NHS: Medical Staff

Debate between Baroness Wall of New Barnet and Earl Howe

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

Debate between Baroness Wall of New Barnet and Earl Howe

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.

Health: Secondary Care

Debate between Baroness Wall of New Barnet and Earl Howe

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

Debate between Baroness Wall of New Barnet and Earl Howe

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

Debate between Baroness Wall of New Barnet and Earl Howe

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.

NHS: Midwives

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 17th March 2014 Lords Chamber

[Earl Howe]

My noble friend is right to draw attention to the attrition rate. NHS England is focusing on this very closely. It is not always possible to predict the attrition rate because midwives leave practice for varying reasons—for instance, to take a career break. It is, however, very important that the motivation of midwives should be maintained. There is a great deal of work going on to ensure that we do not lose highly qualified and skilled midwives from the NHS.

[Baroness Wall of New Barnet (Lab)]

Does the Minister accept that the issue is trying to work out how many vacancies there are? The ratio that is defined in the area depends on the hospital. For instance, Barnet and Chase Farm Hospitals, of which I am chair, has 30 births to one midwife, whereas in other parts of London it could be 28 or fewer. What we have tried to do, in looking at whether we should have a lower ratio, is work with the midwives’ associations. I think it is difficult to establish the number of vacancies because that ratio dictates what is paid for.

[Earl Howe]

The noble Baroness is quite right. Helping commissioners to reduce unwarranted variation in service delivery is one of the key roles of the maternity and children strategic clinical networks, as I am sure she is aware, which are being established and supported by NHS England. Clinical commissioning groups are responsible for commissioning maternity services locally, but they work with local authorities and in conjunction with provider partners to give assurance that processes and service specifications are in place which ensure that midwifery staffing is appropriate for the locality.

Health: Midwives

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 5th March 2014 Lords Chamber

[Earl Howe]

My Lords, any bridging loan requires to be repaid, and that is one of the issues that we are looking at.

[Baroness Wall of New Barnet (Lab)]

My Lords, following on from the question from the noble Earl on the Cross Benches, I am sure that the Minister is aware that most trusts—this is certainly the case in the maternity unit at Barnet hospital—now have a community midwife at the birth, and that midwife follows the mother home and stays there for as long as the mother needs support. Therefore, there is one-to-one care from a midwife, not necessarily during the delivery but certainly in the care that the mother receives when she goes home.

NHS: General Practitioners

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 26th February 2014 Lords Chamber

[Baroness Wall of New Barnet (Lab)]

I follow on from the question of my noble friend Lord Hunt and the Minister’s acknowledgement that the effectiveness of primary care needs to be improved. I agree with what the Minister said about the improvement in some GP services, but still many individuals come to A&E at all times, whether the surgery is open or otherwise, which makes things very difficult. For instance, Barnet Hospital received 117 ambulances yesterday, which made it extremely difficult to deal with people who had walked in, who probably could have had their treatment somewhere else.

[Earl Howe]

The noble Baroness is quite right. The NHS is seeing an extra 1 million patients in A&E compared to three years ago. Despite the additional workload, it is generally coping very well although we know that departments are under strain. This is not just about A&E, as the noble Baroness will be aware, but about how the NHS works as a whole: how it works with other areas, such as social care, and how it deals with an ageing population and more people with long-term conditions. Dealing with all that means looking at the underlying causes, and that work is going on at the moment in NHS England.

NHS: Walk-in Centres

Debate between Baroness Wall of New Barnet and Earl Howe

Tuesday 10th December 2013 Lords Chamber

[Baroness Wall of New Barnet (Lab)]

My Lords, the noble Earl suggested in his response earlier that part of the problem might be that the commissioners felt that they were paying twice. Obviously, GPs are paid for the people on their lists; those same people could use the call centre and they would have to be paid again. How does this fit with the view—certainly the view on the policy—that you can belong to any GP throughout the country, which is exactly what should happen and, if it did, we would not have this dilemma? Walk-in centres are hugely important. I assure the House that, from the point of view of the provider trust, they are absolutely vital to stop people coming into A&E and possibly being admitted.

[Earl Howe]

My Lords, I would not deny for a second that walk-in centres had a role in many places, and indeed the fact that so many are still open is proof of that. However, it is a mixed picture. Those centres that have closed are in many cases ones where doctors locally have perceived that, in one form or another, there is adequate provision for patients, whether through pharmacies, GP surgeries or community services of a different kind.

Health: Local Healthwatch Organisations

Debate between Baroness Wall of New Barnet and Earl Howe

Tuesday 5th November 2013 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. The first annual report from Healthwatch England was laid before Parliament on 9 October and it outlined some encouraging progress at both a national and a local level. There are already examples of the impact that local Healthwatch is having—for example, the work of Healthwatch in Peterborough, which is looking at how to improve health outcomes for offenders. My noble friend mentioned autism. I am aware that Healthwatch Cornwall uncovered a gap in the services meant to deliver a diagnosis of autism in children. That work resulted in a really practical solution so that families could access a diagnostic service without losses to other services in the area.

[Baroness Wall of New Barnet (Lab)]

My Lords, will the noble Earl acknowledge that, certainly from the point of view of people who are working on the ground, the process we are going through is somewhat different from that set out by my noble friend, with whom I hate to disagree? There are obviously challenges at the moment, particularly in A&E, as the noble Earl is aware, but many of the changes have brought a lot of good news for health trusts, and my own in particular. However, the Healthwatch bodies—certainly locally where my trust is involved with them—need some support and guidance about what they are meant to achieve. It may seem odd but there is still some ambiguity about who is doing what. We are working with them as an acute trust to make sure that we can link with them, but there needs to be more clarity about their role.

Medical Litigation: Impact on Medical Innovation

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 15th July 2013 Lords Chamber

[Earl Howe]

I cannot give my noble friend a figure for that, but I can tell him that mediation and arbitration are increasing features in cases of this kind. We are very keen for that mechanism to grow, because the more that cases get into the hands of lawyers—I say this with great respect to noble Lords who are lawyers—the higher the bill to the NHS and the more distress there is to patients and families.

[Baroness Wall of New Barnet]

My Lords, I congratulate the noble Lord, Lord Saatchi, on linking these two important issues of innovation and litigation. I worry that the innovation that has become part of the Liverpool care pathway has had the reaction that it has. We understand today that there is going to be a cessation of that care pathway, because people are reporting being tarnished by it, whereas many patients have had great experiences and families’ involvement in that. It concerns me that we will either stop something because there is an issue about it or stop innovating.

[Earl Howe]

I share the noble Baroness’s concern, but at the same time I recognise that the noble Baroness, Lady Neuberger, and her expert group have done a very thorough job of work. It is now up to the Government and the whole medical community to consider and reflect on the conclusions that the noble Baroness has reached. One thing that she has said is that her decision is not a recommendation to move away from best practice in end-of-life care.

NHS: Mid-Staffordshire NHS Trust

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 24th June 2013 Lords Chamber

[Earl Howe]

My noble and learned friend makes an important point. Of course, that will be the virtue of local Healthwatch, which will be the eyes and ears of the local community in a particular area. We have also strengthened the role of governors of foundation trusts, whose job it will be to have an equally up-to-the-minute view of their organisation’s performance.

[Baroness Wall of New Barnet]

My Lords, I want to reinforce the message put to the Minister this afternoon and tell him what it feels like at the sharp end of the health service. Both my noble friends who have spoken echoed the comments—misquoted or otherwise—made by the Secretary of State. Those comments have caused absolute fear and I am not exaggerating. We had the CQC at our trust on Friday. Our regional person for the CQC is fantastic, the CQC’s reporting is really good and, as noble Lords know, I am supportive of it. However, will the noble Earl please ensure that the messages stop? These people carry out a really important job and if we stop believing that what they do matters, then I do not know where we go. Can we please make sure that the reinforcement of the CQC, with new people involved, will make a difference?

[Earl Howe]

Ministers have been highly supportive of the current CQC leadership and in no way do we wish to undermine its work. Having said that, if concerns arise about how the CQC has done its job in the past, Ministers have to be candid about that.

