Social Mobility

Debate between Baroness Farrington of Ribbleton and Earl Howe

Monday 20th February 2017 Lords Chamber

[Baroness Farrington of Ribbleton (Lab)]

My Lords—

[The Minister of State, Ministry of Defence (Earl Howe) (Con)]

My Lords, it is the turn of the Cross Benches and then, if we have time, we can hear from the Labour Benches.

Gender-based Violence: Screening

Debate between Baroness Farrington of Ribbleton and Earl Howe

Monday 9th March 2015 Lords Chamber

[Earl Howe]

My Lords, NHS England is working with the Department of Health to identify the right pathways, access to and availability of psychotherapeutic support for victims of sexual abuse and, in that context, the risk factors at play for women who have HIV. It is vital that the support services that we have and the alerts in the system are sensitive to the issue which the noble Baroness raises.

[Baroness Farrington of Ribbleton (Lab)]

My Lords, would the Minister care to reassure the House on the progress towards parity between mental health services and the rest? It is no good identifying people who need mental health service support and psychological support if those services are not there, and in many parts of the country they have been decimated.

[Earl Howe]

My Lords, we are concerned about the sometimes patchy provision of mental health services in certain parts of the country, and we have channelled additional money to address that in recent months. One of the main ways in which we have demonstrated our commitment to parity of esteem is by introducing, for the first time, waiting-time standards for mental health treatment. That it is a landmark.

NHS: Financial Tariff for 2015-16

Debate between Baroness Farrington of Ribbleton and Earl Howe

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

This is part and parcel of the discussions going on at the moment. There is a balance of interests here—above all, the interests of NHS patients, but within the system, the interests of those who hold the budget and the interests of those who provide the service. The risks relate, on the one hand, to affordability, and, on the other hand, to financial and service stability, and the need not to sacrifice quality in the process.

[Baroness Farrington of Ribbleton (Lab)]

My Lords, would the Minister care to comment on his former colleague in his department who views the reorganisation of the National Health Service as the biggest mistake this Government made? As we come towards the end of this coalition Government, some of us watch in horror as an increasing number of people within the coalition stand up and say, “It weren’t me, guv”, and, “I didn’t agree with it”. Does the Minister accept that his party, this coalition and the Liberal Democrats did not actually ask the people whether they should do this? They told them that they would not do it.

[Earl Howe]

My Lords, I remain a staunch defender of the 2012 Act. In this context, the 2012 Act did two things that were different. It gave responsibility for setting the tariff to an independent body instead of to the Department of Health and Ministers. I believe that that was a good thing. It also provided a statutory right, which did not exist before, for the NHS to be consulted on the tariff. I believe we should keep those two elements of the Act—as well as the rest of it.

Health and Social Care Act 2012: Risk Register

Debate between Baroness Farrington of Ribbleton and Earl Howe

Wednesday 9th July 2014 Lords Chamber

[Earl Howe]

I agree completely with my noble friend. The Commonwealth Fund report covers the period from 2011 to 2013—exactly when we were in the middle of reforming the NHS. The findings of the report were a credit to all those working on the front line of the healthcare system throughout that period of change.

[Baroness Farrington of Ribbleton (Lab)]

My Lords, the Minister is right to refer to that report, which I believe was based on 2011 figures. Does he accept that it is not politicians who are entitled to see the risk register but the public, particularly when the coalition Government promised separately and together that there would be no top-down reform of the health service? Are the public not entitled to know what regard this coalition Government have to the public’s need to know? The public want to know if the risk register identified risks post-2011.

[Earl Howe]

The noble Baroness is absolutely right. The public are entitled to know the areas of risk identified by the Government at the time that the transition risk register was drawn up. That is exactly why I laid out for the House a comprehensive list of the areas covered by the risk register on 28 November 2011. That was a full list, which nevertheless did not disclose the actual content of the risk register. That is the balance that I believe any Government are entitled to strike. The public are therefore in a position to judge how well the system has done.

Mental Health: Social Work

Debate between Baroness Farrington of Ribbleton and Earl Howe

Monday 23rd June 2014 Lords Chamber

[Earl Howe]

My noble friend makes an extremely important point about continuity of care. Not only is this important in terms of sheer administration; it is vital for the health of the service user or patient, as the social worker is very often the key point of contact for vulnerable people living at home and maybe on the brink of being admitted to NHS in-patient care. My noble friend makes a very good point. If I can amplify those remarks in any way I will write to her.

