NHS: Leeds General Infirmary

Baroness Masham of Ilton Excerpts

Tuesday 23rd April 2013 Lords Chamber

[Earl Howe]

My Lords, if the noble Lord can supply me with some examples, of course I will look into them. I remind him that tomorrow we are debating a set of regulations that bear on this very question and I shall have plenty to say on that occasion, which I hope will assuage his concerns.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that it has been really splendid to witness the Members of Parliament from all over Yorkshire supporting their constituents? Will the Government listen to them?

[Earl Howe]

My Lords, I have made clear that it is not for the Government to take a decision on this question. It is for the NHS to decide what the best configuration of services should be, and I think most noble Lords agree with that.

NHS: ECMO Machines

Baroness Masham of Ilton Excerpts

Monday 22nd April 2013 Lords Chamber

[Earl Howe]

My Lords, the department itself no longer has a role in commissioning highly specialised services. NHS England is implementing a single operating model for the commissioning of 143 specialised services. That replaces the previous arrangement whereby 10 regional organisations were responsible for commissioning specialised services and, to be frank, there were wide variations in the standard of those services. The new operating model represents a significant change to the previous system and should result in better outcomes.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that Glenfield Hospital in Leicester, which has ECMO, saved many lives in the swine flu epidemic last year and does more than just hearts?

[Earl Howe]

I am fully aware of that. Glenfield has been leading the development of ECMO services. It is one of the biggest ECMO centres in Europe. It is currently the largest provider of children’s ECMO in the country, treating about 70 paediatric ECMO patients a year, and now provides an adult service.

Mid Staffordshire Foundation Trust Inquiry

Baroness Masham of Ilton Excerpts

Tuesday 26th March 2013 Lords Chamber

[Earl Howe]

My noble friend is right to raise this issue, and I pay tribute to the work that she has so consistently done to improve the lot of those with autism. I undertake to write to her about this, but I can give her the general reassurance that the Department of Health will certainly be involved in the scrutiny of these measures, as will the NHS Commissioning Board. I want to ensure that we learn the right lessons from the actions already taken.

[Baroness Masham of Ilton]

My Lords, does the Minister not think that, with the duty of candour, those who make mistakes should take responsibility and be accountable for them? Otherwise people will not learn from those mistakes and they will continue. I also want to ask about the 10 disciplines. I was very surprised that respiratory conditions are not included as nearly all death certificates have pneumonia on them.

[Earl Howe]

I undertake to look at the latter point made by the noble Baroness. The 10 disciplines were selected as ones that could reasonably and readily be subject to the kind of assessment process that we are looking to achieve. I will come back to her on that.

As regards the duty of candour, individuals should certainly take responsibility for their actions and be encouraged to do so. We fear, however, that criminalising individuals’ behaviour within an NHS organisation could risk doing the opposite of what we all want to see: a much more open culture, one that has made the NPSA and its work so successful; a no-blame culture, where people take responsibility for when things go wrong but do not feel that the heavy hand of authority is going to descend upon them at the merest mistake. However, it is important that people are held to account if they are dishonest or deliberately withhold information, and that is a different set of issues.

Health: Cancer Drugs Fund

Baroness Masham of Ilton Excerpts

Wednesday 13th March 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Lord raises a very important point because clinical audit of the drugs in the cancer drugs fund and their use will be extremely important in informing the use of these drugs going forward and, indeed, in determining their price under a value-based pricing scheme. As yet we have not heard from the Oxford Cancer Intelligence Unit although I understand that we will receive a preliminary report quite soon. However, as I mentioned earlier, when the current fund comes to an end we will ensure that those patients who are receiving drugs under it will continue to do so.

[Baroness Masham of Ilton]

My Lords, does the Minister agree with me that the cancer drugs fund has been very helpful? Will he find some way of getting more orphan drugs for the very rare cancers, because that is a problem?

[Earl Howe]

The noble Baroness raises another important point about orphan drugs and indeed ultra-orphan drugs as they are termed—drugs which are efficacious and helpful for patients with very rare conditions. It is likely that we will need to put special arrangements in place for the pricing of those drugs. Overall, however, I agree with the noble Baroness that the cancer drugs fund has been immensely helpful. So far, since October 2010, the funding has helped more than 28,000 patients in England to access the cancer drugs that their clinicians recommended, which they would not have done otherwise.

