Health: Local Healthwatch Funding
Baroness Pitkeathley Excerpts(10 years, 8 months ago)
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Earl Howe
My Lords, we will not have a comprehensive picture of the impact that local Healthwatch has made until it publishes its annual reports later in the year. At the moment, we have anecdotal reports of some considerable successes around the country, but until we have those annual reports, it would be premature for me to make a general comment.
Baroness Pitkeathley (Lab)
My Lords, it is surely disingenuous to think that local Healthwatch can properly represent the interests of patients—the Government made very strong commitments about that during the passage of recent health Bills—when it is being starved of cash. What discussions have been taking place between the Department of Health and the Department for Communities and Local Government to ensure that the money gets to the right place?
Earl Howe
I simply say to the noble Baroness that it is too soon to say whether local Healthwatch has been starved of cash. What matters most to local communities is the difference that their local Healthwatch is making, such as rooting out poor practice, ensuring that the views of local communities are heard in inspections and helping to improve local services. It is only after a period of time that we can make the relevant judgments. I can tell the noble Baroness that Healthwatch England is playing the role that it was designed to do: overseeing and supporting local Healthwatch where necessary.
Health: Multiple Sclerosis Nurses
Baroness Pitkeathley Excerpts(10 years, 9 months ago)
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Earl Howe
I have already mentioned the NICE guidelines, which we expect NHS professionals to take account of. In that context it is worth saying that the guidelines are due to be updated later this year, and patients and patient groups will have the opportunity to feed into that. However, in the end it is up to local healthcare organisations, with their knowledge of the needs of their local populations, to determine the workforce required to deliver safe and effective patient care within their available resources.
Baroness Pitkeathley (Lab)
My Lords, given what the Minister has said about the variations, can he explain a bit more about the tremendous regional variations in the numbers of patients who have access to an MS nurse, because this causes great confusion to patients and their families? For example, I understand that in the east of England there are 220 patients per MS nurse, whereas in the north-west there are as many as 650.
Earl Howe
I am aware of those variations. Making the NHS more responsive to the needs of people with long-term conditions such as MS is a key government priority. We have committed to it in the NHS mandate, the NHS constitution and the outcomes framework. Strategic clinical networks have a key role to play in providing expertise and guidance and to smooth out the variations that the noble Baroness mentions. She may be aware that NHS England has appointed David Bateman as the first national clinical director for neurological conditions, whose job it will be to look at the very issues that she has raised.
NHS: Cancer Treatment
Baroness Pitkeathley Excerpts(10 years, 10 months ago)
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Baroness Pitkeathley
To ask Her Majesty’s Government what action they propose to take to ensure that older people receive equal access to NHS cancer treatment.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
In December, the national clinical director for cancer at NHS England launched a call for action on the treatment for older people. NHS England is now setting up an advisory group to identify where improvements in cancer services for older people can be made. It is also supporting an initiative to ensure that patients are better informed about the options available to them and that they are fully involved in decisions about their treatment.
Baroness Pitkeathley (Lab)
I thank the Minister for that welcome Answer, but is he aware of the recently published Macmillan Cancer Support report, which shows that up to as 10,000 cancer patients die needlessly each year because of blatant ageism among doctors? For example, recommendations for chemotherapy diminish by as much as half if you are over 70. Since we are an ageing population and half of all new cancer diagnoses are in people over 70, does the Minister agree that it is of the utmost importance that we ensure that people are treated as individuals regardless of their age? How will he ensure that this view is held also among GPs and hospital consultants?
Earl Howe
My Lords, I completely agree. The noble Baroness is right that a series of reports has shown that the NHS has too often failed to provide the best possible services to older people. We cannot save lives without tackling inequalities. The NHS has a statutory duty to reduce health inequalities and to improve the health of those with the poorest outcomes. A ban on age discrimination in the NHS services was introduced in 2012, meaning that NHS services need to do everything they can to ensure that they do not discriminate against older people. We will hold the NHS to account for that through the mandate and the NHS outcomes framework.
Health: Confidential Patient Information
Baroness Pitkeathley Excerpts(10 years, 10 months ago)
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Earl Howe
My Lords, under the 2012 Act, the Health and Social Care Information Centre cannot release data that could be used to identify an individual without a legal basis to do so. As a result, there are strict controls about how such information is released. As regards the UK Biobank, the noble Lord is right to be concerned because the proposed text from the so-called LIBE committee would rule out the work of the UK Biobank, in that it would need explicit and time-limited consent for any research project that it undertook, instead of being able to support a range of research purposes, as it now can, using its existing consenting mechanism. So there is cause for concern if this text is adopted, but that is not yet clear.
