Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011
Baroness Thornton Excerpts(13 years, 3 months ago)
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Baroness Thornton
That this House regrets that the timetable for implementation of the Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011 (SI 2011/1256) may result in up to 4,000 more young people taking up smoking than if the original implementation date had been kept to; further regrets that the Government have not explained how they will mitigate burdens on business “while maintaining the expected public health gains”; and calls on the Government to make the health needs of young people the priority by keeping to the original timetable for implementation.
In its 32nd report, the Merits Committee raised some important points. It suggested that the House might want to seek explanation from the Minister about how the regulations could achieve the Government’s policy objectives. It pointed to the inconsistencies of the growth review, which seeks to reduce the regulatory burden on small enterprises. This might account for the delay in implementation for small shops—although I would question this anyway, and will in a moment—but it does not explain why the implementation date for larger shops is being put back. However, I accept that from today, because of the government delays, three months may not be sufficient time for large shops to prepare for this, although they have had quite a lot of notice. The Minister will need to explain the reasoning behind this decision.
The Merits Committee also called attention to the Written Statement on tobacco control issued by the Government on 9 March, in which the Government state that the take-up of smoking by young people is a particular concern. Smoking is an addiction largely taken up in childhood and adolescence and it is crucial to reduce the number of young people taking up smoking in the first place. The report went on to say that nicotine is highly addictive and that each year an estimated 320,000 young people under 16 will try tobacco for the first time and 200,000 of them will become addicted.
We are all aware of the troubling statistics which surround this issue. The Merits Committee went on to say that, taking the Government’s own baseline statistics, the 18-month delay being proposed as a result of the amended regulations may result in 4,000 young people and children becoming addicted to tobacco, with the consequent long-term health effects. I should therefore be grateful if the Minister would explain whether the Government think that this is a price worth paying for the delay in implementation.
It is worth noting that in March 2009 Norway passed a similar law, which it implemented from January 2010, allowing retailers only nine months to comply and protecting Norwegian children from tobacco marketing five years earlier than the proposals before your Lordships’ House. There is no objective evidence that the Norwegian retail trade has suffered unduly.
I understand—but I am sceptical—that the reason given for such an extended delay for small shops has clearly been the concern that the legislation might adversely affect their businesses. I am afraid I have to question this. I believe that the cynical campaign that has been mounted to delay implementation can be shown to be more for the benefit of tobacco manufacturers than for small retailers. It has become increasingly clear that what purported to be a cry of pain from thousands of small retailers was really a covert and dishonest campaign by the tobacco industry.
Members of both Houses of Parliament have been contacted by three groups, each purporting to represent tobacco retailers: the Tobacco Retailers Alliance, the Association of Convenience Stores and the National Federation of Retail Newsagents. We know that the Tobacco Retailers Alliance is, in effect, a wholly owned subsidiary of the Tobacco Manufacturers’ Association. It is the most obvious kind of front group; it does not even have its own offices but operates from the Tobacco Manufacturers’ Association headquarters. At least that is clear and transparent.
The Association of Convenience Stores can claim a little more independence, and yet it, too, is beholden to manufacturers for subscriptions, sponsorship and advertising. When asked by Stephen Williams MP, the chair of the All Party Parliamentary Group on Smoking and Health, it confirmed that it receives around £100,000 a year from tobacco manufacturers. I would, however, point out that the Association of Convenience Stores has claimed that the cost of compliance would be between £2,000 and £5,000, and yet its own survey of small shops in Ireland found that the average cost of compliance was only £300.
I regret to say that the National Federation of Retail Newsagents has been much less forthcoming, seeking to conceal tobacco industry funding of its far reaching campaign against the display legislation. It recently procured, without any cost to itself, the services of a lobby firm called Hume Brophy, which telephoned and e-mailed the offices of Conservative and Liberal Democrat MPs on its behalf in the weeks before the Government were due to announce their decision on the display ban seeking their support for the repealing of the legislation. The Government are to be congratulated on resisting these blandishments.
It was discovered that Hume Brophy also acted for British American Tobacco and the company was asked whether it was funding the campaign. At first BAT denied this but, following questions at its AGM from Kevin Barron MP, it had to admit that not only had it funded the NFRN campaign against the display legislation but that it had also had meetings with Hume Brophy and the NFRN to discuss how it should be taken forward.
Once this was revealed, Hume Brophy wrote to Stephen Williams on 7 June to apologise for its involvement in such covert lobbying—it needs to be congratulated on so doing—and said that the NFRN agreed that it should write to Members of Parliament to explain. John Hume, of Hume Brophy, wrote:
“I understand that a letter to MPs will be forthcoming from the NFRN in the next couple of days”.
So far we are not aware of a single MP having received such a letter from the NFRN. In fact, it has refused to send one.
