The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, this has been a wide-ranging and most fascinating debate, marking, as it does, the conclusion of our deliberations on the gracious Speech. Having been given the privilege of responding, I can begin by expressing my appreciation for the congratulations extended to me and to my noble friend Lord Hill from around the House. I also thank all noble Lords who have spoken so well and so eloquently. Chief among those have been our four maiden speakers, who have provided us with truly splendid contributions. The first of those came from my noble friend, who referred in brief to the Government's programme for health.
In health, as in education, our desire is simple. It is to see standards driven up in response to those who are closest to the delivery of the service: the professionals and, in the health service, the patients whom they look after. Those are the people whom we wish to empower. In fulfilling that wish, we shall move away from centrally imposed targets which focus simply on process in favour of quality standards linked to results. Those quality standards will be defined by reference to clinical evidence. We will commission for quality care. We will pay for performance. We will put the patient at the centre of care by giving him information and choice, and we will encourage health and social care providers to be more efficient and effective at delivering quality and good value. I say to the noble Baroness, Lady Wall, that that does not mean that providers will no longer be held to account. Good regulation matters very much, but it has to be meaningful regulation.
That is a far-reaching programme. One of the key steps in setting the NHS free from central diktat will be the creation of the autonomous NHS board. I was grateful to the noble Lord, Lord Patel, for his remarks in that connection. The board will allocate resources; it will provide commissioning guidance; and it will support GPs to commission services on behalf of their patients.
For the first time, the NHS will be led not by politicians but by clinicians, who will be fully accountable for what they do. Despite the huge investment in the NHS in recent years and the improvements that we have seen—which I am the first to acknowledge—the fact is that costs have risen, productivity has fallen, bureaucracy has increased and outcomes have simply not kept pace. In many of the common cancers, our survival rates are the worst in the OECD. We are on the wrong side of the average in western Europe for infant mortality and for premature mortality from lung cancer and heart and respiratory disease. People are more than twice as likely to die from a heart attack in the UK than in France.
We want our health outcomes to be among the best in Europe—indeed, among the best in the world. To achieve that, we have to set doctors, nurses and midwives free to do their job. It is a sobering statistic that the system now demands in the order of 250,000 separate data returns from trusts every year. We have to reduce that burden dramatically and trust the professionals on the ground to judge what is right for their patients.
If we are to match the best health outcomes in the world, we will have to improve our public health services alongside the NHS. That theme was pursued by the noble Baronesses, Lady Greengross and Lady Masham, my noble friend Lord Fowler, the noble Lords, Lord Kakkar and Lord Patel, and others. We will have to invest in prevention—to keep people healthy and prevent them getting ill in the first place. To do that, we shall give local communities greater control over public health budgets, with payments linked to the outcomes that they achieve. We will work more closely with local NHS organisations, local authorities and the voluntary and private sectors, and we will take more targeted action to reduce health inequalities.
That is where our health premium comes in. Like the pupil premium, it will directly tackle disadvantage and reduce inequalities, and it will make for a much fairer approach to public health. In the coming weeks, we will be publishing a White Paper which establishes our long-term strategy for reform of the NHS and we plan to introduce a health Bill in the autumn.
The right reverend Prelate the Bishop of Chichester spoke about the NHS workforce and asked who was included in that term. He was right to give me a prod on that. We will give all NHS doctors, nurses, allied health professions and other health professions back their professional autonomy. They need to be able to use their professional judgment about what is right for patients. He asked me specifically about chaplains. We very much value the work done by NHS chaplains, who play an important part in providing high-quality spiritual care services to patients and staff, and we are committed to ensuring that patients and staff in the NHS have access to the spiritual care that they want, whatever faith they may have.
The noble Baroness, Lady Greengross, asked about Monitor, which was also raised by the noble Baroness, Lady Murphy, who also asked me about the NHS board. In short, by creating an independent NHS board, we will make sure that funding decisions are made on the basis of need, that commissioning decisions are made according to evidence-based quality standards and that resources are allocated appropriately. We propose to develop the role of Monitor to establish an economic regulator with responsibility for ensuring that patients have access to essential services and that the money invested in the NHS achieves maximum value. The noble Lord, Lord Warner, was right in all that he said on that issue.
