NHS: Immigration Rules

Baroness Wall of New Barnet Excerpts

Wednesday 24th June 2015 Lords Chamber

[Lord Prior of Brampton]

As usual, the noble Baroness is more than familiar with the latest developments in the world of nursing. Health Education England is committed to commissioning an additional 23,000 nurses over the next four years. On safer standards of nursing, I know that she has taken a keen interest in the work that has been done around nurse staffing levels in relation to the numbers of patients. It is the Government’s view that the actual decisions about safe staffing should be taken at a local level, based on the acuity of patients on the ward, and should largely be up to the judgment of the ward sister and senior nurses within the hospital.

[Baroness Wall of New Barnet (Lab)]

My Lords, I declare an interest as chairman of Milton Keynes Hospital NHS Foundation Trust. How are we to reconcile the dilemma that we have just heard about from the Department of Health and from Monitor—cutting back on agency staff—with the impact that this legislation will have on nurses in our hospital and in many others? It will affect not just nurses; lots of people who work in hospitals, whether in ophthalmics or pharmacy, will have the same kind of issue. How do we reconcile the fact that we are trying to run a hospital that ensures the best experience for patients while this will have the opposite effect?

[Lord Prior of Brampton]

The noble Baroness makes a strong point. There is a dilemma, but we have to differentiate between the long term and the short term. In the long term, it is very important that we develop enough nurses for our own healthcare system. In the very short term, there will be ups and downs. Unquestionably, in the light of the Francis report into the awful happenings at Mid Staffordshire, there has been a spike in demand for nurses, particularly those to be employed in acute hospitals. That has caused short-term difficulties, leading to problems with the agency staffing that she referred to. It is worth pointing out that last year 3,500 nurses—largely from the Philippines—came from overseas to this country. In the short term that provides an escape—a way out, if you like—but it is not a permanent solution.

NHS: Maternity Care

Baroness Wall of New Barnet Excerpts

Thursday 5th February 2015 Lords Chamber

[Baroness Wall of New Barnet (Lab)]

My Lords, I, too, congratulate my noble friend Lord Harrison on securing this important debate about maternity services. Noble Lords have a range of interests to bring to debates and this is no exception. That is terrific. I wish to concentrate on the training and development of maternity staff to meet future needs.

We all know that, with advances in clinical techniques and technology, it is very possible that premature babies, even those who are 22 weeks old, can now, with careful, 24/7 care provided by skilled staff, live to be healthy babies to the joy of their parents. However, that outcome requires a skilled maternity team.

Our midwives and support staff require knowledge and experience to deliver babies who have gone to full term. However, something may still happen that should not, and their preparation for such events, and the skills they deploy, are hugely important in delivering babies safely, which brings a lot of love and joy for the mum, the midwife and the family.

I want to share with noble Lords some of the training and support mechanisms that Milton Keynes Foundation Trust, of which I am chairman, has developed, and continues to develop, to ensure that the skills of our maternity staff are constantly updated and refreshed. If you were to ask our head of midwifery at Milton Keynes—as I did—what the key issues are for her, she would say, “The key areas around the provision of great care are attracting the right people into the profession, standards of training and the ongoing development of staff to provide that care”. At Milton Keynes we train student midwives in partnership with Northampton University. Our clinical practitioners are involved at the very beginning with the recruitment of prospective students and use a value-based recruitment strategy which tries to ensure a caring and compassionate approach to the midwifery profession. Applicants need to have demonstrated that they have undertaken some care work prior to applying. This is hugely important as it illustrates their interest.

During training, the students work in all areas of the profession and we carefully monitor the time they spend with an appropriately trained midwifery mentor. Through discussion with our head of midwifery at Milton Keynes, I learnt that our consultant midwifes and senior lecturers run reflection sessions throughout the training to enable discussion and learning from experience to guide the students in providing safe, quality care. I was fortunate and honoured to take part in such a discussion last week in preparation for this debate. After students qualify at Milton Keynes, there is a very robust preceptorship competency programme. That programme is hugely important and is valued highly by students.

