Accident and Emergency Services: Staffing
Baroness Finlay of Llandaff Excerpts(9 years, 11 months ago)
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Lord Prior of Brampton
The right reverend Prelate is right that reliance on agency and non-permanent staff has become far too high. It is something we must reduce, not just because it is very expensive to use agency staff, but because the continuity and quality of care suffers. We are taking strong action to reduce the role of agency staffing in the NHS.
Baroness Finlay of Llandaff (CB)
Do the Government accept that demand on services is now outstripping the increasing workforce that they have tried to invest in? The workforce crisis is made worse because of the brain drain, with emergency medicine trainees being attracted to other parts of the world that often have very good working conditions. The Government therefore need to take an urgent look at the whole pinch point of emergency departments, given the increased number of patients who go to where the lights are on all the time and where they know they will be seen properly by someone who is properly trained. The crisis means that they now will often be seen by a locum and the staff are on their knees.
Lord Prior of Brampton
My Lords, the noble Baroness raises an important point, but it is not new: 24% of all doctors who work in the NHS have been trained overseas. This problem goes back over 20 to 30 years. We must train more of our own doctors. On the specific point on emergency medicine, I was surprised that, over the last 10 years, there has been an increase in emergency doctors—A&E doctors in the main—of 9% per annum, against growth in demand of between 2% and 3%. That does not fully answer the noble Baroness’s point, but, compared with other parts of the NHS, there has been greater investment in doctors and other staff in emergency medicine.
Health: Adult Psychiatric Care
Baroness Finlay of Llandaff Excerpts(9 years, 11 months ago)
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Lord Prior of Brampton
No, it is not very simple, or at least it is not simple to me; but then I perhaps have a smaller brain than the noble Lord opposite. It is certainly additional to the £1.5 billion for children and young people. I cannot tell the noble Lord now, without fear of making a mistake, whether it will be £1 billion every year from 2016-17 to 2021. It is certainly £1 billion in 2021. If it is all right, I will write to the noble Lord to confirm and clarify that.
Baroness Finlay of Llandaff (CB)
How do the Government intend to monitor the efficacy of this investment, and against what performance indicators will this investment be audited?
Lord Prior of Brampton
My Lords, that is a very hard question to answer. The talking therapies, for example, seem to be effective in about 50% of the cases, and whether they are effective is clearly a clinical decision. As for other standards, we tend to rely, as the noble Baroness will know, on proxies such as waiting times and the four-hour standard, which the noble Lord recommended in his report. We are considering the introduction of a four-hour waiting-time standard for people suffering from psychotic problems, in the same way as we have for physical health.
Allied Health Professionals: Training
Baroness Finlay of Llandaff Excerpts(10 years ago)
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Baroness Finlay of Llandaff
To ask Her Majesty’s Government what discussions they have had with Health Education England to ensure that the number of student commissions for 2016–17 supports the goal of increasing the number of student places for allied health professionals set out in the comprehensive spending review, and ensures stability in allied health professionals’ education provision and workforce supply.
Baroness Finlay of Llandaff (CB)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper and I declare an interest as the honorary president of the Chartered Society of Physiotherapy.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, Health Education England plans to commission, overall, 7,554 AHP training places in 2016-17—an increase of 344, or 4.8%, compared to 2015-16. The announcement in the 2015 spending review to move nursing, midwifery and AHP students on to the standard student loan system is for new students commencing their courses from 2017 only and therefore does not affect students commencing their courses in 2016-17.
Baroness Finlay of Llandaff
Do the Government recognise that 500 more physiotherapy places will be needed in training each year until 2020 just to meet current needs? With Health Education England proposing cuts in training places in six out of 10 of the allied health professions—cuts ranging from 3.4% to 9.7%—how will the new models of care in prevention, patient treatment and reablement be met, given that they depend on these professionals taking on extended roles? This goes across sectors commissioned by the NHS and by other departments, including the Department for Education, the Home Office and the Ministry of Defence.
Lord Prior of Brampton
My Lords, Health Education England is proposing a net increase of 334 places in 2016-17 and we expect a growth in overall numbers of nurses and AHPs from 2017 onwards as a result of moving on to the standard student loan system.
NHS: Trust Finances
Baroness Finlay of Llandaff Excerpts(10 years ago)
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Lord Prior of Brampton
The cap on agency staffing rates and on agency staff has really started to apply only in the past six weeks. So far, it looks as if we are making significant progress there. As I said in answer to the Question, the NHS is receiving £3.8 billion of extra funding in the forthcoming year. We believe that that will enable it to restore its finances to a proper balance by April 2017.