However, instead of accounting to MPs and Peers for its dubious lobbying techniques, the NFRN has attacked the Public Health Minister for attending the All-Party Parliamentary Group on Smoking and Health celebration of the 40th birthday party of Action on Smoking and Health and for presenting ASH with an award from the World Health Organisation for its work. We know of the right honourable Lady’s commitment to this issue and she is again to be congratulated on her continuing support. Frankly, rather than attacking the Public Health Minister for her commitment to reducing the harm caused by tobacco, the NFRN should do the decent thing and apologise to MPs for covertly doing the tobacco manufacturers’ dirty work.
I believe that the tobacco manufacturers have repeatedly sought to deceive parliamentarians by concealing their central role in the campaign against the display legislation. I would like the Minister’s view of this matter. Does he agree with me that this is unacceptable and does he think that it may have undermined in some way the UK’s publicly stated commitment to live up to its obligations as a party to the World Health Organisation’s Framework Convention on Tobacco Control? Indeed, the Prime Minister is on the record committing this Government to putting an end to what he has called the scandal of secret industry lobbying.
The Tobacco Control Plan for England published in March clearly states:
“The Government takes very seriously its obligation as a Party to the World Health Organisation Framework Convention on Tobacco Control”.
A full chapter is devoted to protecting public health policy from the vested interests of the tobacco industry. Is the proposed delay not a concession to exactly those vested interests and the result of a campaign by those who sell cigarettes on behalf of those who make them? Specifically, the Government have affirmed that the tobacco industry had no hand in the development of the tobacco plan, that they would publish details of any policy-related meetings with the industry by any part of government, and that they would require those engaging with the Department of Health on tobacco control to declare any links with or funding from the industry and encourage local authorities to follow that lead. In doing so, the Government are reflecting the mood across the House when during the passage of the Health Bill 2009 the noble Baroness, Lady Northover, moved an amendment to require the publishing of written guidelines on engaging with the tobacco industry. That amendment was withdrawn as the Government undertook that the Secretary of State would write to all Cabinet members reminding them of their duties under the World Health Organisation convention.
This is a Motion of regret. I do not seek to overturn the revised regulations, but I would like the Minister to confirm the commitment of the Government to live up to their obligation under Article 5.3 of the World Health Organisation convention to protect their public health policy from all commercial and vested interests of the tobacco industry, and to publish without any further delay details of all policy-related meetings with the tobacco industry and its front groups by any part of Government. I beg to move.
Lord Borrie
My Lords, three years ago the Chief Medical Officer, Sir Liam Donaldson, said that the ban on smoking in enclosed public spaces, which began in 2007, had been a great success in terms of both compliance and improved health. There had been a considerable drop in the number of smokers. I believe that the enclosed spaces ban has indeed been a great success, and for our social environment—a benefit to the whole population.
But in the Health Act 2009 the Labour Government sought to go further and ban the display of cigarettes in shops in order particularly to give even further discouragement to underage smokers. I thought the case for such a ban on display was a thin one. It ignored the fact that in recent years the display has had to be festooned with off-putting words such as “Smoking kills”, plus hard hitting pictorial warnings. Moreover, evidence from the likes of Iceland and the Canadian provinces where displays are banned was somewhat speculative as to the effect on smoking among the young.
In the UK we seem to have given up trying to keep a balance between the rights of individuals to do something which is legal—to sell and consume tobacco and cigarettes—and society’s desire to help people give up smoking and stop children purchasing cigarettes. The Labour Government ruled that a display ban should come into effect in 2011 for large outlets, but to protect small and medium-sized enterprises to some extent from the costs of the new regulations they should be subject to a ban only from 2013. I leave aside the arguments that this distorts competition between one group of retailers and another, and it may have been justified. Now, because of the recession, the present coalition Government seek to delay the imposition of the ban a further six months for large retailers, and a further 18 months for small retailers. My noble friend Lady Thornton from the opposition Front Bench regrets these delays. I regret I cannot join her in grumbling about the modest delays that have been proposed. There are more restrictions in the offing: from campaigning groups, particularly ASH; a ban on open-air smoking—in parks and beaches, such as applies in parts of Australia—bans on smoking in cars, which would be very difficult to enforce; and, of course, banning the use of brand names, which cropped up during the discussions on the Health Act a few years ago.
There is one country in the world to which I draw the attention of the Government: Bhutan, known perhaps to many walkers on the lower levels of the Himalayas as an interesting country somewhere between India and China. I mention Bhutan because all smoking is banned there, as are all displays of cigarettes and tobacco. How far do the Government want to go in their efforts to discourage the young from smoking? It is a splendid objective, but one which sometimes ignores the other aim of allowing people their own individual choices.
Baroness Thornton
My Lords, I thank the Minister for his usual detailed and very thorough explanation. I will resist the temptation to open up the arguments we went through in detail in 2009, notwithstanding the fact that my noble friend Lord Borrie, the noble Lords, Lord Stoddart, Lord Naseby and Lord Palmer, expressed their consistent views about this matter. The noble Baroness, Lady Tyler, was right to say that the Government should take credit for the tobacco plan, and certainly Members on these Benches will support further work on tobacco control.