Baroness Pitkeathley (Lab)
My Lords, many noble Lords will have received recently a leaflet through their letter box, saying that their records are going to be made available unless they opt out. The means of opting out is to contact your GP. First, has anyone noticed how difficult it is to contact your GP in some circumstances? Secondly, would it have been beyond the wit of the department to include a simple, tick-box form for people to use? Does the absence of such a simple process lead us to conclude that the Government do not actually want people to opt out of making their records available?
Earl Howe
My Lords, everybody in the country has a right to object to their data being shared. Those objections will always be respected. A practical way had to be found to enable that process to happen, and we believe that it is not unreasonable to expect a patient to have a conversation with their GP. I will, however, take the noble Baroness’s suggestions on board and feed them in.
NHS: Essential Services
Baroness Pitkeathley Excerpts(10 years, 11 months ago)
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Earl Howe
My Lords, the CCG assurance framework sets out how NHS England will ensure that CCGs are operating effectively to commission safe and high-quality sustainable services within their resources. Underpinning assurance are the developing relationships between CCGs and NHS England, which should not be overlooked. One key source of evidence is the national delivery dashboard, which provides a consistent set of national data on CCG performance. In addition, there is the CCG outcomes indicator set, which will be an important wider source of evidence from 2014-15 onwards.
Baroness Pitkeathley (Lab)
My Lords, I know that the noble Earl has disputed the figures but if the volume of operations such as knee and hip replacements and cataract removals is declining, does he accept that this is likely to cause further problems in the social care sector? If older people do not receive timely treatment that will transform, as these operations do, their mobility and ability to manage at home alone, surely they will continue to need more support in the community, which we know is under pressure because of shortages in local authority funding. We may call these operations non-essential—we often do—but they are not non-essential if you are an older person with mobility problems.
Earl Howe
I fully agree with the noble Baroness and her point about mobility is very well made. However, NHS England has stated to me explicitly that the assumption that there should be a rising trend in the number of operations proportionate to the rise in the number of elderly people may not necessarily be right, so we have to be wary of using a statistic in isolation to prove one thing or the other.
Children and Families Bill
Baroness Pitkeathley Excerpts(11 years ago)
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Baroness Pitkeathley
“Welfare of disabled children
(1) The Children Act 1989 is amended as follows.
(2) After section 23A insert—
“23AA Welfare of disabled children
Regulations, subject to approval by resolution of both Houses of Parliament, shall provide for those who care for disabled children to have the same entitlement to a carer’s assessment as young carers and adults caring for adults.””
Baroness Pitkeathley (Lab)
My Lords, I begin by apologising for being such a latecomer to this Bill, over which so many of your Lordships have laboured long and hard. The reason is simply the clash of commitments that we so often have to contend with in your Lordships’ House: I was very involved with the Care Bill, and it is on the subject of the Care Bill that I now rise to speak.
Your Lordships will know that the Care Bill enshrines in legislation many more rights for carers than hitherto. Adult carers featured strongly in the Care Bill and thanks to the Government being willing to listen and amend the Bill—and to what we might call a pincer movement between the Care Bill and the Children and Families Bill—young carers have similarly been well recognised. However, in spite of much effort—much of it focused in this Bill by many noble Lords and noble Baronesses present today—the rights of parent carers remain weaker than those of other carers.
When I moved a similar amendment to the Care Bill, the Minister was kind enough to say that he recognised my concerns and would consider them. The outcome of those considerations was that the proposal would sit better in this Bill and it is for that reason I am moving it today. Briefly, as I know that many noble Lords are familiar with the issues, the purpose is to strengthen the rights of those who care for a disabled child to receive an assessment of their need for support in line with the assessment rights of adults caring for adults and of young carers.
It is vital that the rights of parent carers to assessment and support are not lost in the current legislative reform of carers’ rights and that their rights are enhanced along with those of other carers.
Like other carers, parents of disabled children already have an existing right to request a separate assessment of their own needs, which is in addition to having their needs assessed as part of their child’s assessment under the Children Act 1989. The existing rights for parents to have their needs assessed separately were introduced in three Private Members’ Bills, with which I was involved and which will be familiar to many of your Lordships. The three Acts were taken through Parliament with cross-party support, in recognition of the huge contribution that carers make and of the need to set out clearly in law their rights to receive support for their care and their right to a life outside caring.
