(12 years, 9 months ago)
Lords ChamberRead Hansard Text Read Debate Ministerial Extracts
Baroness Royall of Blaisdon
My Lords, our public services face significant challenges over the coming years—cuts that are too far and too fast; an aging population and ever rising expectations—yet it appears from today’s White Paper that the Government are simply obsessed with presenting an argument rather than providing the reform that our public services need. The Government have certainly not lacked ambition in the way they have heralded the White Paper, referring to it as bringing a complete change in public services, where power will be placed in people’s hands. The Government may believe that the narrative is there, but the content appears to be lacking.
The White Paper contains few new ideas and even fewer new proposals. In many cases the Government are lagging behind their earlier rhetoric and the actions of the previous Labour Government. Indeed, some of the proposals are already being implemented as a result of our legislation—for example, the provision of data on health outcomes.
On personal budgets, to which the Minister referred, the Sunday Times newspaper was told several weeks ago that the right to a personal budget, now used by approximately 250,000 adults, was to be extended to those with long-term conditions and to children with special needs—and yet there is nothing of this in the White Paper.
The Minister also referred to the expansion of mutuals. Back in November, the Minister for the Cabinet Office said that every department would put in place rights to provide for public sector workers to take over the running of services. Almost nine months later, only the Department of Health has obliged and no timescale for any other has been forthcoming.
Ahead of today’s White Paper we set out three tests for public services reform. First, will these reforms make services more accountable and responsive to the needs of service users? Secondly, will there be clear accountability for the way in which public money is spent and members of the public are protected? Finally, will the proposals strengthen the bonds of community and family life? So far the Government are failing that test of reform. Their policies are inconsistent between departments and sometimes within them. Little has been done to put service users and their communities in control.
It is now clear that the Government have lost their way on public service reform. After the incompetence that characterised their failed approach to the NHS, the Government’s pace of reform is slowing. They are all over the place on public service reform and the White Paper does nothing to change that.
Perhaps I may ask the Minister, first, are the Government still planning to bring forward proposals for personal budgets and mutuals? Can the Minister give any indication of the timescale on which they are likely to proceed? Secondly, given that the White Paper has little to say on these two important issues and many others, will there be another White Paper with a set of proposals, which are so apparently lacking in this one? Thirdly, in relation to what has been for the employees concerned a major issue about reform—staff pensions and employment conditions—can the Minister assure us that this is being taken seriously and that those members of staff transferred out of the public sector will retain access to the same pensions and conditions of employment that they currently have? Fourthly, if the public will not wear competition by price in the NHS, will the Minister guarantee that this will not form the basis of proposals elsewhere? Finally, we are particularly concerned about the report in today’s Guardian that Ministers have been privately advised that schools and hospitals should be allowed to fail. On the day that Southern Cross has closed down, does the Minister agree that the education of children and the treatment of the sick should not be treated as a commodity to be traded and that these proposals should never see the light of day?
In conclusion, I quote what the independent think tank Reform has said about the Government’s proposals so far: It states:
“The Coalition Government are failing the test of practical reform. Viewed as a whole, the Government’s public service reform policies are all over the place”.
This is a difficult and damaging conclusion for the Government, and there is nothing in the White Paper today which will change that judgment.
Baroness Verma
My Lords, this process is signed up to by all government departments and it has had wide consultation. We are building on what the previous Government were doing—ensuring that there was proper reform and that public services were able to deliver the best possible service and outcome to individual users. I do not accept the noble Baroness’s premise that the White Paper is going nowhere and that it has not responded to the needs of individuals. What we are trying to do is very significant. This is about building accountability and transparency into the processes. As with social care, which is a sector I know well, personal budgets are available to some but this is about ensuring that personal budgets are available to many more. It is also about making sure that people are aware of what they are buying into, and that process takes time.
I have not read the Guardian article so I cannot comment on it. However, I will say that for us it is really important that children who come from disadvantaged backgrounds and are followed by the pupil premium will be able to get better outcomes and go on to enjoy social mobility and rise up, rather than remain stagnated as some children have become through—I am sorry to say to the noble Baroness— policies that were not delivered well under the previous Government. We need to find a way of working together to ensure that our public services deliver the best outcomes for those who need them the most. We have to agree that this will not come through sitting doing nothing. We must ensure that delivery of our public services is done in a way in which everyone has choice and power over how their services are delivered, and this White Paper goes towards that.
