Health and Social Care Bill
Baroness Wheeler Excerpts(14 years, 4 months ago)
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Lord Patel
My Lords, I apologise to the Minister and to the noble Baroness, Lady Northover. Yesterday afternoon I told them that I was degrouping these amendments to be taken at a later stage of the Committee. That was, however, before I got beaten up later in the day and lost my normal aggression. I had to retable them and I apologise for that. I hope that it is possible to take them today.
I will concentrate mainly on HealthWatch England. The purpose of this amendment is simple—to make both HealthWatch England and local healthwatch organisations independent bodies and, in doing so, to give patients and public a truly independent voice. It does not change the broad thrust of the policy in any way, nor does it have any more resource implications.
In the Government’s list of intentions for HealthWatch England, the Minister recognised the need for it to maintain independence; to set its own work programme; to publish its own annual report to Parliament; and to have independent membership. He also said that regulation would be brought forward by the Secretary of State in relation to this. It would also provide advice directly to the Secretary of State, the NHS Commissioning Board, Monitor and local authorities. At the same time, the list also suggests that HealthWatch England will be able to advise the Care Quality Commission on the views of people who use the service; that it will be a committee of the CQC; and that the CQC will respond in writing to HealthWatch England’s advice.
HealthWatch England’s operating plan, which was discussed by the CQC board, suggests that its main focus will be local; it will be small and strategic; its accounting officer will be the CEO of the CQC; its staff will be employed by the CQC; and service-level agreement on its functions will be put in place. The plan also suggests that HealthWatch England’s committee will be appointed by the CQC; that its chair will be subject to CQC board governance; and that conflicts of interest will be decided by the board. HealthWatch England will publish reports on a “no surprise” basis. This is quite contrary to the suggestion that HealthWatch England should be independent of the CQC. The CQC clearly sees itself having a close relationship with HealthWatch England, with the latter relying on it for significant analytical intelligence and other analytics and data. Joint data collection will not be appropriate for the diverse functions of the two organisations. The relationship between the two has not had a good start either, with LINks and others feeling that they have not been fully consulted by the CQC in developing the plan.
The proposed duties of HealthWatch England are intended to provide local healthwatch organisations with advice and assistance in relation to promoting and supporting the involvement of people in the commissioning, provision and scrutiny of local care services. Under the duties, people will be able to monitor local health and social care services; their views will be obtained on the standard of local services; and information will be gathered on local need for and experiences of care services. Recommendations will be made to commissioners and providers of services about how local care services could or should be improved.
The relationship between HealthWatch England and local healthwatch organisations is important. The Bill establishes HealthWatch England as a statutory committee. Ministers say that the relationship between HealthWatch England and local healthwatch organisations must be an open dialogue so that critical knowledge of the views and experiences of patients and local service users will have a real influence on the delivery of health and social care. The aspiration is that local healthwatch organisations and HealthWatch England will collaborate with local authorities and clinical commissioning groups. However, the Bill does not give local healthwatch organisations any specific role in relation to clinical commissioning groups. They have no direct role in influencing the commissioning arrangements of CCGs in relation to the needs of local people, nor do they have any say in it.
In my view, therefore, HealthWatch England should be established as an independent body outside the CQC; be the guarantor of an independent local community voice; have clear accountability to local healthwatch organisations; and have adequate resourcing—there are concerns that the CQC will not adequately fund HealthWatch England. It should provide an expert team that has the knowledge and experience to build HealthWatch; and support the transition of LINks into healthwatch organisations and the development of local healthwatch’s ability to carry out its five statutory functions. It should provide local healthwatch organisations with support, training, advice, resources and expertise on health and social care policy, legal processes and myriad other issues if local healthwatch is to take off quickly. On the basis of current and previous experiences, I feel that the CQC’s belief that local healthwatch can be built and become operational quickly is misplaced—that is the experience of LINks, too.
HealthWatch England should have a capacity to carry out research that is needed by local healthwatch organisations to support their work. HealthWatch England should support the development of local expertise to gather information and data from all sources—public, patients, complaints and serious incident investigations—so that it has a well developed and informed view of the state of local health and social care services. It should support the development of regional healthwatch organisations so that a powerful regional voice on services and commissioning can be developed. It should provide the capacity to elevate local and regional demands for better health and social care to the NHS Commissioning Board, the Secretary of State, Monitor and the CQC. It should support the co-ordination of major demands for changes to health and social care policy and commissioning, integrating local healthwatch.
It was pointed out to the CQC that a research capability was essential for HealthWatch to function. If a potential service problem is suspected, it is necessary to check how widespread it is. Beyond this, the organisation must be able to carry out original research on consumer needs in order to improve services. No research capability had been placed in the plan that the CQC develops. It appeared in meetings with LINks that the CQC might commission research, but we know from examples that research at a local level is important—staff being the classic example.
Diverse and inclusive healthwatch organisations could substantially increase the power and influence of local people to monitor services more effectively, improve safety, influence commissioning and provide a voice that will be heard in the local, regional and national development of health and care policies. To be effective, HealthWatch, nationally and locally, must be fully independent and democratic. Others with experience have informed me that the dependent relationship that HealthWatch is intended to have in relation to local authorities is deeply flawed. They believe the proposed system will be expensive and difficult to establish. The decision not to ring-fence funding will make these bodies weak and vulnerable.
The way forward is for HealthWatch England to be an independent body helping the local healthwatch organisations, which should also be independent of the local authority. If the Government are serious about what they say—that the Bill is about putting patients and the public at the centre and the slogan, “no decision about me without me”,is what they wish to follow—then the way to create public confidence is to have HealthWatch England as an independent body. I beg to move.
Baroness Wheeler
My Lords, I start by saying that I was not one of the ones who beat up the noble Lord, Lord Patel, over grouping issues, although it was extremely frustrating to have them appear and disappear all the time. Anyway, we now have our list and I am speaking to that.
I am pleased to support the amendments in the group, which have two important aims: first, to ensure that HealthWatch England and local healthwatch organisations are truly involved and consulted where decisions are made about the development and planning of commissioning services and on reconfiguration or changes to services; secondly, to ensure that it is an independent statutory body and not a subcommittee of the Care Quality Commission.
The Government’s far-reaching proposed changes to the NHS, with the emphasis on competition and regulation, make the need for HealthWatch England to be given robust and independent scrutiny powers even more important. Amendment 305 from my noble friend Lord Harris and myself is a probing amendment with the intention of ensuring that HealthWatch England and local healthwatch organisations have the strengthened power and functions they need. It establishes HealthWatch England as an independent body responsible for providing the Secretary of State, the NHS Commissioning Board, the Care Quality Commission, Monitor and local authorities with information and advice on the views, needs and experiences of users of health and social services, and the views of local healthwatch organisations on care standards and how they can be improved.
Under Amendment 305, HealthWatch England is responsible for providing local healthwatch organisations with resources, advice and assistance. The amendments of my noble friend Lord Whitty, Amendments 318C and 318D, set out similar and additional powers and functions for HealthWatch England to those proposed in Amendment 305. We fully support these, which include powers of investigation into complaints and powers to seek disclosure of information from health and social care providers, the NHS Commissioning Board, CQC and others. Important functions also include information, research and representation functions.