Baroness Finlay of Llandaff (CB)
What are the Government going to do about the haemorrhage of finances into the PFI deals, given that £11.8 billion of buildings will have cost the country £79 billion by the time 31 years comes round? By then those buildings might very often not be fit for purpose because things have moved on so fast. Year on year there is a haemorrhage of money from the NHS to finance these deals. Last year, £2 billion went in that direction.
Lord Prior of Brampton
It is clear that a number of these PFI deals were massively expensive and have put huge pressure on a relatively small number of trusts. However, the fact is that we have entered into these long-term contracts and there is no way of getting out of them. I am afraid that it is a cost that the NHS will have to continue to bear.
National Health Service: Nurses
Baroness Finlay of Llandaff Excerpts(10 years ago)
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Lord Prior of Brampton
My Lords, I think the noble Lord is wrong in what he says, but I will double check. I believe that there will be an additional 10,000 placements per year, but I will check that afterwards. That is not until 2021 because the new scheme will not come into place until August 2017, which means that the first students will come out of the new scheme in 2020. We are estimating that there will be 10,000 in that year.
Baroness Finlay of Llandaff (CB)
Do the Government recognise that the retention of nurses is also extremely important and that the loss from the profession later in life may reflect difficult working conditions and lack of support? Will the Government also note that nurses in the hospice world and specialists in palliative nursing tend to be older nurses who have left NHS employment and gone to the charitable sector precisely because they feel that they can work as they want to, fully and professionally, and have a supported working environment?
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.
NHS: Preventive Medicine
Baroness Finlay of Llandaff Excerpts(10 years ago)
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Lord Prior of Brampton
I thank the noble Lord for raising this issue today. We discussed it yesterday and the Government will give him a full response to the issue of fortifying bread with folic acid in the very near future.
Baroness Finlay of Llandaff (CB)
Does the Minister recognise in his answer that people should be responsible for their own health and the health of their families that there is a responsibility on the NHS to ensure that there is adequate support before, during and after bereavement of children? The preventive effect on mental health problems later in life is very clearly shown. Those who are unsupported do less well in the whole life course in mental health, and in social and educational outcomes.
Lord Prior of Brampton
My Lords, clearly, the state has a huge role to play in prevention; I was certainly not questioning that for one moment. I was just saying that I believe that individuals and families have responsibilities as well.
Children: Obesity
Baroness Finlay of Llandaff Excerpts(10 years, 1 month ago)
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Baroness Finlay of Llandaff (CB)
Can the Minister outline what is being done specifically in relation to women in pregnancy, given that excessive weight gained in pregnancy, which is often linked to the phrase “eating for two”, is very difficult to lose afterwards, particularly if women do not breastfeed? Moreover, postnatal depression can itself be a cause of excessive eating after delivery of the baby, causing the maintenance or even aggravation of obesity. That requires specific services to target these women.
Lord Prior of Brampton
The noble Baroness will know that the report of the Chief Medical Officer which came out two or three weeks ago laid particular stress on the importance of women who are pregnant because of the impact of obesity not just on themselves but on their children as well. Advice is available through NHS Choices, Start4Life and Healthy Start; we have various schemes that are focused on pregnant women. I am sure that we can do more, and perhaps when the government strategy on obesity is announced in the near future, it will address that issue as well.
Health: Liver Disease
Baroness Finlay of Llandaff Excerpts(10 years, 2 months ago)
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Baroness Finlay of Llandaff
To ask Her Majesty’s Government what progress has been made to implement the recommendations of the Lancet Commission on liver disease, to address the incidence of liver disease in the United Kingdom.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
Since the publication of the report of the Lancet commission, the Government have continued to address the incidence of liver disease through a number of measures which focus on both the prevention of liver disease, and improved care for those with liver disease. Public Health England has a programme of public health action to tackle liver disease and is working with key stakeholders, including the Lancet commission, to produce a framework for liver disease next year.
Baroness Finlay of Llandaff (CB)
As we enter the festive binge drinking season, do the Government recognise that 28% of deaths in 16 to 24 year-old males are alcohol-related and that 85% to 90% of the cost of in-patient liver disease is due to alcohol? By raising the floor cost of alcohol by 10%, we may be able to reproduce the Canadian evidence of a 30% fall in deaths attributable to alcohol. Do the Government also recognise that we have a responsibility to the next generation because in pregnant women hepatitis, obesity and alcohol are each risk factors, each compounding the other? If we implement a six-in-one vaccine programme for hepatitis B in neonates, we may prevent the next generation suffering from hepatitis B as well as decrease the incidence of foetal alcohol syndrome by tackling alcohol abuse in pregnancy.