Baroness Royall of Blaisdon
Before the Minister sits down, I remind her of the very important question that I asked towards the end of my response to her Statement about the fact that it is said that the Government are willing to allow educational and health establishments to fail. That cannot happen, and I would like a guarantee from the Minister that this will not be allowed to happen.
Baroness Verma
I apologise for not responding to that. I have not seen any evidence that we would allow schools to fail. It would not be in the interest of children who are growing up today for us to allow failure: they have been failed for far too long. We need to ensure that every child growing up in this country today has an opportunity to achieve their best potential.
Lord Maclennan of Rogart
My Lords, while I acknowledge the sense of many of the objectives spelled out in this White Paper, does my noble friend recognise that across the whole White Paper the proposals to achieve these ends raise far more questions than answers? The modes of delivery are very far from clear and this House needs to debate them serially and at length. For example, does my noble friend recognise that cuts in public expenditure are seriously diminishing the access of local people to central services? The closure of the income tax offices and the removal of visa and passport offices in the part of the country that I live in are examples of this. Although these are central services, they cannot be neglected as they touch upon the lives of people in the locality. Does she also recognise that there are big questions about who is going to make the decisions on the money that is to be dispensed by the public service locally—is it to be central, or local government, or some new sources of funding? How is the need of the particular person who is to enjoy the personal budget to be calculated if not by some local organisation which is very closely in touch with the specific circumstances of the individual? I repeat that the general objectives seem unchallengeable but the mode of delivery seems highly opaque.
Baroness Verma
I will reassure my noble friend. We are working against a really difficult economic backdrop, and we will have to make some incredibly difficult choices. Having said that, it is also an opportunity for us to open up to a variety of providers and see if services are then better delivered, with best value incorporated into how those services are delivered. As with personal budgets, delivery will not just be left to one set of providers. What is important is working in partnership—in this case, personal budgets and local government. It is about being able to deliver services far better and with greater choice. Those who have access to personal budgets have said to us in consultations that they feel relieved that they are going to be able to make choices on how their care is delivered.
Lord Beecham
My Lords, is it not ironic on the day that Southern Cross has collapsed—closing 560 residential homes, which account for over 30 per cent of residential care places—that the Government are proclaiming the virtues of diversity? How diverse is a system that allows a single private operator to provide such a high proportion of places, with the results that we can now see? In talking about diversity, how many organisations, particularly voluntary ones, have been contracted on the welfare to work programme? It seems to have been commandeered by a handful of national organisations.
Can the Minister also explain the relevance of the passage in the Statement that talks about,
“open, real-time data on road conditions, speeds and accidents along our motorways”?
Is she suggesting that motorists can then find another supplier of roads on which to travel or is this a question of diversity in the provision of satellite navigation?
More seriously, on the health premium paid to local authorities achieving the greatest improvements in public health, clearly one shares the objective of incentivising the improvement of public health. Is it not going to be difficult for authorities such as my own—the noble Lord, Lord Shipley, is also a member—to improve the very serious and long-standing conditions in public health? There are areas where it will be easier to do that and they will be rewarded for achieving targets while authorities that may need investment to secure improvements will presumably struggle to get it. Will that not have to be reconsidered to ensure that the investment goes in the right place to achieve public health objectives? Those are not in any event entirely under the control of local authorities.
Baroness Verma
My Lords, it is a great disappointment that Southern Cross has had to go down the route that it has gone in. The noble Lord is of course aware that many providers perform excellent work and have greater safeguards in place. We do not want to take one example and judge all private providers on it.
I am not quite sure that the significance of the roads question will be answered as fully as the noble Lord would like. I assume that those data are so that the public—the people who use those roads—are able to question why there is not greater improvement and how greater improvement can be brought about. It is not about avoiding roads but being able to say, “Where judgments are to be made about mapping on those roads, how do we deliver better services? Is it about speed or variable speeds”? I suspect that that is what it is, incorporated into that response.
