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  • Sep 18, 2017:
  • Sep 12, 2017:
    • Gaming Machines - Question | Lords debates

      My Lords, younger gamblers, aged 18 to 24, have a greater propensity to develop problem gambling and mental health issues. They do it mostly online, which is very quick and easy. What will the Government do to reduce the volume of gambling advertising, particularly at sporting events? In many cases, the tone of this advertising is very clearly aimed at young people.

  • Sep 6, 2017:
    • National Health Service (Mandate Requirements) Regulations 2017 - Motion to Regret | Lords debates

      My Lords, we on these Benches support this Motion.

      This debate shines a spotlight on the existential quandary facing CCGs and NHS Providers. I am sure that at the end of the debate the Minister, in his usual courteous and thorough way will, as he always does, give us lots of figures about how much more the Government are spending every year and how many more treatments are being delivered and how well the STPs are doing. With demand rising, naturally the raw numbers are higher, but the Government have chosen an RTT target in percentage terms and they must live with that decision and fund the consequences. Over recent years, the increase in funding for the NHS has not kept up with rising demand. This year we have a lower increase than before, and so now is crunch time. As the noble Lord, Lord Hunt, said, nobody is even pretending that providers will be able to deliver the targets while remaining within their budgets. So there is no point in the Government watering down the targets and pretending that no one will notice. The noble Lord, Lord Hunt, and many others have noticed, and I am grateful to him for giving us the chance to have an honest and open discussion about this.

      NHS staff work hard and do their best to meet the targets under difficult circumstances. It is not their fault that the RTT targets have not been met for 16 months. But changing the targets is a political decision, whether it is being done openly or not, and that is only right. It should certainly not be left to local decision-makers, in a postcode lottery, to quietly ignore them or try and fail to live up to them and then take the flack when people criticise. If the Government choose to change the target, they should take the responsibility for the consequences. But the trouble is that patients will live with the consequences, living longer with debilitating and painful conditions. Having those conditions worsen and requiring more complex and expensive treatment, they may even become untreatable, and their quality of life and perhaps their mental health will deteriorate. So although the 2012 Act was intended to pass the blame on to anyone but the Government when things go wrong, everybody knows that the Government's NHS mandate is the Government's NHS mandate and nobody else's. The NHS can spend the money only once, and the Government should not be expecting two treatments for the price of one. The bald facts are that, this year, demand was expected to rise by 5.2% while the funding is only going to rise by 1.3%, which is 2.3% less than last year-which was too little anyway. So this is a deliberate choice on the part of the Government.

      Waiting lists are projected to rise to almost 5 million by 2020, and clearing this backlog will require not only funding but appropriately trained staff. With staff who are EU citizens leaving in droves because of Brexit uncertainty, and UK staff leaving because of overwork and stress, NHS Providers is finding it impossible to deliver waiting time targets. At the same time there is spare capacity in the private sector but it charges more than the NHS, so that is a hard choice for managers to make. I therefore ask the Minister a simple question: what assessment did the Government make of the potential impact on patients and waiting lists of deprioritising elective care and taking the decision to relax the 18-week target?

      The RTT is not the only target the Government have changed, as the noble Lord, Lord Hunt, mentioned, and this is looking rather like a habit. For example, NHS England and NHS Improvement are reportedly setting new targets for CCGs and providers for bed occupancy levels, to keep them below 92%. This is significantly higher than the recommended safe limit of 85%. The Royal College of Surgeons has warned:

      "Anything over this level is regarded as riskier for patients as this leads to bed shortages, periodic bed crises, and a rise in healthcare-acquired infections such as MRSA".

      This is another target that was routinely missed last winter, and the latest figures show that the overnight occupancy rate for general and acute beds hit a record high in the fourth quarter of 2016-17, averaging 91.4%. If the Royal College of Surgeons is right, this high level of bed occupancy is not a measure of efficiency but could lead to greater costs and crises, which put patients in danger.