NHS: Mid Staffordshire NHS Foundation Trust

Baroness Masham of Ilton Excerpts

Monday 11th March 2013 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I thank my noble friend for securing this debate but I have to say that, with such an emotive and tragic subject, the time given is totally inadequate.

Some time ago, I had the honour to chair a meeting in your Lordships’ House of some of the next of kin of those who had died in Mid Staffordshire hospital in such distressing circumstances. They were honourable people, who told us of their experiences. The Patients Association, of which I am a member, was involved in organising this meeting. I hope that the Members of your Lordships’ House who attended were as convinced as I am that hospitals should not be places of fear and bullying but that patient safety should be the top priority, with patients being the focal point and with enough trained staff to care for them with understanding and compassion.

With the ongoing system of cruelty for so long a period at Mid Staffordshire, I wonder what the hospital chaplains were doing. They should be a support to both patients and staff. Why did they not notice the inadequate patient care and speak out? Perhaps they, too, were silenced and shunned.

The Francis report states the need for a “duty of candour”. There should be transparency, the need to report wrongdoings, and communication with patients and their next of kin when things have gone wrong. I brought amendments concerning this during the passage of the Health and Social Care Bill. Now, with the recommendation in the Francis report, I ask the Minister: what is going to happen about this? The report must not become just a talking exercise; action is needed. The NHS, throughout the country, must have the highest standards for all patients.

Sixteen babies and two mothers died at University Hospitals of Morecambe Bay NHS Foundation Trust. As stated in the Sunday Times,

“In both cases”—

of Stafford and Morecambe Bay—

“managers are accused of covering up patient deaths as they chased the prize of foundation trust status”.

Many people have lost confidence in the NHS. Patients should be treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty. In addition, they want safety and clean hospitals at all times.

I ask the Minister: is the NHS in safe hands? There is much to do to restore the public’s confidence in the NHS so that it can flourish. We need it.

NHS: West London Hospitals

Baroness Masham of Ilton Excerpts

Thursday 28th February 2013 Lords Chamber

[Earl Howe]

No, I do not accept that at all. A reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, develop services that are closer to home and, most importantly, save lives. It is not about saving money.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that the downgrading of anything is very depressing, worst of all for patients when they want upgrading?

[Earl Howe]

My Lords, I think that often when plans are explained to patients, they realise that the word “downgrading” is inappropriate. For example, in north-west London, there has been a lot of unnecessary worry about urgent care centres as substitutes for A&E units. The majority of people who attend A&E can very well be treated in an urgent care centre on the same site, and patients who dial 999 will be taken by ambulance straight to the appropriate hospital. Therefore, I think there is, in some senses, a false debate going on here.

Health: Healthcare Assistance

Baroness Masham of Ilton Excerpts

Wednesday 13th February 2013 Lords Chamber

[Earl Howe]

My Lords, the policy on nursing is clear: there is general acceptance that nursing should be a graduate profession. The problem with giving responsibility to the NMC for healthcare assistance is that that is not currently within its remit, and I think it would say that it has enough on its plate to deal with, without that added dimension as well.

[Baroness Masham of Ilton]

My Lords, what does the Minister think of the care assistant who posed as a nurse for four years, working in four different surgeries, before she was found out? She did several hundred vaccinations and cancer smears on patients.

Health: Sugar Consumption

Baroness Masham of Ilton Excerpts

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

My noble friend makes a good point, but in healthy children exercise is very important as a preventive measure for obesity and diabetes. The central point he makes is absolutely right. We look to healthcare workers, not only health visitors but also midwives, through programmes such as the Healthy Child programme and Start for Life, to get families and children off to the right start, so that they eat properly and live healthy lifestyles.

[Baroness Masham of Ilton]

My Lords, does the Minister think sweeteners are a good substitute for sugar or do they have side effects?

[Earl Howe]

My Lords, we are clear that artificial sweeteners are safe if taken as intended. That is the advice of the European Food Safety Authority and we take that advice. However, encouraging people to take low-diet fizzy drinks, for example, in preference to sugary drinks is problematic because all fizzy drinks have an adverse effect on tooth enamel. We need to be balanced in our messages but we think that artificial sweeteners have a role in a proper calorie-controlled diet.