The independence of HealthWatch England from the Care Quality Commission is vital if it is to be the national service users watchdog and champion. It must be able to hold regulators in the whole of the health and social care system to account and be the independent guarantor of the rights, duties and independence of local healthwatch organisations. Given the uncertainties still surrounding how Monitor and the CQC will work together, and the current trials and tribulations facing the CQC, how realistic is it to expect the CQC to undertake this role or for HealthWatch England to function properly as a CQC committee?
Does the Minister acknowledge these problems? Will he—or she—consider working with NLAM and other interested stakeholders to produce an alternative model for HealthWatch England that will secure the Government’s stated policy for a powerful and independent system of public involvement in health and social care? To be effective, local healthwatch must be able to scrutinise how consortia and health and well-being boards undertake public engagement and transparency and are ensuing that the public voice is embedded in the care pathway design. They should also be given the right to comment on tenders and commissioning contracts before release.
LINks organisations currently have significant powers to enter and view the premises of all health and social care providers regulated by the CQC—another potential conflict of interest if the CQC relationship is not changed. These powers are often little used by local LINks organisations and we hope that their retention in the Bill and robust guidance to local healthwatch organisations on how they can be applied to the benefit of improved patient care and treatment will lead to these important powers being more frequently used. I would welcome the Minister's endorsement of that.
Baroness Williams of Crosby
I have actually gone in to the story of Kaiser Permanente very carefully. It is not surprising that if you choose the very best example in another country you can make a favourable comparison. I am talking about the outcomes for a whole population rather than a particular part of a population. I have said already that there are certainly areas where competition can play a very important part—I referred to innovation and new ideas—but I am simply putting on the record that if you look at the comparison between the health services of the 11 most advanced, richest and most industrialised countries in the world, the combination of integration and competition that we have here appears to have rather better outcomes than in those countries that rely much more heavily on competition such as the United States.
Baroness Wheeler
My Lords, I will speak briefly to my Amendment 135B. Since the Future Forum report, there is a renewed focus on integration in the Bill, and we welcome that. However, as a number of noble Lords pointed out at Second Reading, there is a need to define what we mean by integration. Government amendments largely reinforce the benefits of integration to the NHS rather than looking at the system from the perspective of health and social care, service users and using integration to develop person-centred services. My amendment and others in this group seek to begin to address this.
Since most people with long-term and complex health needs also depend on social care services in order to maintain their health, well-being and independence, it is crucial that the Bill ensures that measures to increase integration also extend to social care. In the NHS, integration has primarily focused on integration of primary and secondary healthcare and to integrate back office support such as IT, human resources and estate management in order to make efficiency savings. While both of these aspects of integration are important, they will not lead to the system transformation hoped for in the Government’s Liberating the NHS White Paper. We need to continue the now reasonably well established place-based approach to integration which brings health and social care together, in which the totality of public resources is directed to develop seamless services which support individuals. As such, they are far more likely to lead to system reform in which all public services focus on achieving better outcomes for individuals and communities.
Local councils have an established record of commissioning for people with complex and ongoing health and social care needs: in particular, homeless people; people with mental health problems, learning disabilities, AIDS/HIV and dementia; and children’s health. It is vital that commissioners of services for people with complex health and social care needs understand the important contribution of housing, leisure and recreation, access to education and other mainstream local authority services to supporting vulnerable people to remain healthy, independent and productive members of the community. Noble Lords have pointed out that clinical commissioning groups will have little understanding or experience of commissioning the complex package of support required. I would therefore emphasise the importance of joint commissioning or delegating commissioning to local authorities and hope that the Minister will respond positively to this.
Health and Social Care Bill
Baroness Wheeler Excerpts(14 years, 4 months ago)
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Baroness Wheeler
My Lords, I am pleased to speak on this group of amendments, in particular on Amendments 143A and 143B, on behalf of my noble friends Lady Thornton and Lord Hunt. I am also speaking to the clause stand part debate on Clause 275, which relates to the abolition of the National Patient Safety Agency.
A critical function of the NHS Commissioning Board is to improve the quality of services and drive improvements in health and social care. A key way of achieving these objectives is learning from complaints information. There is a clear need for the NHS Commissioning Board to have meaningful comparable complaints data from service providers which can be used to help drive improvements in healthcare and strengthen the quality of services for patients and the public. This information can contribute significantly to an enhanced patient experience and enduring service improvement. It can enable the board to identify possible trends and patterns of risk and to take appropriate action through putting pressure on healthcare providers to raise standards and demonstrate how they have learnt from patients’ complaints.
Through this means, the board can hold providers to account for the safety and effectiveness of healthcare. Having this information is important because it identifies which providers are failing to learn from complaints. In collaboration with other organisations, such as the Care Quality Commission, Monitor, the NHS Information Centre and HealthWatch England, there will be the capacity to identify trends, themes and patterns of significant risk and respond through the commissioning process.
While NHS complaints systems have been much improved and enhanced in recent years—my own Government introduced the current system in 2009—we recognise that the current systems for capturing complaints information require significant improvement. We know that a sadly recurrent theme at the Mid Staffs public inquiry has been that the complaints of patients and families were not heard. A system which ensures that complaints information gets transmitted to the people running the NHS would help to remedy this.
Another crucial point is that, with the loss of primary care trusts, there is nowhere independent where complaints about GPs who are members of the local CCG can be investigated. It is clearly not appropriate for the CCG to investigate a complaint about a GP who is a member of the group.
The Health Select Committee has supported the view that commissioning bodies should be the engines that drive improvement in complaints handling, in the analysis of data and leading change within the NHS. Amendment 143A, in particular, would enable the NHS Commissioning Board to play its part as a major service commissioner in developing more meaningful NHS complaints procedures and information, establishing a duty on Monitor to publish information.
Amendment 143B is a probing amendment, which would delete the board’s proposed functions in relation to information. This is in the context of our support for the continuation of the National Patient Safety Agency’s much valued independent role. The National Patient Safety Agency provides a vital function under its current remit, managing the National Reporting and Learning Service, the National Clinical Assessment Service and the National Research Ethics Service. The NPSA acts as an umbrella organisation, providing a valuable overview of patient safety incidents by collection and analysis of data, and monitoring to ensure that lessons are learnt that can be fed back and used to improve patient safety.
Under the National Reporting and Learning Service, the NPSA receives confidential reports on patient safety from incidents from healthcare staff across England and Wales, and oversees the independent processes of clinicians and safety experts who analyse these reports to identify common risks to patients and opportunities to develop improvements in care and practice. However, under the proposed new arrangements, the NPSA is to be dismantled and split up. On these Benches we are totally opposed to this. I ask the Minister how the information monitoring and service that it provides can be provided by the separate bodies that will now span across these issues. The NPSA’s value is as an arm’s-length body that is respected and valued by the NHS for its independence, expertise and the service it provides. Therefore, I also ask the Minister how he will ensure that there continues to be an overview, information and reporting system for the important functions currently undertaken by the NPSA.