      Is it not time for the Government to stop pretending that all is well and that they have all the right answers, and set up a cross-party commission on the funding of health and social care, as recommended by my right honourable friend Norman Lamb MP? We on these Benches would be enthusiastic about taking part in such discussions. I think that the public are very fed up with health and care being a political football and would like to see us working constructively together. They want some honesty and realism. Of course we do not want to go back to the 1950s: I was waiting for a tonsillectomy and after two or three years, when my mother was fed up of waiting, she discovered that I had been taken off the list on the assumption that I had grown out of it. Actually, I had, but we need to be a great deal more ambitious for the NHS than that.

      I know that the Minister makes the best of his brief but I would like to think that he will go back to his department and use his considerable powers of persuasion to stop the Secretary of State from burying his head in the sand.

  • Sep 5, 2017:
    • End of Life Care - Question | Lords debates

      I thank the Minister for his reply. The resource impact tool published with this guidance shows that by investing £12.7 million in implementing the guidance, savings of £34.7 million could be made by the NHS in England. What plans do the Government have to emphasise to local commissioners the cost effectiveness of implementing the guidance? Secondly, does the Minister think it is right that adult hospices in England receive 33% of their funding from statutory sources while children's hospices receive only 22%?

    • End of Life Care - Question | Lords debates

      To ask Her Majesty's Government how they intend to implement the NICE guideline End of life care for infants, children and young people with life-limiting conditions: planning and management.

  • Jul 20, 2017:
    • *No heading* | Department of Health | Written Answers

      Her Majesty's Government when the next meeting of the Crisis Care Concordat Steering Group will take place.

    • Health: Congenital Heart Disease - Question for Short Debate | Lords debates

      My Lords, I congratulate the noble Baroness, Lady Boothroyd, on her tour de force and many other noble Lords on their very authoritative speeches. I feel a bit sorry for the Minister, who might be feeling a bit lonely.

      In decisions such as the closure of a highly successful and reputable unit such as the CHD unit at the Royal Brompton, the key driver must be to maintain and improve the quality of patient care. Any merger or closure decision must be made on the clinical evidence and not on cost saving, although, in this case, the costs of the change could well be greater than the existing provision.

      The Brompton is a highly experienced unit, as the noble Baroness, Lady Finlay, told us. It performed 512 congenital heart disease operations and 554 catheter procedures on children and adults in 2014-15, more than any of the 12 other NHS trusts performing such work. As the noble Lord, Lord Patel, mentioned, its adult CHD research team is responsible for publishing more cited research papers than any other CHD centre in the world. It is at the cutting edge of innovation. Despite the severity of the health problems experienced by its patients, as we have heard, survival rates and the quality of care are very high.

      However, NHS England's concerns about the Brompton focus on two issues. First, Standard B10 requires there to be four CHD surgeons, each of whom has presided over at least 125 operations per year. At the Brompton, I am told, three out of the five surgeons fall short of 125 cases-an arbitrary figure, according to the noble Lord, Lord Darzi. I listened to him very carefully.

      Secondly, NHS England is concerned that a number of linked paediatric services are not collocated in the same hospital but are provided by the Chelsea and Westminster and St Mary's hospitals, both easily within 30 minutes of a child's bedside. It is worth nothing that 30 minutes is the time limit proposed by the standards even when the services are collocated. This partnership is very close, with joint rotas, ward rounds and meetings and shared IT systems. This high level of communication is essential to the working of such a partnership.

      To comply with the rapid availability of paediatric cardiology, ICU, anaesthesia, gastroenterology and other services, the Brompton has formed joint teams with the Chelsea and Westminster, which is five to 15 minutes' walk away, depending on how fast you walk. You can be more than 10 minutes' walk away from another department in the same hospital on a large site such as my own local hospital-I have done such a walk many times. The main thing is that you can get there in time. The Brompton has proved that it can do this by its claim that, for the 1% of paediatric CHD patients who have needed these services, it has a 100% record of providing them in time, in an emergency, day or night.