Care Quality Commission: Morecambe Bay Hospitals

Debate between Baroness Wall of New Barnet and Earl Howe

Thursday 20th June 2013 Lords Chamber

[Earl Howe]

My Lords, I can give that assurance. In part, we have the answers in the Grant Thornton report commissioned by the CQC on the actions that the CQC took or did not take. As I said in answer to the question asked by the noble Lord, Lord Hunt, it is reassuring that the chief executive of the CQC has undertaken to produce for the department within the next two months a report to provide assurance that any cover-up has been fully exposed and that we will learn fully not only the facts but the lessons that we can draw from them.

[Baroness Wall of New Barnet]

I thank the noble Earl for repeating the Statement. It has caused quite a stir. My worry is two-fold. First, we had a big reaction to what happened at Mid Staffs, and now we have this. I would want us to be very careful not to become desensitised by some of these things—I do not mean in this House, but elsewhere.

I will pick up on the comments of the noble Baroness, Lady Emerton, and agree with her totally. As chairman of Barnet and Chase Farm Hospitals NHS Trust, I find it bewildering that, never mind any cover-up at the CQC, the board was not aware of those tragic deaths of mothers and babies. Certainly, in my trust that would absolutely be reported, both through the quality and safety committee that deals with what are called SUIs, or serious untoward incidents, and from the board itself. It would be helpful, as has been suggested, that the inquiry goes a bit further than just the CQC.

[Earl Howe]

I am grateful to the noble Baroness. In fact, the trust has taken significant action in response to the concerns raised by the CQC and Monitor. In addition to responding specifically to the three warning notices issued by the CQC, there have been significant leadership changes at the trust. Sir David Henshaw was appointed as interim chair and Eric Morton as interim chief executive. The trust appointed four new non-executive directors and a new chief operating officer and recruited a new obstetric consultant and additional midwives. There have been other appointments as well. It has established a programme management office, as requested by Monitor, to oversee the implementation of programmes of work to bring about lasting improvements across the trust—and it has recruited a number of posts to the programme office to take that work forward. So I am encouraged that it is taking the position as seriously as it should in the circumstances and that, again, there is a refreshed team at the top of that organisation.

NHS: Accident and Emergency Units

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 19th June 2013 Lords Chamber

[Earl Howe]

My Lords, I have to emphasise to the noble Lord that, although I understand his concerns in relation to Wexham Park and other hospitals, there is no government policy about the closure of A&E departments. The whole thrust of government policy since we were elected to office has been that there should be no top-down direction of this type of decision. Rather, we are clear that any changes to healthcare services should be locally led, clinically driven and involve the local population in a consultation. All patients have the right to high-quality urgent care at whatever time they use the health service. The key for local commissioners and decision-makers is to ensure that that happens. I am aware that the situation at Wexham Park has improved and money is being invested to ensure that there are enough beds for the future.

[Baroness Wall of New Barnet]

My Lords, I declare an interest as the chair of Barnet and Chase Farm Hospitals NHS Trust. I was in my A&E department at Barnet Hospital this morning for two hours. In addition to the concerns that my noble friend has expressed, the real issue is that people are turning up at A&E who really should not be there, do not need to be there and ought to be able to get treatment elsewhere. Obviously, government policy is to ensure that we have more services outside, but can we make sure that that happens more quickly than is currently the case?

[Earl Howe]

My Lords, the noble Baroness is absolutely right. There is no doubt from Sir Bruce Keogh’s urgent and emergency care review, published this month, that attendance at an A&E department often reflects the lack of availability or the lack of awareness of alternative sources of help. Some patients may default to A&E departments when they are unsure about which service is most appropriate to their needs. That has to be addressed and is being addressed in Sir Bruce’s review. It will look at the entire system of emergency care and how we can make sure that it provides the right care, in the right place and at the right time.

Care Bill [HL]

Debate between Baroness Wall of New Barnet and Earl Howe

Tuesday 4th June 2013 Lords Chamber

[Earl Howe]

Certainly, I do. I am happy to take that idea away, and if I can give him any further information during the course of our debates I will. Equally, the LETBs have strongly established connections with professional regulators and professional bodies. For example, the postgraduate medical and dental deans, who are now an integral part of the LETBs, work very closely with the GMC and medical royal colleges in the management and quality assurance of training for junior doctors. I hope that those remarks will reassure noble Lords sufficiently for them not to press the relevant amendments.

In reply to my noble friend Lord Willis, who expressed concern about the way the Explanatory Notes were framed, it is important to look at the entire context of the passage he quoted. The words “such as” appear in that passage before “the medical Royal Colleges”, so it is not meant to denote an exclusive reference to the medical royal colleges; it is very much trying to say that the professional bodies in general will be relevant here.

Amendment 35, tabled by the noble Lord, Lord Hunt, and the noble Baroness, Lady Wheeler, seeks to amend Clause 89 to require HEE to seek advice from the Care Quality Commission and Monitor. It is very important that Health Education England works closely with those two bodies. The Care Quality Commission plays an important role in assessing the quality of healthcare services, and in so doing it assesses their ability to deliver services safely and effectively. In doing so, it will consider whether healthcare providers have suitably skilled staff and in the right numbers. It will need to work closely with Health Education England to share findings and evidence to support improvements in education and training. Health Education England will also be able to share information on the effectiveness of providers in supporting clinical placements and training programmes to support the Care Quality Commission in its role.

HEE and Monitor will work closely together to ensure the financial stability of the health system. This will include working together on the reform of education and training funding and the development of education and training tariffs. To reflect the importance of these relationships, the Bill places a clear and reciprocal duty on Health Education England to co-operate with both the Care Quality Commission and Monitor. I hope noble Lords will feel reassured by that and will be able to withdraw this amendment.

[Baroness Wall of New Barnet]

Is the Minister in a position to respond to my points? I understand the importance of the medical royal colleges and the professional bodies, but the noble Earl described earlier how Health Education England has responsibility for the whole workforce. I sought from him the opportunity to describe where Skills for Health and Skills for Care come in. I should point out that I have spoken three times and have not declared an interest as chair of Barnet and Chase Farm NHS Trust. I hope noble Lords will forgive me for that.

[Earl Howe]

I am grateful to the noble Baroness. I have to go a little further, so if I may I will cover her point in a moment.

Amendments 40 and 42 to 46, tabled by the noble Lord, Lord Hunt, and the noble Baroness Lady Wheeler, focus on the need for expertise on the local education and training board. Specifically they seek to change Clause 91(3) to require a LETB also to have as members persons who deliver education and training to healthcare workers, a registered nurse, persons with experience in staff groups that are not professionally registered, healthcare workers who receive education and training from within the area, patients and carers or their representatives, and a representative of the local health and well-being board.

I fully expect Health Education England and the LETBs to work closely with and seek advice from a range of key stakeholders, including those providing education and training, members of staff, patients and carers. That requirement is clearly set out in Clause 89. I appreciate the position of noble Lords but do not agree that we need to specify all these groups in the governance structure.

In establishing the LETBs, the Government are committed to driving up standards and the quality of education and training provided. I suggest that that can happen only if those directly involved in the provision of education and training are at the heart of the new system. By their very nature, local education and training boards will be representative of local healthcare providers, who play a critical role in educating and training our workforce. They are the health professionals who support and supervise clinical placements and training programmes across the country, providing professional leadership and support to students and trainees.

If we mandate a requirement for a nurse, others will ask why there is no requirement for a doctor, a dentist, an allied health professional or any of the many other professions. I completely agree that these professions, and the bodies that represent, regulate and support them, need to be closely engaged in the work of the LETBs, but it is not practical to require all of them to be members of the board. The Bill makes provision in Clause 91 for those involved in the provision of education and training, such as universities, to be eligible to sit on an LETB. We know from the 13 LETBs established by the HEE special health authority that all of them have a university representative on their boards, and many different health professionals are also represented on them.

HEE will appoint independent chairs of the LETBs. These will be people who are not directly involved in the delivery of health services, or education and training, in the geographical area. Having an independent chair will ensure that the local education and training board acts independently and in the interests of all healthcare providers represented.

To be appointed in the first place, local education and training boards will need to demonstrate to HEE that they have the right governance arrangements and the right mix of people on their boards with the necessary capacity and capability. In going through that process it will be for HEE to assess whether the local education and training board has the right mix of skills, knowledge and expertise with which to carry out its functions. However, as the intention is for local decisions on education and training to be made by the LETBs, it is important that we give them the flexibility to determine who sits on their boards.