[Baroness Farrington of Ribbleton (Lab)]

My Lords, will the noble Earl join me in saying that, important though they are, it is not only patients with mental health issues who need help and support? Many young people in particular live at home with people who previously may have been inside a hospital and now quite rightly are being treated in the community. Those children and young people are in many cases coping with circumstances where adults would find it impossible to work. Will the noble Earl ensure that, in looking at this, the needs of those young people are borne in mind, not least because many of them fail in school because of the pressure they are under at home?

[Earl Howe]

The noble Baroness makes a series of extremely well put points. That is why we are looking at a number of ways to bolster the services that children receive from mental health services and professionals. We have the Children and Young People’s Improving Access to Psychological Therapies programme, as she knows. We are taking forward options for a new survey on how many children and young people have mental health problems, which is of course important for planning. New guidance published last week by the Government will help teachers to better identify underlying mental health problems in young people, and NHS England is currently reviewing children and young people’s in-patient mental health services so that we can see where there are pressures in the system and how money is being spent.

Health: Midwives

Debate between Baroness Farrington of Ribbleton and Earl Howe

Monday 25th February 2013 Lords Chamber

[Earl Howe]

The noble Baroness raises another important point. This will be a particular issue for the local education and training boards, which we are setting up under the auspices of Health Education England, to get a local feel for the needs of patients in an area. The language skills of midwives will be a very important ingredient of that.

[Baroness Farrington of Ribbleton]

My Lords, in the light of the original Question of the noble Baroness, Lady Cumberlege, would the Minister advise the House as to whether NICE will be asked to produce guidelines based on what it believes is needed or based on the current shortfall in midwives? If it is based on the current shortfall, we will suffer the same problems.

[Earl Howe]

As I mentioned, we are doing our best to address the shortfall in the number of midwives in training. However, NICE has been asked to produce a quality standard that will be a benchmark against which the quality and outcomes of midwifery practice can be judged.

NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012

Debate between Baroness Farrington of Ribbleton and Earl Howe

Tuesday 5th February 2013 Lords Chamber

[Earl Howe]

I am surprised to hear that. My understanding is that that is not so and that local Healthwatch, as a social enterprise, is being treated on the same footing. My advice is as any other, but if I am wrong about that, naturally I will write to apologise to the noble Lord and copy all speakers into my letter. As I have said, I completely understand that the wording of parts of these regulations appears complicated. In answer to the noble Lord, Lord Collins, I should say that for that reason I can commit to my officials working with Healthwatch England and the Local Government Association to publish clarificatory material on this.

Having said that, I was slightly surprised that the noble Lord, Lord Warner, cast aspersions on Regulation 41. He asked how small organisations could understand the requirements set out in it. The matters set out in Regulation 41 are matters to be included in local authority contracts with local Healthwatch. In fact, these are based largely on the existing regulations on LINks. I have to say that it has not been previously suggested to us that these have been difficult to understand or are disproportionate.

The noble Lord, Lord Collins, asked me who was consulted before the draft regulations were published and whether Healthwatch England was consulted. We consulted a range of stakeholders, including LINks, local authorities, voluntary and community organisations, NALM, Social Enterprise UK, the Charity Commission and providers on the issues relating to the drafting of the local Healthwatch regulations. That included the Healthwatch England interim team.

[Baroness Farrington of Ribbleton]

I have listened very carefully to the Minister, who I know is trying to be helpful to your Lordships’ House. But I still do not understand who exactly judges, in the cases to which he has referred, whether particular campaigns are appropriate, local or acceptable, or whether it would refer to anyone apart from those who may have a role in funding or developing policy to which Healthwatch may object.

[Earl Howe]

The activities of Healthwatch will be governed by a contract with the local authority. The local authority’s duty will be to hold the local Healthwatch to account according to that contract. If the local Healthwatch were to stray outside the boundaries that I have set out as to what a reasonable person would interpret as legitimate activities and stray into the territory of being a political party adjunct, it would be the duty of the local authority to make a judgment about that. It would be a matter of judgment, but it would be important for the local authority to make its views rapidly known to the local Healthwatch to ensure that it retained the role that it should have, which is a role that primarily involves community benefit. There are checks and balances in the system, and those responsibilities are held primarily by the local authority.

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[Earl Howe]

That is not what I am saying. As I said earlier, it will be important for a local Healthwatch in any campaigning or public statements to assure itself that it is truly representing local people and patients, and has the evidence to back that up. If it does, and if it can show that what it is saying is genuinely supported by local people, it has nothing to fear. It is only where the Healthwatch may latch on to one or other political party without reference to local people that it may be vulnerable.