      Given that there are many downsides to closing the unit, NHS England should apply the standards a little more flexibly when it comes to how they are complied with, as long as the standard of patient care is not compromised. The issue of collocation seems to have been appropriately dealt with by the partnership arrangements. The issue of the number of cases presided over by each surgeon could surely be addressed in the interest of saving the large amount of money that would need to be spent on closing the unit. I understand that the cost of redundancy payments alone amounts to £13.5 million, let alone the cost of increasing the number of beds elsewhere. Last December, my noble friend Lord Sharkey told the House that closure of the unit would remove a quarter of paediatric CHD beds in London. Can the Minister say what the plans are and what the cost would be of recreating beds for these 12,000 patients elsewhere? Where is the cost-benefit analysis? At a time when the NHS is struggling so hard financially, it seems highly risky to take the proposed line.

      There are other, considerable risks to closing the unit. Take staffing: how do we know that existing staff are prepared to relocate? Experienced UK staff and those coming from abroad are attracted by the Royal Brompton's reputation and, especially in the uncertain climate of Brexit, we cannot be certain that they will still come. Already, almost 90% of children's units express concerns over how they will cope with staff shortages over the coming months. Already, one in five vacancies for junior children's doctors is unfilled, on a rising trend. Now is not the time to upset an already wobbly apple cart.

      As we have heard from the noble Baroness, Lady Morgan, then there is the effect on other departments that would be threatened with closure because of volume reductions. The hospital claims that, without child CHD services, its children's intensive care unit would become unsustainable because of the reduction in volume. Consequently, its paediatric respiratory unit and paediatric cystic fibrosis and asthma services would also have to close, and other services would be under threat. NHS England admits that it has not done a detailed assessment of the knock-on impact of closing CHD surgery on other departments at the Royal Brompton. Can the Minister say when this will be done?

      Talking of unintended consequences, will the Minister look carefully at the funding models for surgery to ensure that there is no barrier to the hospital taking a holistic approach to the patient's disease? For example, I understand that the range of a consultant heart surgeon's practice has been limited by the funding model, since, although heart patients may well also have other diseases, the heart consultant will never deal with them, yet it is all part of the same syndrome.

      As the noble Lord, Lord Darzi, mentioned, there are examples of where centralisation of services can improve patient outcomes, which is what we all want, and I congratulate and support them. High among those is stroke and trauma services in London. However, we must not assume that one size fits all. It really depends on where you are starting from and in the case of the Brompton we are starting from a very high base. We have to look at the scope for doing even better and consider all the options for improvement. While this debate has been very supportive of the Royal Brompton, it also raises challenges for the trust, and I am sure it will rise to them. Surely there is a way of addressing some of the issues that NHS England has mentioned without closing the unit, with all the attendant downsides.

      I agree with the noble Baroness, Lady Masham, that "if it ain't broke, don't fix it" is a very good motto. In reflecting that this debate has had contributions from nine women and five men, I wish all hard-working noble Lords a very happy summer holiday.

    • NHS: Contaminated Blood - Statement | Lords debates

      My Lords, I welcome the fact that we are to have a proper inquiry at last and that it will be fully independent. I also welcome that the secretariat to the inquiry will be someone who has never worked at the Department of Health. However, the remit of these inquiries always has an enormous effect on the deliberations and the outcomes. Victims are concerned that the Department of Health could sign off the remit. To be seen to be completely independent, will the Minister consider which department would be more appropriate than her own for signing off the remit? Perhaps it could be the Cabinet Office.

      The inquiry must have statutory powers not just to summon witnesses but to compel them to appear and to receive documents. In the debate in another place last week the Minister seemed to see two alternatives: either giving the inquiry these important statutory powers or providing a,

      "Hillsborough-style panel-which would allow for a sensitive investigation of the issues, allowing those affected and their families close personal engagement".-[Official Report, Commons, 11/7/17; col. 187.]

      I do not see these as two alternatives. If the inquiry is properly constituted and the remit laid down by an independent body with the approval of the victims, it could command their trust and close personal engagement could then be achieved. However, these inquiries usually take a long time, and the victims of this scandal need help now. How will the Minister ensure that victims have access to the compensation they deserve in the short term? Will she reverse the decision made in April not to increase the compensation payments in line with inflation? Will the Minister set a date for responding to the consultation on the support scheme, which closed in April?

    • Health: Obesity - Question | Lords debates

      My Lords, in the SACN report, the variation between different groups was seen to be quite unacceptable. For example, in the Borough of Kensington and Chelsea, the difference between different demographic groups for men was 16 years. To what does the Minister attribute this inequality and what do the Government intend to do about it?