I would like to say a little more about what happens at Milton Keynes in terms of assessment and competency. However, in the short time that I have left, I will focus on the provision of quality evidence-based guidance, which is vital. However, it is useless if staff do not follow it. It is hugely important to encourage them to follow it, and that midwives monitor that. Good care is achieved only through good clinical practice and leadership, enabling staff to be involved in decision-making and supporting individual development and training. We do all this at Milton Keynes but many other trusts do not necessarily have such a robust programme for staff. We have heard accounts from my noble friend about what happens in some instances of community midwifery as well as in some hospitals.

Following the tragic and unacceptable situation at Morecambe Bay and then at Guernsey Hospital, a review was carried out by the King’s Fund. Sadly, this review, which was contributed to by the Nursing and Midwifery Council, took place in a closed meeting. There was no discussion with any of its members or with experienced midwives. The NMC accepted all the recommendations, including on the loss of statutory supervision of midwives in the near future. That is concerning as this has been a gatekeeper for safe midwifery practice since the Midwives Act 1902. Removing it from local maternity units to a centralised system removes this important responsibility, which is key to safe local practices. Everyone understands the horror of those two hospitals and the necessity for the report to look at them. I ask the noble Earl to look at this carefully before it reaches the stage of legislation. Many midwives, including my head of midwifery, believe that—excuse the pun—this is throwing the baby out with the bathwater.

National Health Service

Baroness Wall of New Barnet Excerpts

Thursday 8th January 2015 Lords Chamber

[Baroness Wall of New Barnet (Lab)]

My Lords, I, too, thank my noble friend Lord Turnberg for securing this debate; almost every other speaker has referred to the appropriateness of its timing. I declare an interest as the chairman of Milton Keynes Hospital NHS Foundation Trust, as I will refer to it considerably.

This debate is about the future of the NHS. I was fortunate as the chairman of Milton Keynes Hospital NHS Foundation Trust to meet a group of young students who have just started their medical training at Milton Keynes Hospital through a partnership that we have just sealed with the University of Buckingham. They were bright, enthusiastic and committed people who are looking forward to their future and, I suggest, to the future of the NHS.

It perhaps seems appropriate to look back, as other noble Lords have done, at where we are now and what we are learning from where we are, alongside debating and sharing what future this magnificent service can have—a service of which we are proud and which offers care from cradle to grave. My noble friend Lord Turnberg referred to medical and technological interventions and developments, as did other noble Lords in their speeches. As other speakers have said, although these have clearly made a huge difference to people’s lives—and we welcome that—I do not think that any of us realises the strain that has fallen on the hospitals as a result, in particular on acute hospitals that provide these services.

I will share things that I know happen in my hospital and elsewhere. It is now almost taken for granted that, if a baby is delivered at 22 weeks, it will survive and flourish, which is an admirable thing to achieve. However, to do that, the service required from the NHS is huge as regards the care that that baby needs—in some instances it involves one-to-one specific nursing requirements. The same applies, as other noble Lords have said, at the opposite end of the service. Milton Keynes is a community that includes people of all ages, from the very young to the very old, so it has the same problems as many other hospitals. The interventions and developments that we have had in treating cancer and other medications for improving health, to which noble Lords have referred, have made immense improvements and breakthroughs in people’s lives. However, I am not sure that, as the noble Lord, Lord Desai, rightly said, although in very different terms, we—patients, communities or any of us—understand just what the effect of that is. We all welcome the improvements made in our lives—any of us would want our relations to have all that—but the implications for an acute trust of funding and service provision are extensive.

