Health: Multiple Sclerosis

Baroness Barker Excerpts

Monday 30th June 2014 Lords Chamber

[Earl Howe]

My Lords, we are keen to see candidates being proposed for the early access to medicines scheme. If a body of evidence suggests that benztropine could qualify for designation as a promising innovative medicine—a PIM—the Medicines and Healthcare products Regulatory Agency stands ready to consider such evidence. However, it is for the manufacturer of the drug, not the Government, to decide whether it wishes to propose the drug as a candidate for the scheme.

[Baroness Barker (LD)]

My Lords, three drugs are currently awaiting approval by NICE, some of which have been turned down by the European Medicines Agency because of their side effects. To what extent does NICE take that factor into account in its own decision-making process?

[Earl Howe]

My noble friend will know that NICE looks at the clinical effectiveness of a drug alongside its cost effectiveness. The cost-effectiveness equation will naturally include consideration of unpleasant side-effects. The advice that it issues will reflect the evidence that it has from clinicians on that matter. It will then be for clinicians to decide whether the risk-benefit ratio is appropriate for particular patients.

Health: Transition to Adult Health Services

Baroness Barker Excerpts

Wednesday 11th June 2014 Lords Chamber

[Earl Howe]

I think that we can pay considerable tribute to the Children and Young People’s Health Outcomes Forum. It is one of the bodies that have highlighted the need for more effective transitions and for new outcomes indicators to measure them. Its framework for this year includes a proposal that, where possible, all data should be presented in single-year or five-year age bands up to the age of 25 to support better monitoring. Moreover, the forum asked the National Network of Parent Carer Forums to develop a narrative of what good integrated care looks like in transition. The CQC report has drawn quite heavily on that report in its conclusions.

[Baroness Barker (LD)]

My Lords, the Teenage Cancer Trust had to battle for years to get NHS commissioners to understand that age-specific rather than gender-specific wards are better for young people. It is a good organisation, but it has been a hard job to change the mindset of the NHS. Can he help organisations such as the Teenage Cancer Trust to find ways in which to influence commissioners far more quickly than they have been able to do in the past?

[Earl Howe]

My noble friend raises another extremely important point which applies not only to cancer, but also particularly to mental health settings. We have had many debates in this Chamber about age-appropriate settings. I will take her point back with me and find out where we are in our dialogue with stakeholder groups.

Elderly People: Abuse

Baroness Barker Excerpts

Wednesday 14th May 2014 Lords Chamber

[Baroness Barker (LD)]

My Lords, I thank the noble Baroness, Lady Cumberlege, for the opportunity to return to this issue. The law is an important expression of what we as a nation believe should be the common standards by which everybody in our society should be held to account. It is an important driver of professional behaviour. This afternoon, I wish to contend that, although we are making progress, our law in relation to elder abuse is still deficient in two respects.

In the Care Bill, we have taken a significant step forward by putting into law statutory duties on authorities to investigate adult abuse. Scotland already has the Adult Support and Protection (Scotland) Act 2007, which I want to come back to. We have a new corporate responsibility for wilful abuse or neglect by NHS staff and the Government are considering doing the same in relation to social care. I welcome that. However, during the passage of the Care Bill it was wrong and remiss of the Government not to increase powers of entry in circumstances where there is good reason to suspect that an older person is being abused and access is being denied by somebody else. For that reason, I think that we will continue to see incidents of abuse against older people.

Early last year and in the early part of this year, I took part in the review of the Mental Capacity Act. A very important part of the report produced by our committee under the excellent chairmanship of the noble and learned Lord, Lord Hardie, concerned the criminal law provisions of the Act, known more commonly as Section 44. Section 44 of the Mental Capacity Act introduced a criminal offence of ill treatment or neglect of a person who lacks capacity. However, there is an important flaw in that legislation. It requires the person to lack capacity or the person looking after them to have reasonable belief that they lack capacity for an offence to be committed. That is not the case in Scotland. There, if somebody is guilty of abuse of an older person, whether or not they lack capacity, that is an offence.

When people from the Ministry of Justice came to talk to us, we asked about the use of that provision. First, our committee was rather surprised to know that the Government do not collect any data; they use only media reports. We thought that that was rather remiss. However, from the media reports that they had, it was clear that there is a gap. The noble Baroness, Lady Cumberlege, talked about the millions of people who may be affected by such abuse, yet there have been only a handful of prosecutions under the Mental Capacity Act. It is clear to us that that law is deficient. Professional staff who may abuse older people do not really understand it. They do not understand their responsibilities and they certainly do not fear prosecution under that legislation. The central point of the legislation was to prevent older people and vulnerable adults from being susceptible to abuse. There is widespread recognition that that law is deficient and several judges have said so in making pronouncements about case law.

