Care: Budget

Debate between Baroness Jolly and Baroness Pitkeathley

Wednesday 28th January 2015 Lords Chamber

[Baroness Jolly]

My Lords, I can speak for local authorities but not, regrettably, for bankers. The Government have made care a priority, which is why we have given an extra £1.1 billion to help protect social care services this year, on top of the additional funding in recent years.

[Baroness Pitkeathley (Lab)]

My Lords, whatever the size of the care budget, I think everybody would agree that the majority of caring responsibilities fall on the caring families. Over the course of the next Parliament, some 10.5 million people will start being carers. Is the Minister confident that the budget will be sufficient to provide them with the information and support they so desperately need?

[Baroness Jolly]

A lot of work has gone on in preparing local authorities to give assessments to carers for their needs and support, in exactly the same way as they assess the people they care for. The cost currently being factored in for that is £104.6 million—£31.3 million on assessments and £73.3 million on the provision of support.

Unpaid Carers

Debate between Baroness Jolly and Baroness Pitkeathley

Monday 8th December 2014 Lords Chamber

[Baroness Pitkeathley]

To ask Her Majesty’s Government whether they have made any recent assessment of the financial contribution of unpaid carers to the national economy.

[Baroness Jolly (LD)]

My Lords, the Government recognise and value the significant contribution made by informal carers in providing care and support to their family and friends or those who may be frail, elderly or disabled or have mental health conditions. In our recently updated carers strategy action plan, we have made it clear that we will explore the available evidence to assess the impact of the caring role on people’s broader circumstances.

[Baroness Pitkeathley (Lab)]

My Lords, I put this Question down because of a response I had from the noble Lord, Lord Freud, on 10 November, when I asked him a Question about carers and the bedroom tax. In a reply which I think shocked the whole House, he implied that carers were not taking part in the economic life of this country, so I am glad to have an acknowledgement from the noble Baroness that the Government recognise that. I remind her of the sum that it is estimated that carers contribute, which is £119 billion.

Does the Minister agree that as well as acknowledgment there must be some practical back-up? In the national carers strategy, which was launched in 2008, a pledge was made to alleviate the financial hardship of carers by 2018. I am sorry to say that this pledge was dropped when the strategy was reviewed by the Government, as the Minister mentioned. Given that a recent survey stated that 45% of carers are going short on food and heating because of the contribution that they are making, will the Minister agree that putting that pledge back into the national carers strategy should be a matter of the utmost urgency?

[Baroness Jolly]

I do not think that anybody can underestimate the value of carers. Carers UK, when it did its sum, took from the census the number of carers there were, how many hours they said they worked and multiplied the answer by £18, which is the hourly rate that it worked from, and came up, as the noble Baroness said, with £119 billion per annum. That figure is in the same sort of ballpark as pensioner benefits, which are £112.7 billion, so we certainly do not underestimate the numerical value of carers.

Carers Strategy

Debate between Baroness Jolly and Baroness Pitkeathley

Thursday 3rd July 2014 Lords Chamber

[Baroness Pitkeathley]

To ask Her Majesty’s Government whether they intend to make addressing the financial hardship of carers a priority in the forthcoming update of the Carers Strategy.

[Baroness Jolly (LD)]

My Lords, the updated action plan will focus on the four priority areas of the Government’s 2010 strategy to demonstrate activity against those areas. In reviewing progress and setting out further actions, the plan will consider other emerging cross-cutting policy and practical issues relevant to more than one of the four priorities. This will include issues of financial hardship for carers. These will be referenced throughout the plan to show how they impact on the existing priorities.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that response, and am very glad to hear that financial hardship will be considered. She will know from the recent Carers UK Caring & Family Finances Inquiry that a growing number of carers are finding it really difficult to make ends meet. The commitment was made in the 2008 strategy that carers would always be supported so that they would not suffer financial hardship. That pledge was removed from the 2010 refresh of the strategy. Do I understand the Minister to be saying that it will be reinstated in the current strategy?

