Health: Stroke Treatment

Baroness Thornton Excerpts

Wednesday 30th June 2010 Lords Chamber

[Baroness Thornton]

My Lords, I start by thanking the noble Lord, Lord Rodgers, for bringing forward this debate. It is almost exactly a year since we had a debate in your Lordships’ House in which the noble Lord mentioned stroke and, indeed, his questions were answered by me. I do not expect that the noble Lord imagined that he would be addressing his questions to a Minister who, one year on, is now his noble friend. I hope that the noble Lord, Lord Rodgers, is not going to let up on his consistent holding of the Government to account for what is going to happen to stroke services and the stroke strategy.

It is not often that I do this, but I intend now to quote myself from 25 June last year. In that debate, I said:

“The noble Lord, Lord Rodgers, raised the issue of stroke, as did several other noble Lords including the noble Lord, Lord Walton of Detchant”—

whose debate it indeed was. I continued:

“He was right to point out that we have a new national framework for stroke and we are endeavouring to give it the right kind of emphasis and prioritisation that stroke requires. I can confirm that the 10-year plan is on track, that the stroke strategy acknowledges that the networks are of great benefit and that all the stroke services in England now fall within one of the 28 networks. The work of the stroke improvement programme, including the networks, will be evaluated over the next year, after which future work plans will be considered”.—[Official Report, 25/6/09; col. 1750.]

There is no question that the Labour Government took the issue of stroke very seriously, for all the reasons that have been eloquently described by noble Lords today. I think particularly of the very fair summary of the history of this issue which the noble Lord, Lord Rodgers, gave.

I suppose, then, that my first questions to the Minister are: has the review been finished, what is its outcome and what are the government plans for taking forward the strategy? Indeed, will the coalition Government be following the stroke strategy, or will they be junking it to start all over again in a year’s time? Personally, I would counsel against such a course of action, given the widespread support that the strategy has across a whole range of medical and voluntary organisations and, indeed, the involvement of many of those organisations in the creation and continued monitoring of the strategy.

However, there are some worrying signs, to which other noble Lords have already referred. On the recent decision by the coalition Government, on 10 June, to remove ring-fencing conditions from the £15 million 2010-11 revenue grant to local authorities for implementing the stroke strategy, I can only quote the excellent briefing, for which I am very grateful, from the Stroke Association. It says that in its opinion this,

“makes the risk of cuts to current support service levels even more pronounced and in need of urgent attention”.

I agree with it and would really like to know how the strategy will now be delivered at local level.

The NAO and the PAC, which noble Lords have also mentioned, recognise the risk posed to improvements in the longer-term stroke strategy services by the end of additional funding for the implementation of the national stroke strategy after 2010-11 and the current financial pressures facing the NHS and local authorities. Under these circumstances, we need a commitment from the department that these improvements will continue in the long run. Indeed, as has already been mentioned, the PAC makes a number of key recommendations on how the department can sustain and improve further the standards of service for all stroke patients across the whole care pathway, and asks for reports on progress in areas within 12 months. I agree with that and would like to hear a commitment from the Minister to that course of action. Indeed, when we were in government we regarded the work of the PAC as extremely important in helping us to deliver the stroke strategy.

However, I am alarmed at the current risks to services. The NAO report shows that 76 per cent of local authorities surveyed have used the Department of Health’s ring-fenced funding to develop services with the Stroke Association. As mentioned by my noble friend Lady Pitkeathley, the number of contracts with local authorities to provide information and support has increased from 164 in 2005 to 268 in 2009. It seems that, at current levels, one in every two patients is able to access them. Around half the local authorities have also used the funding to establish their own dedicated stroke-related jobs, such as stroke care co-ordinators, stroke-specific social workers and occupational therapists, and a quarter have used some of the grant to fund breaks for carers.

We know that there is also still an unmet need. It would seem that, at the moment, an estimated 50 to 60 services around the country could be under threat of not having their contracts renewed. This is a very serious issue. Some local authorities have already put recruitment on hold for vacant positions. I am concerned that the message being sent from the department is that this is no longer a priority for local authorities. How will the coalition Government re-establish the priority that we gave stroke, and how will they re-establish those networks that have been so important in improving the treatment of stroke across the country and for the future?

I have several other questions which the Government need to address. They relate to the issue of funding at local level. Do the Government have plans to monitor and evaluate the use of the ring-fenced funds to ensure that they continue to be a priority? Does the Minister feel that the premature ending of ring-fencing sends the message that I have already outlined—that this is no longer a priority? What on earth will they do about that? The Stroke Association and the voluntary sector have a right to be very concerned.

