Health and Social Care Bill

Baroness Hussein-Ece Excerpts

Wednesday 12th October 2011 Lords Chamber

[Baroness Hussein-Ece]

My Lords, like many in your Lordships’ House, I have had many letters and e-mails from people who are huge supporters of the NHS, many expressing real fear. It is unfortunate that much of the campaign we have experienced has relied on convincing the public that the NHS is set to be privatised. Many are convinced that we are heading for an American-style system and I am sure that we have all had e-mails saying that we do not want to see that. People are also worried that their children and grandchildren will not be able to receive the services that they received in their lifetime. I believe that the politicising of the debate on the NHS to this level is at best unhelpful and at worst irresponsible. It is playing on people’s fears, and I felt quite saddened by some of the e-mails that I have had. I want to see a greatly improved and more responsive health service for my children and grandchildren.

We have huge challenges, as many of your Lordships have already mentioned. We have an ageing population; more and more people will become reliant on health and social care services that must—really must—become more responsive and integrated. We have heard from successive Health Secretaries and successive Governments that it has always been their aspiration to integrate health and social care, but on the ground we know that this has not always been the case. Patients should not be passive recipients of health services. They should be treated as individuals, people who place their trust in their local health service and expect quality of care. I believe the general public have far higher expectations that we probably had when we were growing up.

Like many others, my family has experienced the best and the worst of care, and it is the worst that we need to ensure is consistently always as good as the best; for example, the care and treatment of older people, as the noble Lord, Lord Winston, has just touched upon, is not always very good in many hospitals and remains unsatisfactory. I have a story too. Four years ago when my terminally ill 88 year-old father was left covered in bedsores, with poor pain management and personal care and the loss of his basic dignity, we felt there was no one in the hospital who was prepared to take responsibility for the poor nursing care—I was always sent to speak to somebody else. The stories in the media of older people being denied basic care and dignity are nothing short of a scandal, and unfortunately we still hear them daily.

I remember a document called Hungry in Hospital?, produced a decade ago by the Association of Community Health Councils when the noble Lord, Lord Harris of Haringey, who is not in his place today, was the chief executive. It recorded the plight of many older people who were simply left to starve because there were not enough nurses to assist with the most basic form of care—food. Recent reports unfortunately show that this is still happening. I want to see reforms that ensure that this never happens.

I also want to see a better and properly resourced health and social care system for disabled children, and for child and adolescent mental health services. I received a briefing note, as have many others, I am sure, from the campaign group Every Disabled Child Matters. Disabled children are the fastest growing group in the population of disabled people and they deserve better than the disproportionately lower priority than adults that they receive when it comes to the allocation of funds. Time and again I have dealt with cases, in my previous life as a councillor and more recently, where the individual service may be good or even excellent, but the collective system has let that child down. The current legislation does not provide for this.

Health inequalities remain at a grotesque level for such an affluent country. The NHS alone cannot resolve this. I am concerned that the single most important aspect of the phrase “No decision about me without me” is still at risk of failure. This relates to commissioners’ duty to ensure the involvement of individual patients in decisions on managing their own care and treatment. I worked for years at the forefront of patient and public involvement in the NHS as the chief officer of a community health council in one of the most deprived parts of the country. CHCs were very effective. They were the patients’ voice in the NHS, with a statutory right to be consulted on any changes in their local health services. They were local and they were mainly effective. Cynics at the time suggested that that was why they were unceremoniously scrapped by the last Government in 2003, to be replaced by a plethora of successive patients’ groups at a cost of over £70 million in the first year alone. I welcome the proposals to strengthen patients’ voices, but I have concerns that must be looked at if this Bill is to be properly scrutinised at Committee.

My concerns include the patient and public involvement requirements under both the current legislation and the Bill—that those who use services are involved in planning, changes and decisions affecting how services operate. The definition of involvement is very weak. What does that mean? The National Health Service Act 2006 diluted the involvement of patients and the public so that this could be met simply by giving information. The duty is neither comprehensive nor consistent across commissioners and all types of providers; for example, the proposed PPI duty on Monitor makes no sense, referring to whatever it feels “appropriate”. There needs to be a statutory duty on Monitor to respond to referrals made to it by health overview and scrutiny committees because at the moment it simply ignores them.

