NHS: Backlogs

Lord Markham Excerpts

Wednesday 9th November 2022 Lords Chamber

[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.

[Lord Lexden (Con)]

My Lords, what has become of the great hospital building programme that Mr Boris Johnson promised in the 2019 Conservative election manifesto?

[Lord Markham (Con)]

I am very pleased to say that the hospital programme is very much a feature. We are already working on five hospitals, which are in the process of being delivered. The programme for the 40 hospitals is very much in progress, and we see it as a real opportunity for the UK to take a lead, as we are looking at using a whole new series of modern methods of construction, which we believe will be world leading in this space.

[Lord Morse (CB)]

My Lords, the Minister will no doubt be aware that for a long time it has been the practice of the NHS to rob Peter to pay Paul by appropriating capital budget to supplement revenue deficits. That really needs to stop, as it has led to a massive deficit in estate maintenance across the NHS. Care is being delivered in dilapidated surroundings across the system. That means that this building programme really matters—it is not a question of leaping forward but of making good long-term neglect. So I express to the Minister that if, as a result of the financial review, we find the programme being either delayed or cut, that would be deeply unsatisfactory.

[Lord Markham (Con)]

I agree on the importance of that; as the noble Lord says, often these are easy savings to make, but they are not the right ones. I assure the House that it is a key priority of mine that even such things as operational maintenance, which sounds very unsexy, are a key element in all this. As I say, that is why we have seen a 57% increase in the past year. At £10 billion a year, I hope we all agree that this is a good plan, albeit that there is a lot that needs to be done.

[Baroness Manzoor (Con)]

My Lords, the Public Accounts Committee has stated that £8.6 billion was lost by the DWP last year in overpayments to benefit claimants and fraud. That is £8.6 billion that could be used to maintain the NHS estates. Can my noble friend the Minister say what the Government are doing to ensure that not only are the inefficiencies cut in the NHS, but efficiencies are made within the wider government departments?

[Lord Markham (Con)]

Thank you. I am sure the whole House will agree the need for efficiencies to make sure every pound is well spent. I have a little knowledge in the DWP space. Although it falls outside my responsibilities now, I was the lead NED there and I know that the team worked very hard during the pandemic to make sure that universal credit reached people quickly, and as a result they did not proceed with as many checks as they would do normally. It was deliberate policy to make sure money was paid quickly to those who needed it. At the same time, they absolutely understand that they need now to get on top of it and it is key to their action because, as my noble friend says, the more money we can free up in other departments, the more we can focus it on the front line where we really need it.

[Lord Blunkett (Lab)]

My Lords, I recognise that the noble Lord is new in post and the Secretary of State is sort of new, having been in and out and then back again. But the backlog in repairs is mirrored by the exponential increase in waiting lists. Has this something to do with the atrophy that now exists in the health service due to the changes brought in by Matt Hancock, which have led not to the integration of services but the integration of bureaucracy?

[Lord Markham (Con)]

I can assure the noble Lord that bureaucracy is not the aim of the game and that getting money to the front line is the priority. We have record levels of investment in this area. We are currently devoting about 12% of GDP to health spending, which sits alongside the highest in the world. That is not to say we do not have to make sure every penny of that is spent effectively and, where possible, on the front line rather than on back office and bureaucracy.

[Lord Stoneham of Droxford (LD)]

My Lords, the key test of any organisation with a backlog of maintenance is whether it sustains that expenditure when it is under financial pressure. So will the Government commit that the extra money they have budgeted for maintenance in the health service will be maintained in real terms when inflation is running at 10%?

[Lord Markham (Con)]

We understand the importance of the programme, as I mentioned, and, in terms of the finances of the country, we have people in high positions who know its importance in the health debate. So the noble Lord can rest assured that it is top of our agenda, and we will be fighting hard to make sure that the capital programme is given the priority it needs.

[Baroness Masham of Ilton (CB)]

My Lords, would the Minister like to visit Masham GP surgery, where I live? He will find it is a GP surgery that needs updating. It was turned down, and one of the doctors left and went to Canada. It is now totally unsuitable for a growing population, for both patients and the staff working there.

[Lord Markham (Con)]

I do recognise the importance of primary care. We know that a lot of the people who turn up to A&E would be better served in the primary care system, so making sure we have good facilities in this place is vital, and again it is something that is part of our agenda. There was an excellent report in this space recently, and it is something we are working towards—so, yes, GP surgeries are very much an important part of this £10 billion programme.

[Lord Kamall (Con)]

My Lords, in response to an earlier question about the hospital building programme, my noble friend the Minister mentioned the modern construction techniques of hospitals. I wonder whether he could enlighten the House on some of the leading technology methods we are looking at when it comes to the new hospital programme.

[Lord Markham (Con)]

Absolutely; I look forward to sharing this with the House in a lot more detail shortly. This is a real opportunity to create a world-leadership position. The idea behind it is to have a standardised approach to building hospitals—hospitals 2.0, as I like to call them—where we look as much as possible to have standard processes, procedures and components, so that we can build them quicker, cheaper and more efficiently, and get economies of scale from doing that. I believe that it will not only pioneer the way we build hospitals in this country but give us an opportunity to be a pioneer worldwide and create a major export industry.

[Lord Berkeley (Lab)]

My Lords, I believe that Prime Minister Johnson promised 40 new hospitals, but the Minister has mentioned five—what has happened to the other 35?

--- Later in debate ---

[Lord Markham (Con)]

The other 35—I will happily read them out if the noble Lord wishes—are very much part of the programme, and extensive work and business plans are being performed. I visited one myself, Watford General Hospital, just the other day to go through the plans, so the noble Lord can rest assured that the other 35 are very much still part of the programme.

Bereavement Support

Lord Markham Excerpts

Wednesday 9th November 2022 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what steps they plan to take in response to the report by the UK Commission on Bereavement, Bereavement is Everyone’s Business, published on 6 October, which found that over 40% of respondents who wanted formal bereavement support did not get any.

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

Ensuring that bereavement support is available to those who need it when they need it remains a priority for the Government. The Government have set up a cross-government bereavement working group to ensure better join-up across government. We will use this group to address the recommendations raised in this report, and we will continue to work with the voluntary sector and across all four nations to improve access to support for bereaved individuals.