My noble friend Lord Colwyn, as he customarily does, spoke about his own subject: dentistry. We will introduce a new dentistry contract that will focus on achieving good health and increasing access to NHS dentistry. At this stage, we need to review the details of the system that we have inherited. Once we have done that and have talked to the profession and patient groups, we will announce the details of the reforms that we are proposing.
The noble Lord, Lord Mitchell, spoke about foetal alcohol syndrome, a subject about which he and I have spoken many times in the past. We want to improve labelling so that people are more aware of the amount of alcohol in drinks as well as of guideline limits. We want to see the necessary improvement in labelling information through a voluntary approach if we can, but we will consider all responses from the consultation that closed very recently—I think on 31 May—before we make any decisions on that matter.
The noble Lord, Lord Sutherland, chided the Government for setting up a royal commission on long-term care. He rightly pointed out that we have had many papers on this subject, not least the royal commission that he chaired in such a distinguished way. I simply say to him that this is an urgent matter. We are not pressing the reset button, as it were, on reform of long-term care. It is a hugely challenging issue, and the independent commission will consider the evidence and information gathered through the public debate over the past few years. We know that we must reform social care on a sustainable and long-term basis. A number of options have been put forward for funding a reformed system, so we just have to build on all this work and keep up the momentum of change. I welcomed what the noble Lord, Lord Warner, said on that subject.
The noble Baroness, Lady Masham, asked about the patient voice. We are going to give the public a strong and independent voice though Health Watch, which will be a statutory body with the power to investigate and support complaints. I hope that this will be music to the ears of my noble friend Lady Knight. Locally, we will strengthen the patient voice by having directly elected members of the public on the boards of PCTs. That will ensure that boards are balanced between locally accountable individuals and technical expertise. We will publish detailed data about the performance of healthcare providers online so that everybody will know who is providing a good service and who is falling behind. We will measure our success on the health results that really matter, such as improving cancer and stroke survival rates and reducing hospital infections.
The noble Lord, Lord Patel, asked me about preventive health measures, including those relating to alcohol, tobacco and nutrition. Lifestyle-linked health problems like those and the spread of infectious diseases are leading to soaring costs for the NHS. We will provide separate public health funding to local communities that will be accountable for and paid according to how successful they are in improving their residents’ health.
The noble Baroness, Lady Thornton, asked me about targets. The service priorities for the NHS have to be based on evidence about their benefits for patients; that is, they should be focused on the outcomes that they achieve, rather than on chasing nationally mandated targets with incomplete clinical justification. We are going to remove the politically motivated process targets. I am looking at the list that we have inherited from the previous Government with a view to ensuring that any targets that work against better patient care are removed at an early opportunity.
The noble Baroness asked me about creating a department of public health. The coalition agreement is not the entire sum of our policy, and we will announce further information in due course. As I have indicated already, we are committed to taking action on public health and encouraging behaviour to change, to help people to live healthier lives.
The noble Baroness, Lady Murphy, asked about foundation trusts. I apologise for being so brief, but can say that we are considering a number of options for all NHS providers to become foundation trusts, taking into account many of the issues that she rightly raised. We want to resolve issues of efficiency, issues of clinical sustainability and an explicit assessment of quality, as those are affecting the flow of trusts becoming foundation trusts, as she well knows. This is not easy, but we are determined to make progress.
The noble Lord, Lord Rea, criticised the purchaser/provider split, particularly in relation to the costs of running a commissioning system. I should say to him simply that before we created the division between purchasers and providers, we did not have an accurate idea of how much anything cost in the NHS. That was a very basic lacuna in budgetary control and service planning, so the split has been a helpful feature of our health system at a time when value for money is more important than ever.
The noble Lord also asked about the workability of patients being able to choose their own GP. We believe that patients should be able to choose their own GP practice and not have an arbitrary set of rules that dictate where they can register. If people want to be able to register near their work or near their home, or with a practice that offers better service, they should be able to do so. We know, incidentally, that these problems persist mainly in our most deprived communities, where patients have historically had less choice, yet these are the areas with the greatest health needs.
