Primary and Community Care: Improving Patient Outcomes

Baroness Merron Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I also congratulate the noble Lord, Lord Patel, and thank him for bringing this debate before your Lordships’ House, which he did with his customary attention to detail, but also searing analysis of what is before us today. This has indeed been a very sobering debate, and I hope it will be of use to the Minister and also to the new Secretary of State, who of course we wish well in her endeavours.

The noble Lord, Lord Patel, spoke of primary and community care as the bedrock of the health and social care services, and indeed it is the door through which most of us enter when we are seeking to access health and community care. However, our access to it and its suitability are deeply affected by the lack of co-ordination, resources, staffing and planning, as we have heard during the debate.

Dissatisfaction is running at an all-time high. This is not only a bad thing in itself but it affects confidence in the system. It is of increasing concern that those who should be making contact with their local GP are simply put off from doing so because they cannot access the service they require, not least because getting an appointment is beyond them, or so delayed, or difficult. This is not how it should be.

My noble friend Lady Pitkeathley hit the nail on the head when she reminded your Lordships’ House that people do not know or care who provides services; they just want the right service, at the right time, in the right way. People need to be seen as whole people and not only according to the bit of the system that is seeking to treat them. I think there is a very strong message for the Minister about the organisation of health and care services being around individuals and all that comes with them, rather than the other way round.

There are critical backlogs in both the sectors we are considering. There are some 1 million people waiting for care services within the community. The backlogs are a key factor in the dire ambulance delays that we are seeing, and they are added to by the number of patients who are in hospital beds when they should be in their own beds, either in their own homes or in a care setting—something about which the noble Baroness, Lady Masham, spoke so clearly.

The Community Network, which is comprised of organisations including NHS Providers and the NHS Confederation, has called for the Government to treat waits in the community sector on an equal footing to backlogs in the acute hospital sector, including through the development of a plan to address these delays as well as accelerating work to improve the quality of national data collections in community care. Could the Minister confirm whether the department has explored this option, because it would be a helpful way forward?

The noble Lord, Lord Kakkar, was right to put down a challenge to how systems are organised and about whether hospitals are the right place—the best place—for dealing with chronic conditions when there is so much opportunity to deal so much better with a number of these closer to home. I hope the Minister will reflect on this.

It is the case, as we have discussed so many times, that the issue of the workforce comes up time and again. We know that there is an increasing volume and complexity of demand, a rapidly aging population and, with that, huge workforce shortages. I must repeat the call for a long-term workforce plan to address what is a stark situation. Failure to address this will only exacerbate the backlogs and health inequalities still further.

The response so far has been disappointing, as we saw in the passage of the Health and Care Bill. This is not just about numbers, important though they are. It is also about what staff do, and whether we have the assessment available to make a judgment as to whether we have the right range of staff, as the noble Baroness, Lady Watkins, referred to, to make sure that they can be available to meet peoples’ needs.

Although it is welcome that there are, as we have heard, additional roles to be developed and additional staff to be made available to work in primary care networks—including pharmacists, physiotherapists and link workers—and it is welcome that there is to be recruitment, there is a gap: how will general practices implement a multidisciplinary model of care, either within or across practices, which will embrace these roles? This is lacking, as we have seen from the King’s Fund investigation into this issue, and it is leaving staff isolated and demoralised. How will this be dealt with beyond recruitment? How will these additional and new roles come into play?

How will the fact that appointments are getting ever more difficult for people to get be dealt with? A GP Patient Survey found that only 56% have reported having a good experience of making an appointment, and there are early signs that the pressure on GPs is affecting patients’ experience of their appointment even when they actually do get one. Similarly, the British Social Attitudes survey showed that satisfaction with GP services fell to 38% last year, which is the lowest level ever recorded. What will be done to address this problem?

On GP numbers, my noble friend Lord Hunt again raised the important question about the reduction in GP training places. What is the thinking on this reduction? How does this square with the expectation that we need, and are told that there will be, greater numbers of GPs?

Improving access will require actions from across the health and care system, and it is critical that integrated care systems and their partners consider how they will provide support to general practice to improve access in the short term. How will this manifest itself within the new integrated care boards?

As we know, and as the noble Lord, Lord Bethell, referred to, the pandemic accelerated new ways of working, including a rapid uptake of existing digital tools to deliver patient care. While this has benefits for patients and staff, there is a proportion of the country who are digitally excluded or who have needs that make digital access less appropriate for them. How will this be addressed so that nobody is left behind?

Finally, I refer to the proposal from the noble Lord, Lord Patel, for a special Select Committee to take forward how we can address the lack of co-ordination in the primary care sector. I hope that the new Secretary of State will consider this worthy of consideration, because there is no doubt that the debate today has shone a very clear light on the fact that we need to step back, make the change and build the system around the needs of the patient, and not the other way around.