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Lord Astor of Hever rose to ask Her Majesty's Government what steps they are taking to ensure that the National Health Service has sufficient resources to cope from 11.00 p.m. on 31st December 1999 till 7.00 a.m. on 1st January 2000.
With the continual scare stories in the press, and the regular, and deliberate eye-catching status reports of Action 2000, we feel it is right that the Health Minister responsible for millennium cover should have a chance to put the public's understandable and widespread concerns to rest.
In 226 days staff throughout the NHS will have to cope with what is expected to be the busiest and most stressful time on record. A normal New Year's eve is almost the peak period of winter admissions. However, this year there will also be thousands of spontaneous events taking place at the same time all over the country. The likely exuberance of the night, heightened by the relaxation of the drinking laws, is widely expected to lead to an increase in drunkenness and potential violence.
All this may well be exacerbated by millennium bug chaos. Most people accept that there will be computer problems, but no one, not even the industry experts, can say how great, how widespread or how damaging this will be. Will there be equipment failures in the middle
The previous government were keenly alert to the potential problem of the millennium bug. Taskforce 2000, established in 1996, was the first of its kind to be set up anywhere in the world. Its aim was to convince the country of the threat, the need to take action, and to allow sufficient time for the essential testing.
As a result of the early planning, there is some hope that the software problem is largely resolved, and that the great majority of embedded chips in electrical equipment will not fail. Although there is still work to do, I sense that most of the IT issues are mopping themselves up, and that the majority of NHS organisations are making satisfactory progress.
This optimism, however, is not helped by the recent suggestion that the Territorial Army might be needed if a "worst case" millennium disaster stretches health services beyond their limit. I should be grateful if the Minister could tell me if the NHS has plans to use the TA, and in what capacity.
The predicted cost of ensuring that computers and IT systems are millennium compliant in the NHS has been escalating. It was estimated to be £292 million in June 1998 and £312 million only two months later. The NHS Confederation estimates that it is now at least £500 million. Can the Minister confirm that there is some accuracy to these figures as they will have significant resource implications for this year, and for the NHS's clinical priorities thereafter?
There are a number of millennium compliance issues that are still to be resolved, but I have time only to refer to four key areas. The first and most important issue is the lack of compliance information from suppliers, which is affecting the ability of NHS managers to plan effectively and with confidence. Secondly, a common concern raised in returns to the NHS Executive is the need for further assurances regarding the continuity of supply from the utility companies. Hospitals are particularly concerned about the millennium bug wrecking supplies of electricity and water, which are both computer programmed. Electricity and water supplies are an absolute baseline requirement. Indeed without electricity, the compliance, or otherwise, of many IT systems becomes purely academic. Many of the more sophisticated diagnostic services, which the NHS uses on a daily basis, rely extensively on electronic equipment. The failure of such systems will have serious and perhaps fatal consequences for patients.
Despite this, a major electricity supplier sent round a letter at the end of last year which conceded that, despite its best efforts, it could not guarantee a continuity of electricity supply. I should be grateful if the Minister could give the House some assurance that, as far as the NHS is concerned, the Government believe that essential utilities will not be affected.
Thirdly, there are limited and declining numbers of local, skilled IT staff in some areas. There is much evidence that freelance programmers who agree to stand by as "firefighters" on millennium night can expect to
Fourthly, computer virus experts are warning that the rogue programmers' next big trick is likely to be the "millennium virus". It would seem that the significant date, and concern over the millennium bug, will prove to be only too tempting for them. Can the Minister confirm that the latest anti-virus software has been installed throughout the NHS to offer protection against a virus such as this?
On 30th September the NHS must have completed contingency plans to provide health care without these IT systems or the machines that may be at risk. Action 2000 tells me that the NHS still has a mountain to climb, particularly some individual hospitals. However, if these hospitals maintain their present rate of progress, Action 2000 anticipates that there will be no significant disruption. I am reasonably confident that almost all parts of the NHS will achieve this millennium compliance deadline and that the real problem that the NHS will have to face over the millennium period is one of staffing.
The Government have made it clear that they will not provide any national millennium pay bonus for NHS staff, insisting that staff's public service duty should override financial gain. Bearing in mind that some babysitters and waiters are charging £1,000 for the night, this decision has understandably bred an atmosphere of discontent and low morale.