Lord Prior of Brampton
My Lords, there was quite a lot in that question. Some 6,000 babies suffer from foetal alcohol syndrome and it is a shocking and appalling by-product of alcohol. Canada has increased the floor price of alcohol and I understand it has seen some reduction in alcohol-driven disease as a result of that. We are watching what happens in Canada carefully. Of course, Scotland is considering a similar move although it is awaiting the outcome of a court case in the European Union. I gather that Wales will possibly follow suit if that court case goes accordingly. We will watch what happens in those other countries, study it and then make up our minds accordingly.
Junior Doctors Contract
Baroness Finlay of Llandaff Excerpts(10 years, 2 months ago)
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Lord Prior of Brampton
I agree entirely that industrial action is the last thing that any of us want. I have worked with trade unions of one kind or another off and on since 1980—for 35 years. I think that the Junior Doctors Committee of the BMA is behaving in an extraordinary fashion.
Baroness Finlay of Llandaff (CB)
My Lords, can the Minister say how sincerely the Government are considering going to ACAS, which, as far as I understand it, is acceptable to the BMA Junior Doctors Committee, and can he explain why there is resistance to doing that? Given the threat of terrorism that we now face, have the Government assessed the impact and the security that would be needed on the strike days both in the event of a terrorist attack on the population at large, when those who are well versed in managing it will not be working, and in the event of a terrorist attack specifically targeted at demonstrations by junior doctors, when they will be injured and the hospitals will be empty?
Lord Prior of Brampton
The Secretary of State has said that he is open to conciliation. Frankly, it would be so much better if we could sort this out ourselves rather than go to conciliation, but he has said that he is open to it. If there is a terrorist attack, speed will be of the essence if people are severely injured. Junior doctors care hugely about their patients, so I think we have to rely on junior doctors to be available in hospitals in the event of some awful terrorist outrage, even if they are on strike. I will certainly draw to the attention of COBRA and the relevant authorities the question of the impact of terrorism on a demonstration by junior doctors.
Mesothelioma (Amendment) Bill [HL]
Baroness Finlay of Llandaff Excerpts(10 years, 2 months ago)
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Baroness Finlay of Llandaff (CB)
My Lords, like others, I congratulate my noble friend Lord Alton on his tireless work in this area and on his perseverance in trying to improve the outlook for the future. I shall concentrate on mesothelioma not as an epidemic of today but as one that is looming because of the problem in our schools. The need for research is ever more pressing as time goes on.
It has been estimated that more than three-quarters of our schools—my noble friend Lord Alton referred to 87% of schools—have asbestos in place. We know that deaths from workplace exposure are more common among healthcare workers, teachers, telephone engineers, shop workers, finance workers and so on. It is estimated that about 20 deaths a year occur among teachers. In healthcare, we are not sure of the exact number of deaths. When I was a junior doctor the lagging was hanging off the pipes in the basement of Westminster Hospital, just across the road from here, and in other hospitals in London in which I worked. To go to cardiac arrests, we would literally run through the dust and sometimes hit our heads on bits of lagging that were hanging down. Everyone was oblivious to the dangers.
The problem is that we have asbestos in our schools and that means children are being exposed. Other countries have decided to have a phased removal—for example, Australia has already implemented that—and the European Parliament has called for the removal of asbestos from all public buildings by 2028. The Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment reported that,
“it is not possible to say whether children are intrinsically more susceptible to asbestos-related injury. However, it is well recognised … that, due to the increased life expectancy of children compared to adults, there is an increased lifetime risk of mesothelioma as a result of the long latency period of the disease … for a given dose of asbestos the lifetime risk of developing mesothelioma is predicted to be about 3.5 times greater for a child first exposed at age 5 compared to an adult first exposed at age 25 and about 5 times greater when compared to an adult first exposed at age 30 … we conclude that exposure of children to asbestos is likely to render them more vulnerable to developing mesothelioma than exposure of adults to an equivalent asbestos dose”.
The current advice with regard to asbestos is that it should remain undisturbed, and indeed that seems sensible. However, there does not seem to have been a comprehensive assessment of what happens in our schools when children’s chairs and desks scrape along the walls and a little shower of asbestos dust comes into the classroom; or when windows or doors are slammed, not because of children behaving badly but simply because the school is a building with lots of boisterous children in it. Assessments have been done when buildings have been empty.
