NHS and Social Care: Winter Service Delivery

Baroness Eaton Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Eaton (Con)]

My Lords, I declare my interests as a vice-president and former chairman of the Local Government Association.

Health and social care are vital services that support our nation. Social care helps to reduce pressures on the NHS, by both supporting people to be discharged from hospital and helping to prevent them needing hospital treatment in the first place. It is an essential public service that helps working-age disabled adults, older people and their carers, as well as promoting well-being and independence.

The money the Government have brought forward for both the NHS and social care is welcome, particularly during the winter, when there are increased demand on services but, as we have heard, the timing of such allocations needs to be more realistic to be really helpful. It is also encouraging, as mentioned by the noble Baroness, Lady Pitkeathley, that the Government have included “social care” in the Secretary of State’s job title and appointed a Minister in the department with responsibility for the service. This shows that health and social care should now be afforded the same level of political importance across government.

A great deal of the public debate this winter has focused on problems associated with the delayed transfer of care, particularly as the pressure increased on NHS beds and staffing. Local authorities remain committed to supporting people as they are discharged from hospital. It is positive that councils have reduced delayed transfers of care attributable to social care by 20% since July 2017, which was when the Government first introduced the target. As the noble Baroness, Lady Wheeler, said in her opening remarks, citing the LGA, delayed transfer of care is a symptom, not the cause, of the pressures on the NHS. In many cases, the solutions are additional investment in prevention, primary care, community services and initiatives that keep people out of hospital.

It is crucial that, in the important debate on how we make sure our NHS is funded, we do not lose sight of social care. We cannot have a sustainable health service without sustainable, and sustainably funded, social care. The LGA estimates that social care faces a £2.3 billion funding gap by 2020. According to the LGA, the financial situation is making it increasingly challenging for local authorities to fulfil their legal duties under the Care Act. The message from local government and the wider care and support sector is that the situation is now critical and we need political agreement nationally and locally on the solutions. That is why it is important that we have a national debate about how we ensure high-quality, sustainable health and care services in future. With this in mind, I welcome the Government’s commitment to bring forward a Green Paper on social care by the summer.

In my closing remarks, I ask the Minister whether, further to suggestions being made by Members in the other place and by the noble Lord, Lord Macpherson, today, the Government are considering hypothecated tax for the NHS. If they are, will the option be consulted on in the Green Paper as the Government look at the funding model for social care? Our health and social care services are essential to the nation’s well-being. These services look after people when they need it most, care for them and help them live healthy lives. We need to work hard across this House, in the other place and with national and local government to find political agreement on how to ensure that we can continue to provide a high level of care for generations to come.

Care Bill [HL]

Baroness Eaton Excerpts

Wednesday 9th October 2013 Lords Chamber

[Lord Shipley (LD)]

My Lords, I rise to support Amendments 15 and 23. I would draw attention to a welcome tribunal judgment in Middlesbrough last week concerning the decision by Redcar and Cleveland Council on the under-occupancy charge. A woman, who is disabled, won an appeal against the decision of her local council which the council claims it took in line with DWP guidance. The tribunal concluded:

“In considering whether there is under-occupation of the appellant’s property, the local authority have not taken into consideration her disabilities and her reasonable requirements, as a result of these, to sleep in a bedroom of her own”.

Redcar and Cleveland Council said that it had properly applied the law as it stood when it decided this case but that the tribunal had introduced an additional test of reasonableness which did not appear in the Department for Work and Pensions guidance. Amendments 15 and 23 would remove a great deal of the doubt that has now been raised. Amendment 23, which refers to access to suitable living accommodation, must include access to suitable sleeping accommodation. That requires there to be a separate bedroom if reasonably required. Amendment 23 would also make it clear that there is a requirement on a local authority to provide access to suitable living accommodation for a person who needs a specific amount of accommodation to enable them to lead a full life.

There is now a great danger for the Government in a large number of tribunal hearings as a consequence of the decision that was made in Middlesbrough last week. One way of avoiding this is for the Government to give a clearer definition of what “reasonableness” is. Amendments 15 and 23 define what is reasonable. I hope that the Minister will agree to look further at this issue in order to ensure that adults who have care and support needs have access to suitable living accommodation. That is clearly not the case at present and it is unfortunate that a large number of people with disabilities are being placed in an impossible situation because of the under-occupancy tax.