Health: Care Homes

Debate between Baroness Jolly and Baroness Pitkeathley

Tuesday 11th March 2014 Lords Chamber

[Baroness Pitkeathley]

To ask Her Majesty’s Government whether they have any plans to abolish the practice of payment of retainer fees to general practitioners for providing services to care homes.

[Baroness Jolly (LD)]

My Lords, my honourable friend the Minister of State for Care and Support has written to the chief inspector of general practice and to the chief inspector of adult social care to ask them to consider this issue. Let me be clear: GP practices should ensure that any services provided to care homes for which a retainer is charged are not those currently provided under their contract with NHS England. NHS England is responsible for ensuring that the terms of the GP contract are being met.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that reply, but does she agree that, since all patients in care homes are, as she says, entitled to NHS services anyway, to charge them for an enhanced service and then not provide it is actually fraudulent? Moreover, it causes a great many problems in the NHS as well. If an old person is not adequately treated in the care home, that often results in unnecessary admission to hospital through A&E, unnecessary distress for the older person and unnecessary cost for the NHS when they could have been treated simply and quickly in the care home had the GP been doing a proper job. Will the Government take further action on this?

[Baroness Jolly]

The noble Baroness is right, and the Government have made clear their commitment to improving care for vulnerable old people. As I said in my Answer, any GPs who provide services should do so free of charge, and any money paid by care homes to practices should be for something over and above that. The sort of thing that we might be thinking of is assistance with training or possibly helping out with something like a health and safety audit, but certainly not basic NHS care.

Care Bill [HL]

Debate between Baroness Jolly and Baroness Pitkeathley

Wednesday 3rd July 2013 Lords Chamber

[Baroness Jolly]

My Lords, I am very sorry that the noble Lord, Lord Warner, is not in his seat. He tabled Amendment 79 to express the strength of feeling of Members of this House who were sitting on the scrutiny committee about the Secretary of State’s the duty to have regard to well-being. Were there room for more than four names to the amendment, there would have been more Members of your Lordships’ House on that list.

To put this in context—and the noble Lord, Lord Hunt, has taken us through quite a lot of this—this Bill was widely consulted. It was probably the coalition’s most widely consulted Bill; somebody might be able to tell me to the contrary. At each stage, people welcomed the well-being principle. Perhaps I may remind the House that in the majority report on the Bill, one of the recommendations was that the Secretary of State should have due regard. When the final Bill was produced, many in the sector approached me, and I suspect many others, to express their disappointment that that was not included in it. When the Secretary of State came to give evidence with the Minister for Care and Support, the right honourable Norman Lamb, he was very positive about it. According to the transcript of the session, Norman Lamb said:

“We absolutely want the wellbeing principle to apply comprehensively”.

The well-being principle is around the change of culture and it puts the person at the centre. It is absolutely critical that that happens, and next week we will debate the whole business of assessment and how we are undertaking it. However, unless the Secretary of State has to have regard to the same principle as local authorities, there is an opportunity for future Secretaries of State when making regulation to disregard well-being and just make regulation in the old way. One thing that sets this Bill aside from many others is that it is written in plain English and throughout its intention is pretty clear.

I ask the Minister if he is able to offer any assurance to the House, to the sector and to those for whom the Bill is written—the service users and the carers—that the Government will think again about the decision not to include in the Bill a duty on the Secretary of State to take well-being into consideration.

[Baroness Pitkeathley]

My Lords—

Health and Social Care Bill

Debate between Baroness Jolly and Baroness Pitkeathley

Thursday 8th March 2012 Lords Chamber

[Baroness Jolly]

My Lords, I have a couple of amendments in my own name in this group, and I shall also speak to amendments in the names of my noble friends Lady Tyler and Lady Cumberlege.

We welcome the decision to set up a patient and public involvement organisation and network across England based on local authority geography and with HealthWatch England at the centre. It offers the possibility of real engagement for all stakeholders and the consequent improvement of health and social care services for all. However, there are still some areas for concern in relation to HealthWatch England, whose role is to engage with all the key national players—the Secretary of State, the NHS board, Monitor, the CQC and the local authorities to which I referred a moment ago. It is charged with providing the views of those in receipt of services, their carers and other members of the public, and also with offering advice to the key stakeholders to whom I have just referred. It will thereby be influencing the Secretary of State mandate, commissioning practices, the process of registration of providers and the authorisation of clinical commissioning groups.

