Care Services: Elderly People
Baroness Jolly Excerpts(11 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Jolly
My Lords, safeguarding the vulnerable needs real commitment from us all. Will the Minister tell the House whether the Government intend to support this by ring-fencing funds, as have Wales and Scotland?
Earl Howe
My Lords, we are not taking that approach. However, we have declared our intention to strengthen safeguarding arrangements to prevent and reduce the risk of significant harm to adults in vulnerable situations. That is a key priority for the Government. We intend to put safeguarding adult boards on a statutory footing. This will assist in furthering the agenda which my noble friend rightly raises, by ensuring that organisations involved in safeguarding have to make a co-ordinated contribution to local adult safeguarding work. Of course, it continues to be an offence for a provider to employ a person barred by the Independent Safeguarding Authority.
National Health Service (Clinical Commissioning Groups) Regulations 2012
Baroness Jolly Excerpts(11 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Finlay of Llandaff
The noble Lord, Lord Hunt of Kings Heath, has done us a major service by bringing forward a full debate on these regulations. We have discussed at length the problem of secondary care representation. Indeed, the fact that there will be secondary care representation and nurse representation on clinical commissioning groups is welcome. However, the principle of integration seems to be blown apart by the way in which these regulations are written. The Royal College of General Practitioners and the Royal College of Physicians—I declare an interest as a fellow of both—and the Royal College of Paediatrics and Child Health produced a document entitled Teams without Walls about involving generalists and specialists to ensure a better, more seamless journey for patients.
In an area—and we are trying to have more localism and more local involvement in decision-making—the very clinicians on half of this pathway are now excluded from involvement in the planning and decision-making for those services yet they are the clinicians who have an in-depth knowledge and experience of the health economy, integrated working and, indeed, of the deficits in standards. That is where I wish to focus my remarks for a moment. The Francis inquiry has not yet reported but I understand that the Government have given a commitment to implement the findings when they come out. I do not understand why the Government have not left this matter completely open at the moment. If the Francis inquiry considers that there is not enough integration between secondary and primary care in decision-making, planning of services and so on, then allowing a secondary care clinician from the local area to be on the clinical commissioning group would provide the flexibility that Teams without Walls refers to.
The clinical governance of an area and its problems will be known to the local secondary care services, and they will know it across the board. There has been concern about conflicts of interest, yet a medical director in a trust represents a range of different specialties, and that has not been a problem. Clinicians have learnt how to do it. The Royal College of Physicians has produced guidance. It will produce guidance on a competitive appointment process whereby the best person for the job gets the job, and it has produced a clinical commissioning hub as a support for secondary care in its involvement in clinical commissioning groups. You could say that the basic rule of physics pertains—two negatives make a positive. It is difficult to understand why the conflict of interest that the GPs will experience, where they may be providing part of secondary care services themselves, does not matter in this, and yet it is completely prohibited to have a secondary care person who might understand how that interface between primary care and secondary care will work better at a local level. That person is excluded. It seems to work particularly against rural areas.
The last point I should like to make—apart from reminding the Government that the absolute reverse principle has been in place with the local education and training boards, where local people are involved in the very processes of commissioning the education—is about the people who will come forward. We already know that, to date, there is underrepresentation of secondary care. A clinician who is going to apply to be on a board and leave their clinical service, travel long distances and be involved elsewhere is not going to be the clinician who is completely dedicated to their local NHS service. The clinician who is dedicated to their local service and driving up care for patients is going to be the very person who will be most motivated to work with the clinical commissioning group to improve the services and the seamlessness across the piece. Excluding local clinicians seems unnecessarily to be closing down flexibility.
Baroness Jolly
My Lords, this is a debate about conflicts of interest and getting the right person for the job. During the passage of the Bill, my noble friend Lady Barker led the call for conflicts to be declared where a board member has connections with a provider, where GPs can provide secondary services from their practices and where there are connections with commissioning support organisations. This was deemed right and proper, and was incorporated into the Bill.