[The Lord Bishop of London]

I thank the Minister for his response. During a Westminster Hall debate on 5 July this year, the former Minister for Care and Mental Health, now the Secretary of State for Education, made a commitment that the Government will formally respond to the commission’s report. Now that the commission has published its findings, highlighting the challenges that bereaved people face today and setting out our detailed recommendations for improving support in the future, will the Minister reaffirm the Government’s commitment formally to respond to the commission’s report?

[Lord Markham (Con)]

First, I say on the record that I welcome the support in this area—the title of the report encapsulates the whole issue, in that bereavement is everyone’s business. That sums up the whole approach, which is one I totally agree with. We have set up a new policy team to work in this area, and it is meeting with the commission next week to talk about how to address those recommendations. The right reverend Prelate and I have a meeting shortly afterwards, to which I am intending to bring some members of that team so that we can discuss it further.

[Baroness Whitaker (Lab)]

My Lords, one group in particular need of bereavement counselling is young men from the Gypsy and Traveller population. Although the absolute numbers are not very large, the proportion of suicides among that group is far higher than in any other group. Nevertheless, they are not on the NHS register of groups particularly at risk. Will the Minister ensure that they get proper recognition, in spite of the fact that the absolute numbers are not large, because of the huge preponderance of suicides?

[Lord Markham (Con)]

I agree; we have to address every group. Part of the research into this is about ensuring that every group has access to support. I cannot speak in detail on the group mentioned, but I will make sure that the new team we have set up addresses this, because mental health and the causes of suicide are often the tip of the iceberg, and we need to make sure that every single group is addressed.

[Lord Lexden (Con)]

My Lords, for centuries, people at times of bereavement have turned to their priests, pastors and other spiritual leaders. Should not the Churches, and the Church of England in particular, react to this report by renewing and indeed enlarging their spiritual mission to comfort and succour the bereaved? Or could it be that in the diocese of London there is a feeling that some are no longer equal to this task, it having caused a bereavement in 2020 by driving to suicide a priest who was the friend of my heart in Cambridge years ago, accusing him, falsely, of sex abuse, refusing to disclose the allegations to him and then later asking a commoner to cover up for it?

[Lord Markham (Con)]

I am afraid that I do not have any knowledge of the case in point. As I said before, I welcome the role of the right reverend Prelate the Bishop of London in producing this report, which I know all the bishops and all the Church, of whatever faith, will take directly to heart. Again, I can only repeat the title of the report: Bereavement is Everyone’s Business. The Church has a key role to play in that, as it fully understands.

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government ensure that groups who are undertaking good bereavement support of children, particularly in schools, are actively engaged in cross-departmental working, given that a large number of children who are acutely bereaved do not get any support at all and often do not have the language with which to express their feelings? Will the Government also ensure that, through the Ministry of Justice, the Prison Service is actively involved? It has been estimated that about four out of five remand prisoners have had a seriously traumatic bereavement experience with no support at all, which has culminated in progressive anger resulting in criminal activity.

[Lord Markham (Con)]

I was very struck when I read the report by the breadth: for every death, five to nine people are bereaved, and often they are young people or people in prison. The truth, as we know, is that it is people across the board. That is why I particularly welcome the new policy team, which has members from the DfE and, I think, the Ministry of Justice; however, I will check, because the point the noble Baroness has made is a good one. The whole point of the policy team is that it is cross-functional, to try to ensure that we really can touch every single point where there are institutions which can help the bereaved.

[Lord Rennard (LD)]

My Lords, I lost my father at the age of three and lost my mother just before I was 17. At that point, my schoolfriends did not know what to say, my teachers’ concern was confined to my academic progress, and when I was suffering from the consequences of bereavement while at university, I found no sympathy or support from staff. Recently, half of the respondents to a Childhood Bereavement Network survey said that they had little or no support from their educational setting after bereavement. What can be done to improve access to bereavement services, to improve the training of education professionals in helping young people manage their lives after bereavement, and to help children better understand the process of dying and managing their emotional feelings in those difficult circumstances?

[Lord Markham (Con)]

I thank the noble Lord, and I agree. I have to admit that when I was a child, I failed a friend, because I did not know what to say. As I mentioned, the DfE is part of this working group and we are training 10,000 early years practitioners in this space to try to ensure that they can provide the training that is needed in schools. The number of schools supported in this way is increasing, but today it is still only 35%, so clearly there is more work to be done. The noble Lord can rest assured that we take this very seriously.

[Baroness Browning (Con)]

Does my noble friend agree that the pain of bereavement, for all people, under whatever circumstances somebody has died, is a pain like no other? Will he consider the need to act swiftly for people whose loved ones have died—perhaps I might use the word—prematurely? Sudden death brings with it a shock that requires professional support from well-trained people, and which lasts for a very long time, if not a lifetime. Will he also consider whether registrars of death should hold in their offices a lot more localised information, with good contacts and reliable resources that can be made immediately available when a death is registered?

[Lord Markham (Con)]

Yes, and again, that is where I welcome the report, which sets out how we must all ensure that we are training people to respond in the most appropriate way possible. I see our role in this as enablers, so that we can get the right people and put the right support in place at every level and in every circumstance. Clearly, where there is a sudden death, that adds a particular circumstance that needs a different approach. Again, that is why I welcome the report and the policy team, and I look forward to meeting with the right reverend Prelate the Bishop of London later to ensure that we are covering all these different examples.

Ambulance Delays

Lord Markham Excerpts

Wednesday 9th November 2022 Lords Chamber

[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.

[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.

[Lord Tomlinson (Lab)]

The Minister referred to the ABCD. I remember from when I read about it—it treats us rather like kindergarten children, does it not? —that “A” is for “ambulances”. But the big idea for ambulances in that document from the former Deputy Prime Minister was to create an auxiliary ambulance service. As the problem with the ambulance service at the moment is getting patients out of ambulances and into hospitals, what good will an auxiliary ambulance service do if it merely gets more people into hospital car parks, where more of them are waiting in more ambulances?

[Lord Markham (Con)]

The noble Lord is referring to the whole-system issue here, which I mentioned before. There is a £450 million investment to increase capacity in A&E facilities; that has already worked to upgrade 120 trusts to enable them to offload quickly. There are also 7,000 extra beds, and the £500 million social care discharge fund is all about freeing up more beds so that ambulances can discharge quicker.

