NHS: Unsafe Hospital Discharges

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Wednesday 15th June 2016 Lords Chamber

[Lord Prior of Brampton]

The third and voluntary sectors have a potentially huge role to play. I was talking this week to the chairman of the Chelsea and Westminster Hospital about the plans he had for involving the voluntary sector far more in discharge planning, particularly for frail and elderly people. I agree entirely with the noble Lord’s sentiments.

[Baroness Wall of New Barnet (Lab)]

My Lords, the Minister has referred to the STP, the sustainable transformation plan. Could he accelerate the way in which that plan is now going? We are into phase one, and some of the shocking things in the report that the noble Baroness, Lady Walmsley, has referred to could be remedied by using the STP properly. I wonder if we should look further and quicker at how we can achieve that.

[Lord Prior of Brampton]

My Lords, this is a difficult issue. You can lead a horse to water but you cannot make it drink. To some extent you have to rely on local people working together, and it is behaviour and culture that determine long-term sustainable improvement. If we try to force the pace beyond that at which local people are prepared to go, in the long run we may not make as much progress. In the first instance we hope that the STP process, involving all local people and giving them a framework for working together, will deliver the results we need. If it does not, we will have to revisit it.

Obesity

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Thursday 26th May 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness makes a very important point. That is what lies behind the chief executive of NHS England’s decision to address the presence of unhealthy food and drinks on NHS properties, and to encourage staff to live a much healthier lifestyle.

[Baroness Wall of New Barnet (Lab)]

My Lords, does the noble Lord have a view on whether the sustainable transformation plans that are now in, joining all the services in a community, will make a difference to obesity when providers are working with the community and also with CCGs?

[Lord Prior of Brampton]

I completely agree with the noble Baroness. Integrated care organisations and accountable care organisations, although similar, will bring together in one pool the money for preventing as well as for curing disease—and will bring in social care as well. That should lead to a much better, more joined-up and more cost-effective way of delivering health and social care.

Healthwatch England

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

I agree with my noble friend. Healthwatch has two principal roles: first, to gather intelligence locally, which it can then feed into the CQC and its inspections; and secondly to be the strong voice of patients at a national level.

[Baroness Wall of New Barnet (Lab)]

My Lords, is the Minister satisfied with the support that Healthwatch gets, both physically and financially? In many areas it is struggling, particularly now that it has had to stand off and be independent. With all the changes going on, is there a view on whether it is effective because of the way it is being dealt with?

[Lord Prior of Brampton]

My Lords, that is a good question. The truth is that Healthwatch is good in parts. Some local Healthwatches are extremely good and some are quite weak. Part of the rationale for the restructuring that the noble Lord, Lord Harris, raised in his Question is to save central overhead costs, which means that there will be more money available to Healthwatch England to do its core job locally.

National Health Service: Nurses

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Tuesday 26th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, retention and return to practice are crucial. The noble Baroness may be interested to know that Health Education England has up to 90, I think, courses that have so far attracted just under 1,000 nurses back to practice. The cost of attracting someone back to practice is some £2,000 each compared with some £50,000 for a new nurse.

[Baroness Wall of New Barnet (Lab)]

My Lords, the noble Lord will be aware of the pressure that is quite rightly on trusts to reduce their agency spend. How can we cope with doing that when we are also still trying to get in nurses whose visas are being stopped, despite the fact that that restriction was supposed to have been lifted?

Junior Doctors Contract

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Friday 20th November 2015 Lords Chamber

[Lord Prior of Brampton]

I probably did not make the situation clear enough. The Secretary of State said that there are no preconditions. If there are concerns about time off to have children or to carry out research, those are absolutely the kinds of issues that should be discussed around the table.

[Baroness Wall of New Barnet (Lab)]

I declare an interest as chairperson of Milton Keynes Hospital. Where in all this are we talking about patients? I am not going to enter into any discussion about who should be doing what. I spent this morning at Milton Keynes Hospital with my chief executive, medical director and all the consultants discussing this. I obviously associate myself with everybody’s plea that this does not go ahead, but if it does, how are we going to ensure that our patients get the best possible experience? I am equally surprised that the Minister has not referred to the letter from Sir Bruce Keogh, which went out to the chairman of the BMA and provided us with many opportunities. I am anxious that the Minister understands that the prime thing in this is patients. Whatever we have to do, patients need to be looked after.