It is important that the right people sit on clinical commissioning group boards and there are clear guidelines about competence, as well as protocols about conflicts of interest. This piece of secondary legislation puts restrictions on a clinical commissioning group in the choice of its members, irrespective of their competence, in two areas. One restricts councillors from being on the board and the other restricts the clinicians to those who work for providers from whom the clinical commissioning group does not commission services.
Time restricts me from addressing both issues so my noble friend Lady Williams will address the area of clinicians. In nearly 10 years as a member of an NHS trust board, I have sat with members of all political parties and none, some of whom were councillors. Where we had conflicts, they were declared. In that time, everyone left their party allegiances at the door. They were clear that they were there to look after the interests of the NHS in their patch, and had the skills and competences required for that role. It has been like this all over the country for years. It is worth mentioning that the work of Torbay Care Trust, which has been referred to frequently, depended on both NHS non-executive directors and councillors being on the board and working together.
Clinical commissioning groups want the right person for the role. They advertise, interview and appoint. It might be that the right person is a councillor, or not. This SI restricts their choice. Councillors know the community and, furthermore, particularly in the beginning, could have given useful guidance on the workings of the council because that is an area where GPs have generally not ventured—unless of course they are a councillor and a GP. This legislation has an unintended consequence for both doctors and indeed a nurse appointed as one of the two clinicians. The LGA wrote to the then Secretary of State as soon as the SI was published. The letter was signed by Councillor David Rogers, who is chair of the LGA Community Wellbeing Board and the only councillor member of the NHS Future Forum. He wrote:
“We do not accept the case for barring councillors from the governing body who hold professional roles within the NHS, as the reason for the appointment would be their professional experience within the health service—such as the GP … The Government, if it does not listen, is in danger of creating an unintended consequence of both discouraging experienced health service personnel from getting involved in their clinical commissioning group and from discouraging them from getting involved with their local authority”.
Councillor Rogers adds:
“I know that you are fully aware that all councils have standing orders that address conflicts of interest. We expect all public bodies, including clinical commissioning groups, to have equivalent rules regarding membership of their governing bodies but the proposed statutory instrument is far too wide-reaching and disproportionate. It will not only affect GP councillors serving on the governing bodies of clinical commissioning groups but any health professional group that a clinical commissioning group decides it wants represented on the governing body”.
I also received an email from a councillor GP who had been told that he had to make his mind up. Did he want to sit on the clinical commissioning group or did he want to remain a councillor? This level of restriction was not mentioned during the passage of the Bill. He asks:
“What are the justifications for this action which makes clinical commissioning groups the most politically restricted Public Body within the UK ? Where is the evidence”—
we spent a lot of time during the passage of the Bill trying to ensure that things were evidence-based—
“that this is in the public interest? Will GPs be banned from holding political office as Councillors on the basis that they could influence Health and Well Being Boards?”.
I should like the Minister, in summing up, to reassure the House that this was indeed an unintended consequence, and that when the implementation of the Bill is reviewed in 2014, clinical commissioning group governance will indeed be part of that review. Also, for those councillors who would have wished to become engaged in the commissioning of services, will he indicate how the clinical commissioning group might still involve them, so that their skills and competences are not lost?
Baroness Cumberlege
My Lords, I declare an interest, which is in the Register of Lords’ Interests. I want briefly to address two points. The first regards the wording that the noble Lord, Lord Hunt, has tabled for the debate, which concerns the prohibition of,
“a registered nurse or secondary care specialist if employed by a body which provides any relevant service to a person for whom the Clinical Commissioning Group has responsibilities”.
My second point is simply about local authority members being members of clinical commissioning groups.
In the past two months, I have had in-depth discussions with four CCGs in different parts of the country. I will be visiting a fifth tomorrow. The impression that I get, quite understandably, is that they are very variable. Some are only just getting established and hardly have their membership in place, and others are well under way. We expect that. It is a new architecture. CCGs have a lot to do, as the noble Lord, Lord Hunt of Kings Heath, said, and some are quicker than others. We would expect that.
