Winterbourne View

Baroness Thornton Excerpts

Wednesday 8th June 2011 Lords Chamber

[Baroness Thornton]

I am seeking assurance from the Minister that there will be a wide-ranging and independent review of this matter, held in public, that will shine a light on what happened at Winterbourne View and allow the wider lessons to be learnt. We need to know whether the CQC’s failure to monitor the treatment of residents was due to the fact that there was a shortage of CQC staff. Does the CQC have sufficient powers to act in this case and, if so, is it using its powers adequately? Could the Minister also comment on the wisdom of placing more regulatory tasks with the CQC, as the Government are proposing in the process of reorganisation? Surely we need to see that the CQC is carrying out its current functions adequately.

[Earl Howe]

My Lords, first, there is a criminal investigation under way and it would not be appropriate to launch an inquiry, even if we were minded to do so. As the noble Baroness knows, the CQC has launched its own internal investigation. It has admitted that there were failings in its processes. South Gloucestershire Council will lead an independently chaired serious case review, as has been mentioned, involving all agencies, which will look at the lessons to be learnt. The strategic health authorities involved have instigated a serious untoward incident investigation. The department will, after these reviews have been concluded, examine all the evidence and report to Parliament.

We want to understand not only the immediate facts and why things went wrong at Winterbourne View but also whether there are more systemic weaknesses in the arrangements for looking after people with learning disabilities and who exhibit seriously challenging behaviour. It is very easy to make the CQC into a scapegoat. It is difficult to ask of the CQC that it polices every room in every hospital at every hour of the day. We rely on the CQC and have been supportive of it. It does much good work and clearly it will want to review its own processes as part of this.

Health: Hospital-acquired Infection

Baroness Thornton Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

The noble Baroness is absolutely right. The headline figures disguise considerable variations between the best and worst performers. Our approach has been to adopt a zero tolerance policy to all avoidable healthcare-associated infections. To support that we have introduced a number of specific actions, including establishing clear objectives under the NHS operating framework, which are requirements for all trusts to meet, and for primary care organisations, and extending to health and social care settings the regulations on infection prevention and control. We have also increased the requirements on publishing data trust by trust.

[Baroness Thornton]

My Lords, I welcome very much the fact that the Government have continued to bear down on this issue, which of course my Government made great strides on when we were in office. Can the Minister assure the House that the funding to continue bearing down on it will be ensured from a national level?

[Earl Howe]

My Lords, as the noble Baroness knows, we expect trusts and primary care organisations to utilise funds from within their global budgets to meet the requirements that I have just outlined, such as those in the NHS operating framework. These requirements are mandatory, and it appears that over the past few years, trusts and primary care organisations have really got to grips with this problem.

Care Homes

Baroness Thornton Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

On my noble friend’s last point, there is a national surplus of care home beds—the figure I have here is some 50,000. Therefore, there is, to my knowledge, in no area a shortage of beds. We are dealing here with a series of local markets. The point that I emphasised earlier remains important. Should it come to the closure of a care home—an event of which we should have reasonable notice if it happens—we will ensure that those in that care home are properly looked after.

[Baroness Thornton]

My Lords, does the Minister actually think that a Written Ministerial Statement is sufficient to deal with the gravity of the treatment of the learning disabled in Winterbourne View care home, as shown on the “Panorama” programme, although I realise that that is not the subject of this Question? I agree with him that it is absurd to suggest that there is no role for private, voluntary, mutual and social enterprise providers in social care. How will the Minister ensure, therefore, that in the private sector—none of these things can happen in any of the other sectors—regulation is extended to cover the financial stability, including asset stripping, of organisations which provide these vital services for thousands of elderly people? I invite him to agree with me that it is very distasteful indeed that older people’s care should be regarded as a commodity to be traded.