However, there is a deficit in the Bill. There is no representation on the HealthWatch England board of a local voice. Reports may be sent by local healthwatch organisations and they may be read, but there is no one on the board of HealthWatch England who can tell it as it is at a local level. The board, as with all other boards, is charged with making decisions involving running the organisation but, without a local perspective, it runs the risk of being metrocentric, south-east based and out of touch. Therefore, I support Amendment 224 in the name of my noble friend Lady Cumberlege and, as a good Liberal Democrat, I of course welcome elections run by STV.

The relationship between HealthWatch England and local healthwatch organisations has to be pivotal to the success of this proposal, and one certain way to cement that is with the presence on the HealthWatch England board of members of local healthwatch organisations, as we have just discussed. However, another way would be to use Amendments 229A and 234ZA in the name of my noble friend Lady Tyler. These allow for local healthwatch organisations to have a power to recommend to the board of HealthWatch England the reports that they think, from their local information-gathering, HealthWatch England should carry out, and HealthWatch England is bound to have regard to these recommendations. This should help to avoid situations such as Winterbourne and Mid Staffs. An effective local healthwatch organisation would have confidence that its advice would be considered and acted upon by HealthWatch England, precipitating early intervention and service improvement. It would also allow HealthWatch England the opportunity to spot national patterns, determine their significance and take appropriate action.

I have an amendment in my own name which concerns specialised services commissioned by the board—in particular, those for rare and complex conditions. Here, I need to declare an interest as chair of the Specialised Healthcare Alliance. I should be very grateful if my noble friend could clarify how it is envisaged that information can be collected about these services, how patients and carers can have confidence in a local healthwatch organisation dealing with issues with which they might only rarely get any concerns, and how HealthWatch England can put these scarce data together in a useful and timely manner for stakeholders. That will need careful management and crystal-clear guidance to ensure that the information gathered and the advice based on that information find their way to the board. Many people with such conditions are keen to hear the Minister’s response and I would welcome total clarity from her in that regard.

[Baroness Pitkeathley]

My Lords, I wish to speak in support of the powerful case made for the independence of HealthWatch England by the noble Lord, Lord Patel, and by noble friends on these Benches. It is a mystery to me why, in the face of a genuine commitment by successive Governments to public and patient involvement, we have made such a mess of it thus far. I am not one who looks back on the work of community health councils as some kind of nirvana. As someone who was briefly a chief officer of a CHC, I know that they were very patchy and variable in quality. However, they had a strong national voice, and I pay tribute to my noble friend Lord Harris of Haringey in that regard.

Since then, we have struggled. I think that the failure of the Commission for Patient and Public Involvement in Health has made successive Governments frightened of setting up one of these national organisations. It has put them off having a national body to support local groups, to help them to develop successfully and to help them when they are in difficulties, as well as provide a national, challenging voice for patients. Will HealthWatch England, as currently envisaged, be this missing national body? I am afraid that at present the answer is certainly no. As a committee of the CQC—an organisation for which I have the highest regard—it will not be independent or accountable to the patients and public it represents, and its links with local healthwatch organisations, which we will discuss later, will be very variable and often not sufficiently robust for them to be in full receipt of the amount and range of information that they need. We simply must have a proper governance structure with an independent, publicly appointed chair. Surely the independence of the whole organisation is essential to how it will provide the strong voice for patients that everyone involved say they want.

Health and Social Care Bill

Debate between Baroness Jolly and Baroness Pitkeathley

Monday 19th December 2011 Lords Chamber

[Baroness Pitkeathley]

My Lords, I, too, support this amendment. I remind the Committee of my role as chair of the Council for Healthcare Regulatory Excellence, which has an oversight role with the General Pharmaceutical Council. We believe that single dispensing errors should be treated in a proportionate way that still prosecutes those who have been negligent or have committed a deliberate act but does not penalise pharmacists who want to declare a dispensing error in the interests of patient safety—and I very much agree with the noble Baroness, Lady Finlay, that this is about patient safety.