The Minister would expect me also to refer to FAST. The previous Government invested £10 million between 2008 and 2010 in awareness-raising activity around strokes, centred on the highly visible Act FAST campaign, which I demonstrated to your Lordships’ House twice last year. The PAC report describes this campaign as “excellent” and concluded that it,

“had improved public awareness of stroke and the responsiveness of ambulance and hospital staff”.

Given that the mantra we keep hearing is that the Government want an evidence base for the decisions that they take, I hope they will take on board the NAO’s public survey, which gives the evidence that this campaign has worked. Will the Minister confirm that the funding allocated for the continuation of the excellent Act FAST campaign will be spent? What plans does the department have to continue funding the excellent campaign to improve awareness of stroke over the medium to long term?

I am proud to have been part of the Government who transformed the treatment of stroke in this country. We made the National Stroke Strategy a priority and gave additional funding to strategic health authorities for its implementation. We ensured strong leadership at a national level with a national clinical director for stroke and the new NHS Stroke Improvement Programme. Progress was aided by the inclusion of implementation of the National Stroke Strategy of the NHS operating framework as a tier-1 “must do” national requirement. I am pleased that the tier-1 status continues to be there in the revised operating framework that this Government have just published. I hope that that is not just for this year, but for the duration of the strategy. Is that the case?

We know that the best way to reduce the human and economic cost of stroke is through prevention. I put it on record that I remain to be convinced that the coalition Government are taking seriously their commitment to issues of public health. The prevention of stroke is key to the whole of the Government’s public health drive. Smoking cessation, obesity campaigns and swimming are all linked to how we prevent stroke in the future. How will the Government’s work to prevent stroke happen in the current financial climate and given the freeze in advertising? Having a policy which just says that we are going to prevent stroke by doing the following things, but are cutting the budget that allows us to communicate that, makes it not at all a useful commitment. It is meaningless. It is important that we hear what the Minister has to say on that.

Finally, what does the moratorium on reconfigurations mean for stroke services? Following consultation, Healthcare for London planned to introduce eight hyper-acute stroke units, all of which it hoped would be up and running by April 2011. However, I have to ask, what is the future for these centres? The Secretary of State has said:

“I am fulfilling the pledge I made before the election to put an end to the imposition of top-down reconfigurations in the NHS … As part of this, I want NHS London to lead the way in working with GP commissioners in their reconfiguration of NHS services. A top-down, one-size fits all approach will be replaced with the devolution of responsibility”.

We have heard this many times before. However, this has potentially extremely serious implications for stroke services in London, which are beginning to deliver an absolutely excellent first-rate service which is saving the lives of Londoners. As someone who lives in London during the working week, I would like to know what would happen to me now if I had a stroke. Would I end up at one of these centres or have they now been reconfigured out of existence? I suggest that we probably need to keep a very vigilant eye on the future of stroke services.

[Lord Clinton-Davis]

I apologise for speaking in the gap. I did not know whether I could be here. However, it would be remiss if I were not to mention the debt that some stroke sufferers owe to the authorities of this place. I am one of them.

Health: Primary and Community Care

Baroness Thornton Excerpts

Thursday 24th June 2010 Lords Chamber

[Baroness Thornton]

My Lords, this is an interesting subject for debate, as the debate has proved. Learning the lessons of the past 10 years at the moment when great change is about to be unleashed on the whole way in which healthcare is delivered in the UK seems appropriate, and I congratulate the noble Lord, Lord Mawson, on his usual entrepreneurship in the timing of this debate and the passion that he brings to the issues of innovation in providing public services—in this case, healthcare—as well as his hopes for less bureaucracy, less political change but not, I hope, less accountability. The noble Lord has been making this kind of wonderful speech for as long as I have known him. Rightly, he blames bureaucracy and politicians in his passion to roll out the models that he knows so well and that work so well. As he knows, I have a great commitment to social enterprise and entrepreneurship, but I think that he needs to give some credit where it is due about the progress of the past 10 years.

I remind the House that some progress has been made. I should like to look at two issues—the LIFT programme and the development of social enterprise in the past 10 years. The LIFT programme, delivered through community health partnership, is there to create, invest in and deliver innovative ways in which to improve health and local authority services. I know that the noble Lord, Lord Mawson, is familiar with the LIFT programme and has tales to tell about the difficulties of this bit of the bureaucracy. But it is there to deliver and provide clean, modern, purpose-built premises for health and local authority services in England. The reason why the programme is so important is because 90 per cent of patient contact with the NHS occurs in general practice. The research shows that primary care in the inner cities, where healthcare need is the greatest, may have suffered from a disproportionately high number of substandard premises in primary healthcare. That is why we instituted the LIFT programme. We knew that the condition and functionality of existing primary care estate was variable, with current facilities not meeting patients’ expectations and quality and access often being below an acceptable standard—and, therefore, service development sometimes very severely hampered by the limitations of the premises.