At Unison's annual health conference delegates voted by a margin of three to one to strike over the two days of the millennium. If this happens, can the Minister tell me what impact the Government believe this will have on NHS services, and what alternative provisions are in place?
Some NHS staff, despite possessing a deep commitment to the public sector, may decide that spending time with their families and friends during this momentous period is more attractive than turning up for work. Does the Minister foresee absenteeism as a significant problem?
The NHS Confederation estimates that the NHS will have to employ thousands more staff, and negotiate considerable stand-by allowances, particularly as flu and bad weather will have an impact on staff sickness levels. How do the Government believe that NHS trusts will cope without substantial budget overruns? It seems unreasonable to expect trusts to meet these costs within their normal budget in a difficult financial year, and one with such a unique period of clinical stress. Will the Minister consider reviewing the Government's approach since the Year 2000 situation is such an exceptional one?
With regard to primary care, GP practices, co-operatives and deputising services are likely to receive the brunt of the pressures over this period. Additional funding will surely be required in order to
Although by the holiday period 60 per cent of England will be covered by NHS Direct, only one-third of that coverage will have been in place from the beginning of December 1999. It will therefore be largely untested. What will be the role of NHS Direct over the holiday period and what further publicity do the Government intend providing to ensure that the service is used?
GPs in some areas will also wish to avoid the problems encountered last winter when the capacity of some telephone services was heavily exceeded, leaving patients unable to contact the out-of-hours services and GPs unable to contact patients and hospitals. The Department of Health must insist that BT provides adequate service capacity at this vital time.
Unlike many other NHS employees, junior doctors do not attract premium rates for working nights, weekends or bank holidays. Under a national agreement, each additional duty hour is paid at less than the full rate, usually half. Junior doctors, after at least six years of arduous training at medical school, will be treating sick and injured revellers for long hours for as little as £4 per hour. That compares with £3.20 per hour that an unqualified 16 year-old can earn in McDonald's. Do the Government believe that that is adequate for those highly skilled professionals who will not only not have the option of celebrating the millennium but probably will be saving the lives of those who have been? The junior doctors committee of the British Medical Association is balloting members on their willingness to strike on this issue. I understand that there is a strong mood tending towards industrial action.
The combination of the shortage of NHS staff and the inevitable pressures of the millennium holiday period will cause hospitals to prioritise emergency cases, inevitably delaying the treatment of others. In previous winter crises there has been a dramatic increase in waiting times, even for major surgery. Does the Minister anticipate that waiting lists will increase as a result of the millennium period?
In the short time available I have covered only a few of the most important points. Our aim is to ensure that there is the necessary quality care for those who need it from the National Health Service over the millennium period. I am much looking forward to the Minister responding for the Government.
Lord Clement-Jones: My Lords, the noble Lord, Lord Astor, has raised some very important issues in his Unstarred Question today. I do not plan to deal with all the issues he has raised but shall concentrate purely on the issues of staffing and pay, which he described as the key question.
However, unless there are such local deals, junior doctors--who, after all, comprise some 50 per cent of the 62,000 doctors in the health service--because a bank holiday has been declared for 31st December, will receive only half their normal rate, that is, £4 per hour, on both New Year's Eve and New Year's Day. Over the full Christmas and New Year period they will receive only two working days' pay out of the 12 days that are worked. This will give rise to all kinds of injustices. In many hospitals leave is already being cancelled for the New Year.
How is a junior doctor or a nurse, whose spouse is also working over the millennium or who is a single parent, going to employ a baby-sitter or a nanny over the millennium? They will have to be paid far more than the doctor or nurse receives. In effect, they will be subsidising the health service.
The meanness to employed hospital staff is in stark contrast to the treatment of locum and agency staff. Agency nurses may receive £700 for working on a millennium bank holiday. In the private sector, Allied Domecq bar staff will receive treble their hourly rate over the millennium New Year. The Nationwide Building Society information technology staff who will be on call over the New Year will receive overtime pay worth six times their hourly rate. Cable and Wireless will be paying its staff four times their basic salary. Scottish Power staff will receive special disturbance payments. Yorkshire Water and BBC employees will receive a £500 bonus. AA employees will receive a £750 bonus. I could go on.