Baroness Pitkeathley
My Lords, I had hoped that we were making a bit of progress, but I am having a kind of throwback moment. When many of us first started getting the issue of carers on to the social policy agenda—many noble Lords here will remember that—I used to be told, “Oh, you can’t think of the needs of carers. The needs of the disabled person or the older person have to be paramount and you’ve got to think of those first. If you look at the rights of carers, you’re going to undermine those roots”. I am hearing the same argument tonight and I find it extremely disappointing. However, we made progress on the other matter: everybody now understands that you can look at the rights of the disabled or older person and the rights of carers and not undermine either of them—the two are inextricably entwined. Therefore, I continue to hope that we will still be able to make progress. We have fundamentally failed to get Ministers and their officials to understand that there is a difference between being the parent of a disabled child and being a parent. There is a fundamental difference and it needs to be looked at. Having had the support of so many of my noble colleagues tonight, I feel that I have a window to come back to this on Report. However, in the mean time, I beg leave to withdraw the amendment.
NHS: Mid Staffordshire NHS Foundation Trust
Baroness Pitkeathley Excerpts(11 years ago)
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Baroness Pitkeathley (Lab)
My Lords, I am sure it will be welcome to patients and their families that the name of a responsible consultant will now be above the patient’s bed, but will the noble Earl say a bit more about the new attention to 75 year-olds that has been promised? In the extensive leaks of the Government’s response over the weekend, GPs were definitely named as the people who would be responsible for the over-75s. The Statement refers to “a named accountable clinician”. Is there a difference between the two?
Earl Howe
Yes. There were no leaks. The report that the noble Baroness saw was a report on the new GP contract that we announced at the end of last week. That was legitimate reporting by the press of an element of the new contract for next year, when we want all NHS patients over the age of 75 to have a named, accountable GP. However, we are saying in this response that every patient in a hospital setting should know who their consultant is, and therefore that there should be a named responsible consultant for every hospital patient. The two issues are, therefore, related but different.
Professional Standards Authority
Baroness Pitkeathley Excerpts(11 years, 1 month ago)
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Earl Howe
My Lords, it is important to understand that the accreditation scheme that we are talking about does not endorse any particular therapy as effective, and that it makes clear that accreditation does not imply that it has. The principle remains that it is for individuals, in consultation with health practitioners, to decide which therapy is right for them. The scheme is not a form of regulation, nor is the PSA a regulator. It sets standards for organisations holding voluntary registers for health and social care occupations, and accredits those that meet the standards.
Baroness Pitkeathley (Lab)
My Lords, I declare an interest as chair of the Professional Standards Authority, and I pay tribute to the skill and experience of my board. Does the Minister agree that as by next March more than 75 occupations and 100,000 practitioners will be covered by the accredited voluntary register scheme, the public are much better informed and better protected than they have ever been?
Earl Howe
My Lords, I agree with the noble Baroness, and I pay tribute to her work as chair of the PSA. The benefits of accredited voluntary registration are clear. The point is to give the public, employers and commissioners choice to use people on a register that the authority has independently assessed and approved, and only those registers that the authority has accredited are allowed to use its kitemark.
Care Bill [HL]
Baroness Pitkeathley Excerpts(11 years, 1 month ago)
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Baroness Barker
My Lords, I draw to the House’s attention three questions put forward by Leonard Cheshire Disability. That organisation has worked extremely hard to support the Government in their stated objective of stopping 15-minute care appointments for older people, and its questions are worth following up.
First, why is it necessary to remove this power completely from the CQC; what will the CQC be stopped from doing by the absence of this power that otherwise it would not be? Secondly, the Government are committed to tackling poor commissioning and poor practice. If it is not going to be the role of the CQC to challenge local authorities on their commissioning practices, whose job will it be? Thirdly, is there any evidence that that power, as it exists, has been misused? Whatever one’s view about where responsibility should lie—the noble Lord, Lord Deben, made interesting points about that—those three questions are worthy of an answer when we come to formulate that view.
Baroness Pitkeathley
My Lords, I, too, am troubled by the seeming perversity of government Amendments 145, 146 and 149. The effect of the amendments seems to be to make it harder for the CQC to conduct investigations into local authority practices, particularly of commissioning. My understanding, from my hazy memory of when the CQC was set up, was that that was a particularly important function. Surely it has become more so, given the commitment to integration between services provided by the health service and those provided by local authorities. Was that not a key feature of establishing the CQC? The timing of this seems to be very odd—perverse, as the noble Lord, Lord Low, said—given the current huge concern about the way in which services are commissioned, the so-called 15-minute care visits, and so on.