To sum up the position, I can reassure noble Lords that LETBs are already developing strong partnership arrangements in their patch to engage with all education institutions involved in education provision in their area. The HEE special health authority has reinforced the importance of this in the appointment criteria that it set the LETBs, which have to be approved by the Secretary of State. These demand that LETBs demonstrate meaningful engagement and collaboration with many stakeholders with an interest in education and training, including students and trainees, and patients and carers. As a result, they are putting in place appropriate advisory and partnership arrangements to support the decision-making of the local education and training board.

NHS: 111 Telephone Service

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 13th May 2013 Lords Chamber

[Earl Howe]

My noble friend, with his experience, is very wise on these matters. I think it would be quite difficult to turn the clock back completely, but I take his point. There is enormous scope for GPs to contribute to the drive to keep elderly, frail people in particular out of hospital. Too many people are landing up in hospital with chronic diseases who should never have been allowed to get there.

[Baroness Wall of New Barnet]

My Lords, the Minister has just stolen my thunder in his response to the noble Lord. Does the Minister have any idea when the failings in the system will be sorted? At the Barnet and Chase Farm Hospitals NHS Trust, of which I declare an interest as chair, we see extra people coming into A&E who, as he has just said, are very poorly and should not really be in hospital because they need antibiotics or something like that and would get better much quicker either in their own home or in a nursing home.

[Earl Howe]

On the issue of A&E, there is no doubt that the NHS has been under very heavy pressure over the past few weeks. I am pleased to say that over the past two weeks the NHS as a whole has met the 95% standard, but obviously that statistic masks difficulties that are still being experienced in particular locations. The challenge now is to ensure that we are ready for next winter, and all the work that is now being done in NHS England, by clinical commissioning groups and within providers is designed to ensure that we are much readier for the pressures to come.

NHS: Out of Hours Service

Debate between Baroness Wall of New Barnet and Earl Howe

Tuesday 26th March 2013 Lords Chamber

[Earl Howe]

We have known that out-of-hours care has been in need of reform for some considerable time. The much strengthened commissioning arrangements that we have put in place, including the national quality requirements that I mentioned earlier, will enable that to happen.

[Baroness Wall of New Barnet]

The noble Earl will, I am sure, recall the discussion we had just a few days ago about the inspection of patients at home. That discussion was about ensuring that patients at home who were poorly in the evening did not end up in hospital. My noble friend has just indicated the tremendous pressure that all hospitals are under in terms of length of stay because of older people arriving and staying in hospital. If this GP out-of-hours service worked well, we would prevent that. We need to ensure that the accuracy and rigour of that service permeate throughout the whole country.

[Earl Howe]

The noble Baroness is quite right; this is an integral part of good primary care and we are determined to see it joined up with GP practices and the other services on which patients rely.

Care Quality Commission

Debate between Baroness Wall of New Barnet and Earl Howe

Thursday 14th March 2013 Lords Chamber

[Earl Howe]

My Lords, the Care Quality Commission has a full range of powers open to it which enables it to take action where it discovers a major failing in the quality of care. We are not aware that that menu of options needs to be expanded. I will write to my noble friend as regards specific instances, having consulted the CQC, but I do not think that there is a general call to expand the CQC’s powers in this area.

[Baroness Wall of New Barnet]

My Lords, I am sure that the noble Earl will welcome this report, as my noble friend has, because there are many good news stories in it. I am sorry that I have had time to read the report only quickly. In the inspection, the Care Quality Commission looked for opportunities to maintain older people in their homes, rather than have them come into hospital; that is hugely important. The evidence is that if an elderly person turns up at A&E at 8 pm, they will be in hospital for many days, and that is not always necessary. Can we look more closely at how, in the care that is given, we can prevent people coming into hospital?

[Earl Howe]

The noble Baroness is right to focus on that issue. There are a number of things that we can do. We will shortly introduce new minimum standards to improve training for care staff, which will help in that regard. We aim to double the number of apprentices in care services by 2017 because there is clearly a workforce imperative here. We are proposing to expand the current care ambassador scheme, which promotes a positive image of the sector. That again will assist in recruitment. We are also launching an online tool to support recruitment and provide information about working in care and support, all of which is designed to address workforce concerns and concerns around skills.

NHS: South London Healthcare Trust

Debate between Baroness Wall of New Barnet and Earl Howe

Tuesday 8th January 2013 Lords Chamber

[Earl Howe]

My Lords, it is important to stress to my noble friend that a trust will be put into special administration only when all other options have been exhausted. I think that the noble Lord, Lord Warner, is aware that that was the situation we faced in this instance. Where possible, NHS providers will be supported to return to sustainability in both the clinical and financial sense. Our priority is to do what is best to ensure that patients receive high-quality care and special administration is a last resort. However, as my noble friend knows, a number of trusts are facing financial challenges. The department is working with Monitor and the NHS Trust Development Authority to oversee the performance of those trusts. I would just say that while some organisations are in difficulties, currently there are absolutely no firm plans to trigger the regime for any other trusts at all.

[Baroness Wall of New Barnet]

My Lords, I am sure that the noble Earl recognises the experience I have had as chairman of the Barnet and Chase Farm Hospitals NHS Trust, which went through a similar exercise that took many years. First, however, I want to associate myself with the comments made by my noble friend Lord Warner, and I support the action that has been taken. I recognise what my noble friend said about the concerns of the local community, but that will always be the case. However, what is most important is to make the decision and secure the support of outlying hospitals. My own trust is working towards a partnership with the Royal Free Hospital, although we are not there yet. The move could have been considered much earlier, which would have prevented a lot of pain and heartache for many people. My advice and plea is to stick with what is being done. That did not happen for Barnet and Chase Farm. As noble Lords know, a number of holds were put on what we were doing that made things worse for the community and for the staff. They almost ensured that the services we were providing were harder to deliver.

[Earl Howe]

As ever, I am grateful to the noble Baroness for her perspective from the front line. I think it was with that in mind that the previous Government drew up the legislation which my right honourable friend now has to abide by, in that there is now a very tight timescale of 20 working days for him to take a decision. That is not a long time but it is indicative of the need for urgency in arriving at the right solution. The TSA has done his work and we must now judge whether the recommendations are the right ones.

Care Services: Winterbourne View

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 10th December 2012 Lords Chamber

[Baroness Wall of New Barnet]

My Lords, I also congratulate the Minister on repeating this Statement made earlier in the other place, and I welcome the report itself. I want to refer to a couple of areas and follow up his reassurance about the patient care pathway. The importance of that pathway, I am sure he knows, is not only in having it but ensuring that it is carried out with regular updates, and that the progress being made is taken into account to make sure the pathway is staying in touch. That does not always happen, so having the patient care pathway is only one part of what I hope he would ensure would happen.

The other part, and the Minister may not be surprised at this, is Part 7 where again, as my noble friend Lord Hunt has done, I urge him to think again about another area. With regard to the expectation as far as training goes—while Skills for Health and Skills for Care, as mentioned in the document, are doing a great job—it is absolutely crucial to recognise that just the induction for health care assistants in social care really is not enough. I have pleaded with the Minister on many occasions in the context of hospitals. It is equally if not more important that healthcare assistants have the confidence given to them by being registered and qualified in the way that registration ensures, so that the very difficult and important job that they do—and more of them are doing it than are working in any other area—is suitably recognised. I urge the Minister to take away that request in the context of this report, and to look again at ensuring registration for these particularly important workers.

[Earl Howe]

My Lords, I am grateful to the noble Baroness for what she has said. She is right to point out that the patient pathway is integral to any proper planning process for individuals, and that it should be built around the particular individual’s needs and preferences if possible. This brings us back to the role of an assessment and treatment centre: namely, as its name implies, to assess the needs of a person and to define what their care plan should be over a future period of time. As I mentioned, the care plan is best when it is drawn up with the benefit of advice from the individual, their family and their carers. Therefore, if we want more community care, we need to ensure that there is the capacity in the community to deliver good patient pathways to individuals. We are clear that some areas of the country are ill equipped to do that. Part of the task of the joint improvement programme will be to look at the facilities and resources that are required in local areas to enable commissioners to plan those patient pathways with confidence.