As a Government, we made an investment in primary and social healthcare facilities. We made it a priority in inner-city areas. It was clear to us that new buildings were required to provide people with modern, integrated primary care services. When we came to power, there is no doubt that the creation of new facilities was fragmented and piecemeal. Developments tended to be small scale and focused on more affluent areas; they tended not to integrate social care at all. The landscape has been transformed in the past 10 years. If I add to this the review done by my noble friend Lord Darzi, it is clear that we have made some progress.

I shall mention some of these outcomes and particularly draw them to the attention of the noble Lord, Lord Mawson. He said that he was tired of words and no delivery. Well, there has been a huge amount of delivery—in fact, £2.2 billion worth of delivery of new schemes. I take for example the centre at Church Road, Manor Park in Newham, which the noble Lord may be familiar with. It brought together three GP practices and contains district nursing as well as health visitors, dentistry, pharmacy and many diagnostic services. Then there is the Thurnscoe primary care centre in Barnsley, which has, among other things, eight GPs and traditional primary care services; it is able to do blood tests, ultrasound scans and minor procedures, which means shorter hospital waiting times. It also includes an ICT training suite, a GP training room, an audiology clinic, a podiatry clinic, district nursing and physiotherapy.

The one that I like best is the Kenton Resource Centre in Newcastle, which was built on the site of an old clinic on Hillsview Avenue. It has a new health facility, including the relocated GP practice, but it also includes community health professionals, Newcastle City Council and voluntary services, a local customer centre, which provides housing and benefit advice, a Newcastle City Council library, which serves three neighbouring districts, and a Northumbria Police office for local beat officers.

I could go on. In fact, the most recent centre was opened last week in Dudley—the new multimillion-pound state-of-the-art Brierley Hill centre. Therefore, I think that we can say that we have been delivering local community centres in the last 10 years, but I ask the Minister what the fate of the programme will be. How will it fare in the reconfiguration of the NHS that we are told is on its way?

Let us turn to social enterprise. I declare an interest as a serial offender in social enterprise. I have spoken many times in your Lordships’ House about the development of social enterprise and I have sponsored things such as the community interest companies Bill. I think that it is worth saying for the record that social enterprise is a business whose objectives are primarily social and whose profits are reinvested back into its services for the community, with no financial commitments to shareholders or owners—it is free to use its surplus income to invest in its operations to make them as efficient and effective as possible. Well known social enterprises include Turning Point, the Eden Project and the Big Issue.

The Department of Health has been promoting social enterprises through the initiatives that the Labour Government took, as we saw the advantages of them for patients and service users. We instituted the right to request as part of our broader vision for the NHS. I know that the first phase of the right to request has been enacted and I think that the second phase is about to be enacted, but I should like confirmation of that from the Minister. I should like to know what will happen to the social enterprise investment fund and to the right to request.

I should specifically like to know from the Minister what will happen to contracting, although he may not be able to give me an answer right now. The Labour Government made a commitment through the department that, when a social enterprise had been established in the health service, had gone through the right to request and was contracting for services, that enterprise would have a three-year or possibly a five-year contract, which would be guaranteed once it had gone through the whole process. Will that continue under the new regime? If the Government are serious about developing social enterprises to deliver primary healthcare and other services within the health service, a contract of three to five years will be vital for those businesses.

The noble Lord, Lord Mawson, talked about the Bromley by Bow Centre, which is a tremendous achievement. I should like to mention the Big Life centres. The Big Life is based in Manchester. It grew out of the Big Issue and works with people completely cut off from health, housing and employment services. There are now eight or 10 centres providing holistic services to the communities in which they are based. The Kath Locke Centre combines the best in conventional NHS healthcare with complementary therapies. It is well built and a good place to relax, and is extremely well used by its local community.

The Big Life Group issued a manifesto for the last general election, which I commend to the Minister. It states:

“We believe, developing a market in the NHS has really only meant opening up to large private sector companies and has largely missed the opportunity to bring in innovation through the social enterprise sector”.

I do not agree completely with that: it may be as unfair as some of the comments made by the noble Lord, Lord Mawson. However, the Big Life Group may have a point. We as a Government did not succeed as much as I wish we had. The challenge is now there for the coalition Government. If they are serious about having an innovative marketplace, they must address the issues raised by organisations like the Bromley by Bow Centre and the Big Life Group.

I agree with the noble Lord, Lord Mawson, that the department must encourage more entrepreneurship. Like him, I have been frustrated by slow progress across the piece. As the founding chair of the Social Enterprise Coalition some 10 years ago, I think we should blow our own trumpet. Where there was one Bromley by Bow, there are now many. Social enterprise was mentioned in every party manifesto, and is now part of the coalition Government's programme. We have made great progress. However, there are still huge challenges.