However, in one of the London CCGs, the consultant from a well known and respected London teaching hospital, which is outside the CCG area and its commissioning remit, is clearly playing an important part in advising the CCG—as is the very impressive nurse. Neither has any conflict of interest within the CCG because they are people from outside, but they are using their experience, as the noble Baroness, Lady Finlay, said, to explain clearly the implications of some of the decisions that could be taken in future. I thought that the CCG was getting really good advice and I could see how that was going to inform it in the future.
NHS: Professional Qualifications Directive
Baroness Jolly Excerpts(11 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
The SiMAP and Jaeger judgments are very much the focus of our representations to the EU Commission. The disquiet about those judgements and the inflexibility that they have brought is shared by other member states. It is also important to recognise that none of us wants to go back to the past, with tired doctors working excessive hours. Tired doctors make mistakes; there is substantial evidence to support that. No one wants or deserves to be treated by tired doctors. There is a balance to be struck. The inflexibilities in the directive need to be addressed, but we should not go back to the bad old days when doctors became too tired to do their work.
Baroness Jolly
My Lords, if a clinician fails to understand a patient or to make themselves understood, their clinical competence is undermined. Will the noble Earl tell the House the current situation regarding the required level of English language competence of a doctor or other clinician from an EU state who wishes to practise in England?
Earl Howe
My Lords, we are now talking about the mutual recognition of professional qualifications directive. We have made it clear that we want to stop foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests. As a result, we have explored the idea of strengthening language testing for doctors through the use of responsible officers; and explored also the GMC’s ability to take action where concerns arise. The directive review is a key priority for the Government, and the Commission’s proposals include greater flexibility on language. It is helpful that the proposal from the Commission makes it clear that controls on language checks are permissible and may be undertaken before a professional is able to practise.
NHS: Walk-in Centres
Baroness Jolly Excerpts(11 years, 7 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Jolly
My Lords, no one doubts the worth of walk-in centres or minor injury units. It is well established, but we need to know where they are. Will the noble Earl tell the House how often the information on the Department of Health website is updated? Who is responsible? Will he please pass on the message that it is woefully out of date and inaccurate, thus defeating its object?
Health: Cancer
Baroness Jolly Excerpts(11 years, 7 months ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Jolly
My Lords, I thank the noble Baroness, Lady Gardner of Parkes, for securing the debate. It is timely and allows all areas around the treatment of head and neck cancers to be discussed. I will examine areas around diagnosis, prevention, treatment and the pivotal role that cancer networks have played in achieving improved head and neck cancer services.
The noble Baroness is well known for her championing of the role of the dentist. In the area of cancers of the head and neck they can be key players in diagnosis, spotting signs and symptoms before the patient and their GP. However, there are issues around this that need resolving in the area of the training and continuing professional development of dentists and GPs.
The evidence on the incidence of head and neck cancers and their occurrence in younger age groups is mixed. The prime causes of most of these cancers are smoking, alcohol and a poor diet—back to the five a day and three different-coloured fruits—as well as the human papilloma virus. That suggests that the age range of those affected might be wide.
There is a clear public health role in prevention. If Public Health England and public health departments in local authorities carry out the roles envisaged for them in the Health and Social Care Act, the incidence of these cancers should reduce. However, care must be taken to ensure that the NHS, Public Health England and local authorities co-ordinate their approaches and campaigns. At least three-quarters of oral cancers could be prevented by the elimination of tobacco smoking and a reduction in alcohol consumption. The scheme to make cigarette purchase less easy is to be welcomed and I urge the Government to follow the advice and not the tobacco lobby in adopting plain packaging for cigarette packs at the earliest opportunity.
Can the Minister tell the Committee what plans the Government have to address the issue of underage drinking in the home? Despite the scenes of rowdy young people in town centres, most alcohol is actually drunk at home by young and old alike.