  • Jul 17, 2017:
    • Health: Obstetrics and Gynaecology - Question | Lords debates

      My Lords, does the Minister agree that it is good practice to involve parents in the reviews of what went wrong during their baby's birth? Why were only 28% of parents involved in the reviews of what went wrong? Surely it is totally unacceptable that 25% of parents were not even told that a review was taking place.

  • Jul 12, 2017:
    • Electric Car Ownership - Question | Lords debates

      My Lords, is the Minister aware that in England and Wales there are over 1,000 nursery schools looking after 47,000 young children that are very near main roads with illegal levels of nitrogen dioxide and the small particulates that come from diesel cars? These can not only cause lung disease but have an effect on children's brain development. So when will the Government start regarding the rollout of electric vehicles as a serious public health matter, not just for now but for the future?

  • Jul 6, 2017:
    • Adult Social Care Services - Statement | Lords debates

      My Lords, quality improvement is really urgent given that, as the noble Baroness, Lady Wheeler, said, one in four settings was found by the CQC either to be unsafe or to require improvements in safety. Safety is fundamental when you are looking for a setting for one of your loved ones. Given that, according to the CQC, the rate of improvement is slowing down in some settings and in others has deteriorated, does the Minister agree that a shortage of well-trained staff is at the root of this problem?

      While we wait for the Green Paper, will the Government respond to the CQC's second warning that social care is at a tipping point and inject some urgent cash into it? Many authorities, which really understand these issues, told us last autumn, when the extra money was announced, that it was really only half of what social care required to keep it at the same level, let alone improve, so some extra cash is urgently needed.

  • Jul 5, 2017:
    • NHS: Working Conditions - Question | Lords debates

      My Lords, in the 2016 NHS staff survey, 47% of staff who responded said that staffing levels were insufficient for them to be able to do their job properly. One in five GP training places were unfilled, mental health and community nurse numbers fell by 13%, and district nurse numbers fell by 42%. Given that workload is the major reason given for staff leaving the service, how do the Government plan to increase the number of patients treated in primary care and in the community as opposed to in acute settings in hospital, as recommended by a number of authoritative reports, including that of the Select Committee of your Lordships' House?

    • Child Welfare - Question | Lords debates

      My Lords, some of the most vulnerable children are those with life-limiting or life-threatening illnesses. They require a lot of social care. Yet the Government omitted children when promising to address the challenges of social care. Will the Government include children in the forthcoming Green Paper on social care? Secondly, how will they fulfil their promise on end-of-life care for children when some children's hospices and children's palliative care charities have to review the care they offer because of a 61% cut in local council funding for their activities?

  • Jul 3, 2017:
    • Fire Safety: Schools - Question | Lords debates

      I thank the Minister for his reply and share his concerns about the victims of Grenfell. Is he aware that last year the London Fire Brigade did 184 school fire safety consultations and that, despite it feeling that all new and refurbished schools should have sprinklers fitted, only 2% of such schools were fitted with them? This indicates that the current guidance is not being followed. Given that sprinklers can save lives and reduce the rising cost of property damage, will the Government commit to making sprinklers mandatory in new and refurbished schools and producing up to date and robust information about the cost of school fires in lives, cash and educational disruption?

    • Fire Safety: Schools - Question | Lords debates

      To ask Her Majesty's Government, in the light of the Grenfell Tower fire, what plans they have to review their guidance Fire safety in new and existing school buildings.

  • Jun 29, 2017:
    • Queen's Speech - Debate (6th Day) (Continued) | Lords debates

      My Lords, this has been a fascinating debate with powerful contributions from many noble Lords. It was admirably kicked off by the passionate speech from the noble Baroness, Lady Sherlock, on poverty, public services and a fair welfare state.