I thank my noble friend Lord Judd for his support. Even if he is what one might call an ultra leftist, if not an outright Trotskyite on these matters, he knows that I am in sympathy with his views. My former noble friend Lady Morgan as always had wise and considered words on this. I wish her well in her new and very important position. The noble Lord, Lord Rennard, rightly reminded us that across the House we have been working on tobacco control issues for many years, and many noble Lords have made significant contributions to that progress. My noble friend Lord Faulkner is a great friend and campaigner on these issues, and I thank him for his hard work. I agree with him that the Government should be congratulated on their plan and their commitment to tobacco control. I also thank my noble friend Lady Gale for her support. She sat behind me and supported me when I was a Minister throughout the days when we discussed these issues at length.
The Minister has offered reassurance on a number of fronts, particularly concerning the tobacco lobby. I am pleased that the coalition Government are building on the policies established by the last Government, and I do not underestimate the battles that the noble Earl, his ministerial team and his honourable friends will be fighting across Government to extend tobacco regulation. The Minister should know that he has support across the House for the battles that he and his noble and honourable friends are fighting. I welcome the banning of tobacco sales from vending machines and the review of access to tobacco, and I look forward to hearing the results of the other initiatives outlined by the noble Earl. I also welcome the promised transparency, in particular on asking about funding from the tobacco industry. The noble Earl has given us an assurance that details of the meetings will be published. Finally, I welcome his emphatic rejection of the reasons for the delay.
I thank all noble Lords for their contributions to the debate and I beg leave to withdraw the Motion.
NHS: University Health Centres
Baroness Thornton Excerpts(13 years, 4 months ago)
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Earl Howe
My Lords, naturally, before preparing myself for this Question, I looked carefully into the way in which university practices are funded. The advice I received is that there is no reason to be concerned on that front. Many university GP practices are funded quite generously. Where they can lose out is over the quality and outcomes framework, which is targeted mainly at elderly patients with long-term chronic conditions, so it is not surprising that university campus practices do not earn the extra money that they could. Nevertheless, we believe that there is no case for making an exception for university practices in the way that they are funded.
Baroness Thornton
My Lords, I congratulate the noble Baroness on getting her head around the system of weighting for payments to GPs for their patients. It contains such gems as,
“An overall weighted listsize for the PCO is generated as the sum of Practice Weighted Listsizes for all Practices in the PCO, and this PCO Weighted Listsize is used together with the PCO Weighted Population”.
I will not go on, but I congratulate the noble Baroness. Given the mental health problems that students often face, is the Minister confident that the system of weighting takes proper account of that medical issue, which is certainly more prevalent than the chronic conditions that he mentioned in a community general practice?
Earl Howe
My Lords, the characteristics of each GP practice will naturally vary according to the patient population. Although a practice situated on a university campus may have higher numbers of patients who require mental health advice and support, there may well be fewer patients in need of other services. I am not aware that there is a particular issue of underfunding of university practices in relation to the mental health burden. As the noble Baroness will know, the QOF was adjusted in 2008 with a two-year time delay, so university practices have had a chance to adjust and prepare for the change.
Health: Stroke Care
Baroness Thornton Excerpts(13 years, 4 months ago)
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Earl Howe
My Lords, the noble Lord is quite right in all that he says. I would just point out that the official statistics are rather historic and it is important that we take stock when the revised figures are before us in some months’ time. As regards how best practice will be driven when the health service reforms are in place, I would repeat my earlier comments about the ability of the NHS commissioning board to drive forward higher quality, informed by the new quality standard produced by NICE. More particularly I think we can do a lot through the tariff. At the moment, best practice tariffs are starting to play a role in encouraging and driving best practice at hospital level.
Baroness Thornton
My Lords, tomorrow is the 63rd birthday of the NHS. Would the Government give the NHS the birthday present of eliminating local differences in stroke services by implementing the recommendations in the stroke strategy? In that way, when we all break into song next year when the NHS is 64 years old, we will actually have achieved something very important.
Earl Howe
It is very appropriate that the noble Baroness should remind the House of the NHS’s 63rd birthday. I can think of few better presents than that which the noble Baroness has outlined. I can say only that the efforts within my department, and indeed throughout the NHS, continue unabated to ensure that stroke patients are treated to the highest possible standards and that unacceptable variations are eliminated.
Reform of Social Care
Baroness Thornton Excerpts(13 years, 4 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:
“Mr Speaker, with permission, I wish to make a Statement on the reform of social care. This coalition Government have from the outset recognised that reform of the care and support system is needed to provide people with more choice and control, and to reduce the insecurity faced by individuals, carers and their families. By 2026, the number of people over 85 years old is projected to double. Age is the principal determinant of need for health and for care services. It is estimated that in 20 years’ time, 1.7 million more people will have a potential care need than do today.
People often do not think about how they might meet those costs in later life. They assume that social care will be provided free for all at the point of need, but since the establishment of the welfare state this has never been the case. Currently people with more than £23,250 in assets, often including their home, face meeting the whole cost of care themselves. The cost of care can vary considerably and it is hard for people to predict what costs they may face. The average 65 year-old today will face lifetime care costs of £35,000. However, as the Commission on the Funding of Care and Support notes, costs are widely distributed: one in four will have no care costs, but one in four will face care costs over £50,000 and one in 10 over £100,000.