As we have heard, HPV is often linked to oropharyngeal cancers. The evidence of this cancer has doubled in 10 years. There must be a case for vaccinating all teenagers and not girls alone. Will the Minister consider looking at the evidence for this?
Most people do not know that radiotherapy cures more cancers than drugs. Cancer patients should have access to treatments that their doctors think will be best for them. It is essential that new radiotherapy techniques, such as intensity modulated radiotherapy—IMRT—are rolled out swiftly. IMRT can be really beneficial to patients with cancers of the head and neck. It focuses very much around the cancer itself and does not spread to surrounding tissue. It is a welcome announcement that £15 million is to be found for such targeted radiotherapy treatment. For this to be widely available across England there are implications for both equipment and training, but it is a good start.
Currently all aspects of cancer care are co-ordinated by cancer networks, multidisciplinary teams looking at the whole pathway through diagnosis, treatment, hospice and palliative care where required, and aftercare when the patient returns home. This is all about integration at work. They have played a key role in driving up the quality of cancer services and patient experiences for the past 12 years. I draw attention to the excellent work of cancer networks and raise some concerns about their future in the new system.
In England there are 28 cancer networks that, since 2000, have been bringing together providers and commissioners of cancer care to work together to plan and deliver high-quality, integrated cancer services for people living with and beyond cancer in their local areas. These networks drive forward local cancer strategies. They are a key source of cancer expertise, encourage service redesign and integration, and monitor the performance of providers to highlight poor outcomes. Many cancer networks have been central to the implementation of NICE’s guidance on improving outcomes on rarer cancers. Many of the cancers that we are discussing today fall into that category. More specifically, they have also been acknowledged as key players in delivering NICE’s service guidance on improving outcomes in head and neck cancers. These are not common cancers, and the networks have been used to disseminate information.
NICE recommends that networks should be charged with deciding which hospitals will diagnose, treat and care for these particular patients. So when it comes to the quality of care that people living with head and neck cancers receive, networks have been driving service improvements throughout the country. An example of integration and service improvement is the Greater Manchester Cancer Network, which has a head and neck clinical sub-group with the aim of overseeing, supporting and bringing together multidisciplinary teams working on these types of cancer to ensure that each patient gets the most appropriate treatment and the highest standards of care. There are several networks that have co-ordinated to inform local strategies for head and neck cancers and to promote integration: East Midlands, Anglia, Central South and North London to name a few. These have been absolutely pivotal. They have also been critical in driving up patient involvement. The Peninsula Cancer Network hosts head and neck cancer support groups across Torbay, Cornwall and Plymouth for people who find it difficult to eat, drink or speak after having treatment due to head and neck cancers.
It was encouraging that, last year, the former Health Secretary made a public commitment to fund and support cancer networks in 2012-13. I welcome the proposals on clinical networks recently published by the NHS Commissioning Board Special Heath Authority which officially establish cancer networks as strategically clinical networks in the new NHS.
However, the significant changes proposed for the new structure for cancer networks leave me with a worry about how networks will be supported in delivering their key services. In the sector, there are fears in three distinct areas. The first fear is of a drastic reduction in the staffing levels for cancer networks. The proposals indicate that there will be only eight permanent staff in each regional team, compared to 20 staff members currently in post per network. Research carried out by Macmillan also showed that a number of network directors reported difficulties in recruiting and retaining staff because of uncertainty around resourcing. Can the Minister assure the Committee that cancer networks will have sufficient staff to carry out their functions effectively?
The second fear is of a loss of experienced directors, which would have an impact on the effective running of cancer networks. Under the proposals, existing directors with a wealth of knowledge in the development and delivery of high-quality cancer care in their region will have to reapply for their roles. Recruiting and training senior staff, some of whom have had no previous experience in cancer, could have a negative impact on the quality of services and support that cancer networks provide. Can the Minister suggest what steps he will take to ensure that experienced directors and cancer experts are retained?
