Following the evidence

‘There’s nothing like seeing something under enormous strain to start to get to know it a little bit.’

Layla Moran, the Liberal Democrat MP for Oxford West and Abingdon, is reflecting on her first ‘foray’ into health and care – as chair of the APPG (all-party parliamentary group) on coronavirus.

It was set up during the height of the pandemic to provide ‘real-time scrutiny’ of the Government’s COVID-19 response, with fellow MPs Dan Poulter, a doctor in Suffolk, and breast surgeon Philippa Whitford as vice-chairs.

It was a role which sparked Ms Moran’s ‘interest’ and has now been followed by her unopposed election as chair of the Commons’ health and social care committee.

While some previous chairs, such as former health secretary Jeremy Hunt and GP Sarah Wollaston, came to the influential role with more obvious backgrounds related to health and care while Ms Moran’s is more heavily focused around education, it is a match which makes increasing sense as she details her personal and career experiences and those years chairing the APPG.

Ms Moran – first elected to Parliament in 2017 – is a scientist by background and a physics teacher by profession, read physics at Imperial College, London, and completed an MA in comparative education, going on to work as a head of year in an international school. ‘I delight in data and I believe in evidence-based policy,’ she tells The Doctor.

‘I’m so lucky in Oxford West and Abingdon I’ve got the bio-tech centre of the south-east and that’s only growing. I’ve got incredible hospitals like the John Radcliffe and the Churchill and probably a disproportionate number of medical professionals as constituents.’

Ms Moran has also had personal, and formative, experiences, which influence her taking the position and the way she wants to have an effect in the role: she has had depression, which was treated with medication and depression; she is the partner and carer of someone with bipolar II disorder; and had bariatric surgery in her 20s, resulting in her losing 60kg.

In April of this year Ms Moran was admitted to hospital with sepsis, following a ‘relatively routine’ gynaecological issue, and ultimately required surgery when things became ‘very serious’. It was an experience which exposed Ms Moran to the best and worst of the NHS – a fragmented system, communications issues, and a longer-than-required hospital stay, but also ‘humbling’ interactions with frontline staff who cared and supported Ms Moran and her wider family.

During that hospital stay the importance of Ms Moran’s first priority for the committee was illustrated clearly – meeting an older patient on the same ward who had been fit to be discharged for more than two weeks but remained in hospital because a care package had not been worked out. ‘You could see people coming in and out with these sorts of stories all the time,’ Ms Moran says.

It is for exactly these sorts of reasons that the committee, which Ms Moran says will be a ‘critical friend’ to the Government, launched its first inquiry on 31 October: Adult Social Care Reform: The Cost of Inaction.

Ms Moran, whose mother is a Christian Arab from Jerusalem and father is a former British EU ambassador, says she was ‘extremely disappointed’ not to see more made of social care in the Government’s budget earlier this year – and still no announcement of any cross-party talks or major action. The committee, she says, will tackle these ‘big, thorny issues’ and Ms Moran is ‘really proud of that’.

She adds: ‘People know it needs to change… And it’s not like there’s a dearth of ideas about what to do – whether it’s free personal care, whether it’s implementing Dilnot, or different systems in Scotland and Wales we can look at. We’ve got plenty of ideas of what to do. But, ultimately, the block seems to be the Treasury and it seems to be that it’s because it’s too expensive or because it’s an investment that’s going to take time to show through.’ 

The inquiry will ask why successive governments have presented ideas for reform of adult social care yet so few have been implemented. It also seeks to understand the cost of this ‘inaction’ – the cost to individuals, the NHS, local authorities and the wider economy and HM Treasury.

Ms Moran cites carers having to take time off work to look after loved ones and working-age adults struggling to get back to employment as examples of how the chancellor, Rachel Reeves, and her team, can be shown that action on social care would relieve pressure on the NHS and boost the economy by increasing productivity. 

Ms Moran says: ‘I think it’s going to take a brave government to do it and what we can do as a select committee is … give you a bit of political cover and then invite all the parties to come on board. I hope that can help to spark that wider solution and allow it to grow around us. It's a very lofty aim, but I think we're in a very good position to do it because of the cross-party nature of the committee itself.’

Ms Moran – who is the first member of Parliament to have come out as pansexual, a term which describes someone whose romantic and sexual attractions are not limited by sex or gender and is in a same-sex relationship – says she also hopes to prioritise looking at mental health among future inquiries but will follow the issues the committee deems most important.

Ms Moran also told The Doctor the committee would be monitoring the review around the issue of physician and anaesthetic associates and that she wanted to be a chair who wouldn’t ignore the ‘canaries in the coal mine’. 

It is early days in this new role but Ms Moran has been true to her commitments to base action on evidence and to speak to as many people with knowledge and expertise as possible – many more meetings are scheduled and she pledges to speak to anyone. But there has been an overriding message: ‘Workforce is everything.’

Ms Moran adds: ‘That is coming clear from all the meetings we’re having. Very much one of the reasons I wanted to take something like this on was for doctors and nurses and anyone who's involved in the system who care deeply about outcomes for their patients.

‘So, we know that the workforce plan is sitting alongside the 10-year review. I'm already starting to ask questions about that. How are those two going to interplay? Is it just the numbers? Have they thought about how they're going to be training X number of GPs? Are they training enough specialists in order to meet further demand?

'And, you know, what does all this mean? But at its heart, and I've seen this over and over again, it's not just about recruitment, it's about retention. And if you want to retain people, you've got to value people. That's so obvious from a common-sense point of view. And yet, I'm shocked by how often that's just not where you start.’

Just a few months into the role Ms Moran has uncovered one of the fundamental truths and tragedies of the NHS and care. This is a workforce which gives so much but so often feels undervalued – and the more people in positions of power who understand that the more hope there is for change.

(Picture credit for Layla Moran, top: House of Commons/Kate Noble)