[Baroness Eaton (Con)]

My Lords, I rise to support Amendments 15 and 23 in the name of the noble Lord, Lord Best. Contemplating the need for changes in lifestyle, managing illness and losing the ability to live independently are very daunting and stressful experiences for many elderly people. The proposals in Clause 4 for local authorities to provide information and advice are crucial in enabling people to have the knowledge they need to make decisions with which they feel comfortable. It does seem that the Bill as drafted has a major omission—the absence of advice on housing options.

I worked as a councillor in a northern metropolitan area for many years. I noticed on many occasions that elderly people were totally unaware of some of the opportunities that were available to protect them. I will give the House one example. An elderly lady asked whether I could help her by getting the electricity board to repair the light on the other side of the footpath across her garden. When I pursued the case, it transpired that because this lady was physically infirm, she was unable to reach her bathroom and lavatory, so she was crossing her garden in the depths of winter to use an outside lavatory. The reason she needed the light was in order to get to it. She was totally unaware of the possibility of making adaptations, with help from the local authority, to provide her with a downstairs bathroom. These kinds of incidents reflect the reality of what elderly people know about in terms of services. It is not good enough to say, “They will find out about them somewhere”. If it was part of this provision, that would be a great advantage to all.

My elderly parents lived at home until they were in their 90s. My father was 96 when he died, and my mother was 95. They were fortunate because I was aware of the adaptations that could be provided for them—small things such as grips, handrails and the like. They enabled my father to cope with the infirmities of my mother and for the two of them together to enjoy independent living. But, as I have said, most elderly people are not aware of this provision. When looking at options for care, most people would not think of asking the local authority about housing options. As a local authority person, I am always cautious of giving extra tasks to local authorities, but I know that this part of the Bill would not create a huge burden because local authorities already provide information about the care-related housing options that are available in their area. The point is that those options are not joined up and they do not come under the provision that this clause as drafted would give. I strongly support the amendments of the noble Lord, Lord Best.

The issue of the shaping of markets under Clause 23 is also important. We are always in danger of the right hand not knowing what the left hand is doing. Criticism is made of departments doing one thing on the one hand and another thing on the other. There is now a requirement on planners to look ahead and make provision for the numbers and types of homes that are needed. Surely the two things should be brought together as indicated and that health provision should advise and direct the planning process in terms of what will be needed in the future. I warmly support both amendments.

[Baroness Masham of Ilton (CB)]

My Lords, I apologise for having only just come into the Chamber, but I have been at an important meeting with representatives from a children’s heart unit. However, this Bill is also important, particularly these amendments. What the Minister gives us assurances about in this House does not always happen on the ground. The matter of housing provision for disabled people has caused aggro up and down the country. People are worried about it. If the Minister can be helpful today, that will do a lot of good.

Care Bill [HL]

Baroness Eaton Excerpts

Wednesday 3rd July 2013 Lords Chamber

[Baroness Eaton]

I endorse what the noble Baroness, Lady Howarth, has just said because I am firmly of the belief that it will take time to find all the appropriate people for the move which the CQC has clearly said it would make, from generic to specialist inspectors. I am sure that this will make a huge difference to the outcomes of inspections. I, too, think that we should give this organisation time. From what I have seen, it has the drive and the initiative to make sure that things improve enormously.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, this has been a very useful debate and in addressing this group of amendments, it might be helpful if I began by setting out why we believe this clause is necessary.

At the moment, there is no straightforward way for members of the public to get a clear view of performance in hospitals and care homes, nor is there a measure to help drive up performance, so we believe that a new system is needed to give patients and the public a fair, balanced and easy to understand assessment of the quality of care provided. Clear ratings on performance will help to incentivise providers to improve their services, as they will be able to see how well they are doing. One of the central principles behind this clause is that it will enable the CQC to develop the new performance assessment system—informed by the views of stakeholders, of course, but nevertheless independent of government. In its report into ratings, the Nuffield Trust said:

“While there is a legitimate role for … government … to influence priorities, the process should largely be sector-led including the public and users”.