My noble friend Lord Addington asked about getting the population involved in sport—a subject on which he is a renowned expert. As part of delivering a health legacy for the 2012 Olympics, the legacy action plan aims to make 2 million more adults in England active by 2012-13 and will be measured by the number of adults aged 16 and over who participate in sport or undertake some form of physical activity.
My noble friend Lord Bridgeman spoke about hospices, which play a very valuable role in end-of-life care, particularly for cancer patients. The coalition’s programme for government included a commitment to introduce a new per-patient funding system for all hospices and providers of palliative care. I am sure he knows that the responsibility for setting standards in palliative care training for nurses sits with the professional regulators, but I shall ensure that his remarks are brought to the attention of the Nursing and Midwifery Council.
My noble friend Lord Fowler spoke about the prevention of HIV and hepatitis B and C. These are priorities for us. The Joint Committee on Vaccination and Immunisation considered the hep B vaccination last year and concluded that a universal programme would not be cost effective in the UK, but I note all that he said.
In view of the number of speakers in this debate, I hope that the House will allow me to take a little longer than I might otherwise take. We have had a curtailed debate on the gracious Speech, and I think that those who have spoken would like to hear what I have to say, although I will inevitably have to be brief.
The noble Baroness, Lady Morgan, made a powerful speech focusing in the main on education funding. She was especially worried about damage to front-line education because of spending cuts. There will have to be savings, but we plan that the savings will be made from reducing waste and cutting the cost of quangos. We have announced that schools, Sure Start and spending on 16 to 19 year-olds will be protected from any in-year spending cuts. Any efficiencies made within schools, Sure Start and 16 to 19 year-olds’ education will be recycled within their respective budgets.
We are not back-tracking on one-to-one tuition. Front-line funding for one-to-one tuition is protected. The first quarter payment for one-to-one tuition for schools has been made this week in line with Standards Fund allocations. That funding will allow schools to provide up to 600,000 tuition places in primary and secondary schools. Although it was part of an overall budget identified for tuition by the previous Administration, it is not part of funding for the front line.
The noble Baroness also asked from where the money would come for new schools and academies. Decisions about the level of funding available to set up and run new schools will be dependent on the outcome of the spending review in the autumn. I cannot be of greater help on that at the moment. I do not agree with the noble Baroness that our policy will entrench unfairness or create a two-tier education policy, as she indicated. That concern was raised in various ways by the noble Lord, Lord Rix, and the noble Baroness, Lady Howe. We are committed to helping all children achieve their potential, which is why we will introduce a pupil premium and will ensure that extra money follows disadvantaged pupils. This will make sure that it is more attractive to establish new schools in areas of disadvantage and that schools with significant deprivations get more money even in less deprived parts of the country. Schools that recruit and retain disadvantaged children will know that they will receive additional funding to help them meet their needs. It will be for head teachers to decide how best to meet those needs, but they might, for example, use the money to attract the best teachers, to reduce class sizes or to provide extra tuition.
The noble Baroness, Lady Howe, asked about the calibre of teachers. The single most important determinant of a good education is for every child to have access to a good teacher. Our aim is to improve the quality of the teaching profession. As an example, I would cite the Teach First initiative. We also want to create Teach Now to build on the Graduate Teacher Programme and to look for other ways to improve the teaching profession, particularly in terms of attracting more science and maths graduates to be teachers.
The noble Baroness, Lady Morris of Yardley, in her thoughtful speech indicated that in her view there was no evidence that structural change led to successful reform or better results. We can see the evidence from academies which have shown a 5 percentage point increase in the proportion of pupils achieving at least five GCSEs at A* to C grades, which is double the average national increase of 2.5 percentage points. As regards non-academies, I have no hesitation in paying tribute to those that are outstanding, and I do not believe that any of my ministerial colleagues would either. The recent announcement allows all schools the opportunity to benefit from the additional freedoms and flexibilities of academy status, with those rated outstanding being fast-tracked through the process.
The noble Baroness made the very good point that teaching and leadership are the most important things. I agree with her on that. A key principle behind the partnership of the coalition Government is trusting professionals, which is why the Government will give them more power and control and will trust them to get on with the job. Many school leaders have already shown a keen interest in gaining academy freedoms.
