NHS: General Practitioners

Baroness Manzoor Excerpts

Wednesday 26th February 2014 Lords Chamber

[Earl Howe]

My Lords, the current Government have maintained funding for the National Health Service; that is contrary to the Labour Party manifesto of 2010, which promised to cut funding to the National Health Service.

[Baroness Manzoor (LD)]

My Lords, I am fortunate that I am registered with an excellent GP practice which is well run, accessible and innovative. Over the last 30 years, I have seen significant improvements, and not only in the range of services that the practice provides. Who is responsible for ensuring that GPs are learning from other GPs the excellent practices which are available across the country?

[Earl Howe]

My Lords, there is a variety of means to ensure that GPs have continuous professional development. It is partly up to Health Education England to see that that happens and that there is peer-to-peer learning and review. Clinical commissioning groups also have an interest in ensuring that the quality of service provided by every member practice is of an equally high standard.

NHS: Black and Minority Ethnic Nursing Directors

Baroness Manzoor Excerpts

Monday 10th February 2014 Lords Chamber

[Earl Howe]

My Lords, I have already mentioned some of the initiatives that are in train. However, I can tell my noble friend that, within the NHS Leadership Academy, there are two programmes specifically for nurses and midwives that map to foundation, mid and executive level leadership development. There is the front-line leadership programme which is for staff who have leadership responsibilities—for example, ward sisters and nurses working in primary care. We expect 6,000 nurses and midwives to participate in that programme in the first year. There is also the senior operational leaders programme which provides senior nursing clinicians with an opportunity to enhance their leadership skills.

[Baroness Manzoor (LD)]

My Lords, a web audit found that only 80 NHS trusts publish annual staff data broken down by ethnicity. Will the Minister reassure the House that all NHS trusts meet their legal obligations under the Race Relations Act and that all workforce issues faced by black and minority ethnic staff are identified?

[Earl Howe]

My noble friend raises a crucial issue about transparency. I can assure her that this is squarely within the sights of the Chief Nursing Officer and her advisory group.

NHS: Seven-day Working

Baroness Manzoor Excerpts

Thursday 6th February 2014 Lords Chamber

[Baroness Manzoor (LD)]

My Lords, I, too, thank the noble Lord, Lord Ribeiro, for securing this debate. As other noble Lords have stated, the variation in outcomes and patient experience for patients admitted as emergencies at the weekend is evidenced in higher readmission rates, higher mortality rates, poorer patient experience and an increased length of hospital stays, while the availability of diagnostics such as imaging can be 40% lower. These facts are, on the whole, not in dispute so it is not my intention to mention the many excellent surveys and reports which evidence them. However, it would be remiss of me not to restate the importance of the report commissioned by NHS London in 2011, which concluded that increasing consultant cover in acute medical and surgical units at the weekends could prevent more than 500 deaths a year in London alone. The evidence clearly demonstrates the need for the NHS to take action.

Like other noble Lords, I applaud Sir Bruce Keogh’s report and its conclusions, except that it is rather disappointing that it took nearly a year to produce. I would like to hear what the Government are doing to ensure that the pace of change is rapid and that the report’s implementation programme is given greater priority. Quite rightly, there is much emphasis by the Government and NHS England on clinical outcomes and reducing inequalities in care, but NHS England will not deliver on its mandate should the current status of health services prevail at weekends.

While the £3.8 billion Better Care Fund which the Government have made available, pooled with local government, is also welcome, NHS England has yet to demonstrate how clinical commissioning groups are addressing the need for services at weekends and what support CCGs are giving to local authorities which support patients being discharged from hospitals and prevent unnecessary admission to hospitals, particularly as CCGs spend three-quarters of the £98 billion NHS budget. Indeed, I find it difficult to understand how the regulator, the Care Quality Commission, could have judged any hospital to be outstanding when such inequalities in care and service have existed in the NHS and been evidenced as such for at least the past 12 years. Perhaps the Minister can reassure the House that regulators will not be awarding outstanding status until a hospital is deemed to have improved its record of safety and patient care for patients at the weekend.