[Baroness Farrington of Ribbleton]

I am sorry, my Lords, but the noble Earl is not answering the point about who makes the judgment. The noble Lord, Lord Greaves, and I have served on the same local authority. I can think of occasions when, had he or I joined Healthwatch and formed a campaign, it is quite possible that either he or I on the local authority could have taken a totally different view about what was happening. I want to know who the independent arbiter is of whether the local Healthwatch is actually doing something that it should not do, or something that the noble Lord, Lord Greaves, or I did not happen to like, because they are two very different things.

[Earl Howe]

They are two different things, and I say to the noble Baroness that we are dealing here with a relationship that she may characterise as overly arm’s length. It is in the direct interests of a local authority to make sure that it has a good, thriving relationship with its local Healthwatch but that it is not tarnished by party political considerations that are irrelevant to the concerns of local people. The very fact that a local Healthwatch comes out with a political statement is not to damn its activity. What makes it vulnerable is if that local Healthwatch cannot show that it is truly representing local people as it speaks out. That is a matter of evidence and of fact.

The independent arbitration that the noble Baroness talks about should not be necessary. The matter could, in the final analysis, be decided in a court, although one hopes that that would never happen. However, in the end, the local authority has to exercise its judgment, and in doing so has to act reasonably and in good faith as a public authority. If it does not, it is acting unlawfully. I hope that that is of help to the noble Baroness.

I was asked a number of other questions by my noble friends Lady Jolly and Lady Cumberlege. My noble friend Lady Cumberlege asked me whether, if there were a controversial policy, say, to close an A&E department, a local Healthwatch would be permitted to provide evidence about patient experiences to campaigners on that issue. Yes. In that scenario, we would envisage a local Healthwatch taking those very views and evidence of good standards of service directly to the commissioners or decision-makers. A local Healthwatch can also make a referral to the health scrutiny function of the local authority, which would be required to keep a local Healthwatch informed of any action taken. If a local Healthwatch thought, as part of its Section 221 activities—patients’ public involvement activities—that local people need to know what their community’s experience of its A&E is, we would certainly expect the local Healthwatch to be transparent and make that evidence known.

My noble friend asked whether people who had been active in a national campaign could be decision-makers in local Healthwatch organisations. The regulations do not set out membership of a local Healthwatch, so it will be down to the local Healthwatch to decide whether such people can add value to the outcomes that it wishes to achieve for its local people. Local Healthwatch has to be different; it has to build up its reputation and credibility in order to secure the public’s confidence that it can have a mature relationship with local authorities, which was the point that I made just now. The regulations seek to ensure that local Healthwatch does not carry out the relevant political activities as its only or main activity. That would not meet the community benefit test.

Would local Healthwatch be subject to purdah? No, it would not. I repeat that it has been set up to be the local consumer champion, and as such its role becomes very important in getting people’s serious concerns listened to and acted upon.

My noble friend Lady Jolly asked me several questions. She expressed the fear that the regulations would render local Healthwatch a mere proxy voice. I emphasise to her in the strongest terms that that is not so. As I have explained, we have sought through the regulations to be as inclusive as possible of people who may wish to give up their time to do what they feel passionately about doing. To be frank, LINks, which is the arrangement that we have at the moment, have all too often been associated with white, middle-class men, and we need local Healthwatch to embrace diversity much better.

Could the manager of a care home sit on its local Healthwatch? Yes, he or she could get involved in their local Healthwatch, but it would be good practice for the Healthwatch in its governance arrangements to have procedures for a code of conduct, and, as set out in Regulation 40, it would be required to have and publish procedures before making any relevant decisions. That is essentially about transparency.

Could a local profit-making provider of primary care be a local Healthwatch contractor, and could its manager sit on the local Healthwatch decision-making group? Again, it would be up to the local Healthwatch whom it wishes to contract with for their expertise to help it deliver its statutory activities.

On the role of local Healthwatch to provide information and signpost people to choices, the decision rests with that individual seeking out the options available to them. We would expect local authorities’ arrangements with local Healthwatch to be robust so that it acts effectively. The local authority will be under a duty to seek to ensure that the arrangements are operating effectively and provide value for money.