The lack of understanding of how the system works and the uncertainty about costs means that it is difficult for people to prepare to meet potential care costs and there are currently few financial products available to help them. This means that paying for care can come as a shock to many families and can have a severe impact on their financial security.
Change is essential. That is why we took immediate action by establishing the Commission on the Funding of Care and Support last July. It was tasked with making recommendations on how to achieve an affordable and sustainable funding system for care and support for all adults in England. In response to its initial advice, we allocated an additional £2 billion a year by 2014-15 in the spending review to support the delivery of social care as a bridge to reform. This represents a total of £7.2 billion extra support for social care over the next four years, including an unprecedented transfer of funds from the NHS to support social care services that will also benefit health.
Since then we have taken forward wider reform. In November last year, we published our vision for adult social care setting out our commitment to a more responsive and personalised care and support system that empowers individuals and communities, including the objective that all those who wish it should have access to a personal social care budget by 2013, and in May, the Law Commission published its report, after three years of work, on how to deliver a modernised statute for adult social care. Making sense of the current confused tangle of legislation to deliver a social care statute will allow individuals, carers, families and local authorities more clearly to understand when care and support will be provided.
Andrew Dilnot’s report comes at the same time as the final report from the palliative care funding review, which I received last week. Tom Hughes-Hallett and Sir Alan Craft have made an excellent start in looking at this complex and challenging issue. We want to see integrated, responsive, high-quality health and care services for those at the end of life. We will now consider the review team's proposals in detail before consulting stakeholders on the way forward later this summer. We will also consider how best to undertake substantial piloting, as recommended in the report, in order to gather information on how best to deliver palliative services.
We are also responding to events at Southern Cross, which have caused concern to residents in Southern Cross care homes and their relatives and families. We welcome the fact that Southern Cross, the landlords and the lenders are working hard to come up with a plan to stabilise the ownership and operation of the care homes. We have also been clear that we would take action to make sure there was proper oversight of the market in social care. That is why, through the Health and Social Care Bill, we are seeking powers to extend to social care the financial regulatory regime we are putting in place in the NHS, if we decide it is needed, as part of wider reform.
A central component of those reforms will be the long-term funding of care and support. Over the past 12 months, Andrew Dilnot, the chair of the Commission on the Funding of Care and Support, together with the noble Lord, Lord Warner, and Dame Jo Williams have engaged extensively with many different stakeholders. They brought fresh insight and impetus to this most challenging area of public policy. We welcome the excellent work of the commission and its final report. I would like to thank Andrew Dilnot, the noble Lord, Lord Warner, and Dame Jo Williams for the work they have undertaken. It is an immensely valuable contribution to meeting the long-term challenge of an ageing population.
The report argues that people are unable to protect themselves against the risk of high care costs, leaving people fearful and uncertain about the future. The commission’s central proposal is therefore a cap on the care costs that people face over their lifetime of between £25,000 and £50,000; it recommends £35,000. Under the commission’s proposals, people who cannot afford to make their personal contribution would continue to receive means-tested support, but it proposes that the threshold for getting state help with residential care costs would rise from £23,250 to £100,000. People would make some contribution to their general living costs in residential care, but this should be limited to between £7,000 and £10,000.
The commission also proposes: standardised national eligibility for care, increasing consistency across the country; universal access to a deferred payments scheme for means-tested contributions; improvements in information and advice; improved assessments for carers and better alignment between social care and the wider care and support system; and to consider changing the means test in domiciliary care to include housing assets. It makes recommendations about how, as a society, we will organise and fund social care. We will now take forward consideration of the commission’s recommendations as a priority.
The commission recognises that implementing its reforms would have significant costs that the Government will need to consider against other funding priorities and calls on constrained resources. In the current public spending environment, we have to consider carefully the additional costs to the taxpayer of the commission’s proposals against other funding priorities. Within the commission’s recommendations, it presents a range of options, including on the level of a cap and the contribution people make to living costs in residential care, which could help us to manage the system and its costs. That is why we intend to engage with stakeholders on these issues, including on the trade-offs involved.
Reform in this area will need to meet a number of tests, including: whether proposals would promote closer integration of health and social care; whether proposals would promote increased personalisation, choice and quality; whether proposals would support greater prevention and early intervention; whether a viable insurance market and a more diverse and responsive care market would be established as a result of the proposals; the level of consensus that additional resources should be targeted on a capped costs scheme for social care; and what a fair and appropriate method of financing the additional costs would be.
The Government have set out a broad agenda for reform in social care. We want to see care that is personalised, that offers people choice in how their care needs are met, that supports carers, that is supported by a diverse and flourishing market of providers and a skilled workforce who can provide care and support with compassion and imagination, and that offers people the assurances they expect of high-quality care and protection against poor standards and abuse. Andrew Dilnot’s report was never intended to address all these questions, but it forms a vital part of that wider agenda.