On health premiums, it is absolutely right that those healthcare providers dealing with very difficult health issues in their areas should be given extra support and rewarded if they deliver better outcomes. It is only right that we work in partnership—sometimes with local authorities or across a range of providers. We must not put a full-stop block on this, so that we are driven by the same service that has gone on for many years and that has not delivered the sort of outcomes that we would like everyone to have—and not because they can buy it. It has to be available for everyone.
Lord Ahmad of Wimbledon
My Lords, as someone who works within local authorities and has local authority experience over 10 years, I welcome the Statement, not least because when we have looked at procurement of services we have, for far too long, seen a repeated reliance on what has happened before continuing. I welcome the White Paper because it opens up different channels, whether it is the state sector, the private sector or, indeed, as we have seen, the growing importance of the voluntary sector in delivering effective services at the ground level, as people desire. One-size-fits-all is not the way forward. Personalised budgets, services which matter to local people delivered by the best provider, are what is desired and this White Paper outlines those objectives. I also ask my noble friend the Minister to emphasise once again that while we have only seen the local DCLG budget being allocated in such a way, we see a relinquishing of Whitehall’s control on budgets and all budgets being delivered effectively by the right provider for local people at a local level.
Baroness Verma
I thank my noble friend for his warm welcome for the Statement and I absolutely agree that it is about decentralisation and being able to give more and more control over to local people and local authorities, so that we can actually get the sorts of services that local people need in those local areas. There is no point in trying to micromanage local areas when one does not have the special needs of those local areas within one’s own way of delivering. My noble friend is absolutely right that it is really important that the decision-makers are part of the communities that are being served.
Personalised budgets, which are something that I know about, are one very good way of being able to deliver. In her response to the Statement, the noble Baroness talked about personalised budgets. Not enough people are signed up to them; we want to deliver, we are building upon what the previous Government were doing, but, of course, it takes time to roll these things out and make people aware. It is about an awareness campaign as well to make people aware of what is available to them so that they will make informed choices.
Lord Soley
My Lords, I do not have a problem with the direction of travel that the noble Baroness is mapping out; indeed, as she said, it builds on what the previous Government were doing, and more acknowledgement of that might make it easier to reach agreement on some of these areas. The problem that the Government are not addressing—as far as I can see, although I will need to look at the White Paper—is the detail of it. I am very much in favour of co-opting mutuals, but I know from personal experience that, for example, setting up a housing co-op and making it work is very difficult and, frankly, it fails more often than not. That has been tried on many occasions.
On more personalised and individual budgets, again I am very much in favour of that. I have argued for children to have budgets enabling their parents to give them extra lessons in whatever they chose—music, or whatever—but that runs into the problem that every now and then a parent wants something which is not considered to be in the interests of the child. To take what is perhaps an extreme example, a parent might say, “I do not wish my child to be in a science lesson which teaches Darwinism; I want to take them out and give them lessons in creationism”. We will run into that problem, so we have to have managerial structures which decide how the money can be used, in what format and who says yes or no. It is not just an issue of money; it is an issue of management structures which allow us to do what I think most of us would like to do, which is to devolve downwards.
Baroness Verma
The noble Lord raises a number of interesting points. I did say that we are building on what the previous Government were doing. We are trying to make it a build-on that will be a bit more directed and focused on what the outcomes are going to be. I think that we are still in that mode of debating. It is important that we debate and discuss the best possible ways of delivering. These conversations do not stop just because a paper is produced. Consultation is an ongoing process, but it is also very important that we do not become so blinkered that we decide that the White Paper is not going to deliver anything. The White Paper is already able to deliver a lot, because we are building on what was already in place.
The structures will, of course, have areas that we will need to fine-tune and to look at how things can be made much tighter, but the Government are making sure that we have continuity plans and safety nets in place so that we can ensure that, when people make those choices, they are not left without support mechanisms. That is why we want to encourage champions to come forward through organisations such as Which? or HealthWatch and also make sure that there are ombudsmen for each sector, so that everyone knows that there is a line of recourse if they face difficulties.
Lord Patel
My Lords, on the face of it, allowing patients a choice as to where they wish their care to be delivered seems a good idea, except that there are several problems. One is the quality of information we have: if that choice is to be based on outcomes, it is pretty poor.