[Baroness Watkins of Tavistock (CB)]

My Lords, I must declare that I am a former deputy chair of an ambulance trust that was an exceptional performer but is no longer, associated with the fact that, in some circumstances, it cannot get patients admitted to two of its largest local hospitals in under four hours. The problem is social care, not increasing the number of ambulances on the roads. Will the Government consider much more innovative approaches to respite care support for people who are ready to leave hospital and whose families cannot afford to leave work to look after them but, with incentives, probably could do so? That would be a practical way of moving the system forward at the moment.

[Lord Markham (Con)]

I agree with the noble Baroness that social care is a key solution to all this. As I said, that is what is behind the 13% of beds that are currently blocked and the £500 million spend in this area. However, we can be more innovative. That is what the virtual ward initiative, which I saw working so well in Watford, is about; it has reduced reattendance rates after 90 days from 46% to around 8% for COPD patients. This is an area where we need focus and innovation, and which is very much top of my agenda.

[Lord Rennard (LD)]

My Lords, as the Minister has already suggested, part of the problem is unnecessary call-outs to ambulance services for people who do not need admission to hospital. Care homes regularly call on ambulance services to lift their fallen residents, even though more than 45% are uninjured and do not require transportation to hospital. If care homes had the right equipment to lift people safely, an ambulance may not be needed after a fall. Some ambulance services are providing this kind of equipment to care homes, from their own resources, to reduce the number of unnecessary call-outs. Should we not ensure that all such homes and blocks of sheltered accommodation have access to this kind of equipment, which would get people up more quickly, reduce the number of call- outs and save money?

[Lord Markham (Con)]

Many noble Lords have talked today about what is a whole-system problem, which the noble Lord has mentioned in terms of care homes. It is all about treating people in the right place, with the right equipment, so I absolutely agree with this approach. It is the approach that we are taking to make sure that people are treated in the right place, so I will take the noble Lord’s suggestion back to the department.

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest in the Dispensing Doctors’ Association. My noble friend has rightly identified the problem of underfunding in primary care. What is he going to do at this time to address the chronic underfunding in the delivery of primary care in rural areas?

[Lord Markham (Con)]

The government pledge of 50 million additional appointments is across the country. It is the job of the ICBs to make sure that each area is well catered for; the idea is that this is felt in every area, including rural areas. I am glad to say that we are making good progress on our target to increase appointments by 50 million and, rest assured, I am working with the integrated care boards and their systems to ensure that they touch every part of England, including rural areas.

[Lord Patel (CB)]

My Lords, the Minister said that this is a systems failure. Who in the Government is responsible and when will the system be fixed?

[Lord Markham (Con)]

I think I said this is a systems issue. It is something on which we—including me and the Secretary of State—are very focused, because we need to address it across the piece. That is what the ABCD plan is all about. I am very confident that, over the coming weeks and months, we will start to see improvements from the investment we are making in 7,000 more beds and £500 million more into adult social care discharge.

Abuse and Deaths in Secure Mental Health Units

Lord Markham Excerpts

Wednesday 9th November 2022 Lords Chamber

[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.

[Baroness Tyler of Enfield (LD)]

My Lords, when this Question was answered in the other place on 3 November, the Minister said that

“staff shortages often contribute to some of the failings we have seen.”—[Official Report, Commons, 3/11/22; col. 1021]

These are some of the most horrific cases of abuse and death in so-called secure mental health units I have ever seen. Can the Minister say what emergency intervention funding will be made available, as happens with maternity services put into special measures, to ensure that every mental health patient in a secure unit is in a safe place?

[Lord Markham (Con)]

I agree, and I have been asking similar questions around whether we should be looking for a special measures-type regime in this space. To be fair to the new CEO, who has come in from 2020, he has set out a plan and progress is being made on many steps. It is the focus of the Minister to see whether that progress is quick enough. We understand that staffing is a key issue. We have increased the number of staff by 24,000 since 2016, and almost 7,000 in the last year alone. Clearly, part of this rapid review needs to be around staffing.

[Baroness Buscombe (Con)]

My Lords, I currently chair the Joint Committee scrutinising the draft mental health Bill. This is an important Bill and is the subject of both Houses on a cross-party basis. We hope to publish our recommendations in the middle of January. Will my noble friend reassure me and the whole House that great care will be taken to consider the recommendations we put to the Government and that an early response will be brought forward in the light of the fact that it is incredibly important that we see this legislation through as soon as possible?

[Lord Markham (Con)]

I thank my noble friend for the work that she and others are doing in this space. I agree that we need to respond rapidly. As I said, this is very high on Minister Caulfield’s agenda, and I assure my noble friend that we will be looking to respond quickly.

[Baroness Berridge (Con)]

My Lords, I am also serving on the Joint Committee mentioned by my noble friend. We received evidence that the highest rate of mortality for those held in custody between 2016 and 2019 was among those held under the Mental Health Act. If you die in a prison or an immigration centre, there will be an independent investigation under the Prisons and Probation Ombudsman, and if you die in police custody, the IOPC will investigate. There is no independent investigation should you die while detained under the Mental Health Act. Is that not a lacuna that the Government could look into in relation to deaths while being detained under the Mental Health Act?

[Lord Markham (Con)]

My noble friend raises a good point. My understanding is that the rapid review that we seek to put in place would involve an independent chair, because independence is key in this area. On the detail of whether that should be the case for every death, I will take back that point and respond to my noble friend.

[Lord Harris of Haringey (Lab)]

My Lords, following on from the noble Baroness, Lady Berridge, until 2015 I chaired the Independent Advisory Panel on Deaths in Custody. As she said, the largest number of deaths in custody were those in secure mental health units. There is no independent arrangement. It is all very well to talk about an independent chair, but, essentially, the assessment is being made by those in the same field—sometimes, indeed, in the same institution. The Government are failing their Article 2 obligations on the right to life. How frequently do the Minister and his colleagues in the department meet the Independent Advisory Panel on Deaths in Custody, and when did they last take note of, and act on, the recommendations it has made?