[Earl Howe]

My Lords, I cannot help but agree with the noble Baroness’s last comment. I am sure she will know that we have embarked on a wide-ranging programme of reform of social care. We are considering the Law Commission’s recommendations for modernising social care law, and the report of the Commission on Funding of Care and Support is imminent. As I have said, many lessons have to be learnt from the events of recent weeks. We will want to reflect on them as part of our wider reform agenda. The business model that underpins many of these issues is a legitimate area for the Department for Business, Innovation and Skills to be looking at, although it will do so in a general rather than specific sense in relation to Southern Cross.

NHS: Reform

Baroness Thornton Excerpts

Monday 6th June 2011 Lords Chamber

[Earl Howe]

The noble Lord is quite right. The vital importance of education and training is one of the four main themes of the listening exercise. We have received some very interesting and significant proposals from the academic sector which Professor Field will no doubt reflect in his conclusions.

[Baroness Thornton]

According to information provided in response to a recent freedom of information request, in Hull GPs have 17 per cent of the budget whereas in the East Riding they have 69 per cent; in Derbyshire there are 12 finance officers supporting GPs, whereas in Bristol there are none; and in London there are 10 executive directors, of which three are public health directors, but nobody knows to which of the 32 boroughs they belong. How will the Government ensure patient safety in what I hope the Government might recognise is possible impending chaos resulting from the de facto implementation of key parts of the Bill, the dismantling of the SHAs and PCTs, the patchwork of growth of new organisation and the leaching away of experienced staff?

[Earl Howe]

My Lords, we are putting patient safety at the centre of the NHS by moving it to the NHS commissioning board. In that way, patient safety will be embedded into the health service through GP commissioning and their contracts with providers. We are strengthening the Care Quality Commission so that patients know whether providers are meeting minimum standards of safety. We are also developing outcome measures for patient safety so that everyone can see how organisations are performing and can be held to account by the people that they serve.

Health: Cancer

Baroness Thornton Excerpts

Tuesday 10th May 2011 Lords Chamber

[Earl Howe]

The noble Baroness raises an important issue, because these conditions are devastating even though they affect only a comparatively small number. There is a good deal of research going on into cancer, some of it funded by my department. I do not have details of whether that condition is the focus of any such programme but I will take away her concern and write to her if I have further information.

[Baroness Thornton]

My Lords, today the Cancer Campaigning Group, which represents dozens of cancer organisations including Kidney Cancer UK, has launched a survey of GPs in which 71 per cent agree or strongly agree that they will require specialist advice effectively to commission cancer services. Given that the cancer networks’ funding is not guaranteed beyond 2011-12, how will that commissioning support be provided? On an individual basis, how will support be provided to GPs when they have to tell a kidney cancer patient that they will not be able to afford to offer Afinitor? That is the drug the Minister referred to, which is not approved by NICE and which costs £200,000 per course of treatment.

[Earl Howe]

My Lords, there are drugs which NICE has recommended for kidney cancer, so Afinitor is not the only drug on the menu. GPs have a crucial role to play if we are to achieve earlier diagnosis of cancer and meet our ambition of cancer outcomes that are among the best in the world. The National Cancer Director, Professor Sir Mike Richards, is working with pathfinder GP consortia to understand how we can support them in commissioning services that deliver the best outcomes. He is clear, as are we, that cancer networks will have a central role in the reformed NHS as a place where clinicians from different sectors come together to improve the quality of care across integrated pathways.

Public Bodies Bill [HL]

Baroness Thornton Excerpts

Monday 9th May 2011 Lords Chamber

Let us be quite clear: the glow that we feel about the HFEA may be slightly tarnished. We have to ask which of the functions we need to retain. I seek an assurance from the Minister that the medical research authority will be set up soon and that it will take over all the research functions of the HFEA. Let us have a debate about whether the HFEA delivers now when it comes to improving care and outcomes for the patients. That, I think, is when we will find that it is currently found wanting.

[Baroness Thornton]

My Lords, I thank the noble Baroness, Lady Deech, my noble friend Lady Warwick and other noble Lords for their determination to have the future work of the HFEA and the HTA clarified during the course of the Bill. I join others in thanking the Minister for his patience and accessibility in discussing the different aspects of the issue.