I have some questions for the Minister. It seems that in two years’ time, £60 billion of NHS funding might be funded through local commissioning, as the noble Lord, Lord Crisp, mentioned. What will happen to these schemes and programmes if this reconfiguration of the NHS is going to be so profound? How will the Bromley by Bows and the Big Life centres be developed under those circumstances? How will this entrepreneurship be taken into account in the new commissioning scheme? The noble Baroness, Lady Finlay, made a valid and wise point: the rush to change might jeopardise what has already been achieved through partnership and innovation. I agree with the noble Lord, Lord Crisp, that we do not want to lose some wonderful examples of PCT innovation in the forthcoming reorganisation. How will the coalition Government build on the platform that we created—or do they intend to dismantle the platform, with all the risks that go with that?

NHS: Patient Targets

Baroness Thornton Excerpts

Wednesday 23rd June 2010 Lords Chamber

Asked By

[Baroness Thornton]

To ask Her Majesty’s Government how they will ensure that patients will be seen in reasonable time by doctors and other primary care professionals following the publication of the revised NHS operating framework which removes NHS patient targets.

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

My Lords, the revised NHS operating framework stops central performance management of process targets that have limited justification. The NHS must be free to manage services at a local level, and will be accountable to the patients and the public it serves. To ensure this, we shall continue to collect data measuring access. Incentives for timely access such as through the quality outcomes framework, the NHS constitution and the contractual regime remain in place.

[Baroness Thornton]

I thank the noble Earl for that Answer. He will recall that in 1992 his Government launched their Patient’s Charter, in which the pledges for patients included:

“to be guaranteed admission for treatment by a specific date, no later than two years from the day when the consultant places the patient on a waiting list”.

I might add that his Government did not achieve that. I take it that the coalition Government’s objective is not that, but the House might like to know what they think is a reasonable waiting time. We got it down to 18 weeks. What does the noble Earl think it should be?

[Earl Howe]

My Lords, it is right for me to make clear that the previous Government achieved a great deal in bringing down waiting times—there is no doubt that that was a major worry for patients—and they are to be commended for that. The noble Baroness is concerned that we do not let the situation slip, and I fully share that concern. As I have indicated in brief terms, two main issues will prevent it happening. The first is that the legal duty on commissioners to commission services that comply with operational standards around the 18-week referral time still applies. The second is the NHS constitution, which contains the right to access services within minimum waiting times, as she knows. Those patient rights within the constitution have not been diluted.

Health: Cancer

Baroness Thornton Excerpts

Monday 21st June 2010 Lords Chamber

[Earl Howe]

The noble Baroness is quite right, which is why in the NHS there is such an emphasis on speed of referral when a GP first suspects that cancer may be present in a patient. This is an area to which we are very alive, and I hope that we will be able to make further announcements about it in due course.

[Baroness Thornton]

Does the Minister accept that new cancer treatments such as PDT have benefited both from crucial investment by the Government and from partnership with leading cancer research charities? Is he prepared to guarantee that this crucial research will continue to be funded by the Government so that more deaths from cancer can be prevented in the future?

[Earl Howe]

The noble Baroness is quite right. This is a partnership effort, and she may know that a systematic review of PDT has been undertaken as part of the Health Technology Assessment programme, which is an element of the National Institute for Health Research. The final report on that will be published in August, but the institute has already identified that there are not enough high-quality research studies in this area. We know from experts in the field that there are at least three or four areas where further research should be prioritised.

Health: Government Spending

Baroness Thornton Excerpts

Monday 14th June 2010 Lords Chamber

Asked By

[Baroness Thornton]

To ask Her Majesty’s Government which health agencies and arm’s-length bodies will be affected by cuts in government spending.

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

My Lords, the Government are committed to reducing bureaucracy and improving efficiency. By streamlining and simplifying the infrastructure, we can ensure that clinicians focus on what really matters: delivering the best possible health outcomes for patients. All non-front-line organisations will be expected to operate efficiently and contribute to the Government’s commitment to reduce central administration spending by one third. That is why we are reviewing how best to organise the national infrastructure. The review will report in due course.

[Baroness Thornton]

I thank the Minister for that Answer. Notwithstanding the Government’s proposed intention to create the biggest quango of all in the NHS board, what can the Human Tissue Authority and the Human Fertilisation and Embryology Authority expect from the bonfire of the quangos? Will it be a third of their work, for example? I choose those two because the Minister and many noble Lords in this House were closely involved in considering the legislation that led to the creation of those two important bodies.

[Earl Howe]

My Lords, the focus of the exercise that is going on at the moment is, on the one hand, to look at value for money and, on the other, to look at how best we can deliver quality. Therefore, the review will consider which functions should be carried out at a national or arm’s-length level, which could be stopped with no detriment to the delivery of front-line services and which could be undertaken elsewhere in the system or, indeed, left to the market. So there is no target as regards getting rid of a certain number of bodies. The point of view from which we come is that of functions.