The second is that the outcome is not based on one treatment: it is the quality of the journey of care of a patient that delivers the best outcome. For instance, poor outcomes in cancer may well be, and are, related to late referrals of cancer patients. How does a patient know what quality of information they will be given that will allow them to make a choice as to how they wish their care to be provided, based on these outcomes?
Another issue is that the best quality might be far away from where the patient can go or have access to. So how would they make that choice? Most importantly, if we are going to do this—and the idea seems good—it should be based on what we have learned from pilots. Have there been any pilots done that will tell us how this will work?
Baroness Verma
The noble Lord has raised a number of detailed questions and I suspect that I will not be able to answer them today. I would like to take them away, write to him and place a copy in the Library, because it would be unwise of me to respond to him about outcomes without details of how those outcomes would be delivered.
Lord Reid of Cardowan
My Lords, perhaps I can assist on this. While not agreeing with everything that has been proposed, on the matter of choice there are difficulties in getting information, in travelling away from your local hospital, in transferring records, but that has never stopped the rich exercising their choice. They have always been able to overcome these difficulties. Therefore, if there are obstacles in the way of consumer choice for patients, the answer should not be to remove that choice; it should be to increase facilities for the provision of information. On outcomes, I would simply say that, since the introduction of choice in the National Health Service, hundreds of thousands of people have been taken off the waiting list and the maximum waiting time has been reduced from two years to six weeks from diagnosis to operation. That was due to the element of competition and patient empowerment which was introduced into the National Health Service through choice.
Baroness Verma
I thank the noble Lord for coming in and assisting me, but I will still follow it through with some letters.
Lord Shipley
My Lords, I declare an interest as a member of Newcastle City Council. There is much to commend in this White Paper in principle, insofar as it gives greater power and responsibility to groups of individuals and third sector providers. However, will my noble friend the Minister confirm that it is not just about sell-off to the private sector for profit and that the Government really mean that this is about groups of residents, individuals and third sector organisations? Secondly, will she comment on increasing choice? While theoretically a very good thing which I strongly support, there has to be spare capacity in a public service; otherwise, choice becomes a mirage. Having spare capacity is inherently more expensive when what people want is to have high-quality services available in their immediate neighbourhoods. At a time of declining public resource, ensuring high-quality services within neighbourhoods, close to home in order to minimise the need to travel, is more important than extending, at higher cost to the public purse, the choice in a wider area.
Baroness Verma
My noble friend should feel reassured first and foremost that it is not about just a sell-off. It is about introducing a much wider and more diverse provision of service so that people are able to enjoy a much more flexible response to their needs rather than, as so often, a stringent delivery of services through local authorities. Often as not, my noble friend will find that within an independent delivery service there is always capacity built in. It is often a prerequisite required of those who deliver services when they buy from the public sector to deliver, because it has to be delivered in their service plans in the first place. So I do not have a worry about capacity.
It is important that we are able to ensure that people who are going to use these services will be able to have a greater say in how those services will be delivered, whether those services meet their needs and, if they do not, how we can have recourse to get those services made better in responding to those needs.
Baroness Armstrong of Hill Top
My Lords, will the Minister accept that many of us are extremely disappointed with this so-called White Paper? It seems to be a Green Paper because it consults on a range of things without any precision on what the Government’s intent is. When I saw the coalition agreement saying that there would be an opportunity for millions of workers to be their own boss, I was expecting more from a White Paper than simply, “We will continue to support mutuals and the public sector workers in them”. The lack of ambition is staggering.
Will the Government now seriously address the manner in which they can reform and change public services? They are getting a bad name now for their lack of ambition on reform and their inability to deliver it. On things like mutuals, they need to answer the questions put by my noble friend on the Front Bench, particularly around pensions and pension entitlement.
Baroness Verma
I am sorry that the noble Baroness feels that this does not address public sector reform. Public services are being reformed. This is an exciting and comprehensive paper. I suggest that if she takes the paper away and looks at it in detail, she will see that we are genuinely working across government to ensure that there is a proper reform of public services so that they are delivered to ensure that people have choices, are able to have their needs met and have a say in how those choices are delivered. These reforms will take time because we want the process to be evolutionary and we want to get it right, but it is a build-on to what was happening already. I hope that I leave the noble Baroness assured that we will be working hard with public services to ensure the best delivery.