My plea to the Government today is that, in their response to the report of the committee on which I sat, they signal that we treat abuse of older people every bit as seriously as abuse of children and that we look at dealing with those two deficient pieces of law.

Care: Older People

Baroness Barker Excerpts

Wednesday 7th May 2014 Lords Chamber

[Earl Howe]

My Lords, the national eligibility threshold has been set at a level to reflect the most common current practice of local authorities. That will allow current practice in 98% of local authorities to continue as it does at present. The national minimum threshold will mean that people with autism, others who need care and carers will know what level of need is eligible for local authority care, no matter where they live in the country. I think most people welcome the element of the Care Bill that gave that certainty.

[Baroness Barker (LD)]

My Lords, one of the objectives of the Better Care Fund is to reduce demand on the NHS by improving preventive social care. Local authorities have sought to put more money into the Better Care Fund than the Government originally asked them to. Can the Minister say what the NHS’s response to the Better Care Fund proposals has been?

[Earl Howe]

The short answer to my noble friend is that it is too soon to say as the plans are currently in formation. However, the whole idea of the Better Care Fund is to enable joint working. It is an opportunity to make the best use of available resources and improve value for money through the collaborative redesign of existing services. The pay for performance element of the fund should incentivise local areas to make efficiencies and will provide initial evidence of the impact of the Better Care Fund on savings and outcomes.

Care Bill [HL]

Baroness Barker Excerpts

Wednesday 7th May 2014 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I have just one issue to raise, on Amendment 32 and the Government’s amendments in light of the Delegated Powers Committee report. I speak on behalf of a number of people who are grateful that the Government have been able to respond very quickly to this. It is much more sensible for this to be an affirmative instrument rather than a negative one.

[Baroness Barker (LD)]

My Lords, in view of the press coverage today, perhaps I could ask the Minister to confirm a point. When the Better Care Fund was announced, the intention was that projects would start in April 2015. Is that still the Government’s intention or has the timescale been put back? What seems to me constructive is the move to have more engagement from the NHS in setting up the projects under the Better Care Fund. One key aspect of the Better Care Fund on which it rests is ensuring that there are enough strong and appropriate providers of community services to ensure that older people get the care in the community that they need.

The noble Baroness, Lady Wall, put a question during our earlier exchanges that went straight to this matter. You cannot simply close spaces in the NHS and expect that somehow people will be provided—magically, at a stroke—with services in the community. I quite see why people have leapt on this as a story, but I struggle to see the substantive issue. I go back to a point that was made earlier: how many times have we stood in your Lordships’ House and talked about integration of health and social care as being a desirable end that will deliver better services? It seems to me that the NHS may be questioning some matters to do with budgets. That is not a case for undermining the Government’s whole policy.

[Earl Howe]

My Lords, I am grateful for the contributions of noble Lords. I will begin by clarifying that the Better Care Fund has not been suspended or delayed. My noble friend was absolutely right to say how important and long-awaited this initiative is. Successive Governments and leading health professionals have talked about joining up health and social care for a very long time. The Better Care Fund is a major step to making this a reality. It will be in operation from April 2015, which was always the intention. For the press to suggest that the scheme has been suspended is completely wrong.

The Cabinet Office implementation unit conducted a deep-dive review of the Better Care Fund in six local areas following the submission of draft plans. This was a small sample of the 151 plans across England and was based on initial drafts that have since been redrafted. The review found that the Better Care Fund is generating pace around service integration, but there are areas where improvement is needed. These include insufficient engagement with primary care and acute providers in the development of Better Care Fund plans and a lack of practical detail and clarity about how cashable savings will be released.

Since receipt of the Cabinet Office report, officials have worked with NHS England and the Local Government Association to improve the offer of support for local areas to address the issues that have been raised. To give councils the resources to start making progress immediately, the NHS will transfer an additional £200 million to councils in 2014-15 on top of the £900 million already committed. This funding will be used for social care with a health benefit and to prepare for the introduction of the Better Care Fund.

We are only half way through the planning and preparation process for the Better Care Fund and it is very premature to imply or state that the fund is in trouble—far from it. One would expect different areas of the country to progress at different rates; that has always been the case. Many areas of the country have been integrating services very successfully for a number of years, so it should not be surprising to anybody that some areas need to catch up. We are on the case, and so are NHS England and the Local Government Association. I am confident that, as I said earlier, we are broadly on track in this area.