Mid Staffordshire NHS Foundation Trust

Baroness Thornton Excerpts

Wednesday 9th June 2010 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating this important Statement. The Secretary of State promised to establish a public inquiry to examine the Mid Staffordshire Foundation Trust as late as February when he was in opposition and my right honourable friend Andy Burnham made a Statement on this matter in another place and announced the findings of the Francis report.

The staff, management and board of the Mid Staffordshire Foundation Trust have worked hard to turn round this foundation hospital and to re-establish good relations with their local community. They now find themselves back on the front page for failures that occurred three or four years ago, which have already been the subject of three inquiries. Therefore, my first question to the Minister is, how do the Government intend to support the staff and management of Mid Staffs during the coming public inquiry? I agree with the noble Earl—it is important to put this on record—that we should acknowledge the work that the current chief executive and chairman have undertaken in the past year or so to turn round this hospital, which has met with a large measure of success. I hope that the Government will support them in the coming months.

There have now been three reports into the terrible events at the Mid Staffordshire hospital. Professor Sir George Alberti published a review of the hospital’s progress in emergency care, and Dr David Colin-Thomé published a report on how the commissioning and performance management system failed to expose what was happening in the hospital. The independent inquiry by Robert Francis QC was then established in July 2009. That report is 800 pages long, and I think the noble Earl will agree that it reflects with accuracy the terrible catalogue of failure of care of patients and their families, the comprehensive failure of the management and the failure of the foundation board. As my right honourable friend in another place said, our job in government then was to hold a mirror up to the NHS, which is why we commissioned the Francis report in July and brought forward the further proposals and terms of reference for a further inquiry. Therefore, of course the new inquiry has our full support, as has anything in the Statement that, for example, strengthens and supports whistleblowers in the NHS.

My next question is: how much account will be taken of the previous reports, conducted as they were by very distinguished medical and legal professionals? Can the Minister explain in what way the questions or terms of reference of the new inquiry will differ from the draft terms of reference which my right honourable friend agreed before the election? How long will this inquiry take and how much will it cost? Indeed, what has happened to the many recommendations made in the Francis report in February, which were accepted in full by the then Government? Will they continue to be implemented while this inquiry is ongoing?

Where I think that the Statement is disappointing and perhaps even dangerous is in the reference to targets. It seems to me that the noble Earl is in danger of prejudging the findings of the public inquiry in his undertaking to get rid of targets. The Conservatives have made it clear that they have an ideological opposition to targets, and they have used what happened at the Mid Staffordshire NHS Foundation Trust as their main example of why the four-hour target in accident and emergency is bad. We can have a discussion about that target. We think it is about national standards and that it is a tool for improvement. We also think it is about patient safety—indeed, it has huge support from patients and health staff, including doctors. What we know about Mid Staffordshire is that staffing fell to dangerously low levels. We know that it was not following the national guidance on targets and that it had a stupid staffing policy, which meant that it did not have enough nurses. We also know that the board and management completely failed to address these matters.

What will the Government do if the public inquiry finds that it was these gross failures at every level that were the problem and not the targets? It would be very unfortunate if this inquiry were used by the Government to justify their commitment to that ideology. Does the Minister agree that there needs to be a balance here? Surely the public inquiry needs to address with an open mind these isolated and awful events in this hospital, and then other hospitals and the NHS can learn the lessons from that. If that is the aim, the Government will have our full support.

Health: Dementia

Baroness Thornton Excerpts

Thursday 3rd June 2010 Lords Chamber

[Earl Howe]

My Lords, my noble friend has raised an important issue, and one which we are giving consideration to. We recognise fully that breaks from caring are one of the top priorities for carers in terms of the sort of help they want. Supporting the physical and mental well-being of carers by giving them breaks obviously enables them to do their job more safely and effectively, and can keep families together. But where violence intrudes, it is often an intractable problem. I hope to be able to give my noble friend more details once we have given this area the thought that it deserves.

[Baroness Thornton]

My Lords, we are at the beginning of the second year of what is in fact a five-year dementia strategy, which is what the noble Baroness, Lady Greengross, referred to in her Question. Some £150 million was earmarked for the first two years of the strategy. Is that £150 million safe, particularly the £90 million for 2010-11, and do the Government have plans to implement the rest of the five-year strategy?

[Earl Howe]

My Lords, the answer to the specific question about whether the money is safe this year is yes, but we want to ensure that the strategy is sustainable over the following three years. We will do that principally by driving up quality standards through a tariff for dementia patients, by better regulation of providers and by better commissioning of services, including public health interventions. Alongside that, as I said to the noble Baroness, Lady Greengross, we plan to provide better information to people with dementia so that they have a good understanding of their local services, and local organisations will be expected to publish how they are delivering on those standards.

