NHS: Health and Social Care Act 2012 Reforms

Earl Howe Excerpts

Wednesday 22nd October 2014 Lords Chamber

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

My Lords, this Government have taken tough decisions to increase the NHS budget by £12.7 billion between 2010-11 and 2014-15. During this period, the Government’s NHS reforms will enable total administration costs to reduce by one-third in real terms, to release funding to NHS front-line services. Already, savings arising from the reforms released £1.5 billion last year and £1 billion in 2012-13 to front-line services.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, did the Minister read, as I did, the headline “NHS reforms our worst mistake, Tories admit” in the Times last week? This was part of a devastating series of articles analysing what had happened to the 2012 reforms, along with the costs which had accrued or the savings which had failed to be achieved but could have been if the Government had not been diverted by the reforms. Who will be held responsible for this devastating and monumental failure in policy? It has been very costly to the country, especially at a time of austerity.

[Earl Howe]

First, let me make it clear that the Government have no regrets whatever about the NHS reforms. These reforms enabled massive savings to be made, all of which have been ploughed into the front line. Without investment in the cost of the reforms—which I concede were considerable—we would not have been able to realise these savings, nor would the NHS have been able to plough those savings back into the front line. This has enabled us to employ more than 7,700 extra doctors, and the NHS is now performing more than 850,000 more operations every year. That is the benefit of the reforms.

[Lord Patel of Bradford (Lab)]

My Lords, if there is so much investment being put into the NHS, as the Minister said, why are mental health services being cut across the country and especially in the north of England? In my own city of Bradford, our mental health care service has been cut by 23%. How do we expect mental health care to have parity of esteem when it is experiencing these kinds of cuts?

[Earl Howe]

The noble Lord raises a very important issue, which results from the fact that commissioning decisions are taken not by the Government but by clinical commissioners across the service. We are very concerned by the reports of lower resources being channelled into mental health services. A lot of work is going on, in my department and in NHS England, to make sure that those services—and, crucially, the outcomes from those services—are maintained.

[Baroness Masham of Ilton (CB)]

My Lords, how much was paid out in redundancy to health service staff who lost their jobs and were then taken on again? Is the Minister aware that emergency medicine and accident and emergency departments are really overstretched?

[Earl Howe]

The noble Baroness asks two questions. We had to abide by the terms of the contracts of employment which were put in place by the previous Administration. In some cases, people were made redundant and were then re-employed by the health service at a later date. No one can take satisfaction from that, which is why we are completely revisiting the terms of those contracts. As regards accident and emergency departments, we know that the NHS is under pressure, but there are now more accident and emergency doctors than there were in 2010. The work being done by Sir Bruce Keogh to look at the system across the piece will, we trust, address a number of the pressures that the NHS is now experiencing.

[Baroness Barker (LD)]

The Minister will know that health commentators usually assess the annual increase in health spending at 4%. In view of that, does he agree that the sustainability of the NHS rests largely on its integration with social care? Does the Minister also agree that this issue should be addressed in the forthcoming Autumn Statement?

[Earl Howe]

I agree with my noble friend that the integration of health and social care services has a major part to play in making the system more efficient across the piece and more effective for the patient. That is why we are introducing the better care fund, which, at a local level, will channel at least £3.8 billion into pooled budgets to deliver that integration.

[Lord Harris of Haringey (Lab)]

My Lords, if the system is quite as wonderful as the noble Earl suggests, will he explain why so many people are waiting so much longer in accident and emergency departments and why so many young doctors completing their GP training decide to leave the country and practise overseas rather than participate in the grotesque mess that this Government have produced?

[Earl Howe]

I take issue with the phrase “grotesque mess”. If the noble Lord cares to look at the figures, he will see that waiting times are low and stable, MRSA and C. diff infections are at record lows, mixed-sex wards are down by 98% and the number of people waiting a long time for treatment is massively reduced. Yes, we know that many A&E departments are under pressure but many are coping. The work that we are doing, including channelling more money into the system for this winter, should, we hope, relieve the worst of the problems.

[Lord Patel (CB)]

Now that general practitioners will have incentives to diagnose dementia, will it lead to a better and more accurate diagnosis? Will it increase the number of people diagnosed with dementia or will it increase the number of people falsely diagnosed with dementia? Let us remember that there is no cure or treatment for any of them.