The noble Baroness, Lady Sharp of Guildford, spoke about reducing bureaucracy in schools. We are committed to freeing all schools from unnecessary bureaucracy so that they can focus on their core purpose of raising standards for all children. We will shortly outline a package of proposals for how we intend to reduce bureaucratic restrictions placed on schools.
The right reverend Prelate the Bishop of Lincoln asked about free schools and how they would drive up standards for everyone. Free schools will be established to meet parental demand. They will be open to meet that demand wherever it exists. The introduction of free schools will make sure that parents get what they want in these schools and will act as a spur to improvement in other schools. I have already mentioned the pupil premium in this context.
My noble friend Lord Baker spoke compellingly about university technical colleges, a subject also referred to by the noble Baroness, Lady Sharp. Technical academies are likely to build on the university technical colleges model which we have been developing with my noble friend and the Baker Dearing Educational Trust. We are working on three pilot projects in Birmingham, Walsall and Greenwich. Those are progressing well, but they are unlikely to open before 2011.
The noble Lord, Lord Griffiths of Burry Port, spoke about school governance and particularly the role of school governors. I would say to him that, from family experience, I recognise all too well how hard school governors work. They give their time and energy to serving on governing bodies. It is true that their duties can be demanding, but a well-organised governing body can spread its workload, as I am sure he knows, by setting up sub-committees. He asked me to comment specifically on the future of Building Schools for the Future commitments, especially in relation to the Central Foundation Girls’ School in Tower Hamlets. The Department of Education has not yet taken any decisions on Building Schools for the Future, and they will be announced in due course.
The right reverend Prelate the Bishop of Bath and Wells asked about the composition of boards of governors in academies. Our current model articles of association say that academies must have one local authority governor and at least one parent governor, but Ministers have not yet made a decision about the composition of future academy governing bodies. The noble Baroness, Lady Howarth, spoke about children’s services, which she does so well. The Government recognise the challenges that local authorities face in delivering really effective children’s services. When Ministers have evidence that a council is not discharging its accountabilities to an acceptable standard, the Government will want firm assurances that the local authority involved has the determination and the capacity to turn its performance around. We do not want to interfere unnecessarily in local authorities’ improvement processes, but in the most severe cases where councils fail to improve, we will not hesitate to consider using our statutory intervention powers.
The noble Baroness, Lady O’Neill, said that there was too much assessment and testing. We are committed to external assessment and will review how the KS2 tests operate in the future. Schools, as she well knows, do not have to narrow the curriculum to achieve good test results, although I was very interested in all she had to say on that theme. The noble Baroness, Lady Massey of Darwen, asked about physical and personal education. These are important areas and the evidence available to us from Ofsted and the conclusion of the Macdonald review is that the quality of PSHE teaching is highly variable. The current policy is that all young people should receive a comprehensive programme of sex and relationship education to give them the knowledge and skills to make safe and responsible choices. High quality PSHE is a core theme of the Healthy Schools programme.
The noble Baroness, Lady Walmsley, talked about Sure Start and health visitors. The coalition agreement commits the Government to refocus funding from Sure Start peripatetic outreach services and from the Department of Health budget to pay for 4,200 extra Sure Start health visitors. We believe that our new approach to early years services and the profile of the Sure Start health visitor role will prove very attractive. The noble Baroness also spoke about child poverty, as did the right reverend Prelate the Bishop of Bath and Wells. We are very focused on this issue. The position we have inherited means that we are not on track to meet the 2020 target, and we will need to consider carefully what action is needed to make real progress in this area. The right reverend Prelate also asked about the commitment to end child detention, and I refer him to the Question on the subject answered by my noble friend Lady Neville-Jones this week.
The noble Lord, Lord Hall of Birkenhead, asked about funding for the arts, and he is right that more than half of this funding comes from public sources. The vast majority of government funding for the arts is of course via Arts Council England. The rest comes from private sources, including the earned income of people who attend events and venues. But as a general point, putting the economy back on its feet and restoring the nation’s finances are in the interests of all our sectors, and that is the prime task of this Government.