On the issue of the training of care assistants, I take the noble Baroness’s point. I think that it is common ground between us that those who lack a recognised qualification should nevertheless be enabled to upskill themselves and get themselves on a register to prove that they are familiar with and abiding by a code of conduct that has been recognised, with the register itself being duly accredited. Our position is that the system of voluntary registration, almost by definition, will result in an upskilling of the workforce, but it is not the whole story. There is a role for employers to ensure that there is proper supervision of care assistants, and that proper delegation takes place that does not require a person to do more than he or she is skilled to do. There is no single answer here, but I believe that voluntary registration is a good start.

NHS: Liverpool Care Pathway Inquiry

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 5th November 2012 Lords Chamber

[Earl Howe]

My Lords, I fully agree with the noble Lord. Training is integral to the care pathway, as is the need to consult the families of patients and, if possible, the patients themselves before a decision is taken to put them on the Liverpool Care Pathway. On the NHS constitution, I completely take the noble Lord’s point. The proposed change to the NHS constitution makes it absolutely clear that patients and their families and carers have the right to be fully involved in discussions and decisions about their care, including that at the end of life. We are clear that that should already be happening, but we understand from reports that that is not always the case. As regards end-of-life care, I think there is sometimes a taboo on discussing death and dying and press reports show how damaging that can be. I shall indeed take all the noble Lord’s points on board, particularly as regards nutrition and hydration.

[Baroness Wall of New Barnet]

My Lords, I am relieved by the Minister’s response to the noble Baroness, Lady Knight. He is absolutely right that the care people receive at the end of their lives is hugely important. National statistics show that 29% of eligible people are on the care pathway. In my own trust, Barnet and Chase Farm, 28% of people are currently on it. The involvement of carers in those discussions is huge and a whole protocol is attached. I, too, am extremely worried about the publicity, some of which I am sure is well meant, but it can be very damaging to a system that provides a great deal of care. My mother-in-law was on the Liverpool Care Pathway in Liverpool hospital and had a very good experience. Please can we ensure that in any discussions we look at the overall benefit to elderly people at the end of their lives?

[Earl Howe]

The noble Baroness is quite right. So often, good experiences are not reported. Predominantly we hear from patient organisations and the Marie Curie organisation that in the vast majority of instances where the Liverpool Care Pathway has been used, it has resulted in better care for the dying person. She is absolutely right. Nevertheless, where the pathway is not being properly followed, we have to take the matter seriously and ensure that there is proper training and communication with care staff.

NHS: Accident and Emergency Services

Debate between Baroness Wall of New Barnet and Earl Howe

Tuesday 23rd October 2012 Lords Chamber

[Earl Howe]

My Lords, I agree with the noble Baroness. That is exactly why the Government are planning to roll out the 111 service, which will run alongside the 999 service for emergency calls. But where the situation falls short of an emergency, the 111 service will instantly direct the patient to exactly the right service, without a call back being necessary. I am pleased to say that that programme is on track and should be rolled out next year.

[Baroness Wall of New Barnet]

My Lords, I declare an interest in Barnet and Chase Farm, which is currently being restructured. Does the Minister agree that, with any restructuring of services in the health service, the public are very concerned? A lot of effort is being made by the trust to assure people, but one of the things that keeps coming back—certainly for Barnet and Enfield—is that the bus services do not always work in the way in which the noble Earl has suggested, and that Transport for London is not always co-operative. Very often it is, but sometimes it is not; we are having a great deal of difficulty reorganising bus services in cases where Transport for London will just not hear of it.

[Earl Howe]

My Lords, in north London and Barnet in particular, Transport for London has diverted the 307 bus route into the grounds of Barnet Hospital, thus improving the link from Enfield. Transport for London has also installed new CCTV cameras in the underpass at North Middlesex University Hospital, in order to enhance its safety. There was a proposal to improve the local underpass at Silver Street station, and that was carried through. I am concerned to hear the noble Baroness’s perception, because all the briefing I have had indicates that Transport for London is very constructive in these situations and will often change bus routes in response to changes in service configuration.

NHS: Evidence-based Medicine

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 10th October 2012 Lords Chamber

[Earl Howe]

My Lords, yes I can. There is a real impetus within Government to look at evidence-based treatment for illegal drug users.

[Baroness Wall of New Barnet]

My Lords, I am surprised that in his response to the noble Lord, Lord Taverne, the noble Earl did not remind him of the health and well-being boards which make decisions now about what is happening locally. Certainly, from my experience, homeopathy has been one of the issues that the health and well-being board in Enfield has been looking at. Obviously, the evidence base is important, but should not that direction on what is locally required be made a priority?

[Earl Howe]

The noble Baroness makes an important point, and of course she is right that health and well-being boards will be very important forums for establishing the clinical priorities in geographic regions and then setting strategies to meet those priorities. However, in the end, it is for commissioners and individual clinicians to decide what is best for patients in a particular area.

NHS: Private Finance Initiative Costs

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

The noble and right reverend Lord is right. We believe that a number of the PFI schemes from the previous Administration were not soundly based in terms of their sustainability. As part of the work that we are doing on the Foundation Trust Pipeline, we have had to work on long-term sustainability solutions to help NHS trusts with PFI schemes, hence the direct financial support that I have referred to.

We have also organised PFI trust forums to disseminate the lessons learnt and to share experiences. We have earmarked resources to support the front line in ways to secure savings and we are currently in negotiation with people who have experience in the NHS and private sector to form a new team to support existing contract managers and, where necessary, to support negotiations with private sector PFI companies.

[Baroness Wall of New Barnet]

Will the noble Earl agree that in addition to the detriment suffered financially by PFI hospitals, as the noble and right reverend Lord Harries described, they suffer from a stranglehold as regards the movement of services, which means that they have to hold services back? Is not such power to stop the increased movement of services preventing trusts modernising and developing?

[Earl Howe]

The noble Baroness makes an important point and it is one that I was aware of some years ago when I visited a PFI-funded hospital. She is right; it does sometimes depend on the relationship established between the contractor and the hospital management but many of these contracts do result in exactly the kind of sclerosis that she has described. It is a lesson that we need to learn for future PFI schemes.

NHS: Annual Report and Care Objectives

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 4th July 2012 Lords Chamber

[Earl Howe]

As so often, my noble friend has alighted on a real issue and I am grateful to her. She is right that we are not seeing enough trainee doctors going into general practice. The previous Government and we have had informal targets for new GPs. We have not met those targets for a few years now. It is a matter of concern and we are working very closely with the universities, the Royal College of GPs and others to see how the numbers can be rectified. It is not just a numbers game because, as she rightly alluded to, we should increasingly be seeing a better sharing-out of responsibilities in the community between not only GPs but community nurses, practice nurses, midwives, health visitors and others. There is quite a lot of work to be done there.

My noble friend is right about women GPs, and headcount numbers in that context are not always the most reliable indicator of the workforce number. This is part of the reason why we set up Health Education England, because with the advice of the Centre for Workforce Intelligence, the body that advises the Government on long-range forecasts of workforce needs, and the input from local providers—primary care providers, not just hospitals—of what they see as their needs into the future, we ought to get a much better handle on long-term needs for the different professional disciplines.

I do not at all brush aside this problem. I hope my noble friend realises that this is a real issue and we are grappling with it. Actually the NHS has grappled with it for a number of years, partly unsuccessfully, but we hope to do better with the new configuration that we have debated so often.

[Baroness Wall of New Barnet]

My Lords, I welcome the report and in particular I thank the noble Earl for his emphasis—which I would like him to re-emphasise when he responds—on just how hard people are working in the NHS. As always, I reflect my own experience. I do not live in a different world from other people and I certainly know from the trust that I am chair of that people are working exceedingly hard.

Although there are some reservations, if I may say so to the noble Earl, around the progress we are having, I think that that is more about people getting used to what the changes mean. In particular, I want to focus on the CCGs. As the noble Earl knows, my trust has a hospital in Barnet and one in Enfield. Barnet CCG is firing away and working brilliantly. Enfield is still trying very hard to get its act together. The noble Earl knows how much I care about this, and the effect is that we are not getting the primary care out in Enfield where we need it. I would have liked the report to have focused more on moving away from hospitals—which I know is supposed to be heresy for someone who is the chair of a provider trust, but I really believe this—and making sure that we have the opportunity for more primary healthcare and support for those CCGs to be urged forward.