Over the last few weeks and even days, my trust, like many others, has been seeing very poorly patients, mostly old men and women, brought in with chest pains, breathing difficulties and even with pneumonia, and others are heading that way. We, like other hospitals, have dedicated staff, from consultants and nurses to healthcare assistants and, importantly, porters, who are often not mentioned but who make the wheels of the organisation move—porters moving trolleys in and out of A&E can make a big difference to the facility that we have to look after patients, and that support is absolutely crucial, particularly at this time. The staff have a huddle every morning or at every shift change and look at what is going on. If you come in, morning after morning, and find that not a single bed is available for anyone who comes through your doors that day, that is a big challenge to start the day with. However, every member of staff works in high spirits and with complete dedication. They care—as I think we all do—about the type of service that they are going to give. They worry, as we all do, when the stress goes on for as long as it has, that they are not able to give the care that they want each and every patient to have who goes through their hands.

The reasons for that are multiple and we have discussed many of them today in this debate. I will pick up on one thing that my noble friend Lord Warner just talked about, which is our relationship with local authorities. As my noble friend Lord Warner and other noble Lords said, many of the bed-blockers—it is a most unfortunate phrase; these are wonderful people who have had interesting and dedicated lives—are there because there is nowhere else for them to go. The ability of local authorities to purchase places in nursing homes and care homes, not just in Milton Keynes but elsewhere, has been reduced because of the cuts, so there is nowhere for people to go.

In addition—and I shall say this quickly, because I am running out of time—what has accelerated the process and caused the overwhelming concern over the past few days is that we have just experienced what in hospital terms is called a “double weekend”. Christmas Day was on Thursday, Boxing Day was on Friday and there followed Saturday and Sunday. The consequences are that we already have challenged services but we also have consultants and nurses who are not working over those days, which means that we cannot provide the usual service.

The Front Bench is getting anxious that I am not finishing in time, so I will finish there. All that I would seriously ask on behalf of my staff in the hospital is that we should not have massive change. Please let us not have a whole new look at what we are doing, with someone coming out with something entirely different. Everybody is weary with that, so let us just look at what we have and make sure that we can make it work better.

NHS: Medical Staff

Baroness Wall of New Barnet Excerpts

Monday 15th December 2014 Lords Chamber

[Earl Howe]

I am not aware of the answer to that question but I can tell my noble friend that the UK has been moving towards self-sufficiency for a number of years. For example, there was a 27% decrease in the number of registrations of non-European Economic Area nurses from April 2010 to March 2014, continuing a longer-term trend. The number of doctors in the NHS with a primary medical qualification from outside the EEA has remained relatively static over the last four years despite the full-time equivalent number of doctors increasing by more than 5% over the same period. I think we can take heart from those figures, mindful, of course, of the need to adhere to the World Health Organization code of practice.

[Baroness Wall of New Barnet (Lab)]

My Lords, I am sure the whole House will join in the sentiments expressed by the noble Lord, Lord Fowler, about the tremendous work that these nurses and doctors do in our NHS. I declare an interest as chairman of Milton Keynes Hospital NHS Foundation Trust. As I am sure the noble Earl is aware, many of the hospitals now are encouraging some of the African nurses to go back and have an opportunity to train the skilled and unskilled nurses who are already in their own countries. Despite the fact that things are obviously very challenging for us here, it is very important that they are able to do that.

[Earl Howe]

I agree with the noble Baroness. It is important to underline that the medical training initiative, which is the means by which we can present an offer to foreign doctors—that is, postgraduate medical specialists—to come to train here, is a fixed-term arrangement for up to two years. It seeks to promote circular migration so that participants in a scheme can return to their home country and apply the skills and knowledge developed during their time in the UK. That is very valuable for those individuals and those countries.

Health: Pneumococcal Disease

Baroness Wall of New Barnet Excerpts

Monday 3rd November 2014 Lords Chamber

[Earl Howe]

My Lords, the noble Lord summarised the position extremely well. I share his hope that we will see an outcome from the sub-committee’s work in which everyone can take satisfaction. He is right that rates of pneumococcal disease in children have fallen dramatically, but it is interesting that the knock-on effect of that has been to reduce the rate in adults as well.