My noble friend suggested that the department’s interpretation of lay involvement boils down simply to the foot soldier role. I do not agree. It would be a wrong picture to paint to the public about how a local Healthwatch discharged its obligations. The obligations are quite clear. Engagement, consultation and participation are all words that can be used to describe different types of involvement activity. Referring to “involvement” therefore provides for flexibility, as I indicated earlier.

Could the decisions listed in Regulation 40(2) be made by a decision-making body within a local Healthwatch composed of a majority of people who happen to be health or social care managers? No. Regulation 40(2) must be read with Regulations 40(3), 40(4) and 40(1)(a). The requirement to be imposed on local Healthwatch in the contracts is to have and publish a procedure for involving lay persons or volunteers in such decisions. As stated in the advice to the Secondary Legislation Scrutiny Committee, the plain provision of information would not in most cases comply with the obligation to involve; the involvement has to be in the making of the decisions.

I hope that I have covered satisfactorily all the questions put to me, and I hope that the noble Lord, Lord Collins, will be sufficiently reassured to withdraw his Motion.

NHS: Clinical Commissioning Groups

Debate between Baroness Farrington of Ribbleton and Earl Howe

Wednesday 16th January 2013 Lords Chamber

[Earl Howe]

I can give the noble Lord that reassurance. ACRA is not a new committee; it has been long-established, and was a fundamental part of the previous Administration’s approach to funding allocations. I can say to the noble Lord that, by using diagnosis information, the formula that has been adopted for CCGs directly picks up a great deal of the increased prevalence of ill health due to deprivation. It also takes account of the proportion of the population in social housing and in semi-routine occupations, and the number of DLA claimants, which is closely related to deprivation.

[Baroness Farrington of Ribbleton]

Will the Minister assure the House that, if the board is able to find a formula more reflective of local need in terms of poverty and deprivation, the Government will look at it? They appear not to take such factors properly into account when looking at the revenue support grant which provides services for people in poverty. I declare an interest as someone who lives in Preston, Lancashire, whose needs are being met with a government cut. I am sure that the noble Earl would not approve of that.

[Earl Howe]

I am pleased to say to the noble Baroness that there has been no cut at all in the allocations to clinical commissioning groups. Indeed, there is a real-terms increase everywhere in the country. I can also reassure her that this will not be a matter for Ministers; it will be decided independently by ACRA advising the board and the board taking the decision.

Department of Health: Budget

Debate between Baroness Farrington of Ribbleton and Earl Howe

Thursday 6th December 2012 Lords Chamber

[Earl Howe]

Yes, my Lords. As the noble Lord will know, the problem of delayed transfers of care is not new. We have seen a drop in delayed transfers in terms of the number of days but there has been a levelling off in recent years. However, it is up to the NHS and social care services to collaborate to ensure that proper and appropriate community services are available to patients when they are discharged from hospital. That planning process begins the moment the patient enters hospital.

[Baroness Farrington of Ribbleton]

My Lords, the Minister very unusually failed to answer my noble friend Lord Warner’s question as to why the money that has gone back to the Treasury could not have been used to meet the needs of the patients to whom the noble Lord, Lord Laming, referred.

[Earl Howe]

My Lords, I apologise. I addressed part of the noble Lord’s question in relation to the issue around social care. The important point to make about the surplus is that none of the underspend is lost to the NHS. Under Treasury rules, the NHS is allowed to carry forward all underspends to the next year. It is not a case of the NHS having to give up any money and thereby depriving patients of treatment.

Social Care: Apprenticeships

Debate between Baroness Farrington of Ribbleton and Earl Howe

Thursday 29th November 2012 Lords Chamber

[Earl Howe]

The noble Lord makes some centrally important points. The CQC, which is the regulator of national minimum standards in this area, is very clear that the need to safeguard the vulnerable is one of the most important tasks that it has to assure itself about when inspecting providers. The role that employers play is key here and he is right to point out that it is the responsibility of management to ensure not only that those working for them have the right skills but that there is also the right supervision, for apprentices in particular.

[Baroness Farrington of Ribbleton]

My Lords, can the Minister assure the House that a voluntary scheme will not allow those very people who have a culture of not caring or of neglect—we know that happens from time to time in this sector—not to take up the option of voluntary registration? Surely it is most important in this field that we protect people from the very people who may well not take voluntary action.

[Earl Howe]

My Lords, accreditation by the Professional Standards Authority will help to foster high standards, because it will allow practitioners and people who use services to distinguish more easily between registers that meet nationally accredited standards and those that do not, and therefore between those social care workers who are accredited to a high standard and those who are not. In addition, we have commissioned Skills for Health and Skills for Care to develop a code of conduct and recommended induction and minimum training standards for healthcare support workers, as she will know. The key here is to progress to a system that encourages employers to employ those with the right qualifications and for users to be able to see that the employees in an organisation are accredited.