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

Baroness Masham of Ilton Excerpts

Tuesday 5th February 2013 Lords Chamber

I conclude as I started. All of us in this House are committed to a strong patient voice. Those who will be that voice and the public whom they will serve need clarity in the areas of governance that I have outlined to the House. I hope that my noble friend will be able to allay my concerns.

[Baroness Masham of Ilton]

My Lords, it is with regret that we are here this evening regretting that the Government have, through restrictions on campaigning, deliberately tied the hands of local Healthwatch bodies from giving public voice to those patients’ interests.

The regulations seem muddled and unclear. I am surprised that the noble Earl, Lord Howe, has not managed to do better. Over the years, he has witnessed the difficulties that the bodies representing patients have had, ever since the closure of the community health councils. This time around, I feel that the Government are missing an opportunity. I support the view—I always have—that it is essential that local Healthwatch be independent and led by the service users and the public if it is to have credibility and influence. It must not be a tool of those whom it monitors and inspects.

With the Francis report to be published tomorrow, I am sure that it will become evident that a clear, independent voice supporting patients and users of care homes is vital. There should be trust. The dangerous culture of cover-up and not listening to family and friends must be rectified. At the moment, the Patients Association is asked to comment when there is a problem. We need good, dynamic Healthwatches to ensure that disasters do not happen. We need people who know the needs of their local population. We need safety and a good standard of all health and social care. Healthwatch England is there to help and support local groups, but the local Healthwatch should have freedom to do the very best for those whom it should be protecting and supporting. I hope that the Government will realise what is needed and do better before it is too late.

[Baroness Cumberlege]

My Lords, I suspect that my noble friend has got the message now that we are not totally enamoured of these regulations. I think back to when we had the White Paper, which was published in July 2010. I remember, as my noble friend Lady Jolly has said, how excited I was then by the fact that in local Healthwatch we were to have an organisation that really would be the collective voice of patients. There was a mechanism so that it would have a very strong infrastructure at the local level.

So far so good, but throughout the passage of the Bill Members of your Lordships’ House fought strongly to get that policy enacted. We were given assurances, as noble Lords have said, and they were given in good faith. Yet now we have the regulations in this statutory instrument, we are not only disappointed but deeply concerned. I share the grave concern of the House’s Secondary Legislation Scrutiny Committee, which says that there is a very real possibility that local Healthwatch is in danger of being manipulated, but our concerns do not stop there.

The Government are right to want local people to have control of local Healthwatch but there is a genuine fear about it being subjected to such complex and draconian restrictions on what it will be able to say and do. It is not entirely clear to us what value local Healthwatch can add to the accountability framework of the NHS. This view is shared by Healthwatch England which, as the noble Lord, Lord Collins, has said, suggests that this could be dealt with by guidance. However, the trouble with guidance is that it does not have any statutory force. However, it could use its powers to sharpen the way in which local Healthwatch operates—as an independent champion through the trademark which all local Healthwatches must have and have to own. I have not given my noble friend any notice of this, but perhaps he might like to think about that and take it away.

Paragraph 36 of the regulations prohibits local Healthwatch from opposing or promoting changes to any national or EU law, any national policy, any policy by a local public authority—including both local authorities, the NHS or “any organ or agency” of either—and any planned or actual changes in any of these. In addition, it prohibits influencing,

“voters in relation to any election or referendum”.

These prohibited activities may be undertaken only if they are incidental to what could be called the core purpose of local Healthwatch—that is, giving people a say in local health and social care—unless that core purpose is incidental to the prohibited activities. This is mind-stretching. That seems to be something of a circular definition whereby X is allowed if it is incidental to Y, unless Y is incidental to X. This is pretty difficult. I have said that it is mind-stretching but I really fear that it will be unworkable. What is certain is that it will be incomprehensible to local people, who are expected to participate in local Healthwatch.

The impact of this provision is likely to have a chilling effect and to negate the aims of Healthwatch. Why should any committed volunteer get involved in local Healthwatch, giving freely of their time and energy to try to influence things for the better, if they risk being penalised for doing so?

I shall describe three situations to the Minister to test this with him, and I hope that he will reassure me on these points. First, say that there was a controversial policy to close an A&E department in order to save money. Would local Healthwatch be permitted to provide evidence to campaigners of how good the patient experiences had been at that threatened department? Would that be banned under Regulation 36 as the promotion of changes to a policy that a public authority proposes to adopt? If the Minister says no, how could local Healthwatch be confident that the local NHS decision-makers would share this view?