I would like to see a much more patient-centred total health and well-being model, which would ensure that the Bill is fit for purpose. I am pleased that the Government have recognised that the powers of health and well-being boards need to be strengthened to ensure the co-ordination of commissioning plans with the health and well-being needs of the area. However, this proposal needs to go further. I was initially a supporter of primary care trusts. I sat on my local PCT board for four years, representing the local authority. We had a good relationship and integrated services, but many of my colleagues across the country simply did not, with local authorities barely having a working relationship with their PCTs.

My local PCT decided to close down a major primary healthcare centre, against huge public opposition. It was put out to consultation and the PCT’s decision was referred to the council’s health and well-being board, where it was properly scrutinised by democratically elected local councillors for many months. When the committee’s report was complete, the PCT board refused even to allow the chair to present the committee’s findings to the board. We were left with a huge conflict. A board of people who were unaccountable to the public and who only answered to the Secretary of State were in the driving seat, refusing to take any notice of a democratically elected health and well-being board. This experience convinced me that the present system needs reforming. Yes, the Secretary of State must be legally and politically responsible for the NHS, but there needs to be more accountability at all levels.

To conclude, I find myself in complete agreement with what the noble Baroness, Lady Thornton, said yesterday. She said:

“Our job is to scrutinise and improve this Bill”.—[Official Report, 11/10/11; col.1480]

I totally agree. She somewhat contradicted herself later by saying that she would support the amendment tabled by the noble Lord, Lord Rea—in other words, no scrutiny of the Bill. However, I am very clear that this Bill needs improving and amending to ensure that we not only improve patient care but give patients and the public greater accountability within the health service and greater confidence. Many of us have welcomed the substantial changes that have already taken place, but I think most of us would agree that the status quo is not really an option.

Health: Multiple Sclerosis

Baroness Hussein-Ece Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

The problem is that, historically, there has been no requirement to publish information on the number of multiple sclerosis nurses. The NHS Information Centre for health and social care extracts data from the electronic staff record and quality-assures the data prior to publication in the non-medical workforce census. The qualified nursing, midwifery and health visiting staff group is broken down only by area of work, so it is quite difficult to keep a handle on this.

[Baroness Hussein-Ece]

My Lords, many people with a long-term condition such as multiple sclerosis are usually in their prime of life and in employment when they are diagnosed. It is therefore important to their well-being that they can continue with that employment as long as they are able to. Can the Minister say whether the government-led initiative Health, Work and Well-being is supporting these people and whether he is satisfied that all employers understand that those diagnosed with multiple sclerosis are protected by the Equality Act and the Disability Discrimination Act, depending on where they live?

[Earl Howe]

My Lords, I am personally involved with Dame Carol Black in a work stream under the Responsibility Deal, which covers health in the workplace. Under that banner, we are emphasising to employers how important it is to understand the circumstances and needs of employees with a long-term condition. I will, however, go back and see whether I can provide my noble friend with a fuller reply.

NHS: Reform

Baroness Hussein-Ece Excerpts

Monday 6th June 2011 Lords Chamber

[Earl Howe]

My Lords, the way we have set out the Health and Social Care Bill means that, wherever possible, decisions on service reconfiguration will be taken at the local level. That will mean that all stakeholders locally, not only the NHS but local authorities, social services and patient groups, will buy in to and contribute to whatever decisions are taken. So my answer to the noble Lord is this: it should be a considered process of decision-making taken locally.

[Baroness Hussein-Ece]

My Lords, as we know, the NHS is the most valued public service in this country. It is one that we all rely on from the cradle to the grave. What are my noble friend’s views about the fact that it is still the most unaccountable public body delivering services that we have? It is still unaccountable to its users. What discussions have been taking place to ensure that the NHS becomes far more responsive and accountable to users?