Votes will be shortly taking place both by Unison and by the junior doctors which could have major consequences for the health service in terms of stoppages and strikes in protest at this decision, at precisely the time when NHS staff will be most needed.
At the end of all this, what assurance do we have that the NHS will be properly staffed? Do we even know that there will be a sufficient number of ambulance drivers to deal with emergencies? What about NHS Direct? On a lighter note, who will help deliver those carefully
The situation reminds me of nothing so much as when the Conservative government came into office in 1979, when they considered that central planning was a dirty word. The attitude was let the market take its course.
Effectively, the Government have left it to others to sort the matter out. They are leaving it to others to pick up the pieces, such as the Doctor Patient Partnership and its Health Alert 2000 task force, who in an extremely effective way are trying to make sure that the best use of primary care health resources is made over the millennium New Year period. Has a Labour Government really come to this?
The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman): My Lords, I am grateful to the noble Lord, Lord Astor, for introducing this topic. It is an extremely important one. As he said, some of the press coverage in this area has been lurid to the point of sensationalism; and there has been inadequate recognition of the scale, depth and complexity of planning that has gone on throughout the public and the private sector in this country. In that context, the remarks of the noble Lord, Lord Clement-Jones, were unusually intemperate in terms of his suggestion of a lack of responsibility, effort and co-ordination. I hope that I can illustrate that in some of my remarks.
The millennium poses particularly difficult challenges for those in the NHS. It brings together the IT complexities of dealing with the date change at a time when major celebrations and large public gatherings are anticipated. That means that there must be contingency planning for whatever might occur as a result, as there is every time there is a large pop concert or football match, but we recognise that these large events will occur on the same night. In addition, it will be the middle of winter, when the NHS is always stretched very hard by winter pressures. Also, a large number of bank holidays will come together, so that there will be only two normal working days in a 10-day period. So it will be a particularly challenging time.
But none of the factors described is unique. Even millennia happen every thousand years! Earlier this evening I went to ask for a document in the Printed Paper Office, and the computers were down. I am sure that they are working again now. Computers do go down from time to time, in NHS hospitals as in other organisations, and we must have standby systems in order to cope in that event. Electricity supplies are
While I understand the passion with which some staff have argued their case over special funding, in the time that I have been associated with the health service I have been in hospitals many times on Christmas Day, New Year's Eve and New Year's Day. We are a 365-day a year service. We are a 24-hour service. We cannot opt out of providing emergency care when it is needed. We must recognise that. Although these celebrations are very special and very unusual, we should not go completely over the top. A survey published this week indicates that the vast majority of the population are planning to do nothing more than put their feet up on New Year's Eve. So we should not get carried away with the idea that everyone will be getting drunk and being violent. It is possible that a lot of people will behave responsibly.
Putting that to one side, this year there are, as I said at the beginning, particular challenges: I hope to be able to demonstrate to noble Lords that we are planning to meet them very comprehensively. The year 2000 date change has challenged the intellects of those involved in the IT industry and beyond. Planning for it in the NHS started two and a half years ago and is subject to rigorous scrutiny internally, and we now also have a system of external audit. We are part of the National Infrastructure Forum. In the spirit of openness in which Action 2000 is conducting its affairs, we report our progress, as the noble Lord, Lord Astor, pointed out.
We have made it absolutely clear to the NHS that it must be assured of the compliance of its own organisations or of alternative contingency plans being in place by 30th September of this year. The NHS Executive analyses bi-monthly monitoring returns from all NHS organisations on year 2000 readiness and follows them up through visits and other action. This is being very closely managed from the centre, as I am sure the noble Lord, Lord Clement-Jones, will be pleased to hear, and then through the regional offices. Current estimates of the cost of the work in the NHS are about £320 million over a three-year period. The results of this process are regularly reported to Parliament and published on the Internet. We are ensuring that those organisations which at the moment are not making the progress that we would wish are effectively coached and managed so that they, too, will reach readiness by 30th September.