Health and Social Care Bill
Baroness Wheeler Excerpts(14 years, 4 months ago)
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“The Secretary of State’s duty as to national workforce structures
After section 1D of the National Health Service Act 2006, insert—“1E Secretary of State’s duty as to national workforce structures
The Secretary of State has a duty to maintain a national pay and bargaining system for healthcare staff, to cover those staff providing NHS services and services for the improvement of public health.””
Baroness Wheeler
My Lords, I am pleased to move this important amendment, supported by my noble friends Lady Thornton and Lord Hunt. The amendment would provide some much needed morale and security at a time of great upheaval for NHS staff. In turn, it would reassure patients that the morale of those treating or caring for them will not impact on the quality of care they receive. Let us just imagine how NHS staff must be feeling now, no matter how dedicated or determined they are to carry on providing the best care possible. There is the Nicholson challenge to implement £20 billion-worth of savings, which they know will seriously impact on patient care, they are facing huge disruption to services and patient care as primary care trusts and strategic health authorities are abolished under the enormous upheaval of reorganisation, and there is massive uncertainty about the future bargaining arrangements for their pay and conditions.
The amendment calls on the Government to commit to the continuation of national determination of pay and national collective bargaining for terms and conditions for NHS staff under the reorganised NHS, leaving employers and trade unions nationally to agree what local flexibilities should operate. The Government have so far failed to acknowledge the need to retain national workforce structures for terms and conditions, pay and bargaining. The Bill prescribes nothing on the pay systems that clinical commissioning groups should adopt, giving them greater leeway to break away from the existing long-established and well-tested pay systems for NHS staff.
Agenda for Change is the single, national pay system in operation for the NHS and applies directly to all staff, excluding doctors, dentists and some very senior managers. It is well established, much respected by employers and staff and delivers equality-proof pay and grading schemes. However, the Liberating the NHS White Paper threatened the viability of a stable, national collective agreement, potentially undermining the NHS pay review body, which makes recommendations on the remuneration of all staff paid under Agenda for Change and employed in the NHS. The current Bill applies only to England, but the implications for national pay determination across the UK are significant.
We know that most staff do not work in the NHS to get rich, despite the constant, distorted picture in some parts of the media about the levels of public sector pay and pensions. Nurses’ pay starts from £21,000 a year and healthcare assistants from as little as £14,000 a year. The average public service pension is around £7,800 a year, but the average pension for a woman working in the NHS is only around £3,500 a year. If staff do not work for the NHS to get rich, what do they value? Job security is no longer the public sector staple employment motivator that it was: 13,000 redundancies have resulted from the current reorganisation. A recent survey by the Royal College of Nursing showed that an estimated 15,000 nurses and healthcare assistants expect to be made redundant in the next 12 months. Staff are not able to value job security any longer, but they do value fairness. Agenda for Change has delivered that, as well as equal pay.
In the uncertain environment caused by the reforms, having some guarantee about access to a fair, national pay system would at least provide an element of security. If, in the future, foundation trusts, with the heavy financial pressures they will face, start to abandon established pay rates and conditions, we fear that this will lead to the rapid downward spiralling of pay for staff, which will be particularly hard in these economic times. Staff morale and motivation are already suffering, and local pay bargaining would make it harder for the NHS to recruit and retain the best available staff, so in turn affecting patient service. Undermining staff pay and moving to local pay bargaining would also have a detrimental impact on patients. We must have an equitable spread of doctors, nurses and other professionals across the country. If local pay bargaining leads to many health staff moving away from a particular area, we could see the quality of service reduced there or patients having to wait longer because vacancies have not been filled. Agenda for Change is generally considered across the NHS to be a vast improvement on the previous fragmented and complex arrangements. It is seen as providing a firm basis for taking forward important, substantive issues, particularly equal pay, new ways of working and workforce reprofiling.
The amendment also explicitly refers to public health staff, because this is one of the major concerns for the NHS public health workforce, who continue to operate in limbo, unsure of exactly who will be employing them and on what pay, terms and conditions. The Government have promised a detailed public health workforce strategy in the autumn to support effective transition to the new system. When is the strategy to be published and what will be the consultation arrangements for all stakeholders? All we know now is that the directors of public health will transfer to local authorities, but precious little else is known yet about the arrangements for the remaining public health workforce, a factor highlighted by the House of Commons Health Committee last week. The committee stressed that,
“uncertainty has inevitably been created by the transition to new structures; this is undermining morale and causing people with valuable skills to leave the profession. Uncertainty around staffing issues must be resolved as quickly as possible. It is also important that the public health specialty is fully integrated into the Government's forthcoming proposals for healthcare workforce planning, education and training”.
The amendment would give the Government a chance to provide some much needed solace for public health staff by committing that they should be covered by the same pay system as other health workers. It would also give hope and reassurance to all NHS staff about their future pay bargaining arrangements. I urge the Minister to respond positively.
Lord MacKenzie of Culkein
My Lords, I rise to support Amendment 45 and to follow on from my noble friend Lady Wheeler. I have spent quite a lot of my working life negotiating pay and conditions for staff in the National Health Service. I sat on four NHS Whitley councils for a very long time—one of them for 21 years. As a nurse, I was privileged to lead negotiations on behalf of Britain’s nurses and midwives for quite a few years as chairman of the staff side of the Nursing and Midwifery Staffs Negotiating Council. So I know a little about the subject of this amendment and the possible consequences of any breakdown in national pay and conditions of service for National Health Service staff.
We have had nationally agreed pay and conditions ever since the inception of the National Health Service, with occasional attempts to break this down, particularly in the late 1980s. The Government of the day thought better of it and backed away. The old Whitley system stood the National Health Service in good stead for many years, but it was far from perfect and there was not always peace and harmony. There were problems in some years, going back, for example, to 1972 for ancillary staff, 1974 particularly for nurses and 1982 for most staff groups. The most recent that lingers in my memory was the ambulance dispute, which I think was in 1990.
Not all staff unions in 1983 agreed that the Government should set up a pay review body for nurses and midwives and professions allied to medicine. However, it was in my view an entirely sensible move, which by and large took a lot of heat out of relations between management and staff organisations for these two groups of staff. Why was the pay review body the right solution? The review body was independent and the staff unions were forced to undertake very detailed research into their pay claims. We used to spend many months getting that evidence right. The management side and government put in evidence as well. The Office of Manpower Economics, which provides the secretariat to the review body to this day, also carried out its own research. The review body took oral evidence from all of the parties. I led that for a number of years on behalf of the staff side. The members of the review body—academics and professionals—put us through the hoops, and any half-baked evidence would have been very quickly exposed. There was no question of any staff side taking inflation, doubling it and—metaphorically at least—banging the table. That clearly would not work.
Earl Howe
My Lords, we value the pay review bodies, and there are no plans to disturb them at the moment. I sought to indicate that we continue to look at how pay arrangements are best structured. The pay review bodies do an extremely valuable job at present, as they have done for many years.