[Earl Howe]

My noble friend has made a key point. As she will know, patient and public accountability is one of the themes of the listening exercise that we have been conducting. I anticipate that Professor Steve Field and his NHS Future Forum will come forward with some substantive recommendations on how we can improve the arrangements for accountability in the service. I agree with her that it is in practice less than accountable at the moment, and our view is that it should be accountable primarily to patients in the local area but also, crucially, to Parliament as well.

Mental Health: Children in Local Authority Care

Baroness Hussein-Ece Excerpts

Monday 23rd May 2011 Lords Chamber

[Baroness Hussein-Ece]

Does my noble friend share my concerns that significant numbers of black and minority-ethnic children in the care system suffer from mental health problems, but do not receive the appropriate intervention and support until it is far too late and they have already become involved in the criminal justice system? Will my noble friend tell me what is being done to ensure early intervention, treatment and support for these young people and children?

[Earl Howe]

My noble friend is absolutely right. She will know that minority-ethnic groups appear to be overrepresented in the looked-after population. Around 3 per cent of the child population of Great Britain is from black, black British or mixed groups, but 8 per cent of looked-after children are black and 7 per cent are from mixed groups. She is right that there is a problem. She is also right that early intervention is key. There is a strong emphasis on public mental health in the mental health strategy. The good foundations are down to early intervention, as I mentioned, and we are clear that this is a priority for the Government.

NHS: Waiting Times

Baroness Hussein-Ece Excerpts

Tuesday 3rd May 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness is right to raise the question of consultant numbers. I simply say that one of the clinical indicators that we have set for A&E is that there should be consultant sign-off. That in itself should encourage consultant capacity over time.

[Baroness Hussein-Ece]

My Lords, attendance at A&E has steadily gone up by more than 1.3 million over the past five years. How much is this the result of the lack of access to GP out-of-hours services? Is it not the case that too many people are presenting at A&E who should be seen at a primary care setting?

[Earl Howe]

My Lords, I agree with my noble friend completely. That is why we are quite clear that general practitioners have to take much greater direct responsibility for out-of-hours care. At the moment they can, if they choose, divorce themselves from that responsibility and I think that was a retrograde move. Equally, we are clear that we should encourage general practitioners to look at ways of avoiding unplanned emergency admissions to hospital in the first place. That will reduce pressure on A&E.

Health: Influenza Vaccination

Baroness Hussein-Ece Excerpts

Thursday 20th January 2011 Lords Chamber

[Earl Howe]

My Lords, the main lesson is one to which I referred a minute ago. We are considering bringing back into central procurement the purchasing of the seasonal flu vaccine, which is an exception to the normal rule. We purchase most vaccines centrally, apart from that one. There is a lot to be said for changing the ordering system so that we can keep better track of supplies and, perhaps, have more cost-effective procurement at the same time.

[Baroness Hussein-Ece]

My Lords, I read a report in the media last week saying that, in light of the high incidence of children under five contracting flu, the Government are preparing to examine new evidence from the advisory group that could allow for all under-fives to be vaccinated. Have the Government reached a view on this?

[Earl Howe]

We have not reached a view on this because the JCVI’s advice remains unchanged. In fact, current evidence shows that children under five are not the age group with the highest risk of death. The age group with the highest risk of death from the flu that is circulating currently is middle-aged adults. Nevertheless, those with risk factors have the highest risk of severe disease and death from flu compared with healthy age groups. However, I can tell my noble friend that nothing is set in stone. We do not wish to constrain the JCVI in any way and we will listen to its advice, as we always do.

Health: Influenza

Baroness Hussein-Ece Excerpts

Tuesday 11th January 2011 Lords Chamber

[Earl Howe]

My Lords, it is quite difficult to substantiate that suggestion, because the immunisation figures do not bear out the noble Baroness’s argument. The level of vaccine uptake in the over-65s is 70 per cent, which is better than in most countries of Europe. Among the at-risk under-65s, it is 45.5 per cent, which is comparable to the past two years. Therefore, it is not clear that a generalised campaign would have added value.