I know we have only a minute so I am not going to say anything else because I know other colleagues have been waiting desperately to get in, but there is a lot more I could say.

[Earl Howe]

The short answer to the noble Baroness is that she is, of course, absolutely right about service redesign locally. It involves the kinds of conversations that are already happening in many areas between primary and secondary care clinicians to see how we can bring about that shift that most experts agree is desirable and certainly patients want to see. This is an ongoing conversation. I do not know as much as I should about the noble Baroness’s particular area of the country, but I will gladly follow that up with her after this.

Health and Social Care Bill

Debate between Baroness Wall of New Barnet and Earl Howe

Tuesday 13th March 2012 Lords Chamber

[Earl Howe]

The key here lies in the standards and the training. If we have standards laid down that are uniform across the piece, I am not sure that having more than one register is a significant issue. As I said, this is something that the professional standards authority is bound to take account of when deciding whether to accredit another register.

The noble Lord, Lord MacKenzie, expressed the view that voluntary registration does not work. The Government’s proposals are for assured voluntary registration. We believe that the effective assurance of the standards of healthcare support workers can be delivered by an assured voluntary register that is underpinned by clear standards of conduct and training and supported by the Nursing and Midwifery Council’s updated guidance on delegation.

The noble Baroness, Lady Finlay, asked how standards will be monitored. We will expect the professional standards authority to assure that any standards set for a voluntary register are appropriate as part of its initial accreditation process. It will keep the operation of any register under review and we will expect it to set out any concerns that it has about standards. The authority will also have powers to remove the accreditation of registers if any of its concerns are not addressed in a timely fashion.

The noble Lord, Lord Patel, asked what criteria would apply in individual cases. In its council paper, Voluntary Registers—Proposed Model for the Accreditation Scheme, the CHRE has stated that all voluntary registers seeking accreditation will be required to complete a risk assessment tool that will assess the risks inherent in a profession’s practice and the means by which those risks are and could be managed. The authority will also keep under review the management of risks by an accredited register. That will be part of its role.

However, having listened to the concerns raised in this House, the Government have given further consideration to this whole issue. Once a system of assured voluntary registration has been established for this group and has been operational for three years, to enable it to demonstrate its effectiveness the Government will commission a strategic review of the relative benefits of assured voluntary registration compared with statutory regulation. The review will involve all relevant professional bodies and trade unions. Such a review would include consideration of any further measures needed to assure the safety of patients and the public, including consideration of the case for compulsory statutory regulation or—and I say this in particular to the noble Lords, Lord Kakkar and Lord Hunt—making standards of training mandatory for employers through the use of standing rules for the NHS Commissioning Board and standard contracts for providers.

The noble Lord, Lord Kakkar, raised what I thought was a very astute point about the NHS standard contract. I can confirm that, yes, the Secretary of State will have the power to include in the standard contract the fact that relevant workers must be on a particular voluntary register. We see this as a strong lever, and we would want to consider it very carefully before deciding to use it in a particular instance, but wherever there was clear and demonstrable evidence that doing so would ensure quality of care, we would give it very serious consideration.

I can confirm that the question of whether to move to statutory regulation will be viewed openly, with full consideration of the potential benefits that it might be able to bring. I can say to my noble friend Lord Newton once again that the power to introduce statutory regulation already exists, in Section 60 of the Health Act, if a decision were to be made to deploy it. The Law Commission is in fact consulting at the moment on an even broader regulation-making power in the future. In the mean time, we are committed to exploring the evidence base on ratios of qualified to non-qualified staff. I totally agree with the noble Baroness that this is a key point. We will look carefully at the evidence from ongoing work by King’s College.

I have tried to set out what one might term, picking up a phrase from the noble Lord, Lord Patel, the direction of travel here. I hope that the noble Baroness, Lady Emerton, will understand our commitment to seeing defined standards and improved skills in the healthcare support workforce. The noble Baroness, Lady Masham, asked whether it is not time to have better safeguards in place. Yes, it is. I agree with her. Where we part company is on what a set of new safeguards should be. I strongly feel that a combination of voluntary registration and training is the more appropriate and proportionate solution to what I agree is a problem that needs to be addressed. The work that we have commissioned takes us on that road.

I hope that I have been able to reassure noble Lords of our commitment to strengthening the assurance processes in place for health and social care support workers, and that, perhaps with reservations but nevertheless more confidently than before, the noble Baroness—

[Baroness Wall of New Barnet]

I have listened carefully to what the noble Earl has said and there are two areas that he has hardly mentioned—indeed, he has not mentioned one at all—but which he should perhaps refer to. What consideration has he given to the fact that, if you talk to healthcare assistants—and I mean literally hundreds of them—you find that they want this qualification and registration to illustrate the value that they have not just to themselves but also to colleagues around their hospitals? This is also the case for patients: if you do any survey of patients, they say that they want healthcare workers to be registered, so that they understand and have the assurance of that. I wonder how much consideration of those factors has gone into the deliberations that he is talking about.

[Earl Howe]

I apologise to the noble Baroness for not covering that point. We are well aware of precisely that view among the workforce. With the creation of a voluntary register, the process that she refers to will gather its own momentum because people will see the opportunities open to them to accord themselves the status that they clearly crave. It is important, from the point of view of the patient, that hospitals—and, indeed, care homes—are employing people of a certain standard of accreditation and skill. I think, therefore, that this will be self-fuelling and I hope that, once the register is on offer, substantial numbers of healthcare support workers will be encouraged to join it.

Health: Stroke Care

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 13th February 2012 Lords Chamber

[Baroness Wall of New Barnet]

To ask Her Majesty’s Government what assessment they have made of the consistency of care for stroke patients across England, and whether the progress made in London will inform the development of their policy on stroke care.

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

My Lords, stroke patients are getting faster and better treatment than ever before. The latest data show that more than 80 per cent of stroke patients spend the majority of their hospital stay on a stroke unit—a 20 per cent improvement since 2009. We want the stroke community to share and learn from what works, such as the London model of providing stroke services. The stroke improvement programme plays a central role in disseminating this knowledge.

[Baroness Wall of New Barnet]

I thank the Minister for his response. I remind him of the debate on stroke that we had very recently. The evidence is very clear that early intervention with stroke, as with many other diseases, plays a key part in ensuring that the cure is of longer standing. The noble Earl will know that last year’s CQC report highlighted the huge differences and inconsistencies in what happens. It would be good if we could have an assurance that the London model will be rolled out and taken on board by the national commission.

[Earl Howe]

My Lords, I agree with the noble Baroness that the London model has, indeed, been a model for others to follow. All Londoners now have 24-hour access to hyper-acute stroke care regardless of where they live, and London has one of the highest rates of thrombolysis for any large city in the world. It may not be appropriate to replicate precisely a model of care which works well in a densely populated capital as regards more rural areas, but that is where the expertise of the stroke improvement programme is essential in working with stroke networks across the country, sharing best practice and improving outcomes for stroke patients.

Health and Social Care Bill

Debate between Baroness Wall of New Barnet and Earl Howe

Thursday 19th January 2012 Lords Chamber

[Earl Howe]

My noble friend is right to remind the House of the repeated reforms of the health service made under the previous Administration. I do not have a figure for how much they cumulatively cost the taxpayer, but it was clearly a great deal and I recall that one of the reforms took place over the course of the summer without any reporting to Parliament at all. The contrast between those reforms and this one is marked. We are doing this to get better care for patients. The previous Government were really only doing it to rearrange the deckchairs.

[Baroness Wall of New Barnet]

Does the noble Earl agree that, contrary to my noble friend’s comments, there is a real regret in the health service that our excellence awards—as you know my trust in Chase Farm has received one—have been done away with by the Government with the CQC. I do not know what the Guardian article said and I do not know what it means by “credit”, but getting credit for good services and proper care is something that everyone in the health service would welcome. The focus for us in the health service is indeed to join social care and healthcare. Can any emphasis that can be given by the noble Earl or the Department of Health come as quickly as possible please?