Queen's Speech

Baroness Thornton Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Thornton]

My Lords, I apologise to the House and to the noble Lord, Lord Hill, for listening to his maiden speech from below the Bar. I begin by offering my congratulations to the new Government and Ministers. Like my noble friend, I wish that the noble Earl, Lord Howe, had got the top job in his department. I congratulate the noble Lord, Lord Hill, welcome him to his place on the Government Front Bench and congratulate him on his outstanding maiden speech. I also extend my congratulations to the noble Baroness, Lady Northover, who is now health whip—a job that I filled happily for a year or so.

It is a rum old world: many noble Lords from both parties opposite, and on this side, will share that sentiment. I was thinking about the rumness of it all and wondering how the conversations are progressing between the Minister and his new whip with regard to tobacco regulations. About a year ago, the noble Baroness and I made common cause against the noble Earl: so we shall see where that ends up.

We have had an excellent and wide ranging debate, with four maiden speeches of great quality. In all cases, I am happy to agree with noble Lords that we can look forward to all the maidens’ future contributions of distinction to the work of this House. The noble Lord, Lord Hall of Birkenhead, is a long-standing friend whose speech made me think what a great champion he will be in discussions about the arts and heritage in this place. The right reverend Prelate the Bishop of Guildford, in his evocative descriptions of his diocese, made me realise that we need to organise a charabanc trip there. The presentation of the noble Lord, Lord Kakkar, showed that he will add greatly to the medical expertise of this House. I am also very pleased to learn that the noble Lord will join the Lord Speaker's outreach programme, of which I can modestly claim to be a veteran. It is an invigorating and humbling experience on every occasion when I go to speak to children and young people in their schools. I wish the noble Lord well and hope that he will enjoy it as much as I do.

My noble friend Lady Morgan spoke to the parts of the gracious Speech that addressed education and welfare. She was amply supplemented in her remarks by our noble friend Lord McKenzie of Luton. It remains for me to say only that I agree with every word that both of them said. I commend the contributions both of my noble friend Lady Hollis, who has given the noble Lord a brilliant pension scheme—we look forward to his comments on that—and of the noble Lord, Lord Kirkwood, who I sense will make a career of keeping his Government on their toes in these matters. It remains for me only to add a word of advice to the noble Lord, Lord Hill. The Government insist that they are about fairness, about closing the gap in achievement and about raising standards. All that they have to do to achieve this is to listen to the wise words of my noble friend Lady Morris of Yardley. Instead of relegating failing schools that need extra help and resources to the bottom of the list for attention and help, they should put them first, before outstanding schools that are doing well under present circumstances.

I turn to culture, media and sports. The gracious Address was largely silent about this important area of national activity, except for the commitment to high-speed broadband internet connections. That subject was well addressed by the noble Lord, Lord Elis-Thomas. My noble friend Lady Andrews added her voice to the championship in this House of heritage, tourism and the arts. The noble Lords, Lord Hall and Lord Macdonald, illustrated well the national benefits of the media, arts and heritage in creating wealth and jobs and in enriching the quality of life for millions of people. The arts and heritage play an important part in our economy, accounting for 10 per cent of our national economic activity. My right honourable friend Ben Bradshaw and his team—Margaret Hodge, Gerry Sutcliffe and Tessa Jowell—left this area in very good shape.

It is clear to me that this Government intend to turn the clock back in their approach to the arts. It is disappointing that—I am sorry to say this to the noble Lord, Lord Hall—the arts institutions have already had a budget cut of 3 per cent this year, despite promises from the Government during the election campaign. It is particularly disappointing that the Arts Council was singled out for a bigger cut of 4 per cent this year. As the BBC’s respected arts editor, Will Gompertz, has pointed out, this creates a precedent that could see arts institutions across the land being asked to realise assets such as bank savings and buildings to fund their activity in lieu of government grants. Responsible saving and budgeting are being punished and to date the Secretary of State has refused to rule out taking the same approach to other arts institutions, so watch out Royal Opera House. I ask the Minister when we will know about this.

While we welcome the Government’s commitment to increase philanthropy, they have gone quiet on moves to encourage philanthropy through the tax system. I am depending on the noble Lord, Lord Inglewood, to chase them on this matter. The Secretary of State has said that he intends to write to the 200 biggest philanthropic donors thanking them for their contributions. I am sure that they will be grateful and perhaps even flattered by this attention, but I suggest that the message might be seen as a little hollow when the Secretary of State’s first contribution to the nation’s great arts heritage has been to cut funding.