In the interests of patient safety and public protection, we of course expect the regulator to be able to co-operate with other agencies if it is aware of a pattern of repeated single-dispensing errors that might reflect wilful and deliberate acts with the intention of harming patients. In those circumstances, there would of course still be recourse to criminal prosecution. With these exceptions, I very much support this amendment.

[Baroness Jolly]

My Lords, I, too, support this amendment. I have some personal experience that I can bring to bear, and it was not until I was reading through the amendments a week or so in advance that I put these things together. Some years ago my mother became really ill with a very strange set of symptoms and no one could work out what the problem was. Eventually her GP came round. Like many people of that age, she takes several drugs. He sat down on her bed, took out her box of drugs from her bedside table drawer and went through them. There was one drug that she should not have been taking at all. It was completely wrong and should have been taken sparingly, not three times a day. My mother lives in a small town and the GP knows the pharmacist well, so he high-tailed down to him straightaway to find out what exactly the issue was. In this case, the dispensing pharmacist was unaware that there was a mistake.

It was really quite interesting to see how it had all happened. The medicines were all stored on a shelf in alphabetical order by drug name, not brand name. The drug in question was adjacent to my mother’s normal drug, and both were generics produced by the same pharmaceutical company. The narrow little rectangular boxes looked the same, so the pharmacist had picked the wrong one off the shelf, popped it into the bag with the rest and it had gone home. My mother, whose sight is not what it was, had taken them all out of their boxes and popped them all into her pill box. The deal was done, it was really very easy, and the whole thing was completely indistinguishable.

Fortunately my mother recovered once it was sorted out. It was a regular, well-known, high-street pharmacy, and it was absolutely excellent. It wrote a letter immediately saying that it was going to instigate a clinical governance review. It then wrote again to tell us exactly what it had done, including changing its methods of storage and ensuring that someone double-checked all drugs before they were bagged-up. This had been a mistake, but there is absolutely no doubt that it was completely negligent, and also avoidable. However, it was not criminal. There was no malicious intent. It could have been terrible, but mercifully it was not. The employer spoke to the pharmacist who admitted exactly what she had done once they had worked it all out. The pharmacy took proportionate discipline, and that is what we as a family wanted. We wanted something to happen, for it be arranged that the mistake could not happen to anyone again and for anything that happened to be professional and proportionate. That is what happened. As a result, I totally support the amendment that my noble friend has tabled with the support of the Royal Pharmaceutical Society.

Health and Social Care Bill

Debate between Baroness Jolly and Baroness Pitkeathley

Thursday 15th December 2011 Lords Chamber

[Baroness Jolly]

I rise to speak to Amendment 311ZA, in the name of my noble friend Lord Clement-Jones, which calls for people’s views on those services commissioned by the board, whether locally or nationally, to be taken into consideration. I need to make a declaration, because I am chairman of the Specialised Healthcare Alliance. When she sums up, will my noble friend the Minister try to give some assurance that those with rare and complex conditions, services for whom will be commissioned by the board, will be included in all consultations by local healthwatch organisations and by HealthWatch England?

I have some general remarks about HealthWatch, which is to be the voice of the patient both nationally and locally. I want to tease out what it is all about, where it should be and who should be doing it. HealthWatch has to do far more than its name suggests—it has to do more than just watch. Clearly, it needs to listen. I totally support the amendments of the noble Lords, Lord Rooker and Lord Harris of Haringey, who are pushing the idea that HealthWatch should be able to recommend. This is not just a tacit thing: it has to be very much more proactive, to push things back. Whether it is pushing it back to the Secretary of State, CQC, local authority boards, NICE or even clinical commissioning groups, it is critical that that should be seen as part of HealthWatch’s role. “No decision about me without me”—well, we will not know about that unless the recommendation amendment is actually woven in.