If I have one quarrel with the noble Lord, Lord Astor, it is with his narrow definition of the period referred to in his Unstarred Question. The challenge facing the NHS is far wider than simply that eight-hour shift. The challenge is to plan effectively for the whole winter.
The noble Lord, Lord Astor, pointed out the demand on services on New Year's Eve. It is absolutely true that that is a busy night for emergency services. It is a busy night for ambulance services and personnel and also in casualty. However, that is not the peak of admissions. The pattern of peak admissions tends to be after bank holiday periods when primary care and social services come back into train. Therefore, we have to plan for the post-bank holiday period. But I assure the noble Lord that, in respect of elective work, the planning of hospitals for this winter recognises that they will face a very challenging period of emergency work extending over several weeks at the year end. We look to organisations to schedule their elective work so that it will not be driven off course by that. We are enormously helped by the very great success that we have witnessed in the reduction of waiting lists during the year.
The noble Lord, Lord Astor, rightly drew attention to the dependence of the NHS on other sectors, particularly the public utilities, and the importance of assuring the supplies of electricity and water. A great deal of work has been done in the National Infrastructure Forum, where Don Cruickshank, chief executive of Action 2000, has reported to us his confidence in the utilities being able to cope with the demands placed upon them. They are showing up very well in his traffic light system in terms of their compliance planning.
But it goes wider than simply the utilities. We have looked particularly at the availability of medicines. We have drawn together the private sector, pharmaceutical manufacturing companies, and pharmacies themselves, GPs and a whole group of interested parties into a pharmacy alliance to look at the whole supply chain both nationally and internationally. Organisations have to ensure that they have availability for other commodities and medical devices. There is a whole tranche of work going on to ensure year 2000 compliance for medical devices, and to inform the public who have medical devices in their own homes about what they need to do and where they can obtain advice.
It is an enormous challenge to bring together effective service planning. I believe that that is best done at a local level within very clear national leadership. We recently issued joint guidance to health services and local authorities, defining the health authority's lead responsibility for local NHS planning, together with social care, and to other local government and emergency service partners. The guidance includes the comprehensive checklist of planning issues that must be addressed locally. We have made it clear that planning must be at least on an integrated health authority basis, and we have told health authorities to establish local
We are putting in place tight monitoring arrangements so that the service's performance will be actively managed against key review points. The date of 30th September is that by which we will ensure that we have confidence in the plans that have been made.
As to telephone services for primary care, I can assure the noble Lord that although there were problems last year, these were discussed between individual co-ops and NHS Direct at a conference last week. There are firm plans in place to double and even quadruple the number of incoming lines, at the same time reserving other lines to ensure outgoing calls can be made so that we can learn from some of the problems that arose last year.
As the noble Lord said, NHS Direct will cover up to 60 per cent of the country by the beginning of December this year. By the millennium weekend, 30 million people will have access to this convenient, highly popular service, one that has enormous potential for providing a more effective and convenient service for patients and for reducing demand on both hospitals and primary care.
The noble Lord, Lord Astor, asked about new services. We are learning as we go along from the success of existing services, but many of the new services will extend those that are up and running to larger geographical areas, so I do not anticipate a big learning curve there.
A great deal has been made about the issues of staff. I know that these are difficult issues, but perhaps I can correct two misapprehensions. There has been no definite vote to strike by Unison. It would not be possible to initiate any ballot until we are much nearer the end of the year. Those junior doctors who are rostered to work on the millennium bank holiday will not lose money. They will receive their full pay. Those junior doctors on call will, equally, receive the same on-call payments as they would at other bank holidays.
We recognise the difficulties of this situation and we have told employers to recognise the commitment of staff who work over the holiday period to meet their needs in terms of catering, accommodation and transport, to see that staff receive their full entitlements under terms and conditions of service and encourage employers to show their appreciation of staff who work over the millennium period. We are also expecting employers to explain their planning and rostering arrangements to staff as soon as possible and to consult staff representatives locally.
Our overall responsibility on this New Year's Eve and this New Year's Day, just as in every other year, is to ensure patient safety and patient services. I hope that, in the limited time I have had available, I have given noble Lords some flavour of the very comprehensive work that is going on throughout the NHS to ensure that we do exactly that at the turn of the century.
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