The third fear is of cancer networks’ role being limited to early diagnosis. Although improving earlier detection of cancer is essential to preventing people dying prematurely—as we have heard today, head and neck cancers often go a long time before they are detected—cancer networks need a comprehensive remit to be able to continue delivering the functions mentioned above. They must continue to play a leading role in improving outcomes and the experiences of people living with head and neck cancers across the pathway. Can the Minister confirm that cancer networks will be able to continue delivering functions that cover the whole pathway? Cancer networks have played a leading role in delivering improved outcomes for rarer cancers, including head and neck cancers. I am pleased that the Government have recognised their value and formally established them as strategically clinical networks. However, significant steps are needed to ensure that they continue to have a comprehensive remit beyond early diagnosis. The Government should be mindful that severe reductions in resource would make it difficult for them to meet their commitment of supporting networks after 2013 and reaching their ultimate ambition of saving 5,000 lives a year. I would be grateful if the Minister could update the Committee on the Government’s plans for cancer networks and reassure us that they will have sufficient resource, human and financial, in the system.
I again thank the noble Baroness, Lady Gardner, for securing such an important debate. We must not forget that the NHS reforms offer an opportunity to refocus on delivering the best possible cancer care and outcomes for all patients, including those with head and neck cancers.
NHS: Health Workers
Baroness Jolly Excerpts(11 years, 9 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
There is a clear role here for the professional bodies. Training should be done in the right disciplines and numbers and in the right way. I am sure I do not need to tell the noble Lord that in virtually all the medical royal colleges and through the Royal College of Nursing, there is an increasing emphasis on leadership backed by resources from the Department of Health. We are seeing a drive forward for innovation and the breaking down of professional barriers, which is another aspect of this issue.
Baroness Jolly
My Lords, we now accept nurse prescribing as perfectly normal and sensible, and these changes were implemented when the NHS was the major provider of health services. Therefore, what challenges or opportunities does the Minister think that the new diverse health economy will pose to task shifting?
Earl Howe
My noble friend poses an extremely complex question. She is right that regulatory improvements such as nurse prescribing are making a difference and we are looking to see what other professions can also share in that sort of freedom. As the NHS gets more plural, we are able to drive the consistency and quality of practice through the NHS standard contract, through regulation, as the noble Lord, Lord Crisp, emphasised, and also through the clinical leadership referred to by the noble Lord, Lord Kakkar. That applies not only in NHS settings, but in private and independent settings as well.
NHS: Specialised Services
Baroness Jolly Excerpts(11 years, 9 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Jolly
To ask Her Majesty’s Government what is their assessment of the future of the work of the Advisory Group for National Specialised Services.
Baroness Jolly
My Lords, I declare an interest as chair of the Specialised Healthcare Alliance, a coalition of 79 patient-related organisations receiving financial support from 11 corporate members, which campaigns on behalf of people with rare and complex conditions.
The Advisory Group on National Specialised Services, or AGNSS, was established in 2010. Its role was to provide a single source of advice to Ministers on whether services, products or technologies for very small patient populations, usually not exceeding 500 for England as a whole, should be commissioned at national level rather than by PCTs, individually or collectively. Some 65 services are enormously important to over 10,000 people with a range of very severe and frequently life-threatening conditions.
What makes AGNSS different is that it brings eminent clinicians together with commissioners in considering these complex matters and integrates other vital perspectives through members with health economics and ethical expertise and from the lay community. For the first time, AGNSS evaluates services, products and technologies using an ethical decision-making framework that holistically balances a range of factors, including patient need, clinical severity, clinical effectiveness, affordability, service efficiency and the value to society. It would be fair to say that the development of AGNSS and its decision-making framework, with widespread input from all parties, was seen as a model of its kind and that the group, under the capable leadership of Professor Michael Arthur, has only grown in stature over the past two years.