On the Olympic Games, the brilliant custodianship of my right honourable friend Tessa Jowell has ensured that this month’s report on progress says that the 2012 London Olympics are on time and on budget. The Government have inherited much in arts and culture; they have inherited something that was working and working well. They need to provide reassurance that the budget cuts that they have proposed will not have an impact on the London Olympic Games in 2012.

I now turn to health. The House would expect me to look at the manifestos of the partners in the coalition Government, the coalition agreement and the gracious Speech, as well as, of course, the words of the partners in the past, to see how the Government will attempt to reconcile some interesting and occasionally diametrically opposed points of view. Let us start with the name of the Department of Health. The Conservatives said:

“We will turn the Department of Health into a Department for Public Health”.

It is a small and relatively unimportant promise to break immediately, but what does it presage?

Here are some of the Conservative promises that do not appear to have survived the coalition negotiations. The Conservatives promised to scrap all central NHS targets relating to clinical processes, but now they do not seem so sure. They promised to end “pointless” reorganisations of the NHS, but now they are about to embark on a massive new NHS reorganisation. They promised to reduce the number of unaccountable quangos, but they are turning the NHS into a new quango. They promised a voluntary insurance scheme to pay for residential care, but they have dropped that. They promised to protect the disability living allowance and the attendance allowance, but they have suddenly gone very quiet on that. I know that government involves compromises—it is a lesson that the Conservatives and the Liberal Democrats are perhaps only just beginning to learn—but who would have thought that one of the benefits of coalition government was that you never needed to look at your manifesto again?

It is important to put on the public record at the start of this Parliament that Labour has left the NHS in its strongest ever position. In 1997, the discussion was about whether the NHS would survive at all; today in 2010, the NHS is substantially rebuilt and renewed. I do not apologise for repeating the figures: waiting times are at an all-time low; infection rates are right down; patient satisfaction with the NHS is at an all-time high; there are 44,000 more doctors and 89,000 more nurses; waiting lists are down by over half a million; and 3 million more operations are done per year. Also, we have seen the biggest hospital-building programme in the history of the NHS, with 118 new hospital schemes completed. As George Osborne might say, we did fix the roof while the sun was shining.

That did not happen by chance. In the teeth of opposition—from some, if not all, of the Benches opposite but particularly from the new Secretary of State—we took the decisions that have left the NHS in this position. I put the Minister on notice that we shall be watching closely the Government’s decisions and the effect that they have on the NHS. I urge the Minister’s Liberal Democrat colleagues to do the same, because they supported many of our changes and they, too, will be held to account for what happens next.

Of course, where we support the work of the Government, the noble Earl can expect my support. He and I have a history of co-operation and friendship, which, for my part, I intend to continue.

I read the new Government’s coalition agreement with great interest. I am astonished that the document seems to have been signed off by the now Secretary of State, who, in opposition, promised over and over again to,

“scrap all centrally-imposed targets relating to clinical processes”.

Perhaps one of the Secretary of State’s new officials told him that his plan to remove targets which have helped to deliver so many improvements for so many patients was “very bold, Minister”—but perhaps not.

Therefore, we await the detail, and of course we have no doubt that any detail will be presented to Parliament before it is published elsewhere. Reports have already suggested that the four-hour accident and emergency target and the 18-week referral to treatment target will be scrapped. I think that the Minister needs to come clean with this House. Are his Government going to change those standards? Are they going to keep the 18-week target? Are they going to back down or keep the two-week target for cancer and the four-hour accident and emergency target? Not only does this House need a direct answer; so, too, do millions of patients.

However, not everyone will be unhappy about the ditching of targets. The Financial Times has already reported, on 18 May, that:

“Private hospitals are expecting a rise in business if, as expected, the Conservatives go ahead with their promise to scrap Labour’s waiting-time targets”.

That choice of going private is one that many patients will remember. Before targets were in place, patients had a choice: wait in the NHS or pay and go private. It is something that we changed, and I am proud of that. I ask the Minister what mechanism the Government are going to use to ensure that waiting lists do not rise. With hospitals encouraged to make savings, what will the mechanism be to ensure that savings are not made by making people wait, as the party opposite has done in the past?

Can the Minister also tell us what will happen to NICE? What will happen to the investment that we proposed for cancer diagnosis? Just before our Government left office, we announced £200 million a year in funding for new diagnostic equipment for cancer. Can the noble Earl tell me whether that target will be met, or has this money been diverted into the Secretary of State’s cancer drugs fund? Can he tell me which is most likely to save more lives: investing in early diagnosis or investing in cancer drugs unapproved by NICE? Can he also explain what relationship the new cancer drugs fund will have with NICE?