NHS England should also demonstrate how, as the commissioner of primary services, it is ensuring that it addresses and improves the variable quality offered by general practitioners. Although an optimist, I remain concerned by the slow pace of change. On the current evidence, NHS England cannot deliver on its mandate, and Public Health England will fail to close the inequality gap in social provision for some of the most vulnerable in our society, such as the elderly and people who need access to mental health services at the weekend. This is mainly because there is an absence or limited availability of consistent support services such as diagnostics, and a lack of community and primary care services which, if available, could prevent some unnecessary admissions and support the timely discharge of patients. It remains, as has been said, difficult to get routine blood tests, X-rays, MRI scans, pharmacy, physiotherapy and social services at weekends. Of course, I have already mentioned the variable out-of-hours primary care.

Sir Bruce is quite right when he advocates a whole-system approach to improve the current, unacceptable standards being offered in the NHS at the weekends. However, although I do not support yet another reorganisation of the NHS, with tight finance restraints, the Government may need to think further about simplifying the current and complex NHS system. They will also need to consider how budgets are shared and pooled between organisations, including with local authorities, and who will lead on this. The NHS is a great institution, and it is our duty to make it fit for the 21st century.

NHS Property Services Ltd

Baroness Manzoor Excerpts

Thursday 30th January 2014 Lords Chamber

[Earl Howe]

My Lords, the National Audit Office is indeed looking at the company—only to assure us and itself that the company is properly organised and structured. We welcome that, as does the company. There was no sinister purpose or concern underlying that process; it is perfectly normal and natural.

[Baroness Manzoor (LD)]

My Lords, can the Minister confirm best value for money on all properties sold and that there has been proper consultation with local organisations on all NHS estates?

[Earl Howe]

My Lords, I can assure my noble friend of that. The company ensures best value by marketing through an arm’s-length open market process, which ensures that the market value is achieved in a sale. Where necessary, the sale price is supported by a district valuer or other third-party independent valuation.

Health: Confidential Patient Information

Baroness Manzoor Excerpts

Thursday 23rd January 2014 Lords Chamber

[Earl Howe]

My Lords, there are circumstances in which potentially identifiable data can be released, but they are very severely circumscribed. A public health emergency is one, but Section 251 of the National Health Service Act 2006 could also allow identifiable information to be shared for specific purposes. However, the controls around that are extremely strict and the only people who can take that decision are the Secretary of State and the Health Research Authority—and then only after expert advice from the Confidentiality Advisory Group.

[Baroness Manzoor (LD)]

My Lords, some patients do not understand the implications and possible effects of the proposed EU legislation. What steps are being considered to ensure that those patients have full understanding?

[Earl Howe]

My Lords, until we are clear about the text that is agreed at European level, it is difficult to issue public advice on what the effect of that proposed measure would be. The text is still being argued over. While my noble friend is absolutely right that a public information exercise would be advisable once we are aware, we are not at that point yet.

NHS: Essential Services

Baroness Manzoor Excerpts

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My Lords, I should first tell the noble Baroness that we cannot reconcile our own figures with those of Dr Foster. We believe that there has in fact been a significant increase in the number of cataract and knee and hip replacement operations since 2009-10 and not a drop. Regardless of that, I suggest to her that the absolute numbers of operations taking place do not tell us anything about possible rationing or the absence of it. That question can be answered only with the benefit of fuller data. The key to consistent access to these treatments is a common understanding among commissioners of the evidence base in each case. That is exactly what Sir Bruce Keogh is working towards and will provide guidance on in due course.

[Baroness Manzoor (LD)]

Can the Minister state which local NHS services NHS England has deemed to be essential? If an independent provider of these services gets into financial difficulty, who will provide and pay for those services—NHS England or the clinical commissioning groups?

[Earl Howe]

My Lords, from April this year, CCGs and NHS England will begin to identify formally those healthcare services that they consider essential to protect in the event of the financial failure of their providers. They will be required to designate such services as commissioner requested services. In doing so, they must have regard to Monitor’s published CRS guidance. Should an independent provider of CRS get into financial difficulty, then Monitor will work with the provider and relevant partners to determine the right solution.

NHS: Clinical Commissioning Groups

Baroness Manzoor Excerpts

Wednesday 27th November 2013 Lords Chamber

[Earl Howe]

My Lords, the CCG target formula recommended by ACRA this time a year ago was rejected by NHS England for the very reasons that the noble Lord cites: because it did not include an adjustment for deprivation and health inequalities. At a recent Health Select Committee hearing, Paul Baumann, the chief finance officer of NHS England, indicated that the proposed new formula would have an adjustment for a health economy’s unmet need—in other words, an adjustment for deprivation where low life expectancy suggests that people are not accessing health services.