[Baroness Wall of New Barnet (Lab)]

My Lords, I am sure that the noble Earl would agree that, not only for this disease, effective vaccination and immunisation lead to fewer people being in hospital and rates of infection being reduced. It also means that we have a much better patient flow coming through. Surely, to be successful, immunisation and vaccination need to be encouraged.

[Earl Howe]

The noble Baroness is of course quite right. It is important to emphasise that part of the benefit of the seasonal flu vaccination campaign is to reduce the risk in adults and children of pneumococcal disease. That is another good reason to get the flu vaccination.

Care Quality Commission (Reviews and Performance Assessments) Regulations 2014

Baroness Wall of New Barnet Excerpts

Monday 27th October 2014 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, the statutory instrument that we are debating tonight arises from an amendment that the Government sought parliamentary approval for during the passage of the Care Bill in 2013 and 2014. That amendment related to the scope of periodic performance assessments to be undertaken by the CQC and the method by which such reviews are to be devised and will allow an aggregate performance rating to summarise and compare the performance of organisations or the services provided. It is for the CQC to devise such quality standards and methodology in consultation with the Secretary of State and those key stakeholders that the CQC considers appropriate. The scope of those performance assessments is set out in these regulations, which by virtue of Regulation 1 will come into force on 1 October this year. That means that the CQC will be under a duty to undertake performance ratings of those registered service providers and regulated activities that such providers carry out, as prescribed by Regulation 2 and the schedule to these regulations.

I remain somewhat sceptical of the ability of the CQC to place such huge organisations as hospitals in one of only four categories. The Explanatory Note to the SI refers to work commissioned by the Secretary of State on the use of aggregate ratings of providers. This is not the first attempt at performance ratings, but the fascinating piece of work produced by the Nuffield Trust and commissioned by the department has a number of warnings on this. The trust says in its report:

“A rating by itself is unlikely to be useful in spotting lapses in the quality of care”,

particularly for services which “complex providers like hospitals” give.

“It is here that the analogy with Ofsted’s ratings of schools breaks down. Hospitals are large, with many departments and different activities, seeing large numbers of different people every day, carrying out complex activities, many 24/7, and in which people are sick and can die. Put another way, the risks managed by hospitals vastly outweigh those managed in schools. For social care providers the risks may be lower, but many are still dealing with frail, ill and otherwise vulnerable individuals”.

Its conclusion is that,

“unless there is a ‘health warning’ on a rating to clarify to the public what it can and cannot say about the quality of care, there is an inevitable risk that the rating (and the rating organisation) will be discredited, as lapses occur in providers scored as ‘good’ or ‘excellent’”.

It says that it will be just a matter of time. In summary the Nuffield Trust concluded that,

“the overall approach to ratings should allow complex organisations to be assessed at different levels and to promote service-specific ratings where possible, particularly in the case of hospitals”.

I would be grateful if the noble Earl could comment on this, particularly on how he considers the rating outcomes of individual providers are to be communicated to the public in an understandable way that none the less pays due regard to the complexity of the ratings so well described by the Nuffield Trust.

My real objective in bringing these regulations before your Lordships’ House is not so much what is in the statutory instrument as what is not. I go back to our debates during the passages of both the Care Bill and the Health and Social Care Bill in 2012. The noble Earl will know that I have expressed considerable concerns about the fact that the way in which clinical commissioning groups and local authorities commission services is no longer to be subject to regular review, audit and, indeed, rating by the CQC. During the passage of the Care Bill only a few months ago we discussed concerns about the quality of local authority commissioning of care services in the context of the scandal of 15-minute visits and zero-hours contracts. We argued then that the CQC should undertake regular inspections of local authority commissioning performance.

