NHS Long Term Plan — House of Lords, 2019-01-31
Topic: Health
Leslie Turnberg (Labour, Centre-left): My Lords, I congratulate my noble friend Lord Hunt on a brilliant speech. I strongly agree with him that the long-term plan is heavy on admirable aspirations but short on implementation in at least three areas: public health, social care and the workforce—I shall focus on just public health and the workforce In public health, everyone agrees that our biggest challenges are smoking, obesity, alcohol and air pollution. It is interesting that three out of these four are due to what we do with our mouths—someone said that the most dangerous organ in the body is the mouth, and that is even without talking. However, the brain is more dangerous because all these challenges are due to behaviour and personal choice, and if we are to make a difference we have to influence behaviour We cannot place all that responsibility under the public health banner alone. Valuable publicity campaigns against smoking and obesity have been led by the Cancer Research campaign. If we are to reduce calorie and sugar intake, it will depend on the actions of the whole of government to persuade the food industry, possibly by legislation, to make a difference. If we look at how we might reduce alcohol consumption, we see that the best way is by increasing duty on alcohol. There is a close relationship between the rate of taxation and alcohol-related diseases: the higher the tax, the lower the rate of liver disease. If we want to change behaviour, it is the responsibility of the whole of government and not just public health in isolation However, there is one vital area of public health that clearly needs support, and that is its role in the control and prevention of infectious diseases. It is Public Health England that detects and controls outbreaks of communicable diseases, nips them in the bud and prevents them by vaccination programmes. Will the Minister please take that on board? I am afraid that I should reveal my own bias, as many moons ago I was chairman of the Public Health Laboratory Service Now what about workforce, where the plan is silent? With 100,000 staff vacancies, mostly nurses, filling that gap is an enormous challenge. The suggestion that we should increase our efforts to recruit nurses from overseas will only go so far, so we must do better at recruiting and retaining UK nurses. We can do things. The first is to fish in the waters of nursing associates and nursing assistants. A large number of them are desperate to be given the opportunity of a career structure that will put them on a ladder leading to a full nurse qualification. We should make nurse associate posts more attractive by offering them the prospect of career progression. We should do much more to attract back into the profession the many nurses who have retired for one reason or another. We do not make nearly enough use of this resource. Will the Government answer that In medicine, we have unfilled hospital consultant posts across the board, but much the biggest danger is the shortage of GPs despite all the efforts of government to bring in pharmacists and others to fill the gaps. General practice has now become an unpopular career. Few going into practice are willing to take on a partnership role, with all the administrative burdens that it entails; many want to work part time and many want to retire early. It is not pay that is the issue; it is the increasing patient numbers, the distractions of paperwork and bureaucracy, and the heavy hand of the commissioners that get in the way of what they were trained to do There is emphasis in the plan on multidisciplinary teams and primary care networks—hardly novel ideas. I seem to remember writing about them in my review of London’s health services in 1997, and my noble friend Lord Darzi’s excellent review proposed the idea of polyclinics in general practice. That has not lost its attractiveness now that we are jettisoning competition in favour of collaboration. Will the Minister look at these ideas again?