The right reverend Prelate the Bishop of Guildford, in his excellent speech, addressed the issue of the churches needing repair. The Listed Places of Worship Grant Scheme, which makes grants equivalent to the VAT incurred, is expected to make grants of around £15 million in 2010-11. However, a decision on the scheme’s future beyond the end of this year is pending. As he will know, though, other funding is available from various sources—the Repair Grants for Places of Worship Scheme, the Heritage Lottery Fund and the Churches Conservation Trust.
The noble Baroness, Lady Andrews, spoke very powerfully about heritage protection. I pay tribute to the work of English Heritage in protecting the historic environment and to her as its chair. We are currently considering options for legislating in this area. In doing so we are mindful that extensive consultation on reform of the heritage protection system has taken place over the past decade and that a programme of non-statutory reforms is now nearing completion.
My noble friend Lord Colwyn spoke about live music. There seems to be evidence that the Licensing Act 2003 has not created the growth in live music that was hoped for, and we cannot ignore public opinion out there, especially among musicians. We believe that there was much to commend in the Bill of the noble Lord, Lord Clement-Jones, but we want to consider the options carefully before deciding how best to support live music.
The noble Lord, Lord Elis-Thomas, asked about broadband. The UK has made a start on the deployment of superfast broadband but we want to go further. Steps are now in train to reduce the cost, and that could make a significant contribution to availability and open the market to new players. As regards S4C, there will be a reduction in its budget from DCMS for the current year of £2 million. S4C has said that it will endeavour to ensure that this reduction will not directly affect services to viewers.
The noble Lord, Lord Rea—I apologise, I am a little out of order—asked me about NICE and I forgot to address his question. I assure him that we believe that NICE has an important long-term role in assessing the clinical efficacy and cost-effectiveness of new treatments and safeguarding taxpayers’ money.
Moving very briefly to work and pensions, the noble Lord, Lord McKenzie of Luton, asked whether the Government would continue his party’s reforms to the operation of the work capability assessment. The Government take seriously the importance of correctly assessing fluctuating conditions and ensuring the accuracy of the WCA. We are currently considering the department-led review of the WCA and its recommendations. Do we plan to continue the timescale for reassessing those people on incapacity benefit set out by the previous Government? We will be testing and learning from the small-scale trial which will run from October 2010; full migration will not begin until April next year and is expected to take place over a three-year period.
The future jobs fund has not been abolished. We will continue to fund the bids already approved, which will mean that more than 100,000 people are likely to get jobs, but we will not accept any new bids for funding and we will tighten up the way in which contracts are managed.
My noble friend Lord Elton asked me whether I would talk to him about identity fraud. I shall be very happy to do that.
The noble Baroness, Lady Hollis, in an extremely powerful and compelling speech, spoke about pensions and savings. There are obvious attractions to introducing a single pension which wraps up the existing three elements of the state pension system, as she suggested. However, I think she will agree that significant issues would need to be addressed before such a system could be introduced, including costs and transitional issues such as what happens when a person has been contracted out of the state system. However, as the noble Baroness acknowledged, the Government have already brought forward the restoration of the earnings link to April next year. If I may write to her about the other points she made, that would probably be appropriate in the circumstances.
The noble Lord, Lord Rix, spoke powerfully about employment support for disabled people. I agreed with so much of what he said. The single work programme will offer targeted, personalised help for those who need it most. We want to give people who have been so-called “written off” the opportunity to work and contribute, and the reforms will aim to promote employment and tackle poverty.
It has been impossible in the available time to answer every question posed. I hope that noble Lords will forgive me for that, but I undertake to write to those noble Lords whose questions remain unanswered.
Our programme for health, as for education and welfare, has at its heart the concepts of trust, fairness and empowerment of the citizen. The role of government is to create the conditions which will make those concepts a reality. As we debate these important matters over the weeks and months ahead, my ministerial colleagues and I look forward to garnering the wisdom of this House in exactly the way that has proved so valuable to countless Governments who have preceded us.
Meanwhile, I am able with pleasure and a good deal of pride to commend the gracious Speech to your Lordships.