We have had another excellent debate that has illustrated why it was necessary to bring the issue back to the Floor of the House for further discussion. The House needs to heed the voices raised across the Chamber—as well as the pleas contained in the letters that we have received from some of the parents of Alder Hey children, the letter in the Times this morning signed by a galaxy of medical experts and the briefing from the BMA on behalf of several organisations—as a sign of increasing concern.

Since Report, the Minister has kindly written to me explaining further the Government’s proposals for the HFEA and the HTA and the staged break-up that seems to be the Government’s preferred option at the moment. In brief, the break-up involves HFEA and HTA functions being transferred to the CQC except for research-related functions, which will be transferred to the health research regulatory agency, presumably covering what have been broadly referred to as the ethical issues. To facilitate this, as the noble Baroness, Lady Deech, explained, a special health authority will be created in 2011-12 and there will be primary legislation to establish the agency proper in the second Session of this Parliament. Presumably, the ethical issues will therefore be dealt with by the interim body in that process. Notwithstanding the proposals of the noble Lord, Lord Willis, regarding the Health and Social Care Bill when—indeed, if—it reaches us, it is clear that there will be primary legislation to establish the new research body.

I am further grateful to the Minister for his explanatory letter because it served to strengthen my view that these bodies should never have been in the Bill in the first place. It also illustrated for me the question that I want to put to him: why go through such disruption, risk, lack of stability, potential loss of expertise and expense for the next two years prior to the introduction of primary legislation to establish the new health research agency, which will address all of these issues? Why not agree the amendment that establishes an independent assessment of the work of both bodies? That could feed into the pre-legislative process and consultation, which will include all the questions that need to be asked, leading to primary legislation in about two years’ time. If the Government go down the route that the Minister is proposing, they intend to launch a consultation this summer, as outlined in the Minister’s letter to me, and then presumably will break up the agencies at some point towards the end of this year and the beginning of next. That means that at the beginning of 2012 the agencies would be broken up and then, by the end of 2012, we would start the pre-legislative programme to set up the new research agency.

That is why we on these Benches will be supporting all these amendments. It is not that either the HTA or the HFEA should be preserved for ever; indeed, it is clear that my noble friend Lord Winston and the noble Lord, Lord Patel, have grave problems with the HFEA. I make the point to the noble Lords, which I have also done outside the Chamber, that that is not the point of the Bill. Passing the amendments would actually be more likely to address their concerns than would leaving the situation as it is. In other words, there is no guarantee that their concerns about the HFEA, which I am sure are legitimate, would be addressed if we left the Bill as it is without the reassurances.

The one thing that we know is that there is going to be a health research agency. It is an idea of merit. It is also a proposal that is ideally suited to the expertise and inclination of this House; the Select Committee, the pre-legislative scrutiny, the draft Bill and, if I may say, the skills that the Minister brought to bear when he helped to create both these agencies make this the place where that process should start. I am certain that that would ensure a good outcome.

The amendments are different from the simple deletion amendments that we tabled in Committee and on Report, particularly the third amendment, because it accepts the principle that the Minister may transfer or modify the functions under Clause 5 in respect of these bodies but would require the Minister to have first established the Government’s new regulatory body with a separate ethics committee. It would ensure that there were no gaps between what is happening now with the current bodies and the Government’s intended independent regulatory body in future, a point that many noble Lords have made. However, it would not preclude an examination and independent assessment of the work of both these bodies. It would ensure that the critically important ethical functions performed by these bodies were recognised and catered for, which, in a way, is where we came in at the first stage of the Bill.

[Earl Howe]

My Lords, I thank noble Lords who have moved or spoken to these amendments. I recognise and understand the sentiments underlying them. I do not in the least wish to argue against or downplay the importance of cost-effectiveness in any legislative changes that we propose, or of ensuring that the right successor arrangements are in place for discharging the relevant functions of the HFEA and HTA. I therefore hope that what I am about to say will satisfy noble Lords that in most key respects I am in the same place as they are regarding the points at issue.