I am rather pleased that we did not debate this group of amendments on the previous Committee day because the CQC has, in the mean time, published a consultation on changes to the way in which it regulates, inspects and monitors care. I draw that to the attention in particular of the noble Lord, Lord Campbell-Savours, whose points I will address in a moment. This consultation, A New Start, sets out the commission’s initial thinking on the timetable for implementing ratings. The consultation document also sets out some detailed thoughts on how the CQC will rate NHS acute hospitals. I take the point made by the noble Lord, Lord Sutherland: this rating process will have to have some fundamental differences from that followed by Ofsted. However, the ratings will be based primarily on inspection judgments. They will be informed by a series of indicators, using data already available and the findings of other bodies such as those from accreditation schemes, clinical peer review and the judgments of other regulators. The CQC will be consulting on this model more fully later this year.

Noble Lords have raised concerns about the ability of a rating system to reflect the complexity of NHS acute hospitals. I assure the Committee that both the CQC and the Government are fully alive to this risk. The CQC is committed to producing ratings at a level which recognises the complexity of NHS services and is useful to people who use them, as well as those who commission NHS care. It is therefore proposing to provide ratings for certain individual services, such as emergency and maternity services, as well as for each hospital.

A rating will also be provided against each of the CQC’s key questions. They are: is the service safe? Is it effective? Is it caring? Is it responsive to people’s needs, and is it well led? This will mean that where the evidence is available, a trust would have five ratings at three different levels—for the individual service level, for the hospital site and for the whole trust. I am sure that noble Lords will agree that this is an ambitious aim, and one that seeks to reflect the complexity of the organisations that provide care.

The Government will draw up regulations that will enable the CQC to develop the programme of performance assessment in the manner outlined in A New Start. The consultation is the first small, but important, step in the process of developing a robust system of performance assessment of providers of health and adult social care. The first ratings of acute hospitals will appear at the end of this year: I will come on to the timetable in a moment. This will be another significant step in developing a ratings system, but it will not be the end of the journey. The Government are clear that the development of ratings will be a process of continuous evolution.

Amendments, 74, 75, 76ZA, 76ZZA and 76ZAA set out areas that the CQC must or could consider as part of its performance assessment of providers. These amendments would mean that the CQC would be required to include or consider the specific issues raised as part of its methodology. The Government share the view of noble Lords on the importance of the issues they have raised through these amendments. I am sure we can all agree that they are useful ideas. However, I hope that they will equally accept the importance of the central principle that we believe should be adhered to: that the CQC should be given freedom to develop its own methodology for the new performance assessments. The clause is deliberately designed to be flexible in that sense. I therefore hope that noble Lords will be content to withdraw their amendments, in the knowledge that the CQC is ready and willing to listen to all good ideas as it puts its final plans together.

The noble Lord, Lord Hunt, has also tabled Amendment 76ZB, which would require the CQC to undertake a pilot of its new performance assessment system and require the evaluation report to be approved by Parliament. The Government agree that the CQC’s new performance assessment methodology should be subject to evaluation. This is why, in our response to the Francis inquiry, Patients First and Foremost, the Government made the commitment that:

“The Department of Health will commission an independent evaluation of the operation of the new ratings system, and this will inform future adaptations”.

The amendment would give Parliament a power of veto over the methodology which the CQC develops for performance assessment. This is not desirable as it would constrain the freedom of the CQC to act on the findings of its consultation with stakeholders. I therefore hope that noble Lords will be content not to move that amendment.

Amendment 74A would require the CQC to undertake performance assessments of commissioners of healthcare services, specifically clinical commissioning groups and NHS England. The wording of Clause 80 could enable the CQC to undertake reviews of local authority commissioning of adult social care services. The absence of a similar requirement for healthcare commissioning therefore requires an explanation. The requirement for the CQC to review healthcare commissioning was removed by the Health and Social Care Act 2012 on 1 April 2013 when primary care trusts were abolished. This is because the function of supporting the development of the commissioning system for healthcare in England has become the responsibility of NHS England. NHS England’s role is to determine how the performance of healthcare commissioners, including clinical commissioning groups, is assessed and managed. There is therefore no need for the CQC to carry out a virtually identical role. I trust that the noble Baroness will be content to withdraw her amendment, but I would like to address the particular points raised.