NHS: Costs of Operations

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Monday 9th November 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness makes an important point. We have what we call a “market forces factor”, which is applied to the tariff to make adjustments for unavoidable differences in costs—for instance, providing care in London compared to providing it in a cheaper place. The way we measure the cost of capital is not entirely satisfactory, though, and if an individual trust has a very expensive PFI, that is not properly compensated for by the market forces factor. We should spend some more time looking at that issue.

[Baroness Wall of New Barnet (Lab)]

My Lords, is the Minister aware of the new system brought in by the department to measure every activity that goes on in a hospital, including the consultant’s time and all the extra things that are used? He talks about reference costs and even tariffs, but they are not actually a very good measure of the cost of materials and services that are already used in the health service.

[Lord Prior of Brampton]

The reference costs try to pick up all the costs attributable to certain procedures. As I was saying earlier, a patient-level costing system would probably be more accurate. I did not catch the first part of the noble Baroness’s question, so perhaps we could deal with this outside the Chamber. Hospitals are incredibly complex and picking up all the costs, particularly allocating overhead costs to individual procedures, is difficult. Compared to any other hospital costing system I have seen in the world, though, the NHS reference-cost system is pretty comprehensive.

Primary Care: Targets

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Tuesday 13th October 2015 Lords Chamber

[Lord Prior of Brampton]

I fully accept, of course, that diagnosis is extremely important but I think that advanced nurse practitioners can play a role in diagnosis, as well as in treatment, as can physician associates, given that both are supervised by GPs. I believe that high-street or community pharmacists can play a big part in supporting the role of clinical pharmacists.

[Baroness Wall of New Barnet (Lab)]

The noble Lord will recall yesterday’s discussion about how the integration of care is crucial. I am absolutely in agreement with the noble Baroness, Lady Walmsley—this is what integration in the health service really means. Providing the opportunity for pharmacists in hospitals to work in those practices should be encouraged.

[Lord Prior of Brampton]

I completely agree with those comments. Over the next five years, we will see much greater integration of acute hospitals and primary care and community care.

NHS: Financial Performance

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Monday 12th October 2015 Lords Chamber

[Lord Prior of Brampton]

I thank the noble Lord for that perceptive and interesting observation. The accountable care organisation is one whose time has come. A health organisation with a capitated budget is indeed the way forward. It will drive the integration that the noble Baroness was talking about earlier on. It is a key part of this Government’s health strategy to support accountable care organisations.

[Baroness Wall of New Barnet (Lab)]

My Lords, I too welcome the Statement, as did my noble friend. I have to admit that Milton Keynes Hospital, of which I am chairman, has contributed to the £550 million deficit referred to in the Statement. I want to focus on the issue around agency staff. I presume that the Minister has not seen the Evening Standard today—it has only just come out, so that is quite acceptable. In it, however, the chief nurse at Guy’s says very much what all chief nurses are saying: that hospitals are really performing with their hands tied behind their backs and that we have no staff to fill all our vacancies and have to recruit agency staff. We have just had an instruction, which the Minister referred to in the Statement, to reduce our agency staff by 1 October. I think it is from 22% to 17%. We have obviously gone back with some mitigation around that, which has been accepted. That has been very helpful but it does not solve the problem: we cannot get nurses through.

We went to Croatia and got 60 nurses. Five of them have had visas to get through and the rest cannot come, so we have to carry on with agency nurses to cover them. We have more 1:1 nurses than any other trust around London. I am going to wind up but as the chairman of a trust, I am talking about what really happens—the Minister knows that. Can he tell us how he is going to get this other money to reduce the deficit that he talked about and which is going to happen? I would be very interested in that. Also, when is the NHS going to make sure that the people who have that remit for nurses being admitted into our country will do something about it?