Do the Government see a continuing role for the CQC in working with local authorities to improve the way that they commission services, or is this a retreat from the way the Government view the CQC? I was very involved in the discussions before the CQC’s relaunch, and understood that to be an important part of its function. The amendments appear to reduce the CQC’s power to help improve local authority commissioning and, because of that, its oversight of care quality. That is a great concern to us all, particularly when we are so concerned about the quality of the services which are commissioned.
Lord Hunt of Kings Heath
My Lords, first, I welcome the amendments in relation to CQC independence. I would like assurance that it does what it says on the tin. I assume that the CQC will be regarded as independent. Perhaps it will be making fewer visits to the Secretary of State than it does at the moment. If there are weekly meetings, as is suggested, between the Secretary of State, the CQC, Monitor and NHS England, it is very difficult to believe that it is going to be truly independent. The proof of the pudding will be in the eating; but it is very difficult to know why the Secretary of State needs to see the CQC on such a regular basis if it is really an independent organisation.
Like other noble Lords, I am puzzled why the periodic reviews of local authority performance in commissioning adult social services have been removed from the Bill. I am surprised at the current policy, which is that, as part of wider moves to devolve responsibility for improvement in the sector, local authority commissioning performance and assessment will be led by councils. Presumably that means that it is government policy that the performance of the commissioning function of local authorities in adult social care will be reviewed by local authorities.
With the greatest respect for the noble Earl, Lord Howe, he knows that I am a great admirer of local authorities; I have served on two. However, like the noble Lord who spoke so eloquently earlier about solar decisions being called in by DCLG—to which, no doubt, the noble Earl will have a detailed response—I would not have thought that the commissioning performance of local authorities was thought to be so excellent that they can be left to themselves to police their performance in future.
Care Bill [HL]
Baroness Pitkeathley Excerpts(11 years, 2 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I shall speak also to the other amendments in this group, Amendments 33, 36, 37, 39, 40, 42 to 45 inclusive, 62, 90, 91, 100, 101 109, 112, 115, 116 and 117. In Committee, we had a wide-ranging and informed debate on assessment. I have reflected on the issues raised and I have tabled amendments which I hope noble Lords will agree address those concerns and clarify our intentions around the assessment process.
In Committee, we considered a provision which was intended to ensure a focus on the adult’s strengths and how these can contribute towards the outcomes they want to achieve as part of the assessment. This provision was drafted to support our aim to build the care and support system around the person and to consider the adult’s own capabilities: what they can do—as well as their needs—and what they cannot do. While most noble Lords agreed with the principle, a concern in Committee was that the provision set out in the Bill might be wrongly interpreted by local authorities as allowing them to place additional caring responsibilities on family and friends rather than providing care and support. Amendments 32 and 33 look to address the concerns that arose.
Amendment 32 removes the requirement to assess the adult’s capabilities and other matters as part of the needs assessment. Amendment 33 provides for a consideration of such matters to happen separate to, but alongside, the needs assessment. Local authorities should have a discussion with adults or carers in parallel to the assessment, considering how their own capabilities and any other matters can help to achieve the outcomes they want to achieve on a daily basis. These amendments remove the source of concern, while retaining the important point of policy on which we agree.
In Committee, there was also concern as to whether the assessment process was sufficiently supportive of the focus of the Bill on the prevention of need. We have considered this and have also brought forward amendments to strengthen this focus. The second part of Amendment 33 and Amendment 45 require a local authority to consider at the time of the assessment whether any universal services available locally, whether provided by the local authority under Clause 2 or Clause 4 or by another organisation, would be of benefit to the person. This replaces the previous provision in which such a consideration took place only after the eligibility determination. This would support situations where, for example, a local authority might decide to defer the final eligibility determination until the person or carer has taken part in a preventive service, such as a reablement programme. Amendments 36 and 37 make similar provision in relation to carer’s assessments. Amendments 90, 91, 100, 101, 109 and 112 make equivalent changes in relation to the assessment of children, child carers and young carers.
In Committee, the noble Lord, Lord Low, pointed out that while the regulation-making powers would provide for an expert to carry out complex assessments, they did not require it. I assured the noble Lord that this was not our intention and that I would look again at the provisions to ensure they provided for this. Having considered the provisions I have concluded that they needed to be strengthened to provide for when an expert must carry out an assessment for complex needs, such as for a person who is deafblind. Amendment 39 rectifies this, and I would like to thank the noble Lord for raising this in Committee.
