prescriptions is twice as high in the most-deprived areas compared to the least-deprived, with the differential even more marked when it comes to severe conditions. With the long-promised health inequalities White Paper now seemingly sunk without trace, where is the Government’s strategy to change the conditions that affect mental well-being in the most deprived areas?
Lord Markham (Con)
My Lords, as set out in the draft mental health Bill, mental health activities are very focused on where help can be given in areas of inequalities. As to the position in the White Paper, I am afraid that the answer is the same as in the previous case: I do not have any information at the moment on any date.
NHS: Backlogs
Baroness Merron Excerpts(1 year, 6 months ago)
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Baroness Merron
To ask His Majesty’s Government what assessment they have made of (1) the backlog of the maintenance of NHS buildings, and (2) the impact of the backlog on the capacity of the NHS to deliver services.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The NHS publishes the annual Estates Returns Information Collection, which provides a detailed breakdown of backlog maintenance. Patient and staff safety is our top priority. While individual NHS organisations are responsible for their estates, we recognise that backlog maintenance can have a significant impact on NHS services. That is why £12 billion in operational capital will be provided to the NHS over the next three years for trusts to maintain and improve the estate.
Baroness Merron (Lab)
My Lords, last month, NHS Digital reported that the maintenance backlog had increased by 11% from last year to over £10 billion, with more than half of it posing a high or significant risk to safety or the delivery of healthcare. So does the Minister agree that, if more facilities, operating theatres and buildings had been properly maintained, they could have been used to provide care and reduce waiting times? Having allowed the maintenance backlog to double over the past 12 years, will the Government now fix this?
Lord Markham (Con)
I agree that it is an area of key priority; that is why the spend in this year as reported by NHS trusts has gone up by 57%—an increase to £1.4 billion. So we recognise that this needs to be worked on, but I put it in the context of an overall £10 billion capital programme, including a new hospital build. We very much recognise that making sure we have excellent facilities is key to success in the NHS.
Ambulance Delays
Baroness Merron Excerpts(1 year, 6 months ago)
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Baroness Merron (Lab)
On behalf of my noble friend Lord Hunt of Kings Heath, and with his permission, I beg leave to ask the Question standing in his name on the Order Paper.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I hope I will get better at this with practice.
We are increasing NHS capacity to reduce delays and support ambulance services in getting to patients as quickly as possible. This includes action to deliver the equivalent of 7,000 extra NHS beds and £500 million in funding to help speed up patient discharge. NHS England is providing direct support to our most challenged hospitals on ambulance handover delays, as well as £150 million of additional funding for ambulance trusts and a further £20 million to upgrade the ambulance fleet.
Baroness Merron (Lab)
My Lords, has the Minister been able to watch the ITV investigation broadcast in which we saw case after case of paramedics graphically describing the desperate situations they are trying to deal with? I note that, in response, his departmental spokesperson said that they recognised the problem. Will the Minister agree to report back to your Lordships’ House on what the Government are doing, when and how, to ensure that people are not left waiting for ambulances, particularly with the anticipated winter crisis on the horizon?
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.
Abuse and Deaths in Secure Mental Health Units
Baroness Merron Excerpts(1 year, 6 months ago)
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Baroness Merron (Lab)
My Lords, week after week we return to this Chamber to hear of patients dying when their deaths could have been prevented and patients being bullied, dehumanised and abused, and their medical records falsified, in a scandalous breach of patient safety. This cannot continue. In reflecting that it feels as though it is being left to undercover reporters to expose such terrible failings in patient care, will the Minister action a rapid review of mental health in-patient services? What are the Government doing to ensure that patients’ complaints about their care are being taken seriously?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I thank the noble Baroness. I first want to apologise for the failings in the care that Christie Harnett, Nadia Sharif and Emily Moore received. My thoughts, and I am sure the thoughts of this whole House, are with their families and friends. The death of any young person is a tragedy, all the more so when they should have been receiving care and support in a safe place.
The Minister in the Commons is looking much more towards a rapid review rather than a public inquiry, as the feeling is that rapid action is needed. We have seen some good examples of that recently, with Dr Bill Kirkup. It is very much at the top of the agenda and I agree with the noble Baroness; this is the third time I have spoken on similar incidents in the short time I have been here. We clearly need to make sure the proper action is in place to identify these issues.