[Earl Howe]

The noble Baroness was absolutely right in what she said in the last part of her question. I apologise to the House if I misunderstood the previous question about credit ratings, which I took to mean something to do with finance rather than gold stars, which I think the noble Baroness was talking about. I will try to clarify that in a letter.

Health: Flu Vaccine Research

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 23rd November 2011 Lords Chamber

[Earl Howe]

My Lords, we are very clear that the Health Protection Agency performs a major public service and we have no intention of disrupting the work that it does, least of all by interfering with its research. As the noble Lord knows, the proposals are to shift the Health Protection Agency into the new, larger government agency, Public Health England. The World Health Organisation is actually the body that monitors the strains of flu worldwide and issues twice-yearly warnings to countries about the strains that are emerging so that countries can prepare for their forthcoming winter flu season.

[Baroness Wall of New Barnet]

My Lords, does the noble Earl agree with me that—despite the view of the noble Baroness, Lady Knight, about the Lancet report, which I have read—there is still an important need for people who work in the health service to have the current vaccine? It is not taken up by everybody, despite many trusts trying to ensure that everybody does take it up. Is there a stronger message that could go out from the Government that it is really important to do this? Forcing people is perhaps too much, but certainly it is a real issue.

[Earl Howe]

The noble Baroness is quite right. The Chief Medical Officer wrote to the NHS on 25 May, citing four studies that provide strong evidence of the benefit of influenza vaccination for front-line healthcare workers. These studies show clearly that healthcare workers can transmit influenza to patients, that vaccination of healthcare workers can prevent that transmission and that vaccination of healthcare workers can lead to better health outcomes in the vulnerable patients with whom they very often deal.

Health: Healthcare Assistants

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 24th October 2011 Lords Chamber

[Baroness Wall of New Barnet]

To ask Her Majesty’s Government whether they have any plans to regulate healthcare assistants by establishing minimum standards and a code of conduct to ensure the protection of patients.

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

My Lords, there are provisions in the Health and Social Care Bill to enable the Council for Healthcare Regulatory Excellence to establish a process for accrediting voluntary registers for healthcare workers. Assured voluntary registration for healthcare assistants would build on existing safeguards such as the Care Quality Commission’s registration requirements and the vetting and barring scheme, and would include setting national standards for training, conduct and competence for those on the register.

[Baroness Wall of New Barnet]

I thank the noble Earl for his response, but is he aware of the worry and concern he has caused in his comments in the Times this morning? At my hospital, the director of nursing is very concerned that there are many reasons why nurses are reported to the statutory body and some of that can just be that they are not caring properly. The noble Earl’s remarks do not take that into account. Will he also accept, in a positive way, that many healthcare assistants would like to be regulated so that they can assure their patients and themselves that the skills they have and the service they are providing are of the very best?

[Earl Howe]

I agree with the latter part of the noble Baroness’s question in so far as I am quite sure that many healthcare assistants would like to be recognised for their skills. The question is whether statutory regulation or voluntary registration is the best and most proportionate route to achieve that. As regards the first part of her question, I regret the slant that the Times took on my remarks, because if a nurse has been struck off because they are considered to pose a risk to patients, then they must be referred to the Independent Safeguarding Authority, which would have the power to bar them. On the other hand, if a nurse is struck off for, say, misprescribing drugs to patients but is still capable of performing care tasks such as washing and bathing, they could still work as a healthcare assistant under appropriate supervision—depending on the circumstances. So there is no blanket prescription in this area; one has to look at the competencies of the individual and whether they are safe to work with adults.

NHS: Hospitals

Debate between Baroness Wall of New Barnet and Earl Howe

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

My Lords, it is clear that one of the causes was that the previous Government—for all the right reasons, I have to say—injected very large sums of additional money into the health service, but alongside that there was no commensurate increase in activity. A lot of the additional money went into settling pay claims. That is not to decry the many benefits that arose from the additional money, but the net effect was a decline in productivity.

[Baroness Wall of New Barnet]

Does the Minister agree that there are dangers in sweeping statements on how NHS hospitals perform and that they perform badly, because that is not the case? In many instances, not just in my own hospital—Barnet and Chase Farm—the improvement in hospital services over the past years has been incredible. Does he also agree that there are already strong and widespread relationships with the private sector in NHS hospitals and that the challenge is for NHS hospitals to be better than private hospitals so that people will choose to go to their local hospital?

[Earl Howe]

The noble Baroness is right to pull me up. If I implied that the NHS was across the board providing a lower standard of care than the private sector, I apologise because that is certainly not the case. There are some shining examples of care delivered by the NHS. However, as she will know, not all hospital trusts are as good as hers. Some give us cause for concern in a clinical sense, and they need to be challenged sometimes on the way they look at quality. That is going on at the moment with the quality, innovation, productivity and prevention programme that she will know very well.

Southern Cross

Debate between Baroness Wall of New Barnet and Earl Howe

Thursday 16th June 2011 Lords Chamber

[Earl Howe]

My Lords, I think I have already indicated that the Government are proactively engaged with all the key parties involved in this situation, not just Southern Cross but the LGA, ADASS, the CQC and others. The precise situation in which we find ourselves with Southern Cross is unlikely to arise again because my understanding is that the business model adopted by Southern Cross is unique. Nevertheless, every privately operated residential care home business will, no doubt, have its own level of business risk, whatever that may be—either slight or something rather less slight. However, the alternative that the noble Lord, Lord Beecham, seemed to desire was a return to the state provision of care homes. The noble Lord is shaking his head, and I am glad of that, because I think neither his party when in government, nor certainly ours, would wish that on the public. I think that all of us believe in choice for the individual, and this is what the current market provides. Nevertheless, there are risks.

The noble Baroness asked about hospitals. To the extent that NHS care is delivered in independent settings, a business risk is inevitably associated with that. However, we are clear in the Health and Social Care Bill that there needs to be a system whereby essential services are protected for the benefit of patients. When the Bill reaches us, we will no doubt debate those provisions.

[Baroness Wall of New Barnet]

I am sure that the noble Earl will be assured that my noble friend did not imply or say what the noble Earl thought he said. It is really important for us to focus on the business side of this issue and the economics of how it is run. The noble Earl is absolutely right to say that there is no complaint at all—in fact, all the carers of residents in those homes are distressed because they may be moved from somewhere that has taken care of their people. It is important, therefore, that none of us loses sight of the real issue—the care of these people, which has been good. Otherwise, the home would be in a very different state and, God forbid, we would be having a very different discussion if the issue was the care of the residents rather than the economics of running the home.

How deeply is the Care Quality Commission involved in this? My own trust has been talking to the CQC because, as the noble Earl will know, there are knock-on effects for hospitals all around the country when those homes are under threat, and on what might happen to elderly people who would normally be discharged from hospitals into those homes. We should all please remember—I am sure that the noble Earl is remembering—that the patients really matter in this, and we should ensure that we get them into safe places where they are looked after. The economics of this are very important, and I am not in any way dismissing that, but we need to measure that up against the care that has been provided for those people in Southern Cross homes, and, I hope, will continue to be provided. The care is valued. It is about the market that goes on out there, and any of us would be foolish to suggest that there is an alternative.

[Earl Howe]

I am grateful to the noble Baroness, and I am also clear about the position of the noble Lord, Lord Beecham. She is of course right. Our first concern should be for the safety and welfare of residents. That is why, as I said earlier, some time ago we asked the Care Quality Commission to engage in close discussion with Southern Cross when the news of the impending redundancies was made public. We did that precisely to ensure that standards would not be compromised. My understanding is that there are no concerns on that front. Southern Cross has, in that sense, behaved impeccably in ensuring that residents have not suffered, other than from the inevitable uncertainty that the publicity over this matter has generated. Going forward, the principles that the noble Baroness has articulated are absolutely right. However, she would agree with me—as I think she did—that questions need to be asked about the financial models adopted by care homes or, indeed, by any independent business providing public services.