Since our debate on Report I have written to the noble Baroness, Lady Thornton, to set out my reflections on the points that she and others have made. There were common themes: a desire for greater clarity on where the Government intend to transfer the functions of the HFEA and HTA to; concern that the dispersal of functions across a range of bodies would risk fragmenting regulation; and concern over loss of expertise. I have considered these concerns carefully. As I have made clear, we intend to consult in the late summer on the options as to where certain functions would be most appropriately transferred. That remains our aim. However, having taken into account the strength of feeling about keeping functions together, we now intend to proceed on the basis that our preferred option is for all HFEA and HTA functions to be transferred to the Care Quality Commission, except for certain research-related functions that will transfer to the proposed health research regulatory agency. We shall therefore consult on this basis but, at the same time, remain open to receiving views on the way forward from all stakeholders through the consultation process. I hope noble Lords will agree that this preferred option will address concerns about the potential impact of fragmentation.

The noble Baroness, Lady Deech, expressed the fear that the Government’s proposals would lead to a vacuum as regards the ethical focus of these bodies—in the decision-making process for research and treatment involving embryos in particular. Let me explain what we intend. Ethical safeguards—for example, the type of embryo and gamete that can be used in treatment, the need to consider the welfare of the child, and the need for consent in respect of human tissue—are clearly enshrined in legislation in accordance with the wishes of Parliament. These safeguards will remain firmly in place.

In keeping an integrated approach to HFEA functions, the CQC would be the focal point for ethical considerations of treatment licensing that arise from the Human Fertilisation and Embryology Act. There is no reason whatever to suppose that it is not up to fulfilling that role. I say to my noble friend Lord Newton that my department’s officials have had discussions with the CQC senior managers about the proposed transfer of functions. The CQC is confident that these can be taken on effectively. The health research agency will provide a focal point for the ethical consideration of research using embryos. It will draw on expert advice, as the HFEA does now. The aim is to simplify and rationalise the ethical approvals process for all kinds of research. Far from the ethical focus for each type of activity being lost, it will be actively preserved.

My noble friend Lord Willis suggested that we might use the Health and Social Care Bill, now in another place, as the vehicle for the proposed changes, rather than this Bill. I recognise the force of his proposal. He will know why we have chosen not to go down that road. We do not want to add to what is already a substantial Bill. It is important, too, that the Government retain momentum for their planned changes across the ALB sector. The ALB review process has already garnered significant rationalisation across the health sector and we do not want that rolled back. By keeping the HTA and the HFEA within the Public Bodies Bill, we can deal discretely with complex issues and undertake detailed consultation and impact assessments in a timely and considered way. We also, as I have indicated on several earlier occasions, wish to avoid reopening the Human Tissue Act and the Human Fertilisation and Embryology Act, which command widespread agreement. Our desire to maintain momentum is why we plan to establish a special health authority to continue and strengthen the work of the National Research Ethics Service and to be a starting point for the simplification of research approval processes. That special health authority would be the platform on which we would build the fully fledged research regulator.

NHS: Chiropody and Podiatry Services

Baroness Thornton Excerpts

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

My Lords, my noble friend makes an important point. She will know that there are universities that specialise in the training of chiropodists and podiatrists, and we place great reliance on them. What will emerge from the new architecture that is foreshadowed by the Health and Social Care Bill is a much greater sense of local prioritisation regarding needs. Flowing from that, with the advice and guidance of Health Education England, which will be the national body supervising workforce requirements, we may well see further centres of excellence in training emerging.