There is an urgent need for research into why some people develop mesothelioma and others do not, and for long-term epidemiological studies, which take money and investment, to understand what is going on in the long term so that we can plan for it if the numbers are going to go up hugely. In my own field, I have made a plea for us to undertake some research into why mesothelioma causes so much pain, and why it appears to be relatively difficult to manage with straightforward analgesics. In my own hospital, the Velindre Cancer Centre, Dr Jason Lester is doing some innovative research on tumour-associated antigens and their expression on the surface of tumour cells, but that research is not cheap—it cannot be done on a shoestring—and needs dedicated cell lines.
The Asbestos in Schools Steering Group was set up by the Department for Education in 2012. What is its position with regard to academies and free schools in relation to their responsibilities for managing asbestos, and where are the levers that the Department for Education has for managing it? I understand that the Health and Safety Executive produces guidelines for how asbestos should be managed, but the responsibility seems to lie with those who are running the schools themselves.
For us in Wales, this has revealed what you could call the “devolution crack” because no one seems to be taking clear responsibility for schools in Wales. In the Senedd on 28 January this year, the First Minister said:
“The responsibility lies with the Health and Safety Executive; that is quite clear”.
He went on to say that,
“in terms of ensuring that the responsibilities are progressed, that is also a responsibility of the environmental health officers”.
However, that appears to be at odds with Answers that have been given in this House. When the noble Baroness, Lady Randerson, was Parliamentary Under-Secretary of State at the Wales Office, she answered a Written Question last year from my noble friend Lord Wigley about responsibility in Wales by saying:
“The Health and Safety Executive has responsibility for regulations and guidance as it applies to the management and control of asbestos in all workplaces in Great Britain, including schools. However, within this framework, the development of policies for the management and control of asbestos in schools is a matter for the Welsh Government”.—[Official Report, 14/1/14, col. WA 11.]
Your Lordships might think that that would be the end of it and it should all sit with Wales, but I suggest that in the long term the devolution crack that has been demonstrated will affect NHS England just as much as NHS Wales. Wales is a net exporter of young people, particularly into the professions, and a net importer of older people. We have a lot of older people coming to spend their last years in nursing homes, particularly in north Wales and along the coastal strips. So Wales may have a problem today but unless there is joint working between those responsible, and unless Wales is invited to join in and share expertise on these committees, we are not going to solve the problem in the long term for the next generation. I also suggest that the confusion over this has been evident in the complaint that was taken to the Parliamentary Ombudsman by Annette Brooke on behalf of the Asbestos in Schools group regarding the conduct of the Health and Safety Executive following the closure of Cwmcarn High School in 2012, the outcome of which is awaited.
This Bill is very important for the future, not only for the health of the whole of our nation—England and Wales joined together—but because it is important to plan expenditure and demand, and to plan how we are going to manage what may be a looming epidemic among our schoolchildren that we have not even begun to take notice of yet.
Lord Prior of Brampton
If there is a shortfall—and there may be a shortfall—given that that levy is raised from the industry on an equitable basis rather than relying upon two or three insurers to do it on a voluntary basis, that strikes me as a better approach. The point has been made that compensation payments are somehow different from funding research, but it strikes me that the two are very closely related. I am just putting it out there for further discussion, and I would like to pursue that discussion with my noble friend Lord Freud, who is probably the expert on our side of the House on this matter and was intimately involved with the Bill which came through the House in 2014. I would like to have that discussion with him and perhaps with the noble Lord, Lord Alton.
I have not dealt with the veterans issue or the schools issue. I shall deal with them by letter, if that is all right. They are both extremely important. The situation with the veterans and the MoD is under active consideration by my noble friend Lord Howe. I will write to the noble Baroness, Lady Finlay, if she is happy with that, setting out the situation on schools in Wales.
The instinct of the Government is not to support the Bill, for the reasons I have given, but there may be a way through this which we are able to explore over the next month or two.
Baroness Finlay of Llandaff
When he writes to me, will the Minister include in the correspondence the noble Lord, Lord Wigley, who has done a lot of work on schools in Wales? He might want to meet him. Will the Minister clarify who has responsibility for free schools and academies? They are in a different position from maintained schools, yet they often occupy buildings which contain asbestos.
Lord Prior of Brampton
I think the answer to that question is that the Health and Safety Executive would have prime responsibility for them. I think the point that the noble Baroness is making is that the local authority no longer has the responsibility it would have over local authority schools. I will look into that issue and write to the noble Baroness.