[Lord Markham (Con)]

I do not have the information to hand on when the last visit was, so I will write to the noble Lord on this. The substance of the question is good: clearly, we cannot have people marking their own homework—for want of a better phrase—in this situation, so I will take back this point. Again, I understand the importance of this; it is vital that these young people, and others in mental health institutes, are supported in the right way. We are spending about £400 million to eradicate dorms, which are often part of the problem, but that is not to say that more does not need to be done.

[Baroness Uddin (Non-Afl)]

My Lords, I declare my interest as a registered social worker. Last year, I had the opportunity to look at mental health services in east London, where the overrepresentation of black and Muslim men is absolutely horrific. Their experiences are vastly different, and there is no recognition of the fact that they are suffering not just bullying but racism and Islamophobia. As the Minister will be aware, the problem is that, as well as cases of bullying, these services are understaffed. More importantly, the staff who are supposed to be supporting these individuals who are very unwell are underqualified and severely underpaid. There is a great deal for us to be concerned about, including underresourcing and staff training. What is the Minister’s department doing about this? Having just announced one set of funds after another, which had no effect at all on the ground in those wards, can the Minister say what the reality is on the ground?

[Lord Markham (Con)]

We are investing, and I understand and agree with the point that training is key to this. We have committed to spend £2.3 billion more in 2023-24 in the mental health arena, exactly around this space. It is something that we are working on, and we understand that we need to ensure that the mental health of all our citizens, whatever their race or colour, is well served and looked after.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, as a member of the committee that the noble Baroness, Lady Buscombe, chairs, may I ask the Minister to especially note what she said about the importance of acting quickly on whatever recommendations come forward? Will he also acknowledge that mental health services, not just in secure institutions but across the country, are under very severe strain and that it is when people get into crisis that they are then put into secure units, often because they have not had the help they need before that crisis arrives? Will he please accept that there is a very serious shortage of mental health provision across the country? It would be interesting to know what real impact the numbers he has been able to tell us about today will have on that.

[Lord Markham (Con)]

As previously mentioned, we are investing to increase the provision—I believe it is £2.3 billion in 2023-24, which is a significant sum. We have increased the workforce by 7,000 in this last year alone, and there are plans to increase it further. Clearly, we need to keep that under review. I agree with the premise that prevention is always better than cure in these instances, and we need to make sure that mental health services, training and support are given at the point of need.

NHS: Discharge to Assess Policy

Lord Markham Excerpts

Tuesday 8th November 2022 Lords Chamber

[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.

[Lord Laming (CB)]

My Lords, I am sure the Minister will recognise that any one of us at any time could suddenly have a major caring role thrust upon us —completely unplanned and unexpected. Carers make a huge contribution in our society and to the success of the National Health Service. Can the Minister assure the House that he will do everything he can to ensure that the contribution carers make is recognised and respected and that they are valued?

[Lord Markham (Con)]

I agree. The legislation was put forward by the Government to recognise the vital role that carers have in all this. As we are all aware, there are 5.4 million carers out there, and they make a vital contribution, not only to the health of their loved ones but to the wider economy. Of those, 1.3 million receive the carer’s allowance; that shows how many of them do it completely unpaid. That is why I welcome the legislation, and I hope the guidance will show a big improvement in the way that carers feel that they are valued, because they truly are.

[Baroness Verma (Con)]

My Lords, I declare my interests as in the register. First, carers need respite, so will the Government focus on ensuring that carers’ families are given respite so that they can have some quality of life, which, at the moment, is not readily available to them? Secondly, will my noble friend the Minister please look yet again at the minimum that councils can pay providers for delivering adult social care?

[Lord Markham (Con)]

First, I repeat that the needs of carers, including for a break, some respite, are very much understood. Part of the £292 million fund in 2022-23 is in place to try to give unpaid carers a week’s break. On the second part of the question, I will need to come back to my noble friend in writing.

[The Lord Bishop of Bristol]

My Lords, there are currently more than 160,000 vacancies in the social care sector, and, so often, the work of voluntary carers—relatives—needs the support of the wider social care system. Research from the TUC finds that one in three current care workers is likely to leave in the next few years due to low pay. It is very good to see the Government’s new Made with Care recruitment drive. However, please can the Minister set out what the Government are doing to address the concerns about pay and status in the social care system, particularly given the ongoing cost of living crisis?

[Lord Markham (Con)]

Carers are well valued, and the need to ensure that our social care workers are well valued was the subject of a lengthy debate that your Lordships will remember from a couple of weeks ago. In that, we set out our plans for recruitment—not only domestically but internationally. I am glad to say that, even since then, we have seen a further uptick in the number of people recruited from overseas. Overall, it is understood that this is a vital area as part of the ABCD—which still exists. The “C” for carers is still very much part of this, so we are actively monitoring those recruitment plans and making sure that we are trying to provide every element of support.

[Baroness Pitkeathley (Lab)]

My Lords, I hope the Minister will forgive me for correcting his figures but the figure we generally use for unpaid carers now is nearer 10 million since the pandemic. In view of the truly shocking statistics in the Carers UK report that was published today—I am glad that the Minister said it will inform the department’s policy—have the Government given any consideration to revisiting the carers action plan, which went out of date two years ago, or, better still, reviving the idea of a national carers strategy? The first one was published more than 20 years ago.

[Lord Markham (Con)]

My understanding is that part of the guidance will be informed by making sure that action for carers is there but, when I see the guidance, I will make sure that it covers those elements. I agree, as we all do, with the premise. If the carers action plan is out of date—again, this is legislation that this Government have brought forward to show that we understand the importance of carers—clearly it is something that I will take up.

[Baroness Tyler of Enfield (LD)]

My Lords, the recent survey conducted by Carers UK, which has already been alluded to, found that 63% of carers disagreed that they had been asked about their ability to provide care. Indeed, the report is littered with harrowing examples of carers who felt that the discharge of the person into their care had happened too quickly, as a result of which their condition got worse and they had to go back into hospital. Can the Minister say how the NHS will collect both qualitative and quantitative data at the point of hospital discharge to ensure that undue pressure is not being placed on families?

[Lord Markham (Con)]

As mentioned, the Carers UK report and its findings made for sobering reading. It clearly shows why it was right to delay the guidance until we had that input; again, that will be followed up at the conference on Thursday. I think we all agree on the premise that we want to discharge people into their home quickly because that is the best place they can be, provided that they are medically able to be there. It is then in their home that the assessment takes place. Clearly, that must happen in a timely fashion and with the carer’s involvement but, again, the survey showed that that is not being done quickly enough in many cases. I accept that there are many things we need to learn from this but I think we can all agree on the direction: it is right to discharge people quickly provided that back-up and support are there to ensure that they have what is needed.