--- Later in debate ---

[Baroness Barker (LD)]

My Lords, if it helps the Minister as he waits for some assistance in his response, I speak as one who has taken part in many of the discussions over the years. The Minister was right to acknowledge the work of a large number of people. One person who should be added to his list is the noble Baroness, Lady Greengross, who has worked tirelessly on this matter for some time. It is a measure of how long this debate has been running that when we first began to discuss it in this House, there were no direct payments for social care to anybody. Therefore, the matter did not arise. It is therefore extremely helpful that the Joint Committee on Human Rights has posed the question that it has. When we started, the scope to argue over what was a private arrangement and what was a public function was considerably less than it is now. Now, someone who has been assessed as needing and being entitled to social care may make an arrangement with a family member using a direct payment, but the question of whether it is a public function that is being discharged is still the one that goes to the heart of whether the Human Rights Act applies. It is extremely helpful that the Joint Committee has raised that question. Having got this far to overcome what has long been acknowledged as a tremendously unfair anomaly—whereby one older person in a residential home has rights and the person in the next room does not, simply because of who arranged, rather than funded, their care—let us get it right, at last.

[Lord Mackay of Clashfern (Con)]

My Lords, as I took part in the debate in this House that secured the original amendment to the Bill, I should very much like to associate myself with the remarks of thanks to my noble friend Lord Howe and to Norman Lamb and others in the other place. I think the root of this difficulty was the decision of this House from which Lord Bingham dissented. That was an indication that the decision might require revision in due course.

Abortion

Baroness Barker Excerpts

Thursday 3rd April 2014 Grand Committee

[Baroness Barker (LD)]

My Lords, I thank the noble Baroness, Lady Knight of Collingtree, for initiating the debate. This is a subject on which she and I hold very different views, but I admire the vigour with which she pursues her very strongly held convictions.

We are having this debate at least in part because of the ongoing campaign by the Daily Telegraph and the sting operations which it has mounted in support of that. Noble Lords will have seen the briefing from the Library. I think it is evident from that that the law is being upheld and that the DPP has yet to find a case where the law has been broken in this regard. It is also clear that the professional bodies—the GMC and the BMA—are dealing toughly with any professional about whom there is the remotest suspicion that they may not be upholding the law in full.

I want to make just one simple point. The NHS is under enormous pressure, particularly as regards maternity services. Given that, there is a legitimate question as to whether or not it is necessary to continue to require two doctors to authorise a procedure in this regard. I am not asking for the law to be changed on the basis of opinion but rather that research is done—that is, comparative research with regard to other countries where the authorisation of two doctors is required—to see whether scarce resources could not be used more effectively in advancing the healthcare of women and children. I am not asking for the law to be changed in any other respect. I think the other four criteria that have to be met should remain. I simply question whether, in this day and age, it is still necessary for two doctors to make that decision.

NHS: Bed Capacity

Baroness Barker Excerpts

Thursday 20th March 2014 Lords Chamber

[Earl Howe]

The noble Lord is absolutely right. That is why my ministerial colleague, Dr Poulter, has written to Sir Bruce Keogh. This issue lies at the heart of the NHS constitution: the patient’s dignity and shaping care around the needs and preferences of patients is absolutely at the centre of the constitution. This is why it is entirely appropriate for Ministers to make their views known and for Sir Bruce to ensure that all hospitals are aware of this principle.

[Baroness Barker (LD)]

My Lords, does the Minister agree that it is possible to discharge patients from hospital in the evening safely and that there are some patients for whom that is the best clinical option, but that hospitals are not good at ensuring that frail older people are discharged at the best time when they live on their own? Could he include that in the review carried out by NHS England?

[Earl Howe]

My noble friend is quite right. As she knows, there are far too many frail elderly people who end up in hospital in the first place. We must get better at the discharge arrangements for them and not keep them in hospital too long. This is the focus of much of the work going on in the department and NHS England at present concerning vulnerable older people. We will announce a comprehensive plan around this later in the year.

NHS: Seven-day Working

Baroness Barker Excerpts

Thursday 6th February 2014 Lords Chamber

[Baroness Barker (LD)]

My Lords, in 2003, the noble Lord, Lord Hunt of Kings Heath, the Minister and I were deep in the depths of the delayed discharges Bill. During our discussions, the journal Nursing Older People published clear evidence that if older people were discharged on a Friday, they were more likely to be readmitted to an acute hospital, or to die.