Contracting Out (Local Authorities Social Services Functions) (England) Order 2011

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 13th June 2011 Lords Chamber

[Baroness Wall of New Barnet]

My Lords, I wish to pursue a matter that has already been discussed and emphasise a couple of concerns that have been raised, which I share. My noble friend referred to the treatment offered by a private consortium being threatened by the financial situation, as has just occurred. If we allow the contracting out to occur—I do not disagree with that—how can we ensure that that does not happen and that the treatment is safeguarded? A couple of noble Lords have asked how the assessment and monitoring will take place. As my noble friend Lord Beecham said, it seems that the trailblazers will also monitor the provision. That might be a bit dubious as their judgment will obviously be biased by their experiences. My noble friend Lady Thornton asked who these trailblazing local authorities are. I should be interested to know that, too.

[Earl Howe]

My Lords, I am very grateful to noble Lords who have spoken, particularly to the noble Baroness, Lady Thornton, for her broad welcome of the order. A great number of questions have been asked. I shall probably not be able to answer them all but I shall be happy to write to noble Lords with the detailed answers. However, I will attempt to cover as much ground as I can.

The right to control trailblazer that has requested this facility is Essex County Council. The social work practice sites are Birmingham City Council, the London Borough of Lambeth, Stoke-on-Trent City Council, North East Lincolnshire Care Trust, Shropshire County Council, Suffolk County Council and Surrey County Council.

I was asked how the SWP pilots would be put in place. The local authority will support the set-up of the SWP and the transition of people to the SWP. Once in place, the SWP will use its income under the contract with the local authority to provide services and improve the experience and outcomes of people in the SWP. As I said, the local authority will then manage the contract, monitor performance and manage the relationship as a whole. The local authority will review the contract with the SWP periodically to set new outcome targets and adjust payments. The Department of Health would expect these reviews to occur annually. In answer to my noble friend Lord Lee as to who will conduct the eventual evaluation, the workforce unit at King’s College, London, will do that. The final report will be an independent evaluation and will be published after the two-year period.

Although the local authority will remain liable for the performance of functions undertaken by the SWP, the authority will be able to sue for any breach of contract. It will work closely with the local authority and each local authority should decide what decisions it wishes the SWP to refer to it for agreement, so everything hinges on the contract. How will the outcomes of the SWP be managed? The local authority needs to maintain a close relationship with the SWP, as I have said, but it also needs to allow the SWP scope to innovate and make decisions about the best packages of support and services for the people involved—the service users—and how to provide these, so there is a delicate balance to be struck here. The department would expect the local authority to monitor outcomes, identify issues early and provide support, while allowing the SWP sufficient autonomy to decide how best to meet the needs of the people with whom it works.

The transfer process will be managed between each local authority and SWP. Where transfers take place, it is for the local authority and SWP to agree as part of their contract clear and transparent criteria for deciding who should transfer. It would be for local authorities to decide where social workers could be most effectively deployed. Ideally, SWPs will provide out-of-hours support directly to ensure continuity of services, but if the SWP is small, and particularly while it is getting started, it could choose to purchase out-of-hours support from the local authority.

The noble Baroness, Lady Thornton, asked how these contracts will operate if there is no guidance. I hope that what I have already said about the importance of the contract has answered that. The contract that each local authority has with an SWP will specify the scope and feasibility of operation of each SWP.

My noble friend Lord Lee asked whether the terms and conditions being contracted out are comparable to current conditions. That would depend on the individual SWP and the individual local authority. There will be flexibility here. We are encouraging diversity so that we can find out from different models what works best.

The noble Baroness, Lady Thornton, asked how the SWP would link with the approved provider for independent mental capacity advocates. The SWP would have access to whatever independent mental capacity advocate services exist locally. I think that there will be no bar to that. She also referred to the very important issue of safeguarding and how that would be ensured. Any body that is carrying out regulated activities in adult social care must be registered with the CQC. We are working with the seven councils to establish which sites are carrying out regulated activities. It is likely that most will need to be registered with the CQC, but the pilots vary greatly. They may therefore be subject to different registration requirements. Ultimately, it is the responsibility of councils to ensure that SWPs, if applicable, are registered individually with the CQC. Organisations registered with the CQC are required by regulations to carry out CRB checks on staff who have contact with patients or service users. Keeping patients and service users safe involves providing training, regular supervision and development and feedback from patients, service users and relatives. It will be for the councils and the SWPs to ensure that CRB checks are carried out as appropriate. The noble Lord, Lord Beecham, asked whether the overview and scrutiny committees would have a role here. I see every reason why they should take an interest in what is happening. No doubt the message will go out that they should be encouraged to pay particular attention to these pilots.

The noble Baroness, Lady Wall, asked how we can ensure that SWPs do not go down the same path as providers such as Southern Cross. We do not, of course, yet know the final models of the SWP pilots and whether there is likely to be much, if any, private sector involvement. Local authorities can decide what they put in their contracts with the SWP pilots to ensure that those risks are mitigated.

Disabled people taking part in the right to control trailblazers will have a legal right to be told how much support they are eligible to receive, and to decide and agree with the public body the outcomes they want to achieve, based on the objectives of the funding streams they access. They will have a right to choice and control over the support they receive, and be able to choose how they receive the support.

Some aspects of the right to control process, such as the extent to which administrative processes are aligned, will be subject to some flexibility and may be different in each trailblazer. However, the broad framework of how the right to control will be tested is already agreed. Disabled people accessing the right to control will be told how much money they are eligible to receive for their support. They will be able to choose, in consultation with the public authority delivering the funding stream, how that money is used to meet agreed outcomes. I should say for the information of noble Lords that the seven trailblazing local authorities are Barnsley Metropolitan Borough Council, Sheffield City Council, Essex County Council, Greater Manchester, Leicester City Council, the London Borough of Barnet, the London Borough of Newham and Surrey County Council.

I was asked whether the trailblazers will be consulting with service users. The answer is yes—the evaluation will include consultation with service users.

A number of other issues were raised in the debate and I shall cover just one before I conclude. The noble Lord, Lord Beecham, asked whether direct payments were prohibited from buying council services in this context. There are no plans to change current arrangements and, indeed, the Law Commission, in its recent report on social care, did not recommend a change in this respect.

Once again, I am grateful to noble Lords for their pertinent questions and comments. As I mentioned at the beginning, I shall endeavour to respond to those questions that I have not covered in my reply.

Motion agreed.

Winterbourne View

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 8th June 2011 Lords Chamber

[Earl Howe]

The noble Lord is quite right. There has clearly been a serious failing in management here. We are looking at that urgently and, no doubt, important lessons will be learnt. All agencies have acted immediately on being alerted to the situation by the “Panorama” team and, as I have mentioned, appropriate inquiries are under way.

[Baroness Wall of New Barnet]

I agree with the Minister about the response around the Care Quality Commission. When such a result as this comes out, the undermining is quite damaging right across the whole spectrum of its work. In hospital trusts and everywhere else, the CQC’s inspection and report are held in great esteem if they are good and are very worrying if they are not. I wonder whether that is denigrated by this unfortunate incident and this awful opportunity that it has had and missed.

[Earl Howe]

My Lords, I take the noble Baroness’s point. It is very easy to blame the CQC whereas we should in fact first point the finger at those who perpetrated these awful acts and at the management of the hospital. There are a number of other agents involved besides the regulator. We are committed to developing the role of the Care Quality Commission to make it a more effective regulator of health services in England. Those efforts can be supplemented by the role of HealthWatch, which she will know we proposed in the Bill before the other place to strengthen the arrangements for the patient and public voice. I am sure that there is more that we are able to do, but it is important that we learn the facts first before pointing the finger at the regulator or anybody else.

NHS: Waiting Times

Debate between Baroness Wall of New Barnet and Earl Howe

Tuesday 3rd May 2011 Lords Chamber

[Earl Howe]

My Lords, I agree with much of what the noble Lord said. There is no doubt that great strides were made under the previous Government to reduce waiting times. That is entirely to the advantage of patients. However, the noble Lord will know that, as I mentioned earlier, the NHS constitution still retains the right for treatment within 18 weeks and the contracts between commissioners and providers still retain the financial penalties if the 18-week target is broken.

[Baroness Wall of New Barnet]

My Lords, will the Minister reflect on the discussion that he and I have had in the past around how important waiting times are to patients? Despite the new six-week “more quality” input into how the analysis is done and the processes to which my noble friend Lady Finlay has just referred, there is still an issue when people leave hospital. They say they waited longer. We need to rethink what that really means. In the context of waiting lists, if we separate elective and A&E, as my husband is proposing, then we will do away with all of that.