I suggest that the same goes for clinical commissioning groups in the National Health Service. When we debate NHS issues the noble Earl frequently—indeed, consistently —refers to the importance of commissioning. Whenever he is pressed on problems or gaps in services he has put his trust in more effective commissioning. However, it is very difficult to see how the performance of commissioners is properly assessed and held to account in the current structure. The noble Earl has previously argued that we should rely on such things as CCG outcome indicators, backed up by scrutiny from local Healthwatch. I think that that is a pretty weak response. So far there is scant evidence to show that this is effective. I am sure we would acknowledge that often when things go wrong in a health system it is a failure of the system—of course of the providers giving the services, but also of commissioners and, indeed, local authorities. Let us take the four-hour A&E target, which is proving to be a major challenge up and down the country. There will of course be issues in the organisation of the hospital itself, but there will also be issues around the organisation of primary care, the way in which services are commissioned and the ability of local authorities to ensure that there are specific and sufficient facilities in the community for when patients are discharged from hospital.

It is a matter of regret that the CQC, as the primary regulator on quality and standards, is no longer concerned on a regular basis with the performance of local authorities as commissioners, and with clinical commissioning groups. It is true that the CQC has the power to conduct special reviews where concerns have been raised about a particular commissioner. I do not know whether that has happened yet—maybe the noble Earl will be able to tell me—but it seems to me that that is not anywhere near sufficient.

I also want to discuss the position of NHS England. The noble Earl will know that, although the original changes brought about by Mr Lansley were designed to hand over nearly all the commissioning budget to clinical commissioning groups, a rather substantial amount of money was ultimately retained by NHS England for commissioning of specialist services. It would be fair to say that NHS England’s performance on that has given cause for concern. The noble Earl will be aware that the budget for specialist commissioning is hundreds of millions of pounds overspent. In essence, we had an out-of-control budget and the board of NHS England seemingly unaware of what was going on. If an NHS provider had performed so lamentably its board would have been sacked, and rightfully so. I ask the noble Earl how the board of NHS England has been held to account for its lamentable performance relating to specialist commissioning. Have sanctions been applied? At the very least, should the CQC not assess NHS England’s commissioning performance?

In our previous debate on NHS England, the noble Earl informed us:

“NHS England has its own governance processes in place, including the development of the direct commissioning assurance framework to demonstrate that it meets the standards required. As this is developed further, elements will be introduced to bring external scrutiny to its board and function”.

He also said:

“Ultimately, NHS England is held to account by the Department of Health for its commissioning activity against its delivery of the priorities set in the mandate”.—[Official Report, 21/10/13; col. 813.]

I am sure the noble Earl thought that they were comforting words, but how on earth does this apply to the debacle over specialised commissioning? To my knowledge, that has still not been properly resolved.

I am not convinced that the Government have the right approach to commissioning. If commissioning in the health service and in local government is as important as the Government say it is, surely it is in the public interest that the CQC should take a much stronger role in checking and rating the performance of commissioners, and indeed of health and care system performance generally. I hope that this leads to a good debate. I beg to move.

[Baroness Wall of New Barnet (Lab)]

My Lords, I support in principle the wording of the business that we are dealing with, particularly the emphasis on regular assessment of other than the provider trusts. I share with the House and the Minister why I now feel that that is even more important. I declare an interest as chairman of Milton Keynes Hospital NHS Foundation Trust. Just last week, we were inspected by the CQC. Obviously, we do not yet know the outcome of that. The CQC was with us for four days and there were 40-odd people there.

As the noble Earl is aware, I have been very supportive of the CQC and share his aspirations for it. To be honest, our inspection was extremely thorough. We have to wait with bated breath for the outcome, but the enthusiasm, what was described as the buzz around the hospital and the way that people felt strongly about the services that they were giving made a huge difference to the whole thing. I am only three months into that trust, but this was not about preparing for the CQC; it was about the culture of the organisation and wanting to improve. I hope that the CQC comes back with recognition of that, whatever the outcome might be.