Let us flick forward to July 2013, when Sir Bruce Keogh concluded, in his review of 14 Trusts for NHS England, that,

“performance … was much worse … for their emergency patients, with admissions at the weekend and at night particularly problematic. General medicine, critical care and geriatric medicine were treatment areas with higher than expected mortality rates”.

In its 2013 report, Dr Foster stated that the mortality rate for patients who had routine surgery is 24% higher if the operation is performed just before the weekend and that the number of patients who return to hospital after being admitted at the weekend is 3.9% higher, so 10 years on it is the same story.

A lot has happened in that decade. Technology has improved and kit is marvellous these days. Data have become much more copious and available. Patients have become better informed and empowered. The pressure on resources was changed out of all recognition during the Labour Government, when lots more resources went into the NHS, but the rising tide of demand continued on ahead. It is the same story over a decade. One thing that we can conclude is that this is not about resources. That is not the answer to these issues.

This is therefore an interesting question for the Government to think about now that we are in a period of austerity. How do we address what we know to be long-standing and systemic issues? First, in order to have a seven-day-a-week NHS, we have to have better integrated social care and improved access to low-level social support. We know that 50% of the users of the NHS in future will be older people with long-term comorbidities, particularly dementia. The bulk of their care will not come from consultants; it will come from their families and friends. What is important is supporting their families and friends to look after them in the community.

Secondly, GPs have a critical role in determining access to the NHS. I think we can by now conclude that the GP contract negotiated by the previous Government was not the roaring success that it was made out to be at the time. GPs have a critical role in managing care pathways and access and we now need to go back and say to them, particularly since their response to Sir Bruce Keogh was simply to talk about resources, that there needs to be a change in their role in managing that point between all-out A&E access and long-term care.

Finally, we need to be absolutely clear with the British public that having a full seven-days-a-week service is not going to be realised in the short term. The general public will have to understand which parts of the health service they can expect to be available seven days a week and which they should not. The British public are very proud of the NHS and are, by and large, responsible. They want to make the best and most sparing use of it they can. Let us not deceive or mislead them into being wasteful and thinking that they are going to have everything all the time.

Health: Local Healthwatch Organisations

Baroness Barker Excerpts

Tuesday 5th November 2013 Lords Chamber

[Earl Howe]

I am very much in sympathy with that thought. However, it is up to the local Healthwatch organisation to organise its funding as it sees fit and in the most cost-effective way possible. I would not want to dictate to them what they should do but, clearly, for a Healthwatch to work effectively, one has to have volunteers who are ready and willing to do the work, which might involve the need to reimburse them for some expenses.

[Baroness Barker (LD)]

My Lords, will the Minister confirm that local Healthwatches retain the power to merge and reconfigure their services with neighbouring bodies if that would make for better outcomes for patients?

[Earl Howe]

That is potentially within their power, although it is for local Healthwatches which find themselves in that position to consult their commissioning local authority to make sure that the local authority is happy with whatever the proposals are.

NHS: London

Baroness Barker Excerpts

Wednesday 30th October 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Lord raises the important question of capacity. The key point is that none of these changes will be implemented until such time as commissioners and the relevant providers are satisfied that the necessary capacity exists. That is a key point. Secondly, on the costing and the financial aspects of the proposals, the way in which we will be able to spend more money on front-line care and better-quality facilities is by spending less on duplicated facilities, underperforming services, and badly designed and out-of-date buildings, which cost a lot to maintain. Therefore, as part of this package, there will be new custom-built hospitals at Ealing and Charing Cross, costing about £80 million each, designed to deliver the specific services needed in those respective communities. That will be part of the way in which the money released will be invested for the betterment of patients in the area over future years.

[Baroness Barker (LD)]

My Lords, the most important part of this Statement is the part stating that none of these changes will come into effect until NHS England is convinced that the necessary primary and community services are in place. How will that be determined by NHS England? Secondly, who will be responsible for the integrated commissioning of community and primary services to bring about the necessary preventive services on which this reconfiguration is based?

[Earl Howe]

Largely, the judgment by NHS England will be made by local area teams—but not in isolation. It has to be a collaborative exercise, which is my overall answer to my noble friend’s second question. The successful integration of services must depend on close collaboration between the different constituent parts of the NHS but also with adult social care and local authorities. It is striking that already we are seeing this happening in north-west London, as we are in many other parts of the country. For the system to work as we want it to, all the constituent parts need to be effective and efficient. The integration of services, which is one example of how the NHS can become more productive in the future, as well as more clinically effective for patients, is an essential way of ensuring that we have a sustainable NHS in the future.