[Lord Naseby (Con)]

My Lords, as one who has been a carer in the recent past, I ask my noble friend the Minister to double-check that, before any patient leaves any form of NHS care, they have had a thorough checklist of every conceivable thing, including medicines, vaccination or any other procedure that has been undertaken on that patient.

[Lord Markham (Con)]

My noble friend makes the point well. I agree. It is my understanding that such a checklist exists but I will check that and come back to him.

British Heart Foundation: Tipping Point Report

Lord Markham Excerpts

Tuesday 8th November 2022 Lords Chamber

[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—

[Noble Lords]

No!

[Lord Markham (Con)]

I will check on that. I have been told that it is being done as part of that. It is available in a large number of pharmacies now and we have sent out hundreds of thousands of blood pressure monitors, so people can do it from home. It is fully understood that it is a vital part of early monitoring and we have a three-pronged strategy to make sure that we can measure people’s blood pressure at every point of contact.

[Lord Patel (CB)]

My Lords, the report identifies shortcomings in the delivery of primary and community care for patients with cardiac disease, which is a systems failure. I have no doubt that there will be similar findings for patients who suffer from other chronic diseases. Does the Minister agree that it is time to look at a systems change in the delivery of primary and community care, incorporating advances in technology and digital healthcare that would improve access for patients?

[Lord Markham (Con)]

Yes, we all agree that prevention is better than cure. One of the few benefits of Covid was that millions of people downloaded the NHS app. People are using that for self-diagnosis now, in exactly the way that has been mentioned. In October alone, 500,000 people used the app for self-diagnosis, the healthy heart blood pressure MoT and diabetes checking. That is part of this and it is all part of our five-year healthier life plan, which, as mentioned, is very much focused on MoTs from age 40 onwards, so that we can diagnose these problems early. Our focus should absolutely be on prevention rather than cure.

[Lord Balfe (Con)]

My Lords, will the Minister look at any connection between vaccinations and worsening heart disease—in other words, the extent to which the vaccination itself might contribute to worsening a heart condition?

[Lord Markham (Con)]

My understanding is that that is something for in-depth research, which I do not have at my fingertips. I will inquire and write back to the noble Lord.

[Lord Scriven (LD)]

My Lords, following on with prevention, prevention measures lead to fewer premature deaths from heart disease, yet this Government have slashed the public health grant by 24%, on a real terms per-person basis, since 2015-16. Some of the largest reductions over this period were in stop-smoking services and tobacco control, which fell by 41% in real terms. Do the Government not understand that decimating public health budgets means more heart disease and premature deaths?

[Lord Markham (Con)]

We are at the forefront of trying to encourage healthier eating, as per the sugary drinks levy and through product placement in shops. We have been at the forefront of anti-drinking and anti-smoking initiatives and are very much in favour of the smoke-free agenda. These are all key elements of our five-year healthier life plan. It takes these things into account because, as I say, prevention really is better than cure.

[Baroness Browning (Con)]

Would my noble friend the Minister consider that, in the same way that people check their own bodies for the possibility of cancer developing, they should be trained to take their pulse regularly to check for atrial fibrillation? It is sometimes described as a disease that nobody notices until something dramatic happens, and it can lead to stroke and pulmonary embolisms, which can cause heart attacks.

[Lord Markham (Con)]

Yes, the more that we can educate people to self-diagnose and take a stake in their own health, the better. Again, many of us now have Fitbits, Apple watches and so on, which can be vital early-warning indicators.

[Lord Sikka (Lab)]

My Lords, austerity kills: 334,000 people have died from it in the period from 2012 to 2019. The Government publish monthly statistics on GDP, inflation, wages and much more. However, we do not get monthly data on excess deaths attributable to government policies. Will the Minister provide this information every month? Secondly, can he ensure that the impact assessment accompanying each Bill shows the human cost arising from that Bill?

[Lord Markham (Con)]

The House will agree that we provide some very detailed information on excess deaths. That is quite sufficient at this time.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that, when we talk about increasing mortality, there is a very obvious cause for this? Some 40 million people in this country are obese and moving inevitably to very premature deaths from a variety of very unpleasant diseases. This could be prevented if they had one fewer meal per day.

[Lord Markham (Con)]

My noble friend is referring to the healthy eating agenda, which we very much support. It is a key component of health and enjoyment of life. The more we can do in that department, the better. We have taken some very solid steps on sugary drinks and, more recently, on the product placement guidelines, to show that that is central to our beliefs.

[Baroness Masham of Ilton (CB)]

My Lords, how much research is being done on Covid-19, specifically on long Covid and heart disease? Who would collect the data?

[Lord Markham (Con)]

I believe that extensive, detailed research is being done in those areas under the overall guidance of Sir Chris Whitty. We will share this when we have the results.

[Lord Aberdare (CB)]

My Lords, what assessment has been made of how many extra deaths could have been prevented by faster access to defibrillators? What steps are the Government taking to increase the availability of defibrillators, particularly in the light of the current severe supply problems affecting them and their parts?

[Lord Markham (Con)]

I am afraid I do not have information on the number of deaths. I will investigate this. I can say that I am sure that we have all seen a great increase in the number of defibrillators and we very much encourage this.

[Lord Hunt of Kings Heath (Lab)]

My Lords, that is very kind of the Minister. May I take him back to his response to his noble friend about vaccination? Would he, none the less, tell the House that the Government are absolutely convinced that the Covid and flu vaccinations have brought huge benefits?

[Lord Markham (Con)]

I thank the noble Lord for giving me the opportunity to state this. I should have done so the first time around, so that is appreciated. As he says, vaccinations have brought huge benefits. We can all be proud to be the leading country on rolling them out, seeing the benefits that have come from it all.