To take it forward, we will work with stakeholders in the autumn, using Andrew Dilnot’s report as the basis for engagement as a key part of a broader picture. This engagement will look at the fundamental questions for reform in social care: improving quality, developing and assuring the care market, integration with the NHS and wider services, and personalisation. As part of that we want to hear stakeholders’ views on the priorities for action from the commission’s report and how we should assess these proposals, including in relation to other priorities for improvement in the system. As the right honourable Member the Shadow Health Secretary and I have discussed, we will also engage directly with the Official Opposition in order to seek consensus on the future of long-term care funding.
We will then set out our response to the Law Commission and to the Dilnot Commission in the spring, with full proposals for reform of adult social care in a White Paper and a progress report on funding reform. It remains our intention to legislate to this effect at the earliest opportunity. The care of the elderly and vulnerable adults is a key priority for reform under this Government, and I commend this Statement to the House”.
My Lords, that concludes the Statement.
Baroness Thornton
First, my Lords, I thank the Minister for repeating the Statement today. It is difficult to imagine a more important issue for us to consider. Care of the elderly and vulnerable is probably the most difficult and intractable problem facing our society. It is one that we have to resolve; we cannot afford to let it go on and on unresolved. We can all agree about this.
It should be a cause for celebration and pride that one in five of us alive in Britain today will now live to be 100, and that our children can expect to spend one-third of their lives in retirement. Instead, thousands and thousands of us approach old age in fear—fear that we will need care that will not be there or will not be good enough, fear that our savings will be wiped out by an open-ended cost, fear that we cannot protect our families from this cost, and fear of becoming a burden or being left alone. That is why we on these Benches welcome the Dilnot report and the Statement.
These proposals contain many important elements that were in the plans that we set out when we were in government in our care White Paper prior to the general election. I join the Minister in congratulating Mr Andrew Dilnot and his colleagues, my noble friend Lord Warner and Dame Jo Williams on the excellent job that they have done. I know that many of the organisations concerned with this issue—Age UK, the Alzheimer’s Society, Care UK and others—have been very impressed by the way in which the commission has carried out its tasks, but they are now, quite rightly, very keen to ensure that the momentum created by this excellent report is not lost. Many noble Lords will have seen the letter, signed by 32 of these organisations, pleading with us not to pass up this opportunity. I welcome the Minister’s confirmation that detailed and important involvement of stakeholders will continue.
I am very impressed with the way in which all the members of the commission have seen it as their mission to explain to the widest possible audience what lies behind their recommendations and why they have reached the conclusions that they have. I know that my noble friend Lord Warner has been in major media contact since the early hours of this morning; many of us will have been treated to the masterclass from Andrew Dilnot on the “Today” programme.
In response to the report my right honourable friend Ed Miliband, the leader of the Labour Party, has said on behalf of the Labour Party that we would be willing to put aside our party’s pre-election proposals in order to try to find a solution. I invite the Minister to agree with me that it is just as well that politicians sometimes ignore the cynicism and negativity of commentators, such as Mr Nick Robinson of the BBC, who I heard recently, and show an understanding of the importance of reaching a national consensus on these matters. We will all need to show the kind of determination that my right honourable friend the leader of the Labour Party is showing. Will the Minister comment on suggestions in the media, including from members of the Conservative Party, that suggest that the Treasury is already lining up to kill these proposals? I hope that this is not the case and that the tweet today quoting Stephen Dorrell as saying that the Government must show willingness to find the money for Dilnot’s long-term care overhaul is more accurate.
The last thing Britain needs is for Andrew Dilnot’s proposals to be put into the long grass, or even the medium-cut grass. This is a once-in-a-lifetime opportunity that we must address. It is what the Government do with it now that counts. My right honourable friend the leader of the Labour Party has made a big offer to the Prime Minister to put politics aside and to work to see a better long-term system of social care put in place for elderly and disabled people in our country. We on this side are willing to talk to and work with the Government and all other parties to do so, because we know that any system of care must give all of us the long-term confidence to know what will be on offer for us and our families. It requires the Prime Minister to give a lead, because agreeing an affordable and sustainable system involves important parts of government beyond the reach of the Health Secretary. It requires the Prime Minister to give a guarantee that the Government will not kick Mr Dilnot’s recommendations into the long grass, because the system needs urgent and lasting reform. Will the Minister give us that guarantee today? If the Government are serious, we in the Labour Party are serious. If the Government are serious, we need to hear what the plan is going to be as we move forward.
Mr Dilnot recommends a White Paper by December this year, but this already seems to have slipped to the spring. Will the Minister say which is it? Will he also tell the House when we can expect a draft Bill—are the Government aiming for this to be in the next Queen’s Speech? In the absence of the noble Baroness, Lady Campbell of Surbiton, will the Minister confirm that the Government welcome and will take forward recommendation 6 on the portability of care assessments? Will the Government be supporting her Private Member’s Bill on this? Does he agree that cross-party talks are required and that the Prime Minister should give this lead? How and when will this start?