Baroness Wheeler
My Lords, I thank the Minister and other noble Lords who contributed to the debate, particularly my noble friend Lord MacKenzie for his reminder to us of the history of the establishment of the pay review bodies and the contribution that they have made, particularly to improving pay and industrial relations in the NHS.
I also thank my noble friend Lord Rooker for a number of comments that he made in support of the amendment, particularly the point that he made about operating the same job in a nearby locality for different pay and conditions, which would be likely to cause serious detriment to industrial relations. We are very concerned about that.
I deeply disagree with the noble Baroness, Lady Murphy. This is not a pedalling-back amendment. The foundation trusts, I would contend, have not implemented local pay bargaining because they know the implications for industrial relations and local employment rates and so on. Agenda for Change has introduced equal pay, as the Minister said, and provided a good framework for addressing issues of equal pay for equal value. It has certainly proved its worth.
I regret that the Minister is unable to offer any real comfort to those in the House who believe that honouring the long-standing pay and bargaining arrangements for NHS staff at national level is not only the fairest thing to do but the wisest course if we are to ensure that NHS staff morale does not plummet even further. It is an important issue and I give notice that I intend to raise this matter at a later stage. I beg leave to withdraw the amendment.
Health and Social Care Bill
Baroness Wheeler Excerpts(14 years, 4 months ago)
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Baroness Wheeler
My Lords, I begin by paying tribute to the excellent work of the charities, Action against Medical Accidents, National Voices and the National Association of LINks Members on this important issue. I also thank the noble Baroness, Lady Masham, and other noble Lords who have supported and sponsored the amendment and have spoken so forcefully in favour of it. They have put forward the strong arguments for a statutory duty of candour, and I do not intend to go over them or to repeat the detail of the many harrowing cases that have led to the huge support among the general public and patients' organisations for the measure.
The instances of serious failure in care and treatment that have led to the campaign in support of a statutory duty of candour are dramatic, shocking and deeply tragic. The need to ensure openness and transparency of instances of patient care which lead to harm or adverse impact on the patient's future care quality of life apply to both those major cases and to everyday care and treatment solutions. I am sure that, in respect of the latter, many of us will have had personal experience of pursuing instances of poor care and treatment, communication and ordination of services, through the PALS hospital complaints system, only to find how quickly the shutters come down, as has been said, and how hospitals can seem to go into automatic denial and obfuscation as soon as an event occurs.
This is a probing amendment. On behalf of the Front Bench, I urge the Government to look closely at the issue and respond positively on how the Bill can be strengthened to enshrine the right of patients, their carers and families to know when things have gone wrong. In April 2010, my Government established responsibility for the Care Quality Commission to require health providers to report incidents which harm patients to the national reporting system of the National Patient Safety Agency. We recognise that that was a first step. The requirement to report the incident to the patient within a specified period would be a major second step that should be considered to ensure that all information about such incidents is shared with the patient and their family.
Many, both inside and outside the Chamber, have worried about the extent to which patients actually feature in the Bill and whether it will really achieve the Government's objective for patients of “no decision about me without me”. Surely, underlining in the Bill the rights of patients to be truly involved in decision-making about their care, to participate in decisions about their future treatment, and to be told honestly and openly when something goes wrong should all be part and parcel of the “no decision about me without me” mantra.
There is clearly growing momentum and enthusiasm for the current CQC regulations to be extended to provide a related duty to share all information about incidents which cause harm with the patient concerned or their family. As we have heard, the House of Commons Health Select Committee in June of this year specifically recommended that a duty of candour to patients from providers also be part of the terms of authorisation from Monitor and of licence by the CQC.
As for the Government’s consultation on how a proposed contractual duty of candour should be implemented, it is regrettable that the consultation does not allow for consideration of whether the duty should have a different status. The concerns of the Health Committee and patient groups that a contractual duty alone will not be effective need to be addressed. A powerful argument for the duty being in the CQC registration requirements is that that would then cover all providers, not just those with a standard NHS contract.
The consultation document does not adequately address a number of issues in relation to the proposed contractual duty. For example, it does not make clear how the Government envisage a contractual duty working in practice; or how commissioners should act when a provider has failed to be open; or what effective remedial measures they will be able to take.
We recognise that further work needs to be undertaken on the amendment. For example, the CQC powers should not interfere with or duplicate the role of the health staffs’ professional regulatory and disciplinary bodies. The noble Lord, Lord Winston, and other noble Lords have spoken about their concerns. This is a probing amendment. It is designed to raise issues and to seek ways to take the matter forward.
It has been an excellent debate. We strongly support the suggestions that noble Lords have made on taking this matter forward, and we urge the Minister to give urgent consideration to them.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, Amendment 20, introduced by the noble Baroness, Lady Masham, looks to place a new duty on the Secretary of State to ensure transparency when something goes wrong in the treatment of a patient. I hope that she feels gratified by the quality of the contributions to which we have listened this afternoon.
I absolutely agree with the noble Baroness, the noble Lord, Lord Harris, and other noble Lords that ensuring full candour on the part of the medical, nursing and allied professions and NHS organisations is essential. We know that achieving an open and honest system is vital to ensure that the health service learns from its mistakes and that patients and their families are treated with the dignity and respect they deserve. I take no issue with the powerful arguments from noble Lords about the need for openness and candour between health professionals and patients. That is a real concern.
To emphasise that, in our response to the Future Forum’s report we made a clear commitment to introduce a duty of candour—a new, contractual requirement on providers to be open and transparent in admitting mistakes. This will be the first time that such a requirement has been specified in contractual agreements with providers. Contracts are increasingly the key way in which providers will be held to account for the quality of the care that they are providing by those who best understand local healthcare—clinicians and patients. The contracts give the people who are actually spending NHS money on behalf of their populations the power and the levers to require quality improvement and to scrutinise the performance of providers. Therefore, placing a duty of candour in the NHS and contracts reflects the importance we place on the issue. I cannot agree with the noble Baroness that it is somehow a snub or an insult to patients, as she put it. Nor do I think that it is an obligation with a lesser status than a statutory obligation would be.
Accordingly, I support the intention behind the noble Baroness’s amendment, but I do not agree that the most effective way to achieve it is through a duty set out in the Bill. The amendment suggests that the Care Quality Commission should have a role in ensuring that health service providers comply with a duty of candour. However, we do not believe that the CQC overseeing compliance would be the most effective way to underpin a new requirement. The CQC itself has said that it would not be able to enforce such a duty routinely and that it would not fit in with its role as a risk-based regulator.
The Government want the duty of candour to be as effective as possible in promoting openness. Rather than rushing to insert what may be an ill-thought-through and impractical duty in primary legislation, we are currently consulting on how best to implement a duty of candour through contracts with commissioners. The consultation explores how we can best support patients and clinicians to demand candour from healthcare organisations and how commissioners would enforce and report publicly on it. If appropriate, there may be an opportunity in future to include such information in the CQC's quality and risk profiles. Incidentally, I encourage the noble Baroness to take part in the consultation, if she has not already done so. The consultation also explores what we should expect commissioners to report publicly in terms of their enforcement of the requirement. As I said, if appropriate, there may be an opportunity in future to ask the CQC to report on that.
