Health and Social Care

Lord McNicol of West Kilbride Excerpts

Monday 6th December 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I first declare my interest as a serving non-executive director on a local hospital board, which is in the register.

I thank the Minister for the Statement from Friday concerning the winter and the NHS. If the House will indulge me for a moment, I put on record what a pleasure and privilege it has been over these years to have had my honourable friend Jon Ashworth, former Shadow Secretary of State for Health and Social Care, as my boss. I welcome Wes Streeting MP to that position; his huge talent will challenge the health team in the Commons and keep them on their toes, I have no doubt, and I look forward to it.

Today, the Daily Telegraph carried a story saying that 10,000 hospital beds were taken up by patients waiting for home care. NHS Providers has done some research and warned that those beds are mostly currently occupied by elderly people who are medically fit to be discharged, but no care is available to look after them at home. The chief executive, Chris Hopson, said that hospitals are now having to deploy their own staff to take on care duties in the community in order to free up hospital beds.

The lack of social care surely lies at the heart of whether the NHS can cope with the winter pressures, deal with ambulances stacking up, tackle the backlog and deal with whatever Covid, and particularly the new variant, may throw at it. When Professor Stephen Powis, NHS National Medical Director, said:

“NHS staff have pulled out all the stops since the beginning of the pandemic, treating more than half a million Covid patients, while continuing to perform millions of checks, tests and treatments for non-Covid reasons”,


he could have added that they are exhausted and need our support and that of the Government to move forward.

We need to add in the fact that about one in 60 people in private households in England had Covid in the week to 27 November—up from one in 65 the previous week, according to the Office for National Statistics. One in 60 is the equivalent of almost 900,000 people. Although it is true that, thankfully, fewer people are hospitalised and even fewer are in ICU, that is still a significant number. But this rate of infection, with the new variant possibly being even more infectious, means that, apart from anything else, there will be a surge in people being off sick, including NHS and care staff.

It is too easy for the Government to say that the winter crisis and the huge waiting lists are simply the result of the challenges of Covid. The reality is that the entire health and social care system has been left dangerously exposed by this Government’s choices over the past 11 years. Before the pandemic, there were waiting lists of 4.5 million, staff shortages of 100,000 and social care vacancies of 112,000. This week, the National Audit Office starkly detailed that things are set to get even worse: waiting lists might double in the next three years.

Those NHS waiting lists stand at 6 million. Almost one in 10 people in England waits months, or even years, sometimes in serious pain and discomfort, because the Government have failed to get a grip on the crisis. Everyone understands that we are in the midst of a global pandemic that has placed the NHS under unprecedented pressure, but that does not excuse or explain why we went into the pandemic with NHS waiting lists already at record levels and with unprecedented staff shortages.

Of course, the investment described in the Statement is welcome, and the plan recognises the many challenges that the whole sector has faced over the past 18 months. Can the Minister say that the Statement is a credible plan to meet those enormous challenges? If it was a genuine plan to prepare for the winter, why did it arrive on 3 December? For example, I noticed that on one of the hottest days of the year, in August, people from GP practices, primary care networks and federations gathered to start to think creatively about managing their winter pressures in a session hosted by the NHS Confederation. When I served on a clinical commissioning group, we did our winter planning in June—it started in the early summer. The board on which I currently serve has been discussing winter pressures and our winter plans for months.

A serious plan to bring down waiting lists would have the workforce at its heart and would have clear targets and deadlines. A serious plan would recognise that, unless we focus on prevention, early intervention and fixing the social care crisis, there is no chance of bringing waiting lists down to the record low levels we saw under the previous Labour Government. A credible plan to tackle the NHS winter crisis—which was foreseeable and foreseen—would have been published long before 3 December. Without a serious strategy to build the health and social care workforce that we need, the plan is not a plan at all.

[The Deputy Speaker (Lord McNicol of West Kilbride) (Lab)]

I call the noble Baroness, Lady Brinton, who is taking part remotely.

[Baroness Brinton (LD) [V]]

I, too, thank the Minister for the Statement and I start by thanking all our NHS and social care staff, at all levels—back room or front line—for all they are doing to keep the NHS and social care going while under the most extraordinary, sustained pressure.