NHS: Discharge to Assess Policy
Baroness Merron Excerpts(1 year, 6 months ago)
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Baroness Merron (Lab)
My Lords, with the permission of my noble friend Lady Wheeler, and on her behalf, I beg leave to ask the Question standing in her name on the Order Paper.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
It is vital for carers to be involved in critical decisions regarding their loved ones’ care. The Government will publish shortly new statutory discuss charge guidance, which will include the new statutory requirement to involve carers. NHS bodies and local authorities will be able to use that guidance as a resource to support carers from the point of hospital admission through to post-discharge care and support.
Baroness Merron (Lab)
My Lords, today’s State of Caring report from Carers UK paints a bleak picture, with one in two carers still not involved or properly listened to over their loved ones’ discharge from hospital. When will the Government live up to the promise of their Health and Care Act to properly involve both patients and carers in moving from hospital to social care? While there is repeated reference from Ministers to the promise of a £500 million adult social care fund, intended to support the discharge process, when will this reach the front line?
Lord Markham (Con)
I welcome the Carers UK report that came out today. It has provided much valued information which will be part of the information that we are using as part of the guidance we will be putting out shortly. It has taken some time because we want to get it right. We have involved NHSE, local authorities and carers, and we are using this report and the Carers UK conference that will take place on Thursday as vital inputs to make sure that we get that guidance out properly. As the report rightly states, the fact that 50% are not getting the guidance and support they need clearly shows that more needs to be done in this space. On the £500 million discharge fund, that has now been agreed, and I understand that that will go out very shortly—in a matter of days.
British Heart Foundation: Tipping Point Report
Baroness Merron Excerpts(1 year, 6 months ago)
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Baroness Merron
To ask His Majesty’s Government what assessment they have made of the report by the British Heart Foundation, Tipping Point, published on 3 November; and what steps they intend to take in response to the finding that from the beginning of the Covid-19 pandemic to August 2022 there were 30,000 excess deaths involving coronary heart disease in England.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
This is a detailed report that requires time to be fully considered. NHSE has been monitoring excess deaths and has put in place the cardiovascular disease prevention recovery plan. This prioritises support to help systems, including prevention planning, risk-factor diagnosis, monitoring and management, to recover to pre-pandemic levels; it also tracks progress and ensures that interventions are effectively targeted. The plan includes resources to create CVD prevention leadership roles in every integrated care system from April 2022.
Baroness Merron (Lab)
My Lords, British Heart Foundation analysis has found that millions of missing heart patients, both diagnosed and undiagnosed, are struggling to get care for conditions such as high blood pressure. At the same time, modelling by NHS England suggests that a decline in blood pressure management could lead to more than 11,000 extra heart attacks and nearly 17,000 additional strokes in the next three years. What are the Government doing to identify and treat these missing patients? How will they address the backlogs in every part of the system, which are affecting time-critical emergency care?
Lord Markham (Con)
It is quite right that blood pressure management or hypertension is a key indicator. That is why we have put in place many points when people’s blood pressure can be measured. Anyone who has had a Covid vaccination recently would have had their blood pressure taken. This can now be performed at—
Ambulances
Baroness Merron Excerpts(1 year, 6 months ago)
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Baroness Merron (Lab)
My Lords, I am glad to follow the noble Baroness, Lady Brinton, and I thank the right reverend Prelate for bringing not just this debate but great clarity to the issues it deals with.
In my view, the NHS faces what can only be described as a perfect storm in the making—except perfect it is not. The situation is absolutely dire and has been for many years; this is not a new problem. We have heard many times in your Lordships’ House about the well-documented challenges of getting an ambulance in an emergency. These challenges have served only to undermine the profound trust that the public ought to have in the National Health Service. In August alone, the Association of Ambulance Chief Executives estimated that around 35,000 patients were potentially at risk of harm as a result of long handover delays, with just under 4,000 of these experiencing potentially severe harm. There is no doubt that delay is the enemy of good care and safety.
As we have heard, delayed handovers are not just damaging in themselves. They result in poorer ambulance response times, as ambulances sit queueing outside A&E departments and cannot therefore get to patients waiting in the community. This increases pressure on not only clinical staff but ambulance call handlers, as the right reverend Prelate said, as distressed patients and their families call to get updates on their wait time, leading to thousands of duplicate calls and placing ever more pressure on ambulance services.
This situation now has all the potential to get even worse, with ambulance workers in 11 trusts balloting for strike action. If it does go ahead, it will be the biggest strike in that sector for some 30 years, which is surely nothing short of a disgrace. Union leaders have said that this is as much about patient safety as pay—and of course, when we talk about pay, we are doing so in the midst of a cost of living crisis. The right reverend Prelate asked the question: what has brought us to this point? I hope the Minister will reflect on that and perhaps give a view on it today to your Lordships’ House.