Transparency is important, but I assure noble Lords that measures are already in place to ensure transparency within the NHS. For example, as has been mentioned, clinicians have a professional duty to act openly and admit mistakes. In addition to their professional duty, the NHS Constitution sets out the responsibility of health service staff to aim to be open with patients, their families, carers and representatives, including if anything goes wrong. The majority of clinicians are open with their patients and will, despite the difficulty of the conversation, admit mistakes to patients, so patients receive an apology. Where openness does not happen, it is usually as a result of a closed culture that exists within an organisation rather than a case of individual clinicians simply covering things up. I agree with the noble Baroness, Lady Hollins: clinicians must be able to work in a supportive environment where they are encouraged to admit mistakes and learn from them. It is this culture that we aim to foster in the NHS. The question is how best to promote that culture.
Baroness Wheeler
Perhaps I may ask the same question about clinical commissioning groups and GP contracts.
Health and Social Care Bill
Baroness Wheeler Excerpts(14 years, 4 months ago)
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Baroness Wheeler
My Lords, the hour is indeed late and I have done my best to cut back on bits of my speech. On behalf of the opposition Front Bench, I commend these amendments for beginning the process of retipping the balance of the Bill from its current predominance of measures dealing with NHS structures, governance and competition. Today’s amendments start to explore ways of addressing in the Bill the need for the NHS, public health and social and community care to work together to achieve improvements in quality of services in diagnosing and treating patients. Integration is a means for achieving this and is not an end in itself.
It is worth reminding ourselves of the recent warning from Chris Ham, chief executive of the King’s Fund, of the very real risk in the Bill of integrated care being,
“a sideshow involving small-scale pilots, with competition the main game in town”.
He also said:
“If the Government is serious in its endorsement on the Future Forum's advocacy of integrated care, it must demonstrate its commitment by putting the best civil service brains on the case and ensuring that the mandate given to the NHS Commissioning Board has the promotion of integrated care at its heart”.
We are certainly not at that stage yet, as the contributions in this debate have demonstrated.
The Bill offers the opportunity for the promotion and enabling of integration to be embedded into the work of the Secretary of State, the NHS Commissioning Board, clinical commissioning groups, health and well-being boards and Monitor, and further amendments throughout the Bill will allow for debate and development of these areas. The Royal College of Physicians has referred to these bodies needing to have, under the Bill, an explicit duty of mutual co-operation and collaboration, and this should be the aim. The Secretary of State, the Commissioning Board and Monitor all need to ensure that national policy promotes, not just enables, the supporting context for integration.
We support working towards a strategic definition of integration that encompasses the NHS, public health and social and community care. Nuffield, the King’s Fund, National Voices and the Local Government Association are all undertaking comprehensive work on producing clearer definitions, so there is no shortage of expertise in this area. Our hope is that this work will help lead us to a more coherent approach and ensure that current provisions in the Bill can be strengthened. As we know, the Future Forum is currently consulting on what now turn out to be the non-legislative steps that can be undertaken. But whatever recommendations it comes up with need to be in the context of a Bill which provides the strategic context, framework and direction. The National Voices key principles of integration have much to commend them in taking this work forward.
Amendment 18A has a particular focus on integrating public health with local authorities. We strongly support the proposed role for local authorities for public health and this amendment would help to address fears of some public health professionals that this might lead to public health becoming divorced from the NHS. Amendments 182 to 184 look to clinical commissioning groups having particular regard for outcomes which show “effectiveness and integration” and integrating “assessment and delivery” by those who provide health and social care services. CCGs need to demonstrate that their commissioning plans address the physical health, mental health and social care needs of their local population under the joint strategic needs assessment.
In this regard, one of the major ways of promoting integration will, as many noble Lords pointed out at Second Reading and today, be by strengthening the powers of health and well-being boards. We strongly support giving health and well-being boards the power to sign off the commissioning plans of CCGs and will be supporting amendments to achieve this later in the Bill. If health and well-being boards own the health and well-being strategy, they must also own the plans to deliver it.
Finally, at the beginning of the debate on how we use legislation to promote integration of services and care, as a carer myself perhaps I may endorse noble Lords who have underlined the importance of this issue to carers. Carers, particularly of people with long-term conditions, oversee care packages across the NHS, local authority social care, the independent agency and provider sector and the voluntary sector. Carers are often the principal players in organising the care package and the ones who fight to hold it together. Hours can be spent going over the same information for different parts of the system or ensuring that one part of the system is aware of decisions and developments, and any possible knock-on effects, taken in other parts of the system involved in the care pathway. Joined-up support is the key enabler for people with severe disabilities or long-term health conditions to remain at home and it is crucial that the Bill gets this important issue right.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, all the amendments in this group have the entirely laudable aim of improving the integration of services across health and social care and improving access to services. I agreed strongly with many of the messages which the noble Lord, Lord Warner, delivered in his excellent speech, and with so many of the powerful contributions from other noble Lords. The only person with whom I felt seriously out of sympathy was the noble Lord, Lord Davies of Stamford. I would simply say to him that the Bill contains a number of provisions to encourage and enable the NHS, local government and other sectors to improve patient outcomes through far more co-ordinated working.
For example, the reformed system that this Bill will give form to—the provision of high-quality, efficient and fair services—represents the fundamental goals of the health and care service. This clause puts on to a statutory footing the three domains of quality identified by the noble Lord, Lord Darzi, in his next stage review: effectiveness, safety and experience. Every aspect of healthcare quality fits into the Darzi domains, and that is a tribute to the noble Lord’s work in co-producing the quality framework with patients and the professions, and it is also why the domains still provide the framework for quality.
In answer to my noble friend Lady Jolly, or at least to give her a partial answer, we seek to measure success in meeting these fundamental goals through the transparent accountability mechanisms of the outcomes frameworks for the NHS, public health and social care. Integration and access, though laudable objectives that I share with all those noble Lords who have spoken about them, are a means to this end. If integration and access help the NHS to meet the quality and fairness duties—and by fairness I mean reducing inequalities—then integration and access will need to be factored in to commissioners’ plans. Commissioning guidance will set out how best to achieve this based on the accredited evidence of what works best that NICE is developing in its quality standards and other guidance.
The point is often made that high-quality care must surely be integrated care. Integration is not an outcome, it is a possible feature of the process. Where it will improve outcomes and reduce inequalities, integration should most certainly happen, and this Bill provides for that. But we must not sacrifice outcomes for process. I thought the noble Baroness, Lady Armstrong, injected a welcome dose of reality on that theme borne out of her considerable experience, and although I did not fully agree with everything that the noble Baroness, Lady Wheeler, said, she also made some very sensible comments on that point. Indeed, the NHS Future Forum’s Phase 1 report highlights well the practical rather than legislative challenge of bringing about more integrated services for patients. I shall quote from its summary report, which states that,
“legislating or dictating for collaboration and integration can only take us so far. Formal structures are all too often presented as an excuse for fragmented care. The reality is that the provision of integrated services around the needs of patients occurs when the right values and behaviours are allowed to prevail and there is the will to do something different”.