Finally, I know the Minister agrees that there is a need for the House to have an opportunity to have a more thoroughgoing debate about this matter, the report and its recommendations. I hope that we can also join forces in trying to secure that opportunity.
NHS: Health Improvements
Baroness Thornton Excerpts(13 years, 4 months ago)
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Baroness Thornton
To ask Her Majesty’s Government how they will ensure that the NHS delivers strategic health improvements requiring levels of technology and expertise appropriate to regions or cities with large populations.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, our commissioning proposals will establish a national NHS commissioning board providing oversight of commissioning in the NHS and directly commissioning some services, including specialised services, where it makes sense to commission for larger populations. The NHS commissioning board will have a sub-national presence and local commissioning will be undertaken by clinical commissioning groups. The NHS commissioning board will have a duty to promote integrated services for patients, both within the NHS and between other local services.
Baroness Thornton
I thank the Minister for that Answer, as far as it goes. The successful reorganisation of stroke services in London, which has saved many lives, was led by clinicians, as it should have been, but the commissioning and its delivery were in fact only brought about by NHS London, the ability of the strategic health authority to manage the PCTs and through great collaboration with the providers. Apart from the providers, all of these bodies are being dismantled and abolished as we speak. In the new system, how precisely would similar improvements be brought about? Who would take the lead and who would ensure their delivery?
Earl Howe
My Lords, where it is deemed appropriate to commission a service at scale but below the level of the NHS commissioning board, as I described in my original Answer, it will be open to clinical commissioning groups either to establish a lead group to take control of the commissioning and to agree budgets and pathways or for clinical commissioning groups to collaborate jointly. The advantage of the system that we are proposing is its flexibility. Depending on population size and the needs of an area, commissioning can be done at several levels.
NHS: Clinical Excellence Awards
Baroness Thornton Excerpts(13 years, 4 months ago)
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Earl Howe
My Lords, as I have just said, we believe that financial rewards, in the form of clinical excellence awards, should remain. It is just a question of how that system is designed. We have not said that non-financial recognition should take the place of financial awards. They would operate alongside financial awards; they would not in any way supplant them. However, we think that there is a role for perhaps more imaginative thinking in areas like speciality-based awards or departmental or division-based awards, for example, or indeed ad hoc recognition for outstanding clinical leadership. The DDRB is looking at these questions too.
Baroness Thornton
My Lords, I commend the noble Lords, Lord Walton and Lord Ribeiro, on doing a really admirable job as the shop stewards for distinguished clinicians—and quite right, too—but I would point out that innovation and excellence cuts across all NHS staff, including nurses, midwives and therapists, who often introduce wonderful innovation at their level. Could the Minister tell us what incentives are in place in the system that recognises that excellence as well?
Earl Howe
The noble Baroness is absolutely right. We do need to incentivise all staff, both clinical and non-clinical in the NHS, to innovate. We can do that in a variety of ways. She will know that the noble Lord, Lord Darzi, proposed a number of ways of doing this, including innovation prizes and innovation funds, which are extremely popular. We also can incentivise through the tariff. As she will know, we have protected the research budget, which in the long term will serve us well in driving through innovation in the NHS.
Drugs: Prescribed Drug Addiction and Withdrawal
Baroness Thornton Excerpts(13 years, 4 months ago)
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Baroness Thornton
Following on from the noble Earl’s supplementary question on how to ensure that good practice becomes standard practice, how will that sit with the dismantling of strategic health authorities, PCTs and other levers that might be used to ensure progress? Who or which organisations in the proposed restructuring of the NHS will be able to ensure that patients who have an addiction to prescription drugs receive the support that they desperately need? I agree with the noble Earl that this is an emergency; it is not the first time that we have discussed this on the Floor of the House.
Earl Howe
My Lords, the responsibility for commissioning these services in future will lie with local authorities, supported by Public Health England. The noble Baroness will be aware that it is our proposal to ring-fence the public health budget. Local authorities will be informed by the joint strategic needs assessment that they carry out and will work in partnership with local delivery organisations and with local GPs, who, as I have mentioned, will be even better informed than they are at the moment thanks to the Royal College guidance.
Health: Hepatitis C
Baroness Thornton Excerpts(13 years, 4 months ago)
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Earl Howe
In the case of hepatitis C, treatments recommended by NICE are of course available that, if taken early enough, can dramatically affect the course of the disease. I think we are in danger of straying into legislative territory that is perhaps the occasion for a wider debate as to how, if at all, we might expand the scope of the Human Tissue Act so as to reach those cases that I think the noble Lord is referring to.
Baroness Thornton
My Lords, we all welcomed the Government’s Statement in January announcing increased support for those with hepatitis C. Will the Minister please tell us what progress is being made to deliver the exception from means-testing of the new payments and the provision of prepayment prescription certificates, and which national charities are in receipt of the additional funding of £100,000 to support the victims of hepatitis C and their families?