Ambulances

Lord Markham Excerpts

Thursday 3rd November 2022 Lords Chamber

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

My Lords, I am pleased to respond to this short debate. I reassure the right reverend Prelate the Bishop of London that ambulances are an utmost priority for this Government. We are absolutely committed to supporting the ambulance service to ensure that people receive the treatment that they need when they need it. However, as many noble Lords have noted, our ambulance services have faced unprecedented pressure since the pandemic, so I totally agree with the point that this is a whole-system issue, as the right reverend Prelate and the noble Baroness, Lady Merron, mentioned, and a “beds and backlog” issue, as the noble Baroness, Lady Brinton, mentioned. We all have similar variants on that. The plan for patients is still valid and is being reviewed by the current team. It is always being worked on and updated.

To directly address the point of the whole-system issue, or flow, some work that I have done has shown that the biggest predictor of ambulance wait times and handover times is bed occupancy. We all know that bed occupancy, which can be as high as 95%, with about 10% of our beds being taken up by Covid, is very much the issue. That is the first priority. Obviously, the Covid and flu vaccination programmes are important parts of that, but the £500 million adult social care fund to remove the 13% of bed blocking is vital to this.

I assure all the speakers who have mentioned it that the question of how the spend is allocated has been the subject of much debate, because we want to make sure that it really is targeted in the right place. Again, as a data hound, I wanted to make sure that we really were spending it in the best place. How it is spent now has been agreed, and that should be seen very quickly in the system.

The other issue regarding bed occupancy is, as the noble Baroness, Lady Brinton, mentioned, the 7,000 new beds. I am a big believer in the use of virtual wards, but I will get that breakdown so that we understand exactly what that situation is. I have been very much at the forefront of making sure that those 7,000 beds are targeted at the areas of most need, which is vital in all of this.

I think we all agree that dealing with the flow to create the space for A&E patients is the central issue. Primary care is a part of it too. That is why the 50 million increase in appointments is a vital part, as mentioned by the right reverend Prelate the Bishop of London and the noble Baronesses, Lady Merron and Lady Brinton. I will get the specific information on pharmacies as well.

On the workforce plan, work is being done on that right now. We are working from the 2020 NHS People Plan, and I will update the House as we get more information.

Central to the whole issue of ambulance handovers is, as I like to call it, the flow—the whole-system issue. It is only when we resolve bed occupancy and the flow into adult social care that we will have the free flow through the whole system and the reduction in handover times.

Response times were brought up by all the speakers. A lot of that is about managing the calls to achieve the right outcome. Yes, it means more call handlers, as was pointed out, so we are increasing the number of 999 call handlers to 2,500 and 111 call handlers to 4,800. I take the point made by the noble Baroness, Lady Brinton, about paying tribute to the work they are doing and the impact they make.

It is also about making sure that the call is navigated correctly. I was made aware of the fact—maybe this was known already—that 50% of 999 calls do not result in a conveyance to hospital. That says to me that there is a lot more we should be doing to help people in their home, such as picking up people from a fall and making sure that we go out quickly to their care homes. The thought is: in those instances, is an ambulance staffed with three people the best sort of response vehicle when someone needs help being put back on their feet? Maybe that is a much better place for us to use quick-response paramedic motorcycle-type people. This is very much at the top of our agenda. It is something that I was speaking to the NHS chair about just this week and something that I am going to do personally in terms of visits.

On the use of 111, unfortunately I had experience of that this week when my four year-old son was up all night throwing up and I was a distressed parent. My wife, like any mother would, was saying, “Should we be taking him to hospital? Should we be ringing 999?” We called 111 between midnight and 1 am. It took me a while to get through, so I am not saying it was a perfect experience, but when I spoke to them and they were able to put me in touch with a local doctor who could support me and get us through, that was key to helping us and stopped us going into A&E or clogging up 999.

Having the right people to deal with the problem in the right way is the best approach. It ensures that when there is an absolute emergency and you are into your golden hour, so to speak, the focus is really on having the right people. I shall not pretend that we have got it all right now but, believe me, it is very much at the top of the agenda. The investment in the ambulance fleet—we are talking about £20 million per year—is about making sure that we have the right type of vehicles to sort out the right situation, while ensuring that this is all overseen by a national ambulance co-ordination centre so that we really are responding in the correct way to each type of call and triaging, as mentioned.

I have mentioned the 15 trusts and 45% delays before; these were also mentioned by the noble Baroness, Lady Merron. I am very much into what the action plan is to address each of those. It is at the top of my agenda when I meet my NHS colleagues and I will give an update on where we are with that plan and our actions. To me, that is all part of an exercise to identify best practice and then roll it out across the system. As part of that, we have just kicked off a winter improvement collaboration programme that is about trying to identify those best practices and roll them out. That is the £450 million fund we are using; we have already used it to fund 120 trusts to create capacity in the system, such as in Leicester, north Bristol and Grimsby, so that we have those wait areas and can increase the capacity in the system. I am personally visiting some of the new system control centres in Maidstone next week, so that we can see what good really looks like and ensure that we are managing it as well as possible.

In addition, within the ambulance services themselves, we have put £150 million of increased funding into the system for these measures. It includes a lot of support, because a lot of these calls are from people who have mental health issues, so making sure that we have mental health-trained paramedics is a key part of this as well. These are all parts of the plan for patients, which is very much alive in all of this. However, as mentioned in the Question of the right reverend Prelate the Bishop of London and by the noble Baroness, Lady Merron, industrial action will clearly have an impact on everything we are trying to do here.

I note at this point that we have made the pay increases recommended by the pay review body at all points but I accept that if people are balloting to strike, there are clearly things we need to understand about why they feel the need to do that. It is premature to predict the outcome of the ballot at this time. We know that there is a range of options on the ballot, be it strike, work to rule or no strike, across three unions nationally and regionally. We are working on a number of contingency plans but, until we know the exact shape it will take, we cannot put those in place. Public and patient safety will come first and foremost; I know that is a view the ambulance staff share, which again is a point made by the noble Baroness, Lady Merron. When the ballot results are known, the NHS will sit down with the unions and staff to agree an approach with this in mind. They will agree the safe level of cover, which is foremost in all our minds, and then deploy our contingency plans around this safe level.

I hope I have managed to cover most of the points raised before I run out of time and sum up. Again, I will go over my notes to make sure that I follow up on any points I may have missed. I accept that this is an issue of key focus. I hope that the plans I have gone through this afternoon give a sense of what we are doing in this vital area. First and foremost, it is the whole-system issue, as mentioned by all the speakers today.