NHS Future Forum
Baroness Wheeler Excerpts(14 years, 6 months ago)
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Baroness Wheeler
To call attention to the extent of the implementation of the recommendations of the NHS Future Forum in the Health and Social Care Bill; and to move for papers.
Baroness Wheeler
My Lords, this is an important debate. It is the first opportunity for the House to discuss the NHS following the First Reading of the Health and Social Care Bill last week. It takes place in the context of the continuing debate, controversy and deep unease over key aspects of the Bill, its incoherence and complexity even in this, its fourth iteration.
When the Future Forum report was published in June, hope sprang eternal among the many critics of the original Bill—patient groups, specialist groups for patients with long-term conditions, medical and other staff, trade unions, carers and Members across both Houses—that the report and the Government’s response to its core recommendations signified a major change of approach and strategy. My noble friend Lord Darzi was among those who recognised this change in the language and approach of the Future Forum and the Government’s response, welcoming the stated main thrust that the quality of service and care should remain the organising principle of the NHS.
We on these Benches welcomed the Future Forum report in the context that it had not covered all aspects of the Bill. We pay tribute to the work that the forum undertook in the eight weeks that it had to consult, deliberate and produce its report. My noble friend Lady Thornton, in response to the Minister’s Statement on the forum on 14 June, recognised that the Government’s proposed changes in response to the forum were indeed significant. Crucially, however, she urged Members across the House not to suspend their critical faculties but to wait for the publication of the revised Bill to ensure that the rhetoric was matched by the reality. We now have the reality before us. Three months on from the Future Forum report, fundamental questions remain about the post-pause Bill. Even after the Committee stage and Third Reading in the House of Commons, we are still no clearer about why this massive upheaval is needed. What is the Government’s future vision for the NHS? Who will be responsible and accountable for making decisions that will benefit patients and improve the NHS?
At the heart of the continuing problems are two issues that are fundamental to the ethos of an NHS that is free at point of need and provides a national public service. First, there is the importance of the Secretary of State having a continuing duty to ensure that we have a comprehensive NHS. Secondly, we must address the real concerns over Part 3 of the Bill, which places competition at the heart of the NHS and sets up an economic regulator that still has substantial powers to promote competition in the NHS. The Future Forum was clear on these issues and the recommendations are welcome and straightforward. However, the amendments to the Bill do not reflect that or translate the Future Forum’s intentions into legislation.
The Commons deliberations have failed to resolve the issue of the Secretary of State’s duty and role in relation to the NHS. Indeed, as the noble Baroness, Lady Williams, said in her recent Observer article, “confusion thickens”. My honourable friends in the other place, supported by authoritative legal opinion, have underlined that if the Bill becomes law then the duty to provide a National Health Service would be diluted and lost. The Government argue strongly for greater freedom for clinical commissioners from political interference. However, as the noble Baroness, Lady Williams, has said,
“to throw out accountability in order to tackle petty interference is to undermine democracy itself”.
The health professionals remain deeply concerned, as seen in the letter in last week’s Times from the BMA, the royal colleges of nursing, GPs, midwives and psychiatrists, and the governing bodies for the physiotherapists and occupational therapists. They warn that the new Bill will destabilise the NHS and requires further significant amendments. They say:
“Though the language may have changed, the Government remains committed to opening up the NHS further to market forces as a priority”.
The Patients Association sums up the ever increasing complexity of the Bill and the NHS structure when it says:
“It is unclear how the original commitment from the Government to streamline the NHS and remove bureaucracy will be met by current changes—one layer of bureaucracy being replaced by another”.
How does a Bill which adds more layers and bodies—increasing the number of statutory bodies from 163 to 521—substantially increases costs and fails to provide a clear rationale why it is all necessary succeed in improving quality of care and promoting integration?
At one of the many excellent seminars that noble Lords have had on the Bill at its various stages, we were promised by the Under-Secretary at the Department of Health an organigram of the proposed new NHS. That was perhaps a rash promise in view of the sheer number of organisations it has to include, but its production would at least help us to try to understand how the reforms will work as a whole and how they stand some chance of improving the quality of patient care. We know that there is a very real risk that the increased complexity added to the NHS structure will slow down or prevent decision-making, either through more bodies becoming involved in decisions or where it is not clear which organisation is ultimately in charge. How do these reforms support effective and speedy decision-making?
After the forum report publication, David Cameron said, “We have listened, we have learned and we are improving our plans for the NHS”. Nick Clegg was beside himself with joy when he declared a great victory for his party, with 11 out of 13 demands for change laid down by the Liberal Democrat conference being achieved. However, the reality is that the scorecard result is far more modest, as a number of prominent Liberal Democrats have recognised. The Future Forum made important recommendations which have not been dealt with by government amendments to the Bill, and which the Government have consistently blocked Labour, and a few Lib Dems, from amending.
In passing, as a former chair of the Labour Party conference committee in charge of the conference’s agenda programme, I have been following with interest the attempts to block debates and votes on the NHS at next week’s Lib Dem conference. For what it is worth, in my experience, keeping issues off the agenda usually results in the people affected going straight to the media and getting even more coverage than they would have had anyway, so I shall watch developments with interest and be very thankful that I am not the one defending that position on the conference platform.
In respect of the Future Forum report, I place on record for the avoidance of doubt that, of course, we recognise that the Government have acted positively on a number of its recommendations, including the change to clinically led commissioning and clarity on the wider input from health professionals. They have also clarified some of the accountability issues of clinical commissioning groups and have recognised that the timetable for reform could not be achieved. However, many concerns and issues remain in these areas and we will pursue them as we deal with the Bill clause by clause in the coming weeks.
I return to the second major area of concern: competition and the role of Monitor. The forum raised strong concerns about promoting competition as an end in itself. Recognising the problems with the original Bill, the report recommended that it should be changed to make it very clear that Monitor’s primary duty is not to promote competition but to ensure the best care for patients. Specifically, it recommended that Monitor’s powers should,
“promote choice, collaboration and integration”.
This is still missing from the Bill. The Government have also ignored the spirit of the Future Forum recommendations that sought a greater balance between competition, and co-operation, collaboration or integration. Compare and contrast the 90-odd clauses of the Bill on the regulatory regime for competition with the woolly references to organisations having to,
“act in an integrated way”,
with no definition of integration.
The Bill remains as lopsided as ever and, for a Health and Social Care Bill, there is actually precious little about social care. However, that is a whole debate in itself.
The Future Forum further recommended that the Bill be changed to clarify that Monitor be a sector regulator for health, not an economic regulator. While the duty to “promote competition” has been removed, it has been replaced with a new duty of “preventing anti-competitive behaviour”. This flipping of the language does not substantially affect how Monitor carries out its duties, its cost and its reach across the whole NHS.