The inspection was carried out under the new way of doing things, which I think is great. There were many more people across all the spectrums of our services, at a professional and clinical level. That was superb. The reporting back every night was very good and helpful to the chairman and chief executive. All that felt good and thorough, which is what it is all about. I agree with my noble friend’s view about extending that for the very reason that he just gave. The importance of that inspection to the outcome for our patients was absolutely paramount, regardless of what the outcome might be in terms of the grading or level of assessment we might be given. But without that thoroughness and rigour, particularly with the CCGs, who are the ones making decisions about our services, with the GPs who run them—unless there is a deep dive, as we would call it, into any other part of the health service—the gaps that are still a worry for us may remain.

In particular, my noble friend Lord Hunt said that there was an issue around local authorities. All trusts are struggling terribly with A&E. There are many reasons for that, as my noble friend has said. But one of the big reasons is the lack of rigour in social care and local authorities’ commitment to or understanding of the role that they play. From the experience that we have had over the past week, I believe that this is not a threat to people: it is empowering for them to have the CQC in there, ensuring that the rigour that they are supposed to apply to their work is there and that the role they play in patients’ experience really makes a difference. I urge the noble Earl to consider this opportunity yet again. We made a decision in the Care Act, which I think even more now is really a mistake from which we need to move on. I do not share the cynicism of my noble friend, but I share the concern about whether the CQC can embrace all that.

The investigation into my trust was supported, as I understand it, by far more clinicians than ever before and far more people had a much greater knowledge of the health service. If the CQC can continue to develop in that way, I believe it is in its interest—and, more importantly, in our patients’ interests—that those commissioning groups go wider and deeper into other than the provider trusts.

[Baroness Barker (LD)]

My Lords, I spent a happy weekend making a start on the 500 pages of regulations that have been issued under the Care Act. What can I tell noble Lords? I am living for pleasure alone. I regard this Motion as the first of many to come our way.

I thank the noble Lord, Lord Hunt, for the opportunity to go back to some of the discussions that we had during the passage of the Bill, particularly on commissioning. We had long debates about commissioning and the extent to which it did or did not impact on services. We also talked at considerable length about the differences between the commissioning of healthcare in the NHS and commissioning in social care. In these regulations, we are beginning to see some attempt to have proportionate and slightly different attitudes towards commissioning in both those settings. I would like to see us taking a more proportionate look at commissioning across the board. To a certain extent, these are the first of the regulations that begin to do that.

We also had extensive discussion about whether performance ratings should be specific to particular services within hospitals or whether they should go across the piece. My recollection, informed quite often by people with valuable experience such as the noble Baroness, Lady Wall, was that there would be a lot of data generated in hospitals, particularly clinical governance data, which would be there to inform one’s opinion about a particular service in a hospital. However, what would have been missed, and what was missed so spectacularly in Mid-Staffordshire, was the across-the-board bad management practices throughout a hospital that undermined patient care. That was why we ultimately took the decisions that we did about the nature of performance review.

I want to pick up two particular issues that are brought to the fore by these regulations. I notice that prison healthcare has been exempted. I understand that there is a sense in which the NHS or the CQC would be able to look at the performance of only a part of prison healthcare. But prison healthcare is, in terms of mental health, addiction services and so forth, becoming much more important. There is a much clearer focus on the amount of ill health that people have within the criminal justice system. I want to be sure that we are not enabling those prison health services to escape proper scrutiny.

My final question to the noble Earl is more fundamental. We had extensive debates during the passage of the Care Bill about the right of entry for those people who are involved in carrying out performance reviews and the extent to which the people responsible for them should be able to go into any service to assure themselves that those services are safe and the people within them are not being abused. I do not see anything in these regulations that gives comfort to those of us who believe we took the wrong decision during the passage of the Bill and that, as a consequence of our failure, there may well be people in health and social care settings who are being abused at worst or ill treated at best.

[Baroness Wall of New Barnet]

I thank the noble Baroness for giving way. In response to her comments on nurses and hospitals, she is absolutely right. I emphasised the clinical stuff. However, the CQC interviewed everyone on our board: the non-executive directors, me—as chairman—for an hour and a half, and all our executive directors. It interviewed not just the clinical staff but the whole of the trust to make sure that we all understood what we were doing in the job we are employed to do.