Secondly, could people who had been active in a national campaign to improve quality and accountability in the NHS be decision-makers in local Healthwatch? Would local Healthwatch have to avoid any connections to an organisation seen as intending,

“to affect public support for a political party”,

that was in power? Again, if the Minister says no, and decisions on such matters are to be delegated to local authorities, how could local Healthwatch be confident of that?

Thirdly, during a local election campaign, would local Healthwatch be subject to purdah, like democratically elected bodies such as local authorities or the Government themselves? Would that apply even if it discovered serious abuses of vulnerable people with learning disabilities in a residential home during this period? Such a discovery would not reflect well on the local authority commissioners, who are “an organ or agency” of local government under the regulations. Would the local Healthwatch have to keep such concerns secret or risk being penalised by that very same local authority?

The very fact that we have to ask these questions demonstrates that we do not have the right set of safeguards for the independence of local Healthwatch. The fact that local Healthwatch is funded and controlled by local authorities, which it is supposed to be scrutinising, is pretty uncomfortable. The added constraints of Regulation 36 threaten its freedom to speak and to act in the interests of patients and the population. These very complex restrictions seem designed to protect those in politics or in the provision of services who have something to hide. They impoverish the debate on health and social care, whether it is about controversial reconfigurations or a Baby P tragedy. Patients could not care less about politics and just want someone to speak up for them when they themselves cannot.

I urge my noble friend to consider modifying, redrafting or, if possible, removing these restrictions, or to find a mechanism to ensure that they are not implemented in the way that I have outlined and the way that I fear. To me, it is not clear whom they are really designed to protect, but I fear that it is certainly not patients.

Health: Medical Innovation

Baroness Masham of Ilton Excerpts

Wednesday 16th January 2013 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I thank the noble Lord, Lord Saatchi, for asking this question so movingly. I feel honoured to be taking part in this debate with such experts. Having a cousin who is research-minded and is a professor, now living in Australia, I want to raise a few points that we have discussed.

Many Britons see their clinical research careers take off after they leave the UK. Some of this is due to the internationalisation of medicine and the growing awareness of how valuable exposure to overseas best practice can be during specialist training. It is a two-way street, so some of the UK’s best specialists come from overseas.

It seems that clinical research comes a poor second after the pressing needs of an overloaded health service have been met. From clinical medical student through resident positions, specialist registrar training and on to first consultant position, it seems difficult to find the time and support for clinical research and development. Apart from a few fortunate centres, where seniors have managed to establish a strong funding stream for R&D, resulting in research fellow appointments, research support staff and so on, there seems to be a poor match between the R&D effort and the acute medical front line. More regional expert centres should be better funded. Steps seem to be needed to recognise where there is already established leadership and to make use of it.

Innovation in healthcare and innovation in clinical research have a symbiotic relationship. Without research there can be no innovation, as there will be no evidence base with which to inform clinical practice. Without that clinically proven innovation being acted on, we will see no advance in clinical practice, no improvement in patient outcomes and less incentive for clinical research to be carried out.

There seems to be frustration from some bodies involved in innovation. For example, Innovation, Health and Wealth promised to:

“launch a national drive to get full implementation of”,

oesophageal Doppler monitoring,

“or similar fluid management monitoring technology, into practice across the NHS”.

This is an admirable policy, but again reality is not living up to intention. Not only is that implementation drive delayed; it has been scaled back. The NHS is also allowing the inclusion of technologies similar to ODM that do not have adequate backing through clinical research and have not been evaluated by NICE. Allowing unproven technology to be on an equal playing field with technology that has been through the rigours of clinical research is both unfair and uncompetitive. It will also result in worse outcomes for patients, lost productivity, fewer savings for the NHS and reduced incentives for clinical research to be carried out in the UK.

Will the noble Earl look again at the ODM implementation plan to ensure that the benefits to both patients and the NHS are realised through proper consideration being given to clinical research? There are so many complicated rare conditions that need new ways of treatment. When medical innovation has come up with the answer, it is vital that patients get the correct treatment for their condition. Nothing is more frustrating for the developers of a treatment and for the patients than when commissioners will not pay, thus holding up treatment and ongoing development.

It is heartening to witness the great support that so many people give to medical research and innovation through charities.