      Noble Lords have heard from 10 of my colleagues on these Benches whose speeches have ranged far and wide. My noble friend Lord Storey absolutely demolished the Government's claims that they are protecting school budgets in real terms. My noble friend Lord Kirkwood talked about the importance of exploiting the talents of the whole of the UK. I hope he is right that we are becoming a kinder country. My noble friends Lady Bonham-Carter and Lord Clement-Jones talked about the creative industries and the importance of starting in schools. I often think of your Lordships' House as being a bit like a school. However, it is clear to me that we in this place understand the importance of arts and culture because we have created so many APPGs on those subjects to enrich our own lives, not least of which, of course, is the famous parliament choir, which reaches its 17th birthday this year. So why should we deprive children of that enrichment?

      My noble friend Lord Lee talked about tourism and the important contribution that it can make in helping young offenders. My noble friend Lady Benjamin talked about school gardening. As a keen gardener and somebody who established a school garden herself 40 years ago, I could not agree with her more.

      My noble friend Lady Jolly talked about the effect of recent judgments on charities and about defence. My noble friend Lord Rennard asked for a new smoking strategy. My noble friend Lady Brinton talked about social care, and my noble friend Lord Addington spoke about disabilities. I was very interested in all those valuable contributions.

      I shall focus my remarks today on an issue that is usually top of the list with voters in a general election. In the last election, health and social care started off as second in line to Brexit, but concerns about Tory social care policy quickly became the turning point. As it happens, I had managed to talk my way in among the Tory faithful when Theresa May did her notorious U-turn in our village hall about 100 yards from my house, so I heard first hand the announcement of the U-turn on a cap on social care payments and the vigorous denial that it was anything of the sort. As it happens, I heard Jeremy Hunt, only four days earlier at the Alzheimer's Society conference, firmly denying the need for a cap. It was indeed a U-turn and a wobbly Monday for Mrs May.

      Other measures, such as including the value of the patient's home when they apply for help with domiciliary care costs, would put the incentive in exactly the wrong place and discriminate against dementia patients, who often need long-term care. Dementia is a disease. So is heart disease, but you do not have to sell your home for that. I call on the Minister to ensure that the Green Paper announced in the gracious Speech addresses the incentives as well as the funding and quality of the provision of social care.

      It amazes me that a Government can publish a gracious Speech with so little about a public service that is in multiple crises. There is a crisis of public confidence, illustrated by a recent BMA survey that showed that for the first time more people were dissatisfied with the NHS than were satisfied with it. There is also a staffing crisis, with vacancies reaching record numbers, despite the Government's recruitment of more doctors and nurses. A recent BMA survey found that around two-thirds of hospital doctors have experienced rota gaps in the past 12 months and that 48% of GPs reported vacancies in their practices. Clearly, with rising demand, what the Government are doing is not enough.

      Your Lordships' Select Committee report on the Long-Term Sustainability of the NHS and Adult Social Care, mentioned by the noble Lords, Lord Ribeiro and Lord Warner, among others, was very critical of the limited powers of Health Education England and the lack of leadership in the Department of Health, resulting in poor planning to provide the workforce needed to keep patients safe in the long term. The committee referred to,

      "the absence of any comprehensive national long-term strategy".

      It recommended that Health Education England's powers be substantially strengthened and criticised cuts to its funding. This is not just a matter of clinical staff. Denmark has three times as many trained radiologists per head as the UK. Such technicians are needed for cancer diagnosis and treatment and are just one example of where we fall behind other developed countries.

      The NHS has always relied on international doctors to fill gaps in the medical workforce. Over the next five years, the general population is expected to rise by 3%, while the number of patients aged over 65 is expected to rise by 12% and those aged over 85 by 18%. Given that the medical needs of these patients will grow ever more complex, the demand for doctors and nurses from overseas will continue. Following our withdrawal from the EU, any future immigration system must be flexible enough to allow EU staff to fill the gaps in the health and care services, as well as in university and research sectors and in public health. So will the Government make special arrangements for the health and care workers whom we so badly need?

      The Government have announced legislation for an independent health service safety investigation board, but will the Minister accept that the greatest danger to patients is a shortage of properly trained staff with high morale? Until the pay cap of 1% per year for public sector workers is removed and the service is properly funded, the results of investigations by the new body will be a foregone conclusion.