Through Amendment 40, we will require assessors who are trained but may not have experience of carrying out an assessment for a specific condition to consult a person with experience in that area. For example, an assessor who normally assesses older people who is asked to assess a person with learning disabilities would have to consult a person with experience in that condition.
I turn now to Amendments 42, 43, 44, 62, 115, 116 and 117. Members of the Committee asked to see clear links between this Bill and the Children and Families Bill, which is also before the House. I share their view that both Bills must work together so that no one falls through a gap in the legislation. Amendment 42 ensures that a local authority can combine an adult’s assessment with any other assessment it is carrying out, whether under this Bill or other legislation, as long as the individual or individuals being assessed agree. For example, it clarifies that the authority can carry out a needs assessment with a young carer’s assessment. Amendment 43 allows the authority to carry out a needs or carer’s assessment jointly with another assessment being carried out by another body, whether of that person or a person relevant to the situation, as long as the individual or individuals being assessed agree. Amendment 62 ensures similarly that local authorities have powers to combine care and support plans and support plans with any other plan of that individual or another. Amendments 115, 116 and 117 make similar provision for a child’s assessment, a child carer’s assessment and a young carer’s assessment when they are transitioning to adult services. These amendments reflect similar government amendments tabled to the Children and Families Bill and reflect the synergy between both Bills and how they work together to ensure that the needs of children and young carers are considered during the adult’s assessment.
I have listened to the strength of the arguments made in Committee. I hope your Lordships will agree that the amendments I have tabled address the concerns that were raised and that they strengthen and clarify the assessment provisions. I beg to move.
Baroness Pitkeathley (Lab)
My Lords, the changes that the Government have made concerning assessments are very welcome. I particularly thank the Minister for the careful and considered way in which he listened to the issues around young carers, and particularly the way in which these now mesh with the Children and Families Bill, which was a concern to many of us. That is very welcome.
Amendment 32, which removes the reference to support available from families and friends, is particularly welcome. Disability and carers’ organisations have very serious concerns that the original wording would lead to local authorities making assumptions about what families could provide without conducting a thorough assessment of a person’s needs and then carefully considering how those needs could best be met, particularly taking into consideration the family’s willingness to provide that care.
Amendment 33 also includes a requirement that when an assessment is carried out it is also considered whether the person would benefit from prevention services or from information and advice. That greater emphasis is also very welcome. However, I would like the Minister’s comments on one concern about Amendment 33. It refers to,
“which might be available in the community”.
If this wording is included in the Bill, it is vital that strong guidance is given to local authorities not to run the risk of negative, unintended consequences. There will be guidance, regulations and assessments, as we know. What assurances can the Minister give that community services will not be seen as an automatic alternative to statutory services and will not therefore create a further barrier for those in need of statutory support?
Can the Minister assure me that guidance will make it clear that local authorities cannot make assumptions about the availability and appropriateness of other support from community services and whether it is wanted by the disabled or older person? The Government have made it clear that they do not intend local authorities to look to families and friends to provide care and support, potentially taking on a greater caring role. Can the Minister give assurances that local authorities should also not be looking to families and carers to provide more care as a get-out clause, if you like, from providing statutory services? This is particularly important given the great variability in so-called community services from area to area and, of course, the huge stress on local authority budgets, which is a fact of life for all local authorities at present.
Lord Low of Dalston (CB)
My Lords, I very much welcome the Government’s Amendments 33, 39 and 40. So far as Amendments 39 and 40 are concerned, in Committee, as the Minister has remarked, I sought a strengthening of Clause 12(1)(f) to ensure that regulations would specify the circumstances in which a specially trained person must carry out an assessment or a reassessment of persons who need one. The Minister was kind enough to thank me for raising the point, and I thank him very much for bringing forward these amendments. I am delighted that the Government have come forward with amendments that effectively meet my wishes, recognising that the Bill, as initially presented to the House, did not precisely reflect the Government’s intention.
Talking of specialist provision, I kick myself that I forgot to refer to this in connection with Amendment 26 from the noble Baroness, Lady Meacher, about the need for local authorities to commission a full range of services to meet the diversity of their residents’ needs. I meant to illustrate this by reference to the situation of deafblind people who are all too often offered mainstream services or services designed for those with a single sensory loss instead of the specialist provision appropriate to their particular needs. Perhaps, in welcoming the Government’s amendment on specialist assessments, I can slip in the thought that if local authorities are required to ensure that sufficient services are available for meeting the needs for care and support of adults in their area, they would rightly be under some pressure to identify the full range of deafblind people’s needs, and those with other specialised needs as well, and plan accordingly.