On the question of pregnant women, the normal procedure is for the Chief Medical Officer to write to all GPs in the summer, setting out all the at-risk groups. She did that in June. We were then alerted in December by the Health Protection Agency to a worryingly high number of pregnant women who had contracted influenza, so we wrote to both the BMA and the Royal College of Midwives to emphasise the desirability of encouraging that group of patients to get vaccinated. We did the right thing, which was to respond to emerging data.

[Baroness Hussein-Ece]

My Lords, is it the case that the highest rate of flu has been among those aged one to four? Have the parents of children in that age group been encouraged to have their children vaccinated over and above others? Also, have the Government changed their policy of publicising the need for the flu jab, which they did during last year’s outbreak?

[Earl Howe]

We did see a higher than expected number of under-fives contracting influenza, so we took urgent advice from the Joint Committee on Vaccination and Immunisation in December and asked it to confirm its previous advice that not all under-fives need get vaccinated unless they were in an at-risk group. It confirmed that advice and we have followed it.

Health: Parkinson’s Disease

Baroness Hussein-Ece Excerpts

Monday 10th January 2011 Lords Chamber

[Baroness Hussein-Ece]

My Lords, I congratulate the noble Baroness, Lady Gale, on securing the debate. I also pay tribute to the tireless work that she has done in chairing the All-Party Parliamentary Group for Parkinson’s Disease, which is a disease that, like other long-term conditions, can have a devastating impact on patients and their families. As we have heard, one person in every 500 has Parkinson’s, which equates to about 120,000 people in the UK.

Like those who suffer from other progressive neurological conditions, Parkinson’s sufferers and their families are entitled to a standard of care and treatment no matter where they live in the UK. When the national service framework for long-term neurological conditions was published in 2005 after considerable consultation with patients and groups, the framework was very much welcomed because it set out 11 quality standards with the aim of reducing differences in the treatment, care and support for people with long-term conditions—including Parkinson’s disease—to ensure that their care is more accessible and better co-ordinated.

The national service framework applies to health and social care services that work with local agencies involved in supporting people to live independently. Such services include providers of transport, housing, employment, education, benefits and pensions. When the framework was first published, a main target was to reduce emergency bed days by 5 per cent by 2008 through improved care in primary and community settings for people with long-term conditions. As we have heard, there are places in the country where the target has been met successfully—for example, in north Devon, the provision of a Parkinson’s nurse has helped to reduce emergency admissions by 66 per cent—but that has not happened in other places. Will the Minister perhaps comment on the accessibility of such specialist nurses around the country?

Patients with Parkinson’s disease continue to suffer delays in diagnosis and in access to specialist treatment because of appalling gaps in NHS care, as the All-Party Parliamentary Group for Parkinson’s Disease report mentions. The report also found severe inequalities in access to services across the country. At the time, there was a chronic shortage of specialist nurses. The report blames Ministers and health service managers for a lack of leadership on neurological services at national and local level.

Another concern is about access to appropriate services for people living in care homes and for black and minority ethnic groups. Does the Minister have any evidence to suggest that the situation for such people has improved?

In June 2006, the National Institute for Health and Clinical Excellence issued implementation advice to accompany clinical guidelines on diagnosis and management in primary and secondary care settings, in particular for primary care trusts and acute trusts. The advice also set out what support is available to help people with a condition to cope and how to plan for the future, with aims such as establishing individual care packages, establishing lines of communication, building support for the patients and looking out for any complications.

On care plans, which I think are very important, my previous experience from working in the NHS was that many patients were not really aware that the care plan belongs to them—they own it—and that they should have a copy of it. They should be able to take it home and share it with their families and relatives, but that is not always the case. Given that people are now living much longer with these long-term neurological conditions—indeed, people are living longer generally and are therefore more prone to developing such conditions—are care plans being reviewed to take that into account? Are care plans updated regularly? A patient’s needs and conditions will change and vary quite radically over the years, but the care plan might not always be updated to reflect that. That is one of my concerns.

Other problems cited by the all-party group’s report include poor access to therapy services, which has already been mentioned, and a lack of information for patients about what services are available. The limited provision of respite care is also an issue.