[Earl Howe]

My Lords, the central point that the noble Baroness makes is absolutely right. We have to look at quality in the round. There is more to quality than simply timeliness, although, as I have said, timeliness of treatment is important. We need to develop indicators that show the full range of the level of care and service that patients receive. We are doing that.

NHS: Consultation on Reform

Debate between Baroness Wall of New Barnet and Earl Howe

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

My Lords, the forum, as I understand it, is now fully composed. The appointments were made over the past 10 days or so. I am not aware of any further appointments. The plan is for the forum to produce a report which will be published at the end of the day. I will, however, write to the noble Baroness as regards the minutes, which are a matter for the chair of the forum, which is independent of the Government, as she will know.

[Baroness Wall of New Barnet]

My Lords, does the noble Earl agree that the pause and the mechanics that he has talked about have to be dealt with—there are lots of issues around that—but that the pause or gap is causing great concern to people working in the health service? Pause is an incidental word as regards the feelings of people who are going through this process and are caring for patients but are not sure what method they are supposed to be using. Will the noble Earl please tell us when we will know what is happening and how these people can get on with the job that they want to do?

[Earl Howe]

My Lords, I am aware of that concern. This matter has occupied the minds of Ministers. I say to those who are serving in the NHS day by day and, indeed, to the pathfinder consortia and the early implementer local authorities that they should continue with the work that they are doing because it is from them that we most wish to hear about the practical lessons that our proposals may point to. It is, I am sure, an unsettling time for them but we hope that after this period of reflection we can continue with the passage of the Bill with proper momentum.

NHS: Prebiotics

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 17th November 2010 Lords Chamber

[Earl Howe]

My Lords, we regard the departmental budget as being there to enable those who have good-quality and well-designed research projects to bid for those funds. I will take on board my noble friend’s implicit suggestion that the department should pursue the issue but, in doing so, I bear in mind that these products are commercially produced and that it is really for the manufacturers to come up with robust clinical data.

[Baroness Wall of New Barnet]

My Lords, is the noble Earl aware that there are more trials on probiotics than on the prebiotics mentioned by the noble Baroness, Lady Masham? Although there are no Department of Health trials that I am aware of, was the Minister suggesting in his earlier response that he is seeking the opportunity for such trials to take place?

[Earl Howe]

My Lords, I merely meant to indicate that we would welcome good-quality proposals. On probiotics, I understand that one study using live yoghurt showed a patient benefit but my advice is that the study methodology was flawed and its findings were not generalisable. Probiotics are not therefore recommended, as studies have failed to show any convincing evidence that they either treat or prevent C. difficile infection.

Healthcare: Costs

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 15th November 2010 Lords Chamber

[Earl Howe]

My noble friend is right to pinpoint this area. If my memory serves me correctly, the average annual increase in management and administration costs over the past 10 years has been 6.2 per cent per year, which is by far and away higher than the increase in costs in clinical areas, for example. That is why we are determined to reduce the administrative cost of running the NHS, and we are in the process of planning for exactly that.

[Baroness Wall of New Barnet]

Does the noble Earl agree that that is an opportunity for us to look at saving costs in the health service by ensuring that we think of methods to persuade people to attend their day clinics? The cost of people not attending—DNA, as it is called in the health service—is huge, particularly in day surgery.

[Earl Howe]

The noble Baroness is quite right, and I am well aware that she speaks from personal experience. Many hospital trusts, and indeed GPs’ surgeries where applicable, have devised inventive ways of reminding patients of their appointments, either on the day or on the day before, perhaps by text. Good practice in this area is something that we need to focus on.

Health: Prostate Cancer

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 19th July 2010 Lords Chamber

[Earl Howe]

My Lords, there is quite a bit of ongoing work to devise such a test but I am advised that no reliable test exists at the moment. The PSA test is the best that we have. The noble Lord will know that the results of tests show that you have to screen about 1,400 men and treat 48 unnecessarily to save one life. It is not an easy equation.

[Baroness Wall of New Barnet]

My Lords—

--- Later in debate ---

[Earl Howe]

My Lords, the noble Lord, Lord Winston, is probably in a better position to advise the House on advances in that area of research. I can tell the House that the National Cancer Research Network, set up by the Department of Health in 2001, has brought about a tripling of the number of cancer patients entered into clinical trials. About 12 per cent of cancer patients in England enter NCRN trials, which is the highest per capita rate of cancer-trial participation in the world. The network currently supports about 51 prostate cancer studies, so there is no shortage of research going on.

[Baroness Wall of New Barnet]

My Lords, does the noble Lord agree that the recording and quality standards around prostate cancer ought to be considered by the Care Quality Commission? Does he also agree that it is a shame that the CQC has decided not to report at the end of this year on the state of the hospitals that it has been working with across the piece? My own hospital, Barnet and Chase Farm, is predicted to be excellent, but it has been told that the Care Quality Commission will not announce those positions at all.

NHS: White Paper

Debate between Baroness Wall of New Barnet and Earl Howe

Monday 12th July 2010 Lords Chamber

[Earl Howe]

My Lords, I shall be brief because time is against us. I agree with the noble Lord that we must not lose the gains that we have made in specialised commissioning following the Carter reforms. He will see that the national commissioning board will retain responsibility not only for national specialised commissioning but for regional specialised commissioning. That will safeguard the quality of those services.

The noble Lord referred to GPs who do not wish to commission or who are in some way found wanting in their performance. Our experience to date—a number of consortia have been formed around the country, all of which are working encouragingly well—suggests that those GPs within the consortium who are in the lead and are the most go-ahead are best placed to bring up to standard their colleagues who are perhaps struggling. We have witnessed that in a number of instances. Those GPs who are incapable of being brought up to an adequate standard may be subject to a question over their future. In certain consortia, we have seen GPs retiring from NHS service.

[Baroness Wall of New Barnet]

My Lords—

NHS: Patient Targets

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is absolutely right. I believe that the message that he wants sent has been sent by the NHS chief executive in his letter to NHS bodies. It is certainly a message that the Government want to send. Timeliness is important. A great deal has been achieved. We do not want to squander that, but we think that clinicians should now be given the responsibility to prioritise patients and treatments for themselves, not have central performance management dictated from above.

[Baroness Wall of New Barnet]

Does the noble Earl agree that it would be appropriate for hospitals such as Barnet and Chase Farm to carry on with our internal stretch targets, which we do not declare anywhere, but which ensure that our patients are aware that it is a good hospital to go to? They are not arbitrary—trust me, they are not; they are real—and they make a big difference.

[Earl Howe]

I have always drawn—and I think that my ministerial colleagues do as well—the distinction between targets that are useful for internal management purposes and for patient decision-making and targets that are micromanaged from Whitehall. There is a distinct utility in the kind of targets that the noble Baroness is talking about because, as she knows, they are often very good proxies for outcomes.

NHS: Budget

Debate between Baroness Wall of New Barnet and Earl Howe

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

My Lords, as I hope was apparent from our debate in the House the other day, the Government attach great importance to chaplaincy in the NHS. The kind of encouragement that the right reverend Prelate speaks of is something that I will consider. I need to be sure in my mind of how best to do that, but his point is well made and I will take it back to the department to see what we can do.

[Baroness Wall of New Barnet]

My Lords, will the noble Earl assure the House that in looking for economies in the health service—I am sure that there are opportunities to do that—he will safeguard the vanguard policy of the last Government, which is fortunately retained by this Government, to ensure that patients’ experience comes first and foremost? Would he also perhaps take an idea from me to look at how we deal with patients who do not attend—DNAs, as we call them—despite having had prior notice? Failure to attend is costly and inefficient for the health service.

[Earl Howe]

The noble Baroness is quite right that patients who do not attend their appointments cost the NHS a great deal. How do we deal with the issue—I am sure that the previous Government wrestled with it, too—if we are to avoid charging patients for failing to turn up? I would resist the idea of charging because I do not think that it is a road down which we should be going in secondary or primary care. However, the ways in which we can encourage patients to turn up on time should attract greater focus in our efforts towards achieving efficiency.