[Lord Prior of Brampton]

I will have to be very quick in replying. Maybe we could discuss this outside the Chamber. There are three ways in which we can find the resources for this. The first is partly through extra government money: there is another £10 billion coming to the NHS over these next five years. The second is driving through efficiency improvements. There are vast efficiency improvements that we must make over the next five years. I regard efficiency as a moral imperative because every £1 that we can save from waste is £1 that we can plough back into patient care. The third way is through new structures of organisations—accountable care organisations are one example; chains of hospitals are another. I think that the days of the independent DGH ploughing its own furrow, or of the foundation trusts structure around the DGH, are behind us.

Health: Skin Cancer

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Wednesday 22nd July 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness makes a very interesting point. It is recognised that there are not enough trained dermatologists in England—I think the figure I have seen is 177. To put it in context, there are 650 consultant dermatologists in England, so the answer is that there are not enough. The growth in the problem, if I can put it that way, seems to be running at about 3.5% a year. We are behind on this and need to catch up.

[Baroness Wall of New Barnet (Lab)]

My Lords, will the noble Lord share with us the discussion going on in the Department of Health about the many young people being treated for skin cancer because of the sunbed culture that has come about? Regrettably, we have noticed in my hospital in Milton Keynes that that is becoming an increasing problem. We did a grand job in making people aware of the dangers of smoking, and we still are, but nobody seems to be explaining just how dangerous some of these things are.

[Lord Prior of Brampton]

The noble Baroness is right but a law was passed in 2010, I think, banning the use of sunbeds on commercial premises by children under the age of 18. That law has had an impact but, in a sense, one can never do too much to raise public awareness, and we should do more.

NHS: Whistleblowing

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Tuesday 30th June 2015 Lords Chamber

[Baroness Wall of New Barnet (Lab)]

My Lords, the duty of candour has made a big difference in hospitals to staff owning up if there is a difficulty or they have made a mistake in any part of their service. Does the Minister accept that there is a relationship between that and whistleblowing and with the guardians that are in existence in hospitals, such as in my own in Milton Keynes, where they are designated by the people in the department and so are trustworthy in the sense of how they are elected or selected? Does the Minister not agree that the duty of candour is making a difference to the whole culture of the health service being open and honest?

[Lord Prior of Brampton]

The noble Baroness is absolutely right. The duty of candour, which puts an obligation on organisations to show candour, is making a difference. I congratulate the GMC and the NMC, which have spelled out clearly in their codes that the professional duty of candour is equally important.

NHS: Immigration Rules

Debate between Lord Prior of Brampton and Baroness Wall of New Barnet

Wednesday 24th June 2015 Lords Chamber

[Lord Prior of Brampton]

As usual, the noble Baroness is more than familiar with the latest developments in the world of nursing. Health Education England is committed to commissioning an additional 23,000 nurses over the next four years. On safer standards of nursing, I know that she has taken a keen interest in the work that has been done around nurse staffing levels in relation to the numbers of patients. It is the Government’s view that the actual decisions about safe staffing should be taken at a local level, based on the acuity of patients on the ward, and should largely be up to the judgment of the ward sister and senior nurses within the hospital.

[Baroness Wall of New Barnet (Lab)]

My Lords, I declare an interest as chairman of Milton Keynes Hospital NHS Foundation Trust. How are we to reconcile the dilemma that we have just heard about from the Department of Health and from Monitor—cutting back on agency staff—with the impact that this legislation will have on nurses in our hospital and in many others? It will affect not just nurses; lots of people who work in hospitals, whether in ophthalmics or pharmacy, will have the same kind of issue. How do we reconcile the fact that we are trying to run a hospital that ensures the best experience for patients while this will have the opposite effect?

[Lord Prior of Brampton]

The noble Baroness makes a strong point. There is a dilemma, but we have to differentiate between the long term and the short term. In the long term, it is very important that we develop enough nurses for our own healthcare system. In the very short term, there will be ups and downs. Unquestionably, in the light of the Francis report into the awful happenings at Mid Staffordshire, there has been a spike in demand for nurses, particularly those to be employed in acute hospitals. That has caused short-term difficulties, leading to problems with the agency staffing that she referred to. It is worth pointing out that last year 3,500 nurses—largely from the Philippines—came from overseas to this country. In the short term that provides an escape—a way out, if you like—but it is not a permanent solution.