[Baroness Barker]

I thank the noble Baroness for that. I trust that if the CQC was doing its job, it would really go to the seat of power in a hospital and interview the porters.

Health: Stroke

Baroness Wall of New Barnet Excerpts

Wednesday 23rd July 2014 Grand Committee

[Baroness Wall of New Barnet (Lab)]

My Lords, I, too, thank my noble friend for raising this serious issue. For many of us, hearing the numbers has come as a surprise. I acknowledge the support I have had from the Stroke Association in getting together some of the research. I had certainly not heard of young children having strokes before my noble friend Lady Wheeler brought this subject to our attention. Looking at the statistics, it is alarming that around 400 young children have a stroke every year. A significant proportion can easily die as a result, and those who survive the impact of a stroke can perhaps be immensely more disabled, physically and emotionally, than they would have been had they been seen sooner.

As with strokes affecting adults, a quick diagnosis and rapid treatment are essential to help save lives and reduce the longer-term impacts in children and younger people. However, research recently carried out into childhood strokes in the UK shows that significant delays exist in diagnosis, with more than half of cases taking longer than 24 hours to be confirmed. This is because, as I said earlier, it is not something that one automatically expects.

I am now chairman of Milton Keynes Hospital NHS Foundation Trust. I was chairman of Barnet and Chase Farm until a month ago. In preparation for speaking today and considering the seriousness of the subject, I was delighted that I had the opportunity to speak to Kate Swailes, who is matron of paediatrics. Although Milton Keynes does not have a children’s stroke unit, it has an incredible adult stroke unit. During our discussion I tried to understand exactly what she would see if a child came into A&E. She confirmed that it was very difficult to identify whether a young person had had a stroke. Her view was that if they knew the child had sickle cell disease, or had had a fall or an RTA, they certainly would scan them. However, she was concerned that because clinicians did not get a lot of exposure to this, they might not be up to speed with it.

Kate Swailes did a lot of homework over the weekend before speaking to me on Monday and rang me this morning to wish me luck with this debate. She told me that she and her fellow clinicians, working with the OTs, physios and speech and language therapists, have now designed a poster, like the Act FAST campaign, and have put “This could be a child” across the top. Nobody has done that before as far as they are aware, so I was thrilled to bits, as I am sure that everybody listening will be. They have done that at Milton Keynes and want to make sure that the Minister is aware of it. Perhaps it is one of the answers to the Stroke Association’s question about what other tools we can make available for the recognition of children’s stroke.

The noble Lord, Lord Lingfield, mentioned Andy Marr. The main shock of reading about this hit home when I listened to Jackie Ashley, his partner and a Guardian journalist, when she came to my trust just a fortnight ago to recognise one of the initiatives that one of our academic nurses has undertaken, to get all the occupational therapists, speech therapists and physios together. She has put an accredited module together. All the nurses working on stroke wards at Milton Keynes now have this additional training module which makes them even more conscious of what they are looking for when they see a stroke patient and what they can do to assist before and after the therapist has already attended.

We have already made gains in having this discussion, but I say to the Minister—and I am sure that he is receptive to this—that the recognition that this debate is giving to the issue must be raised much higher in the health service. Is it possible to do something inside the department?

Health: Secondary Care

Baroness Wall of New Barnet Excerpts

Thursday 26th June 2014 Lords Chamber

[Earl Howe]

Several things are in train. One of those, as the noble Lord will know, was reflected in the legislative reform order that we debated in the Moses Room two days ago. It will cut down the administrative burden of joint commissioning by NHS England and CCGs, as well as the burden currently being experienced by CCGs in joint commissioning between themselves. More importantly, we need to incentivise the system for integrated care, and that is what the better care fund is designed to do. It will ensure that patients receive joined-up care, whether that is in acute settings, in the community or, indeed, from social care.