We recognise the pressures that the ambulance service and the wider NHS are facing. We continue to work closely with NHS England to ensure that patients receive the help they need when they need it. With that, I once again pay tribute to the right reverend Prelate the Bishop of London for securing this important debate. I know that we have a meeting soon, where I look forward to discussing this further.

NHS: Nurses

Lord Markham Excerpts

Tuesday 1st November 2022 Lords Chamber

[Lord Clark of Windermere]

To ask His Majesty’s Government what discussions they have had with the Nuffield Trust further to their research finding, published on 30 September, that more than 40,000 nurses have left the NHS in England in the past year.

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

We welcome the Nuffield Trust publication and the spirit in which its analysis was conducted. Leaver numbers should be seen in the context of overall growth in the workplace. We are more than half way to delivering on our commitment to have 50,000 more NHS nurses by 2024, with nurse numbers more than 29,000 higher in August 2022 than in September 2019 and more than 9,100 higher than in August 2021.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his Answer, but I think his figures are a little out of date now. A record number of nurses left the profession last year, and we are now 46,000 nurses short. These figures show that the Government’s plans for nurse recruitment are inadequate. Retention of staff is the key. In view of the fact that nurses have seen their pay fall by 20% in recent years, will HMG not rectify this and give nurses the pay they deserve?

[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.

[Baroness Brinton (LD)]

My Lords, the comment about the figures by the noble Lord, Lord Clark, was entirely accurate. The Minister gave us the truth, which is that the net increase is 9,000, whereas the manifesto promise of 2019 was for 50,000 extra. Does this explain why the Royal College of Nursing reported last week that 75% of shifts did not have the planned number of nurses? When will the NHS see 50,000 extra, on top of the 2019 figures?

[Lord Markham (Con)]

To be very clear, today, there are 29,000 extra, over the 2019 figures. That is more than half way towards the figure of 50,000. I will quite happily write to noble Lords so that they can see the figures clearly in black and white, but I can assure the House that we are talking about increases in nurse numbers. We have achieved a 29,000 increase on the 2019 levels.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a registered nurse and would like to follow on from the noble Baroness, Lady Chisholm. We must grow our domestic workforce in nursing. I do not dispute the figures the Minister has given, but any nurse earning more than £27,000 who trained recently is now repaying 9% towards their student loan, on top of the 20% tax they are paying. I accept that they get a £5,000 bursary a year, but they work extraordinarily long hours compared with ordinary students. It really is essential that we find a way to retain those young nurses who have just trained by doing a debt write-off of their loan after five or six years.

[Lord Markham (Con)]

I totally agree that retention and attracting people into the profession are key. I like to think that we are looking at all these things in the round, taking into account the £5,000 grant, the service they are giving, and their conditions and pay going forward. As ever, this is a moving feast, for want of a better term, so we will keep looking at it to make sure we continue to both attract and retain the domestic and international staff numbers.

[Lord Turnberg (Lab)]

My Lords, have the Government made any assessment of the reasons why so many nurses are wanting to leave, and, if so, what remedies are being suggested by them?

[Lord Markham (Con)]

The Nuffield study was very interesting: of the reasons for people leaving, 43% said retirement, 22% said it was for personal reasons, and 18% said it was due to too much pressure. Again, in quoting those figures I accept that there is work we need to do on this. Clearly, 18% leaving due to too much pressure is something we rightly need to be concerned about. I know that is why we set up the 40 mental health and well-being hubs with a £45 million investment, to look at whether we can address some of those pressures. Most of all, though, I completely agree that we need to recruit as many nurses as we can so that we have as big a supply as possible to ensure that we continue to relieve any pressures that exist.

[Lord Kamall (Con)]

My Lords—

[Lord Kamall (Con)]

I apologise to the noble Lord but it is some time since I have spoken in this part of the House. Given that it was Black History Month last month, does my noble friend the Minister agree that we owe a great deal of gratitude to immigrants from the Commonwealth who helped to save our public services after the war? Now that we have left the EU, can he also assure us that we will no longer give priority to mostly white Europeans over mostly non-white non-Europeans, and treat all equally when we want to recruit health and care staff from abroad?

[Lord Markham (Con)]

I totally agree. My noble friend rightly states that we have had a fine tradition, right back to the beginning of the NHS, of recruiting people from all over the world, predominantly the Commonwealth. I am also delighted to say that, since we moved the cap on visas from people all round the world in 2019, the number of those who have joined has gone up from 25,000 a year to 48,000 a year. That is almost double the number and very much the result of what my noble friend said about making sure that we are welcoming people into the profession from all over the world.

[Lord Patel (CB)]

My Lords, shortages of NHS staff, whether they be nurses, physiotherapists, doctors, dentists or community nurses, results in poor service. What plans do the Government have to make primary and community care more sustainable in the long term?

[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.

[Lord Lilley (Con)]

My Lords, can my noble friend explain why we none the less turn away every year more than 20,000 applicants for nursing courses? Why does there appear to be a de facto limit on recruitment at universities for nursing, whereas they are allowed to take an unlimited number for media studies, PPE and other less worthy disciplines?

[Lord Markham (Con)]

I have been assured by officials that there is not a cap, so my only thought would be that, if people are turned down, it is perhaps because they may not have the necessary qualifications. I will check that and, if I am wrong, I will reassure the noble Lord, but my understanding is that there is no cap, and the more the merrier.

Nursing: Recruitment

Lord Markham Excerpts

Wednesday 26th October 2022 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what progress they have made towards meeting their target of recruiting 50,000 extra nurses by 2024.

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

This Government are committed to delivering 50,000 more nurses and putting the NHS on to a sustainable long-term workforce supply. We have set up a comprehensive work programme to improve nurse retention, support return to practice, diversify our training pipeline and ethically recruit nurses internationally. We are over half way towards meeting the commitment, with nursing numbers over 29,000 higher in July 2022—our latest available data point—than the September 2019 starting point for this commitment.

[Baroness Merron (Lab)]

My Lords, recent analysis shows that there are over 50,000 registered nurse vacances across all settings in England alone. What assessment have the Government made of the impact of current vacancy rates on patient safety? What is the Minister’s response to the warning of the Chief Nursing Officer that the Government’s pledge for additional nurses, even if it is reached, will not be enough?