Moreover, although the Bill moves away from referring to economic regulation, Monitor is still to be given sweeping pro-competition powers, including concurrent powers with the Office of Fair Trading under the Competition Act 1998 and the Enterprise Act 2002. These powers, alongside the power to license every provider to the NHS, have not been changed by the amendments. Monitor therefore remains an economic regulator in all but name. How will the Government address these concerns and issues? How will the issue of the role of the Secretary of State and the role of Monitor be resolved so that the service does not face constant legal challenges in the future about who is ultimately responsible and accountable for decisions, or about how commissioning has been undertaken and contracts awarded?
There are other issues. On transparency, the Future Forum recommended that all providers of NHS-funded services should hold their board meetings in public. The Government rejected this recommendation in their response to the Future Forum. This means that decisions about NHS services will be made in private, and could be marked “commercial in confidence”. The Government have similarly failed to bring greater transparency to clinical commissioning groups and foundation trusts by allowing substantial loopholes and leeway. There is a get-out clause for CCGs that want to avoid meeting in public. The wording of the Bill states,
“except where the consortium considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting”.
Foundation trusts can exclude members of the public from a meeting for special reasons with no explanation about what these are. This leaves this clause open to abuse.
There is also the important issue of the private patient cap and cherry picking by private providers. Professor Field, the Future Forum chair, admitted that the issue of the private patient income cap was not looked at by the forum and stated that,
“the feeling was that the private patient cap should actually stay”.
The Government have tabled no amendments to the clause abolishing the private patient cap. The implications of the abolition of the cap and increasing financial constraints that the service is operating under are already beginning to be seen. The Government’s amendments on cherry picking in the Bill only require that a provider be transparent in how it chooses its patients, and do not deal with preventing providers from picking the easiest and most profitable patients. All in all there is a very mixed and confused picture of implementation and translation into the Bill of the forum’s recommendations.
Finally, I come back to the Future Forum itself, as we now learn that its work is to continue with listening exercise mark 2—this time on education and training, integrated services, public health and information. Can the Minister give us more details of this? How does he envisage that this work will be fed into the Bill and what impact it will have on its parliamentary passage? Are we to have further amendments to, for example, the integration and information clauses? How long do the Government envisage the role of Future Forum continuing? Is it to be a permanent listening body—another body to be placed on the much awaited organigram? If so, when will the normal rules of public appointments and declaration start to apply to its membership? Are we to have further “pauses”?
Noble Lords will recognise that I set great store by getting the promised organigram. I am really looking forward to receiving it. When it comes, I will be asking myself three key questions. First, is this the structure to take the NHS forward into the future and provide the integrated care pathways that people with long-term conditions must have? Secondly, how will this help the NHS to deal with the Nicholson challenge of £20 billion savings over five years? Thirdly, will it now be easier for patients to find their way through the system and be clear who has responsibility for making decisions about their care? I think I already know the answers.
Baroness Wheeler
My Lords, this has been an excellent debate. I thank all noble Lords for their contributions, particularly the update from the noble Baroness, Lady Jolly, on the Liberal Democrat conference programme. As noble Lords have said, this is a timely debate; it is a precursor, an overture or a limbering-up for the debates that we are about to have. I am sure that we are all looking forward to that in the coming weeks. With that, I beg leave to withdraw the Motion.
Health: Stroke Care
Baroness Wheeler Excerpts(14 years, 8 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what actions they will take to address geographic variations in stroke care identified by the Royal College of Physicians and detailed in the National Stroke Audit Report 2010.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the 2010 audit shows ongoing improvements in stroke care in England. To achieve the high-quality care described in the national stroke strategy and the NICE quality standard, the NHS is continuing to implement the accelerating stroke improvement programme. This aims to go further and faster in delivering improvements in stroke care across England.
Baroness Wheeler
I thank the Minister for his response and his recognition of the tremendous progress that has been made in the past three years with the national stroke strategy. I am sure that he agrees that progress has been most marked where strategic health authorities have provided strong leadership to drive forward strategy. With their abolition, how will the new system, through the subnational elements of the NHS commissioning board—the clinical senates—help facilitate the necessary improvements, and where will accountability lie? Also, I am concerned that the future of the stroke strategy team at the Department of Health seems to be uncertain. I have heard that the national clinical director for strokes will shortly stand down. Will the Minister confirm this and explain, if that is so, who will be responsible for providing strong leadership on stroke improvements at national level both in the short term and under the proposed new system?
Health: Alcohol Minimum Pricing
Baroness Wheeler Excerpts(15 years, 1 month ago)
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Baroness Wheeler
To ask Her Majesty’s Government what is their assessment of the impact of minimum pricing policy on the level of alcohol-related conditions and admissions to hospital.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Home Office review of pricing policy found that increases in alcohol prices are linked to decreases in alcohol-related harms. The review also highlighted that this is a complex issue. The Government intend to ban sales of alcohol below the rate of duty plus VAT. This is a pragmatic first step towards setting the lowest level at which different strengths of alcohol can be sold. We estimate that it would mean about 1,500 fewer alcohol-related hospital admissions per year.
Baroness Wheeler
I thank the Minister for his response. However, two leading advisers from the Department of Health’s own network of experts recently wrote in the Lancet that the Government,
“lacks clear aspiration to reduce the impact of cheap, readily available, and heavily marketed alcohol on individuals and on society”.
They estimate that failure to tackle drink-related problems could cost 250,000 lives over the next 20 years. How will the Minister ensure that in future the health, well-being and recovery of people with drink-related problems take precedence over the lobbying of the drinks industry?
Earl Howe
My Lords, I make it clear that we neither have nor intend to have any sort of cosy arrangement with the drinks industry. The view that we have taken is that the food, drink and fitness industries, together with charities and public health experts, all have a huge role to play in improving our health. The industry has enormous influence in its own right. However, more than that, we believe that we have a collective responsibility to do something about this problem. That is why the industry has joined the Government in a partnership to promote and empower us all to adopt a healthier lifestyle. Through the public health responsibility deal, we are challenging industry to take action that will help consumers to live healthier lives in some areas where it is not possible or effective to regulate.
Human Fertilisation and Embryology Authority/Human Tissue Authority
Baroness Wheeler Excerpts(15 years, 2 months ago)
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Baroness Wheeler
My Lords, I, too, thank my noble friend Lady Thornton for initiating this debate, as well as other noble Lords who have spoken with much experience and in-depth knowledge on this matter. It is particularly timely as the Government consider their response to the major concerns about the inclusion of the HFEA and HTA among the bodies to be abolished under the Public Bodies Bill, whose Committee stage discussions we are set to resume.
As has been stated, we on these Benches can speak with some authority on this matter, having, as the House will be aware, closely examined the case for merging the HFEA and HTA into a single body just over two years ago while we were in Government. We came to the firm conclusion that two distinct independent regulatory bodies needed to be retained to oversee the areas of human tissue and assisted reproduction.
As the BMA has stated, the UK has been well served by the HFEA and the HTA, and both have been used as models for other jurisdictions in dealing with extremely technical and legally complex areas of practice. The RCN has said in respect of the HFEA that the current high level of expertise and experience within the body is extremely valuable and that it would not be in the public interest to transfer regulatory functions to other organisations, as this knowledge might be lost to the detriment of patient safety. The HFEA’s chair, Professor Lisa Jardine, has described areas covered by the HFEA as the most controversial area of medicine apart from assisted dying, the most morally difficult and carefully legislated-for area and the most tightly regulated.