[Baroness Wall of New Barnet (Lab)]

My Lords, the noble Earl will know that a number of trusts like my own, which is Barnet and Chase Farm, are trying to remove the barriers that still exist between providers of secondary care and of primary care. What help can the Government give to make sure that primary care is better funded and reinforced so that people do not have to come into hospital, and so that we have an absolutely seamless pathway of care?

Care: Older People

Baroness Wall of New Barnet Excerpts

Wednesday 7th May 2014 Lords Chamber

[Earl Howe]

My Lords, the Government are not flying blind on this issue. Social care has remained a priority for us, which is why in every year since 2011 we have invested significantly from the NHS into social care, and with a health benefit, as I mentioned earlier. That has enabled councils to give relative protection to social care in implementing their savings. The noble Baroness shakes her head, but the figures are very clear. Spending on adult social care services has been protected to a much greater degree than other service areas. One cannot expect them to be wholly protected. Local authorities have reduced spending on other services by a good deal more than they have on adult social care services.

[Baroness Wall of New Barnet (Lab)]

My Lords, does the noble Earl accept that the real crisis in care for older people is the closure of many beds within local communities, which forces hospitals such as my own, Barnet and Chase Farm, to hold on to those people when they should not be in a hospital? They do not need medical treatment and are very vulnerable to hospital diseases. That is where the real crisis is. Barnet and Enfield is closing beds inside care homes, which affects not only the length of stay but the impact we have on older people, which bothers us greatly.

[Earl Howe]

My Lords, that kind of issue should be absolutely central to the planning that the health and well-being boards undertake, with both the NHS and social services working together to ensure that there are enough beds from year to year. It is difficult to make generalisations about this. The noble Baroness mentioned her own area, which she knows very well. I am concerned to hear that Barnet and Enfield is straining in that sense, but, if she would like to speak to me about this, I am of course ready to see her.

Tobacco: Packaging

Baroness Wall of New Barnet Excerpts

Thursday 3rd April 2014 Lords Chamber

[Earl Howe]

I beg the noble Baroness’s pardon. It is a little early for me to be specific on that. I have been as specific as I can on the timescale in which we hope to introduce regulations, but I will need to come back to the noble Baroness on the timescale for their implementation.

[Baroness Wall of New Barnet (Lab)]

My Lords, I want to briefly add my congratulations on and support for the report, and to associate myself with the frustration that I think my noble friend on the Front Bench has portrayed. Many other people, including clinicians in my own hospital, are already seeing the effects of smoking on children as young as 11, which is very worrying.

I should like the noble Earl to think about two things. First, has the breadth and depth of the consultation been different from and wider than the previous consultation, which was not very long ago? Secondly, the noble Earl made a comment along the lines that we must make sure that we do not end up in litigation because we want to ensure the fairness of this. I must advise the noble Earl that consultation will never be strong enough to prevent litigation. We must do all we can to consult everybody, but we shall be waiting for ever if we wait for something that will prevent people pursuing litigation when they really do not want these things to happen. I am sure the noble Earl is aware of this, but please let this consultation not be so exhaustive that we include everything that will stop the courts taking up some of the issues.

[Earl Howe]

The noble Baroness makes a good point about litigation. My response is that if it comes to litigation, and of course we hope it will not, we will have the strongest possible defence against any accusation that we have somehow skimped or not taken account of evidence. In defence of the Government, I also point to the other measures we are taking to bear down upon the prevalence of smoking. The noble Baroness knows very well that we have had some excellent debates on smoking in cars, proxy purchasing of tobacco, and prohibiting the sale of electronic cigarettes to under-18s. I hope the good faith of the Government is not in doubt here and I share her wish to see progress made as swiftly as possible.

On the subject of the timetable, I did not make clear that while we believe that we have sufficient time to allow regulations to be introduced within this Parliament, we shall move to give both Houses our final decision on whether we are going ahead with this before the Summer Recess.