      There is also a financial crisis in health and social care. The Public Accounts Committee report on financial sustainability showed that the financial performance of NHS bodies had "worsened considerably". NHS trusts' deficits reached £2.5 billion in 2015-16. Two-thirds of trusts were in deficit that year, up from 44% the previous year. Some 40% of mental health trusts saw their budgets actually cut. No wonder the Select Committee concluded that health and social care are underfunded and require a stable and predictable fix, not the short-term sticking plaster referred to by the noble Baroness, Lady Pitkeathley.

      I see no attempt to address this in the gracious Speech. Instead, the Government's response is the capped expenditure process, which is not transparent and in some places risks patients' lives. I have read that cancer surgery has been cancelled in order for one trust to stay within its financial targets. In another place, £900,000 for mental health was diverted to other services in order to stay within financial targets. This makes a mockery of the commitment in the gracious Speech to ensure parity of esteem for mental health. While there is a need for the NHS to get a financial grip, there is a danger to patients if cuts are arbitrary.

      There is also a mental health crisis, despite the marvellous work of my colleague in the other House, Norman Lamb. Last year it was revealed that there had been a 47% increase in detentions under the Mental Health Act compared with 10 years ago. In response, as the noble Baroness, Lady Sherlock, mentioned, the Prime Minister promised to rip up the 1983 Act and introduce new law. However, the gracious Speech instead committed to a review of existing legislation. Actually, I think that that is just as well, as many in the sector call for the Government to exercise caution. The noble Baroness, Lady Browning, was right to ask for pre-legislative scrutiny. The Royal College of Psychiatrists warns against the assumption that the rise in detentions is caused by flaws in the law. Instead, it blames lack of early intervention and of community services. I join the right reverend Prelate the Bishop of Peterborough in asking the Government to ensure that the funding for mental health services reaches them and is not diverted to other services. Timely access to preventive care, a whole-system approach and sufficient funding will do more than any legislative change ever could.

      We also need more skilled staff. There has been a 10% drop in trainees for psychiatric specialisms since 2014. Some 41% of trainee psychiatrists come from abroad-the highest proportion of all the medical specialties-and that would be impacted by the £2,000 international skills charge which the Government intend to impose. If the Government are serious about mental health, they should scrap that tomorrow.

      In some places, there is also a crisis of standards, according to the CQC, and there is certainly a crisis of health inequality between rich and poor. If you look at all these crises, you have to conclude that there has never been a better time for a cross-party health and care commission, as proposed by Norman Lamb MP, to engage with all interested parties to find sustainable solutions. He has already taken a cross-party initiative supported by nearly 20 MPs from other parties, and I understand that a further initiative is imminent. When opposing parties are able to agree on something like this, surely Governments should act.

      Another important proposal from the Select Committee was about public health. It criticised the cuts as being short-sighted. I agreed with it when it said that prevention of preventable disease is the only hope for the NHS, but it accepted that with patient rights come patient responsibilities. But people need help and services in order to look after their own health. I did not expect legislation for this in the Speech but there is a role for health education; cultural, arts and sports facilities; food labelling; and drug, alcohol and smoking cessation services; and these need to be encouraged, not cut, during this two-year Parliament.

      I was about to ask for the Secretary of State for Health to reverse the injustice of not providing abortions for women from Northern Ireland on the National Health Service. I was pleased to learn during the course of this debate in your Lordships' House that the announcement has been made that this will be done. However, I regret that it took the threat of a defeat in another place for the Government to see that they need to do the right thing.

      Finally, the Government's hard Brexit approach cost them the big majority they were seeking. A Brexit that protects the economy is vital for funding the public services we have been debating today. However, the Government's approach reminds me of "The Wizard of Oz". Dorothy is happily skipping along the yellow brick road along with her three friends. I will leave your Lordships to decide which one has no heart, which has no brain, and which is the scarecrow. However, off they go, expecting to find a great wizard behind the curtain at the end of the road. But instead of a little man with a megaphone, as in the film, they will find 27 well-prepared EU officials, determined that the UK will not get as good a deal as we have now. How will the Government deal with this while protecting our public services?

  • Jun 27, 2017:
    • NHS: Shared Business Services - Statement | Lords debates

      My Lords, as I understand it, that Statement on the last day of term before the Summer Recess last year was one of 30-which implies to me that the Government consider the last day of term to be a very good day to hide bad news.