[Baroness Manzoor (LD)]

My Lords, can my noble friend the Minister clarify that responsibility for the development of primary care is to be shared between CCGs and NHS England area teams, particularly as CCGs now control two-thirds of the NHS budget?

[Earl Howe]

My Lords, at present primary care is commissioned by NHS England and has three broad ingredients: primary medical care, primary pharmaceutical services and primary dental services. However, we are looking at ways of making the whole process of primary care commissioning more creative. That could well involve a joint process by NHS England and clinical commissioning groups.

NHS: Accident and Emergency Units

Baroness Manzoor Excerpts

Tuesday 26th November 2013 Lords Chamber

[Baroness Manzoor (LD)]

My Lords, the first choice of most people who think that they need urgent medical attention is to go to their local hospital’s accident and emergency department. I understand that, as A&E departments are trusted by the public as a place of expertise and knowledge. However, as we know, our hospitals and A&E departments are under significant pressure to treat all those who come through their doors. On top of this, the Royal College of Surgeons states that A&E departments are understaffed by around 10% and that in some trusts, such as Barking, Havering and Redbridge University Hospitals NHS Trust, the figure is as much as 43%. The understaffing of A&E departments is a serious issue.

Following the disgraceful events at Mid-Staffordshire hospitals, the Government have given their total commitment to putting patient care first and ensuring that patient safety should always be paramount. However, it is clear that running A&E departments that are under-resourced and poorly staffed poses a high risk to patient care and patient safety. This issue needs urgent attention by the Government and the NHS health board and I look forward to the Minister’s response on the plans that the Government have to rectify this and the timescales involved.

I too have read Sir Bruce Keogh’s review of urgent and emergency care services in England and I agree with the report’s proposals that there must be a “fundamental shift” in the provision of urgent care. I agree with much of the report, which is reasonable. But what we need now is strong leadership to deliver.

I have also read the July 2013 survey findings from the NHS Confederation, which found that its members thought three main solutions could lead to fewer pressures on A&E departments. The first was more money for primary and community care. To this, I would add more extended primary care out-of-hours services provided by GPs. These could be sited in hospitals or perhaps close to A&E departments. This would enable GPs to work in much greater collaboration with hospital A&E staff and could provide the patient with much needed seamless care.

Secondly, winter pressure money for hospitals should be allocated sooner. I would further argue that this money should be part of hospitals’ general allocation so that they can plan service delivery for all their services in a more effective, planned and co-ordinated way. Thirdly, there should be a public-facing campaign about all the alternatives to emergency departments, but these alternatives must provide a good quality of care and service if they are to have the trust of the public.

The Government are moving in the right direction by allocating specific funds, but it is not just about turning the tanker, it is about making our hospitals and GP services fit for the 21st century.

Female Genital Mutilation

Baroness Manzoor Excerpts

Thursday 7th November 2013 Lords Chamber

Asked by

[Baroness Manzoor]

To ask Her Majesty’s Government what assessment they have made of the report Tackling Female Genital Mutilation in the UK by the Royal College of Nursing.

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

My Lords, the Government welcome the intercollegiate report Tackling FGM in the UK, which is published this week. Female genital mutilation is illegal. It is important that children and young women are protected from this abhorrent procedure. My honourable friend Jane Ellison has supported the development of this report. As Minister for Public Health, she has stated that one of her priorities is to continue to work towards eradicating female genital mutilation with the organisations that are promoting the report, among many others.

[Baroness Manzoor (LD)]

I thank the Minister for his reply. Does he welcome, as I do, the proposal that FGM should be treated by healthcare workers as a crime and reported to the police? Does he also welcome the work of the Liberal Democrat Minister, Lynne Featherstone, in prioritising the eradication of FGM in her work in the Department for International Development?

[Earl Howe]

My Lords, I agree with my noble friend. Female genital mutilation is child abuse and violence against girls and women. It is also a criminal offence, and cutters and perpetrators need to be brought to justice. I pay tribute to the work currently in train in the Department for International Development, which has begun an ambitious programme to address FGM in Africa and beyond.