Like others, I am struggling to see what is new in the Statement, which admits that the funding mentioned is not new. Although there is marginally more detail on how some of it will be spent, it is very light on by when the extremely urgent investment will deliver the help that our NHS and the public who use it desperately need.

Repeatedly, the Statement, and the accompanying so-called policy paper, The Health and Social Care Approach to Winter, refer to the urgent need to recruit more staff for both the NHS and the social care sector. However, it reports that currently, the NHS has an 8% vacancy rate at all job levels, and the social care sector, which has had more than 100,000 vacancies for some time, has had a further 3% reduction in staff since March this year.

Although there are proposals to increase staffing, can the Minister please explain where those staff will come from if they have not been able to be recruited over the past few months? How long will it take to recruit them? It is good that money is being put into the workforce, but I struggle with any suggestion that that will help to deal with the current winter crisis. When will the staff who are desperately needed in health and social care be available to join the teams out in the wards?

Both the Statement and the report talk about using locum services for doctors and agencies for nurses and social care staff, but health and social care employers tell the public daily that the extra qualified people are just not there. One of the problems in social care at the moment is that the NHS is poaching nurses from care homes. Please can the Minister explain who is going to fill those roles, given that training those skilled personnel takes a lot longer than a few months?

I echo the comments of the noble Baroness, Lady Thornton, about delayed discharges. We have all been asking the Minister and his predecessor about specific plans to help the social care sector overcome its problems in the workforce, not just for months but for years. The high level of staff vacancies continues to worsen. Can the Government help in the short term? For example, NHS Providers made the very helpful suggestion today that the Government help to fund a winter retention bonus for social care staff. NHS Providers understands that we must get the log-jam moving, and if the only way to do that is for the Government to help, please will they consider that proposal very seriously?

The Statement says that the NHS needs to be able to offer more appointments, operations and treatments, which is absolutely right, including with the NHS itself. However, the capacity to change to innovative ways of working, with a heavy load of staff vacancies and the current sustained 20 months of intense pressure, seems to be extraordinary. To illustrate this, in the second week of November, there were 966,406 more GP appointments in England compared with the same week last year—and we were not in lockdown at that point last year.

The Statement talks about the transformation funding for elective recovery, announced in September. The plan lists the hospitals that have been successful in getting their schemes approved. I know, from experience in my local area in Watford, that some of the modular ward proposals can move ahead very quickly. Can the Minister tell us the likely earliest delivery date for any one of these projects? Once the buildings are there, when will extra staff be available to make these new wards work? We certainly do not want to see a repeat of the Nightingale hospitals.

The plan says that NHS Test and Trace will be carrying out contact tracing, so will the Minister say whether local test and trace will continue? It is noticeable that this was not mentioned at all, yet only two months ago Ministers were saying that this was where the focus of contact tracing would be. May I repeat the questions that I have asked on at least two occasions to the Minister? What is happening to the funding for the local resilience teams for Covid tracing and other pandemic work from April, given that, at the moment, there is no money in the budget whatever for the next financial year?

Last week, the Minister wrote to my noble friend Lady Thomas of Winchester about the delivery of vaccines to the vulnerable housebound who cannot go out either to their GP’s surgery or to vaccination centres. He wrote to her after the Question, confirming that GPs have a duty to offer vaccines to the housebound. He went on to say:

“If there are no GP practices signed up to phase 3, the CCG will make these alternative arrangements instead.”


Today’s Daily Telegraph talks about more than 300,000 people—more than two-thirds of the housebound—having yet to receive their booster doses. This is not hesitancy in people coming forward; it is clear that there is a problem. With many GP surgeries having withdrawn from delivering booster jabs because of their increased workload, can the Minister tell me when CCGs will be setting up these new systems and, most importantly, contacting and reassuring this vulnerable group of people about when they will get a visit from the mobile vaccination team? Putting the booster programme on steroids for all adults is of no use if the most vulnerable are not even being contacted. I look forward to hearing from the Minister. If he does not have the answers at his fingertips, I ask him to write to me.