Queen’s Speech

Baroness Finlay of Llandaff Excerpts

Wednesday 3rd June 2015 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, in the gracious Speech it was welcome to see a commitment to seven-day working. Indeed, in my own Access to Palliative Care Bill, which has now been introduced, I have included a requirement for seven-day services. Like the noble Lord, Lord Sharkey, I welcome the noble Lord, Lord Prior of Brampton, to his position and look forward to working with him closely on this matter.

However, when we talk about seven-day services, we must not forget the nights, because disease does not respect the clock or the calendar. When patients are at home, it is the family who carry the full responsibility for whether to phone somebody and what to do, and that burden of responsibility on them can be huge, particularly if they do not have adequate social care support.

In its report, What’s Important to Me, the National Council for Palliative Care—I must declare an interest because I am taking over as its next chair—has shown just how many patients recognise that they need seven-day services. The appalling findings in the report, Dying Without Dignity, from the Parliamentary and Health Service Ombudsman demonstrate what happens when you do not have seven-day services.

In 2010, the Royal College of Physicians called for such services, with 68% of physicians supporting the move, but physicians are already working on average 50 hours a week. So there is a need for a remodelling of what they do, decreasing bureaucratic burdens on them and ensuring that there are proper roster reviews, otherwise they will not be able to cope and the system will collapse.

An analysis from the Manchester Centre for Health Economics, published last week, looked at the additional risk of death from weekend admissions—it is not just greater on a Saturday but it is even greater on a Sunday. It costs the move to seven-day services at between £1.07 billion and £1.43 billion. Why are those deaths happening? Fewer senior staff are on duty at weekends, with fewer support services, especially in pathology, radiology and pharmacy, and there are fewer allied health professionals, who are so important. There is a higher disease burden in those admitted at the weekends as an emergency, making them less likely to respond well to treatment. The NHS was founded on a principle of equitable care. Failure to provide equity across each day of the week must be considered a failure in one of its fundamental obligations.

For patients who are at home, the need for community support becomes the mainstay of their being able to stay at home. However, they need not only carers but physiotherapy and occupational therapy to maintain their independence. Fortunately, the number of physiotherapy training places has gone back up, having dipped previously, but is not keeping pace with the demand for physiotherapy.

Social care integration is to be welcomed if we are going to use our resources widely. The emergency services, of course, already provide 24/7 cover but the winter funding put in by the previous Government did not reach front-line emergency departments. Only just over 1% of the £700 million went into those departments. The remainder was meant to cut back the pressure on the departments but that seems to have failed. There was an increase in attendances by 500,000, an increase in admissions by 7% and a doubling of delayed discharges.

In its document prescribing the remedy, the Royal College of Emergency Medicine has solutions. Through its future hospital programme, the Royal College of Physicians wants to help the Government to achieve better equitable care, and the Royal College of Surgeons is supportive. However, we must take the administrative pressures off front-line staff to free them up to do the clinical work that we need them to do.

There is a commitment to increasing GP numbers and the Prime Minister, I believe, has said that he wants one in two medical graduates to go into general practice—but how? It will not happen quickly. The time from entry to medical school to being fully trained as a GP is, on average, nine years. However, the shortfall of GPs is already 3,300 and estimated to go up to 8,000 by 2020. Sixty per cent are already providing extended opening hours and 17% are open at weekends.

A Citizens Advice report, Registering Frustration—which was issued after the start of this debate—shows that GP registration is so complex that one in 10 patients finds that it takes them more than two weeks to register; when they cannot register they are directed to walk-in centres; and one in seven GPs has felt that their only option has been to redirect patients to A&E. We should look again at the skill set of those people noble Lords might feel are the least trained and the least qualified—the care assistants and social carers—because, with better training, we will be able to empower them to provide better care.

The UK has a low doctor-to-patient ratio. We are 24th out of the 27 European nations. The Government must re-engage with those who will bring about change— including re-engaging in negotiations with the BMA—to find solutions to work patterns and to the ways that people work.

The noble Lord, Lord Giddens, is right to say that IT must be used imaginatively. We cannot just transfer lengthy paper records on to IT systems and expect that that will do anything other than increase the bureaucratic burden.

As to the threat that comes from the Transatlantic Trade and Investment Partnership, on 28 May the European Parliament’s trade committee agreed a resolution backing the TTIP for the full Parliament to vote on this month. This controversial initiative reintroduced investor state dispute settlements. It would allow corporations to sue the UK for laws protecting public health and represent a destructive force to our NHS. Can the Minister clarify what the Government’s position was in the trade committee and what it will be in a future vote on TTIP? It would be tragic if we undermined our NHS by such a move.