The amendment of my noble friend Lady Cumberlege is about local healthwatch organisations. Local healthwatch organisations will have an opinion on clinical commissioning groups’ commissioning plans, and that opinion should go to the board.

Where should healthwatch organisations be placed? We have said it before in this Committee and I suspect we shall have to say it again on Report: we on these Benches are not convinced that the role for HealthWatch England is with the CQC—as a sub-committee of the CQC—or that the role locally should be with local authorities. One of the things that these organisations will have to do, whether nationally or locally, is to be quite critical of their hosts. It is very difficult to be critical of your host, so it is perhaps not appropriate that they should be their host.

Along with the question of where healthwatch organisations should sit, another issue—certainly, this is an issue at local level—is funding. Funding is currently held by local authorities for LINk organisations. I suspect that many of us who have been involved in this Committee have been receiving letters from LINk organisations saying that their funding is being cut and they cannot possibly manage. That needs to be taken into consideration. I understand that, currently, the pot of funding for local healthwatch is going to be given to a local authority. Should we be unsuccessful in moving local healthwatch out of the local authority, I would like the Government to give some thought as to how that money might be ring-fenced. I know that they are not happy about ring-fencing money, but should money be ring-fenced and be part of, for the sake of argument, the public health budget? If local healthwatch organisations have to remain with local government, then the funding needs some sort of protection.

Who should be involved with HealthWatch? I support the amendment of, I think, the noble Lord, Lord Beecham, that there should be locally elected delegates. HealthWatch England would be far stronger if there were local voices from local healthwatches. Now that we will have not strategic health authorities but sub-national areas, perhaps there should be two members from each sub-national area to represent their patch who could give the views of local healthwatch organisations to HealthWatch England. Perhaps that might be appropriate.

The local healthwatch organisations—LINks and their immediate predecessor organisations—have had problems with who actually forms part of these organisations locally. Some have been very good, but some have been less than effective. The members of these groups have just happened to be whoever was interested and keen at the time. Sometimes the groups were positive, but sometimes they really did not work at all. There might be shades of the past here: I wondered if there was any mileage in suggesting that the local healthwatch should be composed of someone from the local authority, someone from the voluntary sector and, of course, someone representing the patients, so that you weave into the local group some professional expertise in order to help with some of the strategic work.

I pass on apologies from my noble friend Lady Tyler, who was going to speak about children—she had her name down to Amendment 311ZA. Children need to be heard. When you talk about the views of children, you might have a mental picture of very little children, but in this context children go up to the age of 18. A lot of interesting services are currently available for teenage children, teenage individuals, young people or young citizens. It is critical that their views, needs and experiences are sought so that they can be fed into the mix.

I have probably said enough now about HealthWatch for the three groups so I shall sit down and not stand up again, but it is critical that we do this right in the Bill. I look forward to seeing what comes out on Report and to seeing where we need to move on to from there.

[Baroness Pitkeathley]

My Lords, my contribution in support of the amendments is simple and brief: it is to ask that the Minister ensures that we learn the lessons of history and do not repeat the mistakes of the past when it comes to patient involvement. As we know, there is a huge evidence base about the benefits of patient involvement in health outcomes, and I am sure that the mantra of “No decision about me without me” is something that all noble Lords will accept.

While successive Governments have been committed to patient and public involvement, the history of it has not been a happy one. Some of us can go right back to 1974 when CHCs were first set up. Like my noble friend Lord Harris, I believe that this Government are committed to putting patients at the heart of the NHS, but let us look at why the previous attempts to do so have not been successful. In summary, I suggest that the reasons are these: the efforts have not been sufficiently well funded; they have not been seen as sufficiently independent and therefore have had conflicts of interest; they have not had enough status; and there has not been seen to be enough communication between national and local bits of the set-up.

I leave aside the current problems of the CQC, although I agree with noble Lords who have spoken about that, but the very idea of making the new body a sub-committee of anything seems to me to ensure that we are in fact going straight down the route where we have made so many mistakes before. I remind the Committee that those who do not learn from history are doomed to repeat it.