[Baroness Thornton]

My Lords, I hope that the Minister will forgive me for being slightly personal, but I wonder how often he trims his toenails. I expect that he can actually reach his own toenails unlike many elderly people who cannot reach theirs, do not have anyone to do it for them and cannot afford a podiatrist. Would the Minister be happy to have his toenails trimmed once every three months, which seems to be the standard offer by health centres and GPs at the moment? I am sure that he will share my concern that even that service is under threat from the cuts at PCT level. Will the Minister undertake to ensure that podiatry services for the elderly become a priority for the National Commissioning Board?

[Earl Howe]

My Lords, I am fortunate in being able to cut my own toenails. However, the noble Baroness makes a serious point about the elderly. It is often the lack of that simple service that prevents elderly people being as mobile as they wish and sometimes confines them to their own homes. This is a serious issue in terms of the way that we can prevent unplanned hospital admissions due to elderly people falling over. The process that I have referred to whereby we will see joint health and well-being strategies emerging from the health and well-being boards at local level should ensure a sufficient supply of the workforce over a period of time.

NHS: Consultation on Reform

Baroness Thornton Excerpts

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

The noble Baroness makes a very important point about local directors of public health, who most certainly do need the right qualifications for that role. As she will know, they will be jointly appointed by local authorities and by the Secretary of State and we need to ensure that they can perform their role properly. The four main themes to the listening exercise are: choice and competition; public accountability and patient involvement; clinical advice and leadership—that may be an area that impacts on her question; and education and training. In some ways it is difficult to separate those issues; they are all of a piece and we do need to look at them very carefully.

[Baroness Thornton]

My Lords, if the current listening exercise hears the almost universal concerns about the Government’s proposal to introduce a new economic regulator into the heart of the NHS—concerns, I have to say, that were expressed but ignored by the Secretary of State right through the autumn and the spring—will the Government be removing that part of the Health and Social Care Bill?

[Earl Howe]

My Lords, no, because we are clear that the current system requires independent oversight of competition within the health service. Essentially, we have an unregulated health service at the moment; the Government in which she played a distinguished part as a Minister rolled out the independent sector treatment centre programme but its terms were, in the judgment of many, not fair. We need independent scrutiny and determination of pricing in the health service to ensure that there is a fairer playing field for all those providers of NHS services.

NHS Reform

Baroness Thornton Excerpts

Monday 4th April 2011 Lords Chamber

[Earl Howe]

We are assigning particular staff to pathfinder consortia. Those staff will remain within the PCT clusters. They will not transfer officially to the consortia because the consortia are not officially in existence yet. The point here is to have staff who are dedicated to supporting the emerging consortia over the next few months. This is already in train.

[Baroness Thornton]

My Lords, given the progress that has already been made in dismantling the PCTs and the strategic health authorities ahead of legislation, and the millions given to GP consortia to establish their role as commissioners, are the Government not in danger of pre-legislative implementation? Does it not beg the question as to where the role for pre-legislative scrutiny, or indeed any meaningful scrutiny in the House, might be on the matter? Will the Minister assure the House that, when we eventually receive the Health and Social Care Bill, reorganisation will not have progressed beyond the point of no return?

[Earl Howe]

My Lords, the noble Baroness will know that her own party’s plans included a 30 per cent reduction in administrative and managerial costs throughout the health service. We agree with that and we have got on with it. It is right that, when a Government come in and announce their intentions, as we did, expectations should be managed, as we are doing, and uncertainties should be allayed. The way to do that is to get on with the process.

NHS Reform

Baroness Thornton Excerpts

Monday 4th April 2011 Lords Chamber

[Baroness Thornton]

My Lords, I start by thanking the noble Earl for repeating the Statement. I have to confess that this is a very puzzling moment. I do not recall a Statement in the middle of the proceedings of a Bill—a Bill that has only just finished in Standing Committee in the Commons. I would be grateful if the noble Earl could tell me whether there has ever been a Statement announcing a break, natural or otherwise, in the middle of the passage of a Bill. I wonder what might happen in this natural break, whatever that is. Perhaps the Minister can define this new parliamentary term. How long will it be? Why is it really necessary? What is likely to take place during that period? What exactly are the Government intending to do during that period? It seems to me that the things that the Government have said that they are going to do during that period should have happened anyway before the Bill was introduced and that they should have been ongoing. This should not be necessary.