NHS: Health Tourism

Debate between Baroness Farrington of Ribbleton and Earl Howe

Monday 28th May 2012 Lords Chamber

[Earl Howe]

My Lords, it is incumbent on NHS trusts when a patient presents directly to them to ensure that the person in front of them is entitled to NHS care, and they have various means of doing that. However, primary care in this country—care delivered by GPs—is not subject to any checks of that order.

[Baroness Farrington of Ribbleton]

My Lords, would somebody from anywhere in the world who had a British passport be entitled to NHS treatment were they to be in this country at the time of need?

[Earl Howe]

My Lords, the answer is no because the entitlement to NHS care is and always has been dependent upon an ordinary residence test, so that the mere possession of a UK passport does not necessarily indicate that a person is ordinarily resident.

Health: Cancer Drugs Fund

Debate between Baroness Farrington of Ribbleton and Earl Howe

Monday 14th November 2011 Lords Chamber

[Earl Howe]

My Lords, as I told the noble Baroness, Lady Morgan, discussions are ongoing as to the arrangements that will be in place after the abolition of strategic health authorities. I cannot say that we have definite plans in place but I hope that we will be able to announce our plans soon.

[Baroness Farrington of Ribbleton]

My Lords, cancer treatment drugs are often used in a range of measures to treat people suffering from cancer, including both chemotherapy and radiotherapy. Is it not the case that concern is being expressed about the closure of access to radiotherapy in some hospitals, and that people are having to travel for up to three hours? I understand that this is a problem in Essex and other parts of the country. Does the Minister share the concern about people not being able to get the treatment they need if these centres close? Who is responsible now, and who would be responsible in the future under the Government’s proposals, for ensuring that reasonable access is maintained?

[Earl Howe]

We are concerned to ensure that patients have reasonable access to the treatments that they need, including radiotherapy. I can tell the noble Baroness that part of the additional funding that we are making available under the strategy for cancer that we published earlier this year will go towards widening access to radiotherapy—not only better utilising the facilities that we have but commissioning new facilities. However, I am afraid it is the case that we increasingly see specialised units being concentrated in fewer locations. Unfortunately, this will mean that some patients have to travel a little further than they otherwise would have.

NHS: Cost-effectiveness

Debate between Baroness Farrington of Ribbleton and Earl Howe

Monday 12th September 2011 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. A Written Answer was published in Hansard recently that tracked the changes in productivity of the NHS between 1996 and 2008. He will know if he read it that there was a decrease in productivity over that period of around 3.1 per cent. The pressures on the NHS are increasing. In order for it to respond to the needs of the future, including an ageing population and the cost of new technologies, it needs to adapt to new ways of working that reduce cost pressures while delivering improved outcomes. The measures that are before Parliament seek to do just that.

[Baroness Farrington of Ribbleton]

My Lords, can the Minister give an example of any major reorganisation and restructuring that has not cost more money and put the brakes on improvements in the service that were being made, particularly when the Government bringing in to the system such major changes comprise two parties that said that there would be no major reorganisation of the National Health Service were they to be in government?

[Earl Howe]

I commend to the noble Baroness the impact assessment that we published on the Bill. It shows clearly that, over the next 10 years, the savings that we will bring about will dwarf the cost of making the changes that we propose.

NHS Reform

Debate between Baroness Farrington of Ribbleton and Earl Howe

Monday 4th April 2011 Lords Chamber

[Earl Howe]

I agree with every word my noble friend said. It is illustrative of the truth of his remarks that, in the final year of the Labour Government, the administrative costs of the NHS rose by no less than £220 million. The rise in administrative costs was exponential. My noble friend is right: at the moment we largely have an NHS that is managerially and administratively led, rather than clinically led. We want to reverse that balance.

[Baroness Farrington of Ribbleton]

My Lords—

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[Baroness Farrington of Ribbleton]

Will the Minister give the House two assurances? One is that the Government have done nothing that is not legal in anticipation of the Health and Social Care Bill being passed. Secondly, although he may not have the figures with him, what are the relative administrative costs of private healthcare providers and the NHS?

[Earl Howe]

My Lords, I do not have the figures that the noble Baroness asked me for in the second part of her question. On the first part I can give a categorical assurance: the answer is yes.