      The Minister suggests that the company, or its shareholders, will have to pay its share of the costs of investigating this scandal. Can he assure us that the NHS will not be out of pocket, particularly in the light of the fact that the loss is not just financial? A lot of doctors and various officials, in both the department and trusts, have had to spend a great deal of their time looking into this-and, of course, time is money. Will this scandal actually cause the Government to be a little more cautious in future when they claim that putting health services out to private companies always gives better value to the taxpayer and the NHS?

    • Brexit: Nursing Staff - Question | Lords debates

      My Lords, the Department of Health's own modelling predicts that there will be a shortage of 40,000 nurses by 2026. My own local hospital has 60 nurse vacancies, and I am sure other noble Lords have similar examples. What do the Government propose to do to avoid the NHS becoming unsafe because of these nursing shortages, given that some nurses are already being asked to stay on at the end of 12-hour shifts in order to fill gaps in the roster?

  • Apr 27, 2017:
    • Education (Student Fees, Awards and Support)(Amendment) Regulations 2017 - Motion to Regret | Lords debates

      My Lords, this is a terrible time for the Government to undertake a highly risky revision of the funding of student nurses. We are already short of nurses, as the noble Lord, Lord Clark, told us, and of course midwives, and the imminent Brexit has already made that worse with, as we have heard, a 90% drop in the number of applications from EEA nurses. In addition, we are losing nurses due to overwork and poor morale.

      The Government's so-called consultation focused only on implementation rather than looking carefully at alternative ways of funding nurse training to ensure both fairness and a stable increased supply of nurses. The excellent speech by the noble Baroness, Lady Watkins of Tavistock, clearly demonstrates that there are many different ways of doing that, and I am not convinced that the Government have taken all those proposals into account. They ought to stop in their tracks and look at all those alternatives before going ahead with this regulation. We are still waiting for information about how or whether the practice placements will be funded, wherever that is-in the NHS or in the care services. As we have heard, nurses have to do 2,300 hours in a clinical placement. This requires considerable resource input from the hospitals or care placements, and most hospitals are already in deficit. Without proper resources there is no way that the system can accommodate 10,000 extra student nurses, even if, as we all hope, the Government are right and universities do offer that many additional places.

      I understand where the noble Lord, Lord Willetts, is coming from. Clearly, the tuition fees and loans system has not put off students on most university courses. However, nurses are different from other students, so it is not a given that they would respond like students on other courses to the need to take out loans and pay fees. They are more predominantly from lower socioeconomic groups and have a higher proportion of mature students with family commitments. They spend nearly half their course time in supernumerary placements in hospitals and have a higher number of contact hours and weeks than other students. That makes it more difficult for them to get a part-time job to fund their living expenses, as other students can do. Indeed, because they are not highly paid, it has been calculated that the vast majority of them-I apologise to the noble Baroness, Lady Watkins-will not have paid off their student loans over 30 years, so they will be written off. It makes me sad to have to say that but it is a fact. Some even have other student loans from other courses that they have previously undertaken. So this strategy of the Government will not necessarily save much money in total but will simply shift the debt off the books, which I suppose was the objective of the exercise.

      The Government have been very hasty. Instead of arbitrarily removing the bursaries we need a thoroughgoing investigation into the factors affecting nurse recruitment and retention, because the latter is a very important factor. It is no use filling up the bucket if there is a great big hole in the bottom-and in this case there is. Retention of student nurses to the end of their course is poor, and retention of nurses and midwives beyond the first two years after qualification is also poor. Therefore, not for the first time I ask the Minister whether he will ensure that attrition data is collected in a consistent way so that we can identify those settings that are good at keeping their students, nurses and midwives and those that are not. We can then learn from the best practice and spread it.

      The impact of the Government's plans on admissions, student numbers and quality and on the stability of the qualified workforce is yet unclear, and the Government have not said how they intend to monitor the impact on the workforce. Without a solid evidence base this policy should not go ahead. I therefore support the regret Motion in the name of the noble Lord, Lord Clark, and call on the Government to think again.