Earl Howe
My Lords, the Caxton Foundation has been established to address the group of hepatitis C victims identified in the Government’s Statement earlier this year: that is, those victims of the contaminated blood disaster who went on to develop hepatitis C. I understand that the foundation will begin to make payments later this year that will include payments to those who are eligible for the free prescriptions service to which she referred.
NHS: Future Forum
Baroness Thornton Excerpts(13 years, 4 months ago)
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Baroness Thornton
My Lords, I thank the Minister for repeating the Statement. I start by paying tribute to him for the way in which he has facilitated the debate about the future of the NHS thus far across the House. The all-Peer seminars benefited hugely from the fact that his office ensured the input from senior department officials. I have to add that his noble friend Lady Northover attended every one of those seminars. They have continued and, I believe, have ensured a greater understanding of the Bill from which it can only benefit. Notwithstanding Nick Clegg waving about his list of changes and claiming all, I think we might find out as we move on how influential the Minister has been in bringing about changes to the Bill. However,
“there is more joy in heaven when one sinner repents”.
About a year ago the Minister gently chided me, when he launched the health White Paper, by saying:
“I hope that when the noble Baroness digests this White Paper, she will come to view it rather more favourably than she has indicated”.—[Official Report, 12/7/10; col. 535.]
On this occasion, lest the noble Earl misunderstands me, I will say that I welcome the findings of the Future Forum, although I think that we would both agree that it cannot possibly have covered all the important issues in the NHS in eight weeks. In the detailed response that accompanies the Statement, the Government have gone further than the Future Forum in their proposed changes to the Bill; they are very significant. I particularly welcome issues such as the commitment to the NHS constitution. However, it begs the question of whether we might need a whole new Bill, or no Bill at all, if we all now agree that evolution is better than revolution.
I will mention the process. In this House we are more familiar with the parliamentary process whereby you consult, legislate and implement—not the other way around, which is what seems to have happened here. However, the Future Forum was a device that I think everyone understood. There was a pressing political need to get the coalition Government—Nick Clegg, David Cameron and in particular Andrew Lansley—off the hook. I will say this only once, despite severe temptation; the uniformly fulsome and enthusiastic welcome from Nick Clegg and David Cameron for the White Paper and the Bill ring rather hollow today. However unworthy the motivation, the end of the pause means one very good outcome for which we should all be grateful—probably none more so than patients and staff—namely, that the Prime Minister, Deputy Prime Minister and Secretary of State will cease their endless visits to hospitals to prove how much they love the NHS.
The chairman of the Future Forum said that opposition to the Bill stemmed from “genuine fear and anxiety”. He went on to say that NHS staff feared for their jobs, and feared that their NHS was about to be broken up and—their word—“privatised”. Thank goodness the Future Forum had the wisdom to listen to what so many people have been saying for a year to the Prime Minister and the Secretary of State: during the consultation period, after the Bill was published, with increasing volume during its passage in the Commons, and despite two very sensible Health Select Committee reports. Does the Minister think that the terrible mess that the Government have found themselves in could have been avoided, and have they learnt their lessons?
Since we are now promised significant changes, will the Minister confirm that there will be a new and proper impact assessment and a new set of Explanatory Notes, and that there will be consultation on the changes proposed through amendments before recommittal? Will there be a formal response to the well argued report of the Health Select Committee and its recommendations, not all of which agree with the Future Forum report? Most importantly in many ways, if there is to be a long period of enactment when the Bill is passed—and, as the Minister explained, no drop -dead moments—a very strong recommendation of the Future Forum report must be acted on; namely, the production of a timetabling and transition plan. This must be in place as soon as possible and must be robust. When does the Minister envisage that it will be published?
As the House would expect, since Part 3 is still in the Bill we will seek reassurances on competition, the composition of consortia, NICE, the minimum references to social care that are there, and, for example, the lack of references to mental health. We will pursue all these issues in due course. Will it be possible for the Minister to use his good offices to ask the Government to make time available for a longer debate in the House about these issues before we receive the Bill? When does the noble Earl think that we might start consideration of the Bill?
While the uncertainty continues, the NHS is going backwards. The Future Forum suggested—and we all know—that there is widespread demoralisation and even fear in the NHS. Good managers are being denigrated and made redundant, front-line staff are facing the sack and major projects and initiatives have been put on hold, as nobody knows what structures will be in place in the next few weeks, let alone the coming months. That is the result of the earlier rush, which can now be remedied by a robust transition plan.
It is to the credit of all the organisations—patient groups, carers, long-term conditions, medical and others—that have persisted in making their views known and whose views the Future Forum heard. During this period, my colleagues and I concentrated on asking people to look at and understand the Bill because we were confident that the more people understood this legislation, the less happy they would be about the threat to our NHS and to patients. We will be doing the same with the new Bill. We will look at it carefully in detail, and I will again be asking whether it meets the concerns that they and their organisations have raised. I say that because almost every single suggestion in the Future Forum report was put down as an amendment by my colleagues in the Commons in Standing Committee. I suggest to the Government that they might save a lot of time and trouble if they adopted all the other amendments that we put down that were not in the Future Forum. Honestly, what a way to conduct the reform of our most precious national asset. The lesson I take from the past year is this: it is very important not to suspend our critical faculties, even in the face of what seems a huge and, at the moment, welcome change. I am sure that this House will not do that. We have a very important job to do in making sense of this Bill and in ensuring that whatever the Government say today, their rhetoric is matched by the reality. We need to consider these suggested changes in this light. We have much work to do, and the sooner we start, the better.