The general secretary of Unison, Christina McAnea, has said:
“Striking is the last thing dedicated health workers want to do. But with services in such a dire state, and staff struggling to deliver for patients with fewer colleagues than ever, many feel like the end of the road has been reached.”
Recently, the Minister advised nurses considering strike action to regard their work as a vocation. Can he give his view today on ambulance workers who are considering whether to go on strike? Indeed, can he give his views on the widespread balloting for strikes across the National Health Service, the factors he considers have led to this unrest, and whether they could have been avoided?
The Royal College of Emergency Medicine is clear that crowded hospitals is the operational issue stopping A&E doctors treating patients effectively and efficiently. As we know, high volumes of A&E attendances lead to overcrowding, rising pressure on services and a poorer experience for patients. Between April 2021 and March 2022, there were 24.4 million attendances at A&E across England, compared with 21.5 million in 2011-12. What assessment has been made of the reason for that increase, and could it have been avoided by taking action in other parts of the NHS, including on GP access?
It is fair to say that people desperately want to see an increase in the number of social care staff and beds, but perhaps it will be helpful if I emphasise that we are talking not just about beds but staffed beds, an increase in which would relieve the pressure. I add my voice to those of the right reverend Prelate and the noble Baroness, Lady Brinton, in asking a question that has been asked on so many occasions in your Lordships’ House: where is the workforce plan to deliver this increase in staff in the short, medium and long term? All of this is desperately needed.
Perhaps I may offer a helpful suggestion to the Minister: that the Government publish monthly the data, which is already being collected, showing the number of patients waiting two hours or more from the moment they step into the hospital, rather than simply when the doctor decides to admit them. It would be hugely helpful and give a much more accurate picture of patients’ actual experience in the accident and emergency department. Can the Minister take this up with his officials?
From Secretary of State Stephen Barclay saying that ambulance delays were a priority to Thérèse Coffey’s short-lived “ABCD” plan for patients, and now back to Stephen Barclay, it is fair to say that the sector is crying out for stability. Will the Minister indicate whether the plan for patients is still valid? Perhaps he might feel able to tell your Lordships’ House whether the new ministerial team have reviewed it and, if so, whether the Minister and his colleagues feel that the plan is sufficiently ambitious. It would be helpful for your Lordships’ House to have an update on this plan.
In my recent meeting with the Minister, for which I am grateful, he indicated that there are some 15 problem trusts that are especially struggling with ambulance delays. It would be helpful to receive an update on where the department’s work is on this and how lessons might be learned across the system, and for your Lordships’ House to know what action will be taken.
As we approach winter, what forecasting has been done on how the delays in these 15 trusts are likely to develop or change, and what will be done to avert the potential pressure of Covid and flu on these delays? I again emphasise the points about the £500 million adult social care discharge fund. Reports are that it is yet to be released to the health and social care system. Can the Minister say whether this is the case? If it is, why, and what is to be done?
Finally, what assessment have the UK Government made of the impact of current nursing vacancy rates on patient safety and emergency care? If an assessment has been made, can we have a publication of the modelling that has been done? Has there been a cost-benefit analysis of current spend on agency and international staff versus investing in recruitment and retention within our domestic workforce? As the right reverend Prelate said, this is not just about ambulances. This is a whole-system problem. I hope that the debate today will encourage the Minister to see it as such.
NHS: Nurses
Baroness Merron Excerpts(1 year, 6 months ago)
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Lord Markham (Con)
The plans are very much those that we are doing, which I believe are successful. As mentioned before, it is not just that the number of nurses has gone up by 29,000; we have seen significant increases in doctors and the other medical professions as well. We should remember that we have 200,000 more people working now within the profession than in 2010. That is not to say that we will rest on our laurels; I completely agree that we need to carry on expanding supply to ensure that we properly meet the demand.
Baroness Merron (Lab)
My Lords, given that the Minister has previously stressed that nurses should rely on the vocational appeal of their work for their rewards, how does this square with the reasons that he acknowledged exist as to why a record 40,000 nurses left the NHS in the past year alone?
Lord Markham (Con)
I am very aware of the Nuffield figures but that 40,000 includes people who have gone back into other parts of the nursing profession. The actual net number as cited by Nuffield is a 27,000 reduction, which is why we have had the growth. However, we should ensure that it is as attractive a profession as possible for people to work and progress in. That is very much what I would like to see.