[Lord Markham (Con)]

We appreciate that recruitment is an ongoing process, and while I think the whole House would agree a 29,000 increase is a good record—up 9,000 in the last year alone—we cannot rest on our laurels. Vacancies of 50,000 is partially a function of a full-employment economy, which I think we would all support. We are showing that our recruitment is working and, as I say, we are over half way towards our target of 50,000 more nurses.

[Baroness Harding of Winscombe (Con)]

My Lords, a few months ago, the Secretary of State but two said that the NHS long-term workforce strategy would include numerical assessment of both supply and demand of nurses and other clinical professionals but that publishing those details would depend on cross-government agreement. There was broad agreement in this House, in June, that those numbers should be published. Could my noble friend the Minister put on record his support for publishing NHS workforce supply and demand numbers? If he does not feel able to, could he explain how we will know whether 50,000 is the right number of nurses?

[Lord Markham (Con)]

There is a long-term workforce strategy plan being put together, as I think we know, and that builds on the NHS people plan of 2020, which has seen this increase in numbers. I will find out where we are with that, and the details behind that, and write to my noble friend.

[Baroness Symons of Vernham Dean (Lab)]

My Lords, what advice would the Minister give to a senior staff nurse, working in theatre, and at the top of her pay band, alongside agency nurses who are paid two to three times as much as she is for a 10-hour shift? Should she leave the NHS and become an agency nurse herself, or should she vote to strike, as she may well be asked to by her union?

[Lord Markham (Con)]

I would hope and trust that such a respected person would see this position as the vocation that it is and the support that they give. We accept that there are some agency workers being used in this space, because obviously, in terms of safety, we need to make sure we cover that number of people. The whole recruitment plan—which, again, we are on target to achieve—is all about making sure we have enough nurses so that we do not have to use agency workers.

[Baroness Brinton (LD)]

My Lords, following on from the question from the noble Baroness, Lady Harding, can I ask the Minister if there are plans to increase the number of student nursing places at universities and student apprenticeships over at least the next decade? While there is a short-term crisis, there is also a longer-term sustainability crisis, especially with current demographics.

[Lord Markham (Con)]

The noble Baroness is correct that this is a long-term pipeline. We have 72,000 nurses in training at the moment. To be clear, there is no cap at all on student places. We are seeking to increase them as much as possible, and we put a £5,000-a-year grant in so that trainee nurses could enjoy superior levels of financial support than other students. The fact that we have a pipeline of 72,000 shows that this is working, but that pipeline is not capped, so if we can get more people in, we definitely want to do that.

[Lord Turnberg (Lab)]

No matter how many nurses we try to recruit, we never seem to catch up with the rate of loss. What are the Government doing to help retention of nurses? We must try to encourage them and support them to stay. What plans are there to do that, and what plans have the Government got to bring back nurses who have left or retired?

[Lord Markham (Con)]

First, we are actually exceeding the number of leavers. There were 36,000 people who left last year and 45,000 who joined—a net increase of 9,000. That is not to say that we do not want to retain people. I absolutely accept the premise that we do, which is why we have a retention programme in place to ensure that we are able to do so. We also have a restart programme to help people who have left to get back into nursing in a quick and easy way. Overall, the main point here is that the number of joiners is exceeding the number of leavers. We are more than catching the number up; we are exceeding it.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as a nurse and the co-editor of the WHO report, State of the World’s Nursing. It is true that we have 9,000 additional nurses, but of the 48,000 who in the last year joined the register for the whole UK—for the four countries, not just England—more than half had trained overseas. Those nurses are very welcome here, but it illustrates that we are not encouraging people who wish to go into nursing to do so, beyond the 72,000 the Minister referred to. That is very much to do with student finance and the lack of apprenticeship opportunities for older people who want to go into the profession. Can the Minister look into increasing those opportunities?

[Lord Markham (Con)]

Indeed, and towards that aim we have set up the nursing associate role, which is a stepping-stone to allow people to ease in and have qualifications on the way to becoming a fully trained nurse. The overall point I make, as before, is that by putting in a £5,000-a-year grant for student nurses, we are recruiting the numbers. I reiterate that 72,000 is a big pipeline but also that it is an uncapped pipeline. The more we can attract, the merrier—whether domestically or, as in the fine tradition of the NHS, from overseas sources.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that the percentage of nurse vacancies is much higher in community care than in any other part of the sector? What is the department doing to ensure not only that we have enough nurses but that they are in the right places?

[Lord Markham (Con)]

That is an excellent point. One thing I probably should have said is that the number of 36,000 leavers includes people who have left NHS trusts and gone into community care, working in GP surgeries. We do not catch that number who come back in again, so the real number is less than 36,000, but the basic premise of the question—making sure we are attracting nurses to the right place—is absolutely the right one. I believe that is the plan in place, but I will check on that and make sure we are doing as requested.

[Baroness Masham of Ilton (CB)]

My Lords, would it be possible to make it quicker and cheaper to get visas to bring to the UK nurses from across the world who would like to work here? We can never have enough nurses without them, can we?

[Lord Markham (Con)]

I totally agree with the approach. I have declared a personal interest before in that my wife is a dentist from the Dominican Republic who came in exactly that way, so I completely support the intent.

[Lord Brownlow of Shurlock Row (Con)]

My Lords, I raised the subject of agency nurses in my maiden speech. In the private sector, it is quite common that if you receive training by an employer and leave within a certain period of time, you repay the cost of that training. If nurses qualify and then transfer to become an agency nurse and rip off hospital trusts, as we heard earlier from the noble Baroness opposite, should they repay the costs of the training they have been given?

[Lord Markham (Con)]

I do not think I can quite agree with the words “rip off”, but I get the sentiment. As I am sure we all have, I have been involved in industries where, if your employer pays for your training and you do not return the contract—for want of a better word—or investment by giving a few years’ commitment to do it, there should be some sort of clawback. I understand the approach, but right now my focus is on making sure we get as many people into training as possible.

Water Fluoridation (Consultation) (England) Regulations 2022

Lord Markham Excerpts

Wednesday 26th October 2022 Lords Chamber

Moved by

[Lord Markham]

That the draft Regulations laid before the House on 20 July be approved. Considered in Grand Committee on 25 October

Motions agreed.