The HTA, born out of the terrible events at Alder Hey and Bristol hospitals, and the crisis in public confidence over unauthorised retention of babies’ organs and tissues, has in our view established hard-won trust and respect among the public and professionals. My noble friend Lady Warwick is right to express concern that this will be lost if the current clear focus of the HTA is diminished in the transfer of its functions and role.
This does not mean that we do not recognise the scope for review and change within either body, or how the regulatory framework may be developed in the future. Both bodies themselves acknowledge this. We also recognise that many in the key professional groups involved are supportive of such changes as bringing all medical research regulation, including embryo research, within the remit of a single medical research regulatory authority, as recommended by the Academy of Medical Sciences. However, time and space would be needed for independent examination and review of this and the broader issues of how functions should be delivered in future and the risks, benefits and costs, rather than just the current focus on how functions are to be transferred.
We are concerned that the Government’s process is to transfer functions to bodies that are as yet undeveloped and untested in this area of expertise. The Care Quality Commission is very much an organisation in transition and development, as it plans to take on a range of new duties and work envisaged in the Health and Social Care Bill. The role and possible functions of the new medical research body, and of the health and social care information centre, need much more work and development. All this is in the context of the Department of Health having its work cut out, taking on a huge volume of work, responsibilities and functions that will come its way from the abolition or reorganisation of many of the other bodies due to be axed in the Public Bodies Bill.
This is also at a time when the Government themselves are committed to large-scale staff reductions in the Department of Health. There are also key issues of accountability and independence at stake. Professional bodies and clinicians directly regulated by the HFEA, for example, of course have a key view of the changes needed, but they are not the only stakeholders, as speakers in this afternoon’s debate have underlined.
Dismantling the HFEA and HTA, diluting their accountability and handing over their powers to Ministers and civil servants on such sensitive issues needs public involvement and stakeholder conversation, as speakers have pointed out. How would the new organisations be independently scrutinised and accountable? How much money would be saved from transferring the functions of the HFEA and HTA to the CSQ and new bodies? Will the Minister explain in more detail the timetable that he is currently working to for consultation and development of the new framework?
We on these Benches again urge the Government to reconsider their position and remove the HFEA and HTA from the bodies to be deleted under Schedule 5.
Contaminated Blood (Support for Infected and Bereaved Persons) Bill [HL]
Baroness Wheeler Excerpts(15 years, 5 months ago)
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Baroness Wheeler
My Lords, I, too, begin by paying tribute to my noble friend Lord Morris of Manchester, for his tenacious and tireless work in campaigning on the issue before the House today. Indeed, no one reading back through the reports of the debates on the Bill in its previous passage to Third Reading in the House, as I have done in preparing for today’s debate, can fail to admire and be very humbled by his continued determination to ensure that the plight of those whom he has described as,
“arguably the most needful minority in Britain today”,—[Official Report, 23/4/09; col. 1607.]
is fully recognised and properly financially compensated.
We recognise the important and continued role played by him and other noble Lords who have spoken in today’s and previous debates. I refer particularly to the independent inquiry report of my noble and learned friend Lord Archer into NHS-supplied contaminated blood and blood products, which received widespread all-party acclaim, and whose report recommendations form the core framework of the Bill. Like him, we welcome the consensus in the House that victims have suffered for too long. We also value his insights into his report from the perspective of events that have followed its publication. Finally, I endorse the admiration expressed across the House for the work of the Haemophilia Society and the close support that it has provided to the people infected, their carers, widows and dependants.
The debates in this House and in the other place last week recount the very personal and tragic experiences of patients, their families and those who have died. Haemophilia sufferers were plunged into a nightmare of failing health, pain, suffering, financial hardship and social deprivation. The support and campaigning work of the society over the past three decades have helped to provide solace and constant, practical everyday support, and have led to real improvements in care and financial support.
However, we readily accept that there is much more to be done. This is unfinished business from the previous Government and we regret that we were not able to respond formally to the High Court judgment and to the related recommendations in the report of the noble and learned Lord, Lord Archer, before we left office. Despite the sense of frustration at this and the belief that much more should have been done by successive Governments, the House will recognise the work undertaken by my noble friend Lady Thornton to progress through the Department of Health vital improvements such as in the administering, handling and safety of blood products and in developing further best practice and improvement in service provision for the ongoing treatment of haemophilia sufferers.
On behalf of these Benches we welcome the review announced last week by the noble Earl, Lord Howe, following the announcement and debate in the other place. It is a very positive step that will, I hope, take this matter forward towards achieving the closure that is desired in the House.
We welcome the inclusion in the review of the commitment to look at ex gratia payments made to those infected with hepatitis C, including financial support for dependants, issues surrounding the arbitrariness and injustice of cut-off dates for eligibility of the current scheme, and comparison with ex gratia payments made in the UK to those infected with HIV and their dependants. We also welcome consideration of the provision of life, mortgage protection and travel insurance for those infected in light of similar access available to other groups. As we have continually found, there is often a real difference between what insurance companies promise will be their actions on such issues, and what they actually do when considering individual cases.
In respect of prescription charging for those infected, noble Lords on both sides of the House will be aware of the previous Government’s commitment to introduce free prescriptions for people with long-term conditions, which would have included people infected by contaminated blood. I therefore ask the Minister what impact the announcement under the Government’s CSR that the free prescriptions programmes will not now be taken forward will have on the review’s consideration of this matter. Will the Government no longer honour this commitment to people infected by contaminated blood?
We also endorse the inclusion in the review of the provision of, and access to, nursing and other care services in the community for those infected. We hope this will lead to improved NHS and local authority service provision, coproduction and co-operation.
We welcome the Government’s commitment for the review to make recommendations to Ministers for their consideration by the end of the year. As noble Lords have stressed during this debate, it is crucial for this review to be conducted with the utmost expedition. I look forward to hearing further details from the Minister on who is to lead it, how it is to be undertaken, the relevant expert groups and external groups that were referred to in the other place by the Under-Secretary of State for Public Health, Anne Milton, and how the views of those infected, their relatives and carers, and other representatives will be sought and taken into consideration.
The Minister emphasised her desire for the review to be dealt with,
“openly and honestly, with clarity, without party politics, with humility and with empathy”.—[Official Report, Commons, 14/10/10; col. 568.]
We wholeheartedly agree and look forward to it proceeding without delay. Will it include an overview of all the different compensation funds established to administer payments to people infected by contaminated blood to ensure consistency of approach and decisions?
Finally, on the question of continued government funding to the Haemophilia Society, can the noble Earl confirm that the current level of funding will not be affected by the changed basis for voluntary sector funding?
In closing, I again congratulate my noble friend Lord Morris on bringing back the Bill to this House and his dedication, determination and persistence—once again so much in evidence today. We look forward to working on the Bill in its future stages in the House.