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NHS: Winter 2017-18

Volume 790: debated on Wednesday 18 April 2018


Asked by

To ask Her Majesty’s Government what assessment they have made of the effectiveness of their plans for the NHS in dealing with the pressures during the winter of 2017-18.

My Lords, last year the NHS started planning earlier than ever before to support delivery during the challenging winter months. Despite the NHS being extremely busy, with challenging weather conditions and flu rates at their highest level for several years, hard-working A&E staff treated more than 55,300 people within four hours per day between December and March—that is 700 more a day on average than the year before. A review of winter performance by NHS Improvement and NHS England will be published this summer.

I thank the Minister for his Answer. Of course, we are all very thankful indeed that we have got through the worst days of the winter, and we are grateful that new plans were put in place. However, I think we all know that we got through only due to the dedication and commitment of the staff in the health service at every level, and that we face dire shortages in every sector of the health service. Is the Minister aware, for example, that 800 student nurses in 20 universities have had their grants or loans cut off or reduced due to administrative errors by the Student Loans Company, and that many of them now face financial distress, with the prospect of no or reduced support for the foreseeable future? Does the Minister accept that that is preposterous when there is such a shortage? Will he therefore step in and try to sort that out, so that no student nurses suffer?

I join the noble Lord in paying tribute to the dedication of staff who have taken us through what has been the worst winter for eight years. I was not aware of the particular issue he raised; I am glad he has raised it and brought it to me. I shall take it back to the department immediately after Questions to make sure that we get to the bottom of what is going on and try to fix it urgently.

My Lords, community pharmacies are a hugely undervalued resource and could help alleviate pressure. They could do that by helping people who have already been discharged from hospital avoid readmission and by being first port of call for patients, offering advice and treatment to those with minor health conditions. Will the Minister tell the House whether the Government are having a conversation with NHS England about future commissioning of community pharmacy services?

I agree with the noble Baroness that we need to beef up the role of pharmacies. Primary care is an area of investment within the five-year forward view. There are, I believe, nearly as many pharmacists as there ever have been, if not more, so their role is increasing all the time and that is part of our conversations for the future.

While my noble friend is looking at the expansion of advice from pharmacies, will he look at the same time at insurance cover for pharmacists? My understanding is that, while GPs have been very keen for pharmacists to give advice, for example, to asthma sufferers and to provide the equipment that asthma sufferers need to carry with them, they have run into difficulties in getting insurance cover to provide that level of advice.

I shall certainly look into that issue. We are reviewing insurance across primary care, as my noble friend might know, and I shall look into this specific issue.

My Lords, does the Minister agree that one of the problems is the shortage of intensive care beds, which holds up operations in hospitals so that there is a queue?

The noble Baroness is quite right. That is one of the reasons we have taken some big decisions over the winter, one of which is to reduce the amount of delayed discharges. I think it has been reduced by about 1,500 beds. It was also the reason behind what was undoubtedly an unpopular decision and one that we did not want to take: to suspend and postpone some elective surgeries during January. That freed up a number of beds, which helped us to cope with the emergency admissions. Happily, it has not had to be reinstated since the end of January.

My Lords, a huge debt is owed to the NHS for the way that it has responded to the pressures this winter. However, can I ask the Minister about elective treatments and the cancellations in January? He will know that the maximum 18-week wait target has not been met for, I think, at least two years. Given that the BMA has said that winter pressures will really never come to an end—they simply continue throughout the year—does he think that we will ever meet the 18-week target again under the current Government?

I agree that those winter pressures are increasing. One reason that they are doing so, and throughout the year, is that we have a growing and ageing population, as we discuss a lot in this House. It is worth pointing out that the planning guidance for the NHS for 2018-19 talks about not only providing more surgeries but starting to stop the growth in waiting lists and reduce waiting times, as well as halving them for the longest waits. We are focused on this, supported by the extra money that was announced for the NHS in the Budget at the end of last year.

My Lords, does the Minister agree that the structure of the GP service, settled decades ago at the beginning of the National Health Service, is no longer fit for the current demands on primary care services? Could that be looked at in a serious way?

I think the structure of our GP service and primary care is envied around the world. It has many strengths, such as the partnership model being based in the community, but it is changing. For example, more GPs are employed in hospitals. There is a major programme of investment going into primary care, including new models of care around how GPs are structured, but the presence of primary care doctors in the community is one of the great strengths of the NHS.

My Lords, I welcome the review which the Minister has announced. Does he agree that it would be beneficial if we had a debate in this House on the review when it is out, and will he commit to trying to ensure that his Chief Whip gives us the time to have such a debate?

I am not sure how much pressure I can bring on the Chief Whip for anything, but I look forward to debating the review in whatever form we can when it comes out.

My Lords, in view of the discussions about whether people from overseas should be able to use the health service, can the Minister tell us whether any statistics are kept on any impact they would have had during this crisis, or how much of our budget would have been spent on them?

I do not believe that we have specific statistics on the demand from overseas visitors during winter. I say to my noble friend that overseas visitors are most welcome to use the NHS but it is important that they pay. We are reclaiming more money than ever from overseas visitors to go into funding the NHS.

Is the Minister aware that the pressures on the health service are compounded by the difficulties in the social care system? We are promised a Green Paper. We were promised a carers action plan in January; it is now mid-April. Will he update the House on where we are with the carers action plan?

I know that it is still the intention of the department to publish a carers action plan, and I will write to the noble Baroness with the specific time as to when that may happen.