Organisations and others with an interest in the health and welfare of people with very rare conditions were greatly concerned when it was announced at the turn of the year that AGNSS would be entering a moratorium, pending decisions about its future. If the reaction to this debate is anything to go by, it is much appreciated and valued by research scientists, organisations representing patients and pharmaceutical companies, who have all expressed their alarm at its possible demise.
My understanding is that this decision stems from the view that an advisory group for Ministers will be incompatible with the provisions of the Health and Social Care Act 2012, which devolves responsibility for the commissioning of all specialised services to the NHS Commissioning Board. To quote from my noble friend the Minister’s letter of 8 June to Mark Simmonds MP:
“In the future, there will be a clear differentiation between what services the Board should commission and how those services are commissioned. It will remain the responsibility of ministers to consider, on the basis of appropriate advice, the list of services that should be directly commissioned by the Board. Ministers will then consult with the Board on those services before laying regulations that will specify the services that will be commissioned. It will be for the Board to decide how it commissions the service”.
As the letter acknowledges, Ministers will need advice on what services are to be prescribed in regulations for commissioning by the board. My understanding is that the Clinical Advisory Group, presently chaired by a civil servant, Dr Kathy McLean, will fulfil this function in relation to the generality of services. The question is whether highly specialised services should be channelled through the same route.
The views of eminent clinicians presently sitting on AGNSS or leading services commissioned through the AGNSS process suggest that this is at least worthy of debate. In particular, AGNSS is recognised as a route whereby such services can engage with commissioners. I am told that this is an iterative and demanding process, taking some considerable time before a decision is taken. The net result is generally one where there are indeed costs to the NHS, but often costs that are reduced as a result of coherent commissioning. For example, the decision to commission severe acute porphyrias means that young people presenting with potentially fatal attacks should now have speedier access to expert care with less wastage of the relevant drug, haem arginate, which has a short half-life. Similarly, AGNSS was able to advise on the managed introduction of extracorporeal membrane oxygenation, or ECMO, which has saved many people whose lungs are severely distressed, most notably as a result of swine flu.
The danger is that without a clear port of call in the form of AGNSS, these important services may get lost from sight, as will the opportunity to develop them in a way that meets the needs of patients and delivers best value to the NHS. Furthermore, Ministers may be hard pressed to decide on whether the board should commission such services without high-quality advice on what they comprise.
The relevance of these services, not just to England but to all parts of the United Kingdom, would also seem to count in favour of retaining an advisory group alongside Ministers, as would the broader strategic importance of issues such as proton beam therapy. I therefore put it to my noble friend the Minister that in the case of highly specialised services there might be merit in retaining a group providing a single source of advice to Ministers but with a dual reporting function to the board in determining how such services should be commissioned.
As for the composition of this group, I have heard it said from reliable sources that if AGNSS did not exist it would need to be invented. In a recent conversation with Professor Arthur, he outlined the three components that made AGNSS effective, unique and special: the support from the national specialised commissioning team, the strength of the group—an ethicist, a health economist, a geneticist, a pharmacist, representatives of all royal colleges, representatives of SHAs, lay people, carers and patients, commissioners from PCTs and a member of the HTA—and excellent advice to AGNSS from public health doctors.
We are going through a period of enormous change in the NHS, but change for change’s sake is to be avoided at any time—and surely now more than ever. I therefore urge the Minister and the chief executive of the NHS Commissioning Board to think carefully about disbanding AGNSS when the need for it remains unchanged. Historically, the view has been taken that NICE would struggle to combine under one roof the evaluation of products with a cost per quality-adjusted life-year often very substantially higher than the threshold which usually applies. Furthermore, in this highly specialised field, where a service develops around a novel treatment, the distinction between services, products and technology is sometimes difficult to make in areas of previously unmet need.
The AGNSS decision-making framework therefore represents a major step forward. It recognises that the evidence-base for small patient populations may be less developed. At the same time it imposes demanding standards in terms of the number of patients whose condition improves as a result of a treatment, compared to the total number of patients treated. This approaches 100% for more expensive services, products and technologies.