Health: Children's Heart Services

Baroness Eaton Excerpts

Wednesday 12th June 2013 Lords Chamber

[Earl Howe]

I can readily agree with the right reverend Prelate. I think it is illustrative of the IRP’s approach that in its press release it states:

“The critical factor to consider, in the Panel’s view, is that engagement of all interested parties is the key to achieving improvements for patients and families without unnecessary delay. There is now a real opportunity to involve patients, the public and other stakeholders in taking work forward as set out in the Panel’s recommendations”.

I endorse that view wholeheartedly, and it is a point that has been directly picked up by NHS England in its press release today.

[Baroness Eaton]

My Lords, will my noble friend give an assurance that when calculating where centres should be located, account is taken not just of population numbers, but of the make-up of that population? He will know, for example, that children of Asian descent have greater need for these services than other communities, making up 23% of cases at Leeds. Their faster growing population must be taken into account.

[Earl Howe]

I hope that my noble friend will be reassured by the IRP’s recognition that the location and geography of these centres and where they are in the country are material factors in this equation. At the same time, I think it would be wrong to give the impression that one can establish a centre of expertise of this kind in every city; that is clearly not realistic. Merely because there is a certain density of a population in a location does not mean to say that there can be a children’s heart centre very close to the centre of that population. This is a highly specialised service and we must recognise that the centres that will deliver it will be few in number. Nevertheless, I am sure that the message that my noble friend has given will not be lost on NHS England.

NHS: Leeds General Infirmary

Baroness Eaton Excerpts

Tuesday 23rd April 2013 Lords Chamber

Asked by

[Baroness Eaton]

To ask Her Majesty’s Government what was the extent of their involvement in the decision to suspend surgery at the Leeds General Infirmary Children’s Heart Unit.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Government did not play any role in the decision to suspend children’s heart surgery at Leeds. By agreement, this was a local decision taken by the trust, in agreement with Sir Bruce Keogh, NHS England’s medical director, and the Care Quality Commission. The Government strongly believe that it was the right thing to do. It is absolutely right that the NHS should act quickly and decisively if there is any evidence that patient safety may be at risk.

[Baroness Eaton]

I thank the Minister for his Answer and for the concern that I know he shares for those who have been affected by the decision. We all wish to see the safest surgery possible for our children. The Minister quite rightly understands that specialist doctors and experts, not politicians, should be responsible for asking and answering questions of safety. In the particular circumstances of Leeds, however, a number of the experts—

[A noble Lord]

Question!

[Baroness Eaton]

My question is coming. The experts in Leeds have been causing understandable concern because of their partiality and apparent vested interest. In Bristol and Birmingham, children’s heart units have recently had mortality alerts and 14 NHS trusts are under investigation. Will the Minister explain why surgery has not been suspended at any of those trusts? Will he also explain why NHS England has chosen to spend resources appealing the decision of the High Court judge, who called the Safe and Sustainable review of children’s heart units flawed, when the decision for the Independent Reconfiguration Panel and the Secretary of State is imminent?

[Earl Howe]

My Lords, my noble friend raises quite a large number of points. I simply say to her that in regard to Leeds, which is the matter on which I have been briefed, the decision to suspend surgery was taken because concerns had been raised from a variety of sources about the safety of surgery at the unit. Mortality data were supplied to the National Institute for Cardiovascular Outcomes Research with significant flaws, and until those flaws had been rectified, it was impossible to be sure that the trust was operating within acceptable mortality thresholds. Those mortality concerns have, I understand, been resolved, which is why low-risk children’s cardiac surgery has been resumed at the hospital. However, NHS England’s appeal on the Safe and Sustainable review—which, I emphasise, is quite separate from the events of late March and early April—has to be a matter for NHS England. The review of children’s heart services was an NHS review, independent of government, and if NHS England wants to appeal the decision and thinks that there are good grounds for doing so, that is a matter for it.