The NICE guidelines set out the importance of access to occupational health services and other allied health professionals. The key principle must be that it is important to treat the patient rather than just the condition because everyone is different and everyone has different circumstances. By doing that, we could prevent unnecessary deterioration and thereby reduce the burden on the health and social care system. Is the Minister satisfied that, in line with the NICE guidelines, patients have access to the full range of services, regardless of their postcode?

Finally, I pay tribute to Parkinson’s UK, which has been at the forefront of campaigning for greater research and information on the disease and on treatment and therapies for patients living with Parkinson’s disease.

People with Parkinson’s disease deserve the right to access the essential services that they need, notwithstanding the inevitable budget cuts and other restraints on local authority budgets. There are concerns that the eligibility criteria will be tightened in some councils, as has already happened over the years, and that the criteria will differ from council to council. Does the Minister agree that standards should be set for such eligibility criteria, given that it does not seem fair that the criteria for people living in one borough might be tightened to a greater extent than in another borough next door with the result that people might not be entitled to the level of support in social care services on which they rely?

Blood and Blood Products

Baroness Hussein-Ece Excerpts

Monday 10th January 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord, Lord Morris of Manchester, to whose efforts I pay particular tribute in the context of this debate, as in many other contexts, has reminded us of the devastating effect of this tragedy on individuals and families. The previous Government recognised this and significantly improved the payments that were available to the victims of this disaster. We felt that there was still further to go, hence today’s Statement. We have arrived at this point following a brief but nevertheless thorough review of the arrangements, informed by a scientific report which is also published today—noble Lords can read the advice that we received—to enable us to understand rather better the suffering that these victims endure in clinical terms as well as in human terms. On the basis of that, we have arrived at the arrangements whose details I have repeated.

We believe that this is a fair and reasonable package of support for these poor victims. We do not intend to revisit it in the future. I acknowledge that some people might have different views on the appropriate level of payments for this patient group, but the package needs to be considered in the context of the whole range of support that is available for the group, especially Department for Work and Pensions benefits, the care available under the NHS and the care available from social services. Having consulted widely, we consider that the sums announced in this package, taken in the round with the other support available to this patient group, are both appropriate and reasonable. So, while I understand the noble Lord’s request, I am not in a position to accede to it at this point.

[Baroness Hussein-Ece]

My Lords, I congratulate my noble friend the Minister on the package announced in the Statement today. We very much welcome both it and, as the noble Baroness, Lady Thornton, said, the huge progress that has been made. Given that the commitment to review the current arrangements was made just last October, the Minister is to be congratulated on the swiftness with which this matter has been brought back to your Lordships' House. I hope that it serves to bring some comfort to those who have for so many years campaigned for justice, and particularly to the relatives of the deceased and the many other victims of this tragic episode.

The Minister announced that there would be a window for posthumous claims until the end of March 2011. There is concern that that is not a very big window and that it does not offer a lot of time to locate people and, for the many who may need assistance, to put a claim together. Perhaps the Minister can say why it is such a small window. Is he satisfied that it is sufficient time in which to track down as many people as possible who may have lost out?

It is not quite clear from the Statement who will receive posthumous payments. Will widows, partners and children be included in the arrangements? I would appreciate clarification on those points.

Autism

Baroness Hussein-Ece Excerpts

Tuesday 7th December 2010 Lords Chamber

[Earl Howe]

The noble Baroness raises a very important point. We know from general practitioners that they feel an absence of knowledge and training in this area. We are talking to the royal colleges about this.

[Baroness Hussein-Ece]

My Lords, how will the Minister ensure that the guidance ties in with the reforms to the NHS, for example, ensuring that the NHS bodies have due regard to any quality standards on autism that will be produced by NICE?

[Earl Howe]

My Lords, when the National Health Service commissioning board is established, it will have a duty to promote quality in the NHS. One way of doing that will be to utilise the quality standards produced by NICE, to produce commissioning guidance based on those quality standards and, in that way, to promote consistency of commissioning across the health and social care sector.