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NHS: Pre-pandemic Facility Levels

Volume 820: debated on Tuesday 29 March 2022


Asked by

To ask Her Majesty’s Government when they expect the full range of NHS facilities, such as hospital visiting and booking GP appointments, to return to pre-pandemic levels.

My Lords, NHS services are open to patients and numbers of general practice appointments have returned, or are returning, to pre-pandemic levels. As before the pandemic, hospital visiting is currently at the discretion of NHS trusts. Hospitals are expected to accommodate at least one hour of visiting per day, and preferably more. The department is working closely with the NHS to tackle the Covid-19 backlog and restore pre-pandemic activity and performance as soon as possible.

I thank the Minister for that Answer, but in our local hospital there are very big signs saying that visiting is still not permitted, while it seems to be quite in order for staff who are unvaccinated to go in and out of the hospital at will. What steps are being taken to test unvaccinated staff to ensure that they are not carrying Covid, and can the Minister remind me whether we have repealed the bit of legislation that restricted the number of people who can be in a GP’s surgery?

I thank my noble friend for those questions and will try to answer as many of them as I can. We are aware that this idea of returning to normal is patchy in different parts of the country. Some people have told me that visiting their GP or a hospital is fine, while others have had real trouble. Therefore, when these issues come up, I hope that noble Lords and others make us aware, so that we can ask the NHS what is happening. It is clearly an issue of capacity, but also, some people are trying to get face-to-face appointments with their GPs, while some practices are trying to move towards a technology-based service offering. I am aware of that. GP appointments are up to 60% of what they were pre-pandemic, but we understand that there is progress to be made in other areas.

My Lords, I wonder whether the Minister realises that he could make himself hugely popular in the country if he could persuade GP practice reception facilities to be more user-friendly and welcoming to the clients.

The noble Lord makes an important point, and I can see a lot of agreement, judging by noble Lords’ body language. However, we must always be careful about this issue because patients have had different experiences. I have been speaking to noble Lords about this. Some have told me that it is really good and has gone back to normal; others are having real trouble getting access to a GP or even getting someone to answer a phone in the first place. We must be careful, because if I say, “GPs should be doing more,” I will be criticised for being tough on GPs, but if I say that we must understand that GP practices are under a lot of pressure, I will then be criticised for not pushing hard enough to solve the problem. The pandemic accelerated pre-existing trends. We were already moving more towards the use of technology. Some people were quite happy to contact their GP by phone or online, and we will see some of that. We will never go back to 100% face-to-face, but certainly, patients should be able to have face-to-face appointments unless there are good clinical reasons why they cannot.

My Lords, is it not about time that the Government reformed GP services? Should we not have GP and diagnostic centres replacing traditional GP services? At the moment, many GPs are making thousands of pounds out of buildings that have been paid for by the NHS. When will the Government be getting value for money for taxpayers?

One of the advances we have seen with technology is the community diagnostic centre; these will no longer necessarily be at health centres or GP surgeries. We are looking at rolling them out in the community, in shopping centres and sports stadiums. About 80% of the people on the waiting lists are waiting for diagnostics, so we hope that will be a great way of tackling the waiting list.

My Lords, surveys of parent carers during the pandemic by the Disabled Children’s Partnership reveal that more than 70% of disabled children were unable to access their pre-pandemic levels of therapies and health services, and many of their conditions regressed during the pandemic. How do the Government plan to use wider NHS recovery funding to meet the acute health needs of disabled children and young people?

I thank the noble Baroness for making me aware of this issue. We are aware of a number of front-line services where there is a backlog as a result of the pandemic and not being able to have face-to-face appointments. However, I will have to write to her on the specific case that she raised.

My Lords, on the other side of the question from the noble Lord, Lord Laming, I have it on very good second-hand authority that receptionists are getting an extraordinary amount of abuse from the public. That is one of the problems.

My noble friend raises an important point. No matter how frustrating we might find trying to get an appointment with a GP, there is no room for abuse of our NHS staff—whether GPs, doctors, nurses or other health and care workers. I completely support the point he made.

My Lords, for many patients, the service before the pandemic was not nearly good enough, so our ambition ought to be much higher in the future. Why can we not reform the system by empowering patients with choice and competition? With modern IT services, why can GPs not be paid by appointment and why can patients who choose to not be able to ring round to find a GP who can treat them when and where they want, instead of being restricted to one practice?

The noble Lord makes some really good suggestions. On technology, one of the things we are looking at is why, in this day and age, when you can book appointments online for most other meetings, you cannot for GP practices. We want to make sure that people can book online, by telephone, and in advance—rather than having to phone at 8 am —and also let them choose between different places. We have to look at all these options, but, at the same time, technology is not enough: we also have to change the work processes to match the changes in technology.

My Lords, a problem that I have encountered in Lincolnshire is that when one tries to get a telephone appointment with the GP, one is offered a point in a spectrum of a number of hours. One simply cannot sit at one’s desk waiting for a call back within a spectrum of a number of hours.

That is exactly why, as technology has improved, you should be able to book a specific time. In fact, in some practices, it has gone backwards since the 1970s. When I was a child, my mother was able to phone up and ask, “Can my son have an appointment on Tuesday next week?” These days, you have to phone at 8 am hoping to get in the queue to book an appointment. Technology should improve that, and we hope that once we are able to recover, we will be able to use technology to book in advance.

My Lords, the BMA’s Rebuild General Practice campaign has warned that GPs’ lack of time with patients, workforce shortages, heavy workloads and administrative burdens mean that patients’ safety is being put at risk when they attend a surgery. Data shows that GPs are conducting nearly 50% more appointments, but staff vacancies continue to soar and GP numbers to decline. In the light of this, can the Minister explain to the House how the Government expect to achieve their target of an extra 6,000 GPs by 2024—just two years away?

I thank the noble Baroness for reminding us of the target. We have been quite clear that it is important that we have as many healthcare professionals as possible and fill the vacancies as soon as possible. We made £520 million available to improve access to GPs and expand general capacity during the pandemic. That is in addition to the £1.5 billion announced in 2020 to create an extra 50 million general practice appointments by 2024, by increasing and diversifying the workforce.

My noble friend is entirely right that the technology offers benefits, but the health infrastructure plan, promised some time ago, has not yet been published. That will outline the framework for investment in the technology he mentions. When will the update be published?

My noble friend will be aware from when he was a Minister that there were other priorities in tackling Covid, trying to get a vaccine and procuring much-needed equipment. This was therefore all delayed, but we are now working with stakeholders to ensure that the updated capital strategy sets a clear direction for the system, taking into account significant events since the first publication. The multiyear settlement confirmed for 2021 allows us to take the next step forward. We expect the paper to be published at some time in 2022.

My Lords, did not the noble Lord, Lord Austin, hit the nail on the head when he said, regarding GPs, to give the patients choice? Back in the days when we reduced the waiting list from 1.1 million to just under 400,000, we reduced waiting times in hospitals from over three years down to 18 weeks. We did that primarily by giving the patients the choice to go to another hospital if they were not getting the service they needed and making the money follow the patient’s choice. Is that not the way to solve the GP problem?