The Government have promised that the health budget will rise but they have also promised to make savings. Can the Minister say by how much the budget will rise? In opposition, the new Secretary of State managed to do two things. He complained that deprived areas did too well out of the NHS budget at the expense of areas with less deprivation but more older people, and he called for a change in the funding formula. At the same time, he called for more of the health budget to go to deprived areas in the form of a health premium. It was impressive, to say the least, to complain that deprived areas were overfunded and underfunded at the same time, but I wonder how that feat might roll out in government. If we take the Secretary of State’s words at face value, which PCTs will gain and which will lose?

Another promise that seems to have been forgotten is the one made repeatedly by the Prime Minister, when he was leader of the Opposition, that he would have “no more pointless reorganisations” in the NHS. It now seems that the Government are planning one of the biggest reorganisations in the history of the NHS, with not only a new independent NHS board but, according to the Health Service Journal, the abolition of strategic health authorities. I am not sure that the Secretary of State is adopting the right way to deliver a reduction of costs by encouraging members of strategic health authorities to resign in protest. On that basis, it could take some time. The new Prime Minister once asked the question: are serious political issues too important to be left to unaccountable quangos? He has given his answer. The job of allocating the NHS budget is too important to be left with his Health Secretary. My noble friend Lord Morris hit the nail on the head with his analysis on this matter.

I turn to social care. Noble Lords will not be surprised to learn that I was disappointed to see that the Government have decided not to take forward free personal care at home for those with the highest needs. I am sure that I am not as disappointed as the elderly and disabled people and their families and carers who stood to benefit from the legislation. I should like to join with Carers UK in asking the noble Earl what has happened to the £420 million of funding and what is it now being used for. What about the £130 million that was earmarked for reablement and what has happened to the commitment, supported across the House, for the delivery of portability of care packages to those most seriously disabled?

I was less disappointed that the Conservative proposal to create a new private insurance system to cover the costs of residential care has been dropped. It seems to have bitten the dust. That was a policy whose sums never added up.

The Government's new proposal of a commission on long-term care is certainly better than the old Conservative policy, and we will be happy to support that commission's work. I hope the Minister took note of the job application of my noble friend Lord Warner to serve on the commission, as he is definitely very well qualified to do so. I recommend the White Paper which we launched just before the election as a blueprint that that commission might consider.

At the end of this Queen’s Speech debate, I wish to make some general remarks. I want to mention the economy because it is important to put such general remarks on the record. Our Government made the Bank of England independent and that was opposed by the Conservatives. We took tough decisions to get our national debt lower than that of France, Germany, America or Japan before this global financial crisis began. Our Government led the worldwide effort to stop global financial collapse into recession and into depression, in the face of bitter and wrong-headed opposition from the party opposite. Although the Government may now pray in aid the loyal support of the Governor of the Bank of England and the German finance ministry in advocating immediate and deflationary spending cuts to reduce the deficit faster this year, he and his Chancellor are out of step with worldwide opinion and run grave risks with our recovery, our jobs and our vital public services.

We shall be holding this new coalition to account, make no mistake about it. We shall take our responsibilities as a loyal Opposition seriously to probe, to question and to challenge and we shall use the tools at our disposal to do so. I disagree with the noble Lord, Lord Hill, when he said that he felt nothing much had changed since the last time he was in his position. Government in 2010 is not the same as the Government which the Conservative Party left in 1997. There are different terms of engagement these days. I have no fears for the noble Earl, Lord Howe, as a model of transparency and accountability, but he may need to have a quiet word with some of his fellow Ministers.

We have had four days of wonderful, illuminating and considered debate. In closing, I congratulate all noble Lords on their contributions today and on the other days of this debate, particularly the maiden speeches that we have heard from new Members of your Lordships’ House and the speeches by the maidens at both Dispatch Boxes. Your Lordships’ wisdom and eloquence bodes well for our future debates.

Health: Contaminated Blood Products

Baroness Thornton Excerpts

Wednesday 2nd June 2010 Lords Chamber

[Earl Howe]

My Lords, I share the noble Lord’s antipathy to taxpayers’ money being shelled out in legal fees, but what has happened has happened. In the current constrained financial climate, every department of Government will look very carefully at its legal activity.

[Baroness Thornton]

My Lords, I join my noble friend in welcoming the noble Earl to his new position and wish him all the very best. Not so long ago, during the passage of my noble friend’s Bill last November, the noble Lord, Lord Thomas of Gresford, and the noble Baroness, Lady Barker, were very keen on a full compensation package for those affected by contaminated blood products. Has this commitment been translated into the coalition Government’s policy? If so, how and in what timescale?

[Earl Howe]

My Lords, I thank the noble Baroness for her kind remarks. We are in a coalition Government. Not every pledge in either the Conservative or the Liberal Democrat manifesto can be honoured. That is the nature of coalitions. In fact, the specific Liberal Democrat proposal which she referred to was not included in the programme for government which we published.