That progress has been hard won and should not be squandered but built upon. In a debate in the House of Commons on 30 April about a strategy for rare diseases, the Minister of State, the right honourable Simon Burns MP, appeared to suggest that value-based pricing will supersede the need for separate arrangements for treatments for very rare conditions, but that alternative options will be explored in case of need.
All are agreed that value-based pricing has exciting potential. The challenge of expressing that potential will be considerable for the generality of treatments, but it will be undoubtedly greater for very rare conditions. In the mean time, retention and development of the AGNSS framework would seem to have great merit.
AGNSS represents something of a jewel in the crown. The dancer cannot be easily separated from the dance in determining which highly specialised services to commission and how to commission them. Ministers will continue to need high-quality advice. I would hope also that the first mandate to the board recognises the value of this heritage and bestows it for safekeeping.
NHS: Private Finance Initiative Costs
Baroness Jolly Excerpts(11 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
My Lords, the Treasury has been very helpful in advising my department on the kinds of flexibility that we may have in these difficult situations. It has also been helpful in refining the current PFI model so that, as and when we use PFI again, we have a tighter structure which strikes a better balance between risk and reward to the private sector.
Baroness Jolly
My Lords, many community health schemes were funded using the LIFT programme. What is the Government’s view of their affordability now?
Earl Howe
My Lords, LIFT is one tool that we have in financing capital schemes in the community, many of which have been successful. Such schemes promote integrated services, which I know my noble friend will welcome. All LIFT schemes have been and will be assessed for affordability and value for money. It is not a universal prescription by any means, but we look constructively at LIFT as one way of delivering capital schemes.
Care and Support
Baroness Jolly Excerpts(11 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
My Lords, I fully agree with the noble Lord about the need for cross-party consensus. If we are to have a long-term sustainable solution for the funding of social care, we must have that political consensus. Indeed, that was the intent behind the cross-party talks. I very much regret the leaks. These were not our doing, but they did create an impression of bad faith. Again, I regret that. No bad faith was intended from our quarter or indeed from any other quarter in government. I think there was an element of misunderstanding about our intentions, but I agree with the noble Lord that the cross-party bonhomie has been disrupted. We very much wish to put the whole process back on track, and I hope that his party will respond accordingly.
Baroness Jolly
My Lords, I am a glass half-full sort of person, so I heartily welcome the White Paper and the draft Bill on care and support, and note the progress report on funding reform. We are certainly looking forward to pre-legislative scrutiny. Can the Minister give the House some indication of the timetable and the process? Will he also tell the House what the Government’s view is on including enabling clauses in the draft Bill to allow the Dilnot-based scheme to be implemented?
Earl Howe
My Lords, my provisional understanding —and I stress that—is that pre-legislative scrutiny will begin in the autumn, probably in November. Between now and then, plans will be put in place to decide the composition of the pre-legislative scrutiny committee so that the process will conclude by the end of this Session of Parliament. In principle, there is no reason why enabling clauses should not be inserted into the legislation. As I have emphasised before, it would be preferable if they were clauses on which we could all agree.
NHS: Dental Care
Baroness Jolly Excerpts(11 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Earl Howe
My Lords, my noble friend is correct. Treatment provided on the NHS carries only one pricing tariff, which cannot be varied. The OFT report found that only 1% of NHS patients and 2% of private patients chose a dentist on the basis of price. I stand to be corrected, but I do not believe that it made any suggestion that NHS charges were uncompetitive; they are, and always have been, a subsidised contribution to NHS costs—they are not a market price. Therefore, I imagine that the OFT report reflected the fact that patients were comparing private charges with NHS charges. Of course, the NHS is in general free at the point of use, but my noble friend is right. It is important that we are clear that some charges exist, as they have in dentistry for 60 years.
Baroness Jolly
My Lords, some may avoid the dentist because they cannot find one, others for fear of high costs, and others just for fear. Have the Government carried out any work to determine what proportion of the population does not attend a dentist, and the reason why?