However, I welcome the recognition in this Statement of the concerns that people have about the speed of change. I question the use of the word “continue” in the Statement in the context of listening and engaging. Frankly, if Mr Lansley had been listening and engaging, this Statement would probably not have been necessary. However, if it means that the Secretary of State really is going into listening mode, I welcome that and look forward to seeing it.

I welcome the fact that the Statement touches on the areas that are of concern to people. I also welcome the recognition in the Statement of the 10 years or so of investment by my Labour Government, which is why the NHS is as successful as it is today. However, I also note that the Statement, just like Andrew Lansley’s Second Reading speech when the Bill was introduced in another place, elides the question of Part 3, which gives great powers to a utility regulator—the new economic regulator, Monitor. Therein lie many of Mr Lansley’s problems, because people have worked out what the implications of that part of the Bill are for the NHS. When will Mr Lansley start to listen to the concerns that have been expressed by the Health Select Committee, all the royal colleges, the health regulators, all the bodies representing employees and staff in the NHS, including the BMA, the patients’ organisations, his partners in this Government, the Liberal Democrats, many of the voluntary organisations involved in health—those concerned with diabetes, heart disease, cancer, asthma and dementia, for example—and, in particular, organisations concerned with long-term conditions?

We can build a picture of what has happened in the past week or so. First, the Prime Minister was wrong-footed by Ed Miliband on 16 March on whether the health service would now be subject to European Union competition law. It seems to me that he went away, found out about it and confirmed that that was the case. Will the Minister confirm that? There has been a stream of media stories reflecting serious concerns about the Health and Social Care Bill. Most recently, in the Daily Telegraph, Sarah Wollaston MP urged her party to drop plans for the radical reorganisation. On 1 April, Elizabeth Rigby, chief political correspondent of the Financial Times, reported concerns about the rapidity of change.

On 2 April, the Telegraph said that the Prime Minister was drawing up key changes to the Bill and planning amendments. This article is remarkably detailed about meetings at Downing Street with David Nicholson, the head of the NHS, and Mr Lansley. It says that Mr Lansley was not for compromising and that reforms had gone too far to be undone, which was the subject of a question that I asked in Oral Questions only today. I ask the noble Earl to confirm whether that is the case.

The Statement also reflects the fact that Mr Lansley is very firm about the Government’s intentions for the NHS, but it is not consistent with the stories in the media about the activities at No. 10 Downing Street. Will the noble Earl tell us who is correct about these matters? I will draw a veil over what the noble Lords, Lord Owen and Lord Tebbit, have said about this matter in the past few days.

I am concerned about exactly what will happen during this natural break, which brings me to my final questions. My concern is that this break is being taken in order to strike a deal. I can just imagine a possible conversation between Nick Clegg and the Prime Minister. Nick Clegg says to the Prime Minister, “We want local accountability strengthened”, which I think many of us here would agree with. The Prime Minister then says to Nick Clegg, “Okay, but your people in the Lords must deliver Part 3 of this Bill to establish the economic regulator, Monitor, without dilution of its powers”. There is no doubt that that would be the prize for the Conservatives. It has been recognised by the noble Lords, Lord Owen and Lord Tebbit, and by the noble Baroness, Lady Williams. I fear that this is about keeping the coalition together rather than any assessment of what the NHS might need at this moment. The past few days have seen David Cameron conceding that he and the Health Secretary have failed to get their message across. There have also been anonymous briefings from No. 10, to which I have referred.

I am further concerned that this is about playing politics with the NHS. Will the Minister reassure the House that that is not the case? This is too important to be used as a political football or to see decisions taken about the NHS simply to save David Cameron’s face or Nick Clegg’s face. What is required now is a rethink, a pause in the legislation and some root-and-branch changes.