Earl Howe
My Lords, I am grateful for the constructive and positive tone that the noble Baroness adopted in her response. I am grateful to her for her welcome of the Future Forum report, and I thank her for expressing appreciation for the seminars which my department is continuing to run. I can return the compliment in expressing my gratitude for the seminars that she has organised to inform Peers.
There is no disguising the fact that this is an extremely wide and detailed programme of modernisation. There is a great deal to absorb. It is important for noble Lords to understand as fully as possible what the proposals amount to before the Bill reaches your Lordships' House. She is right: they are significant changes. However, I would disagree with her about there being no need for a Bill. Since these changes are so extensive, it is appropriate that Parliament should have the opportunity of approving what is proposed for the National Health Service which, as the Statement said, is designed to be an enduring structure that successive Governments can back. Certainly, lessons have been learnt. I think that when we consulted on the White Paper last year, it was clear that there was general acceptance of the key principles that we set out in it, but when the Bill, which set out how we proposed to implement those principles, was published, the concerns bubbled to the surface, which was why we thought it right, and I still think it right, to have the listening exercise.
The noble Baroness asked me whether we would publish a new impact assessment and Explanatory Notes. We will be updating the impact assessment and Explanatory Notes to reflect the changes to the Bill. They will be published when the Bill is introduced in this House in accordance with normal protocol. She also asked me about timetabling. We want to ensure that the Bill is given sufficient scrutiny in both Houses. We hope that the stronger consensus for change that has been built as a result of the listening exercise will be reflected when both Houses consider timing issues and that the Bill will come to this House at the earliest appropriate moment. Currently, I cannot tell the noble Baroness when that will be. It is, of course, not for us to dictate to another place how it should manage its business. She also asked about the possibility of time being available for a health-related debate. The Leader of the House is sitting beside me, and I am sure he heard that request and that it will be discussed in the usual channels.
The noble Baroness rightly insisted on a robust transition plan, which I believe we have. She will have noticed from the Statement that we have adjusted quite significantly the pace at which these changes will be rolled out. I believe that those working in the health service will be reassured by that because in some quarters there was anxiety that we were going too fast for some to be sure that they would be ready in time.
The noble Baroness asked a number of questions, many of which will be the subject of a paper we plan to publish during the next week or so. The paper will set out more precisely how we plan to implement the changes proposed by the NHS Future Forum. I am not in a position to provide all the answers today but it is clear that, above all, the NHS needs certainty, which we can now give to those who work in it. However, I can say today that there is hardly anything in our proposals that does not represent a natural evolution from the policies and programmes pursued by the previous Government: that is, the development of the quality agenda initiated by the noble Lord, Lord Darzi; extending patient choice; developing the tariff; clinically led commissioning at primary care level, which is a natural extension of practice-based commissioning; completing the foundation trust programme; the continuation of the co-operation and competition panel established by the previous Government but now within the framework of a bespoke healthcare regulator; strengthening the patient voice by the evolution of links to HealthWatch; and augmenting the role of the CQC. None of that is wholly new: the difference is that for the first time we are setting all these things out in one coherent programme and not, as did the previous Government, in a piecemeal fashion.
I believe, and I hope, that we have the basis for broad consensus. We will see when the Bill reaches this House whether that belief is borne out. Not for a minute would I wish the noble Baroness to suspend her critical faculties, or for any other noble Lord to do that. I look forward to those debates in due course.
Health: Transmissible Spongiform Encephalopathies
Baroness Thornton Excerpts(13 years, 4 months ago)
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Earl Howe
My Lords, the noble Baroness will know that the independent Advisory Committee on the Safety of Blood, Tissues and Organs—SaBTO—has advised that there is evidence that a particular filter can reduce potential infectivity in a unit of red blood cells. It has recommended the introduction of filtered blood to those born since 1 January 1996, subject to a satisfactory clinical trial to assess safety. We are undertaking an evaluation of the costs, benefits and impacts to inform a decision on whether to implement that recommendation, and we are awaiting the results of clinical trials, which are expected in early 2012.
Baroness Thornton
My Lords, following on from the noble Countess’s Question and linked to the need for continuing research, can the Minister assure the House that the scientific teams at the HPA and elsewhere will be kept together when the HPA has been broken up, and that during the period of establishing the independent health research agency the work will not be interrupted?
Earl Howe
My Lords, we are keen to see a smooth transition in the creation of Public Health England, which will include the current HPA. The expertise in prion research in this country is largely independent of the HPA. There is expertise particularly in Edinburgh and in the national prion unit in London, but her point is well made.