[Earl Howe]

My Lords, the noble Lord, in his ingenious way, is deviating slightly from the Question on the Order Paper which refers to the costs of the reforms. We are in dialogue with the medical profession to ensure that none of those perverse consequences happens.

[Lord Hunt of Kings Heath (Lab)]

My Lords, let us come back to the Question, which is about funding. If the picture was so rosy, why is it that a record number of NHS trusts and NHS foundation trusts are in deficit? If the picture was so rosy, what does the Minister have to say about the report a couple of weeks ago by the Nuffield Trust? It states:

“Prompt access to services has declined … In mental health services, demand”,

is,

“outstripping capacity for urgent care and for younger people. The wellbeing of frontline staff in both health and social care is”,

deteriorating. When he says that the Government are not ashamed of what they did, who is he speaking for? Is he really speaking for the Prime Minister and the leadership of his party?

[Earl Howe]

I am indeed and the NHS is under pressure for the reason that the noble Lord has just quoted—demand has risen dramatically. However, productivity has also risen dramatically, which it failed to do under the previous Administration.

Children: Obesity

Earl Howe Excerpts

Monday 20th October 2014 Lords Chamber

[Baroness Benjamin (LD)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare an interest as chair of the All-Party Group on a Fit and Healthy Childhood.

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

My Lords, we published our cross-government strategy, A Call to Action on Obesity in England, in 2011. It sets out our approach to tackling obesity and includes a national ambition for a sustained downward trend in the level of excess weight in children by 2020. This requires ongoing collective action across all government, businesses, healthcare professionals and individuals. We are seeing encouraging signs of progress, with obesity rates in children falling to 14% in 2012, the lowest level since 1998.

[Baroness Benjamin]

I thank my noble friend for that Answer. However, a report by the All-Party Group on a Fit and Healthy Childhood has confirmed that childhood obesity has become an epidemic across the country. In some areas, 40% of children are overweight. Medical and dental experts are raising concerns about obesity and health issues in children and millions are being spent by the NHS because of this. Does my noble friend agree that this epidemic has to be called a national emergency and that someone at Cabinet level should be responsible for co-ordinating strategy across all relevant government departments for the sake of our children’s long-term well-being? Will he please agree to meet the all-party group to discuss this report?

[Earl Howe]

My Lords, first, I commend the all-party group for its report. Tackling obesity is one of our major priorities, as it is for Public Health England. We have a well developed and wide-ranging programme of actions to tackle obesity. We have set a national ambition for a downward trend in excess weight in children. We are delivering the programme through initiatives such as Change4Life, the National Child Measurement Programme, school sports funding and the School Food Plan, and through voluntary partnerships with industry. As regards co-ordination, Public Health England is a leader of the public health service and numerous government departments are contributing to the anti-obesity agenda. We have a Minister for Children, and we have already established the Obesity Review Group, which brings together a range of experts and delivery partners from across the system to try to co-ordinate efforts to meet our national ambitions.

[Lord McColl of Dulwich (Con)]

My Lords, will the Minister acknowledge that the Department of Health and NICE misled Parliament and the nation in saying that the obesity epidemic was due to lack of exercise? Will the Minister acknowledge that in fact obese people do not need to increase their activity one iota in order to lose weight? All they have to do is to eat or drink fewer calories.

[Earl Howe]

My Lords, although physical activity can have a role in maintaining a healthy weight, the Government agree with my noble friend that its health benefits are nevertheless subsidiary in those who are obese to the need to eat and drink less. My noble friend may be interested to know that NICE is currently consulting on its draft public health guideline on maintaining a healthy weight and preventing obesity among children and adults. It currently expects to publish this guideline in February next year.

[Lord Elystan-Morgan (CB)]

My Lords, does the Minister accept that many of us are obese because we are the proud but inevitable products of heredity? Further, does he accept the splendid words of the Scottish author, Eric Linklater, who, speaking of a person of ample frame, said, “His outline spoke not of greed but of grandeur, not of gluttony but of the magnanimity of the human form”?

[Earl Howe]

There is, I am sure, no more elegant way of describing the issue under consideration at the moment. The noble Lord makes a very important point about heredity. I do not think that sufficient is understood about the role of our genetic make-up in the way in which we all differ in our weight and size. However, for those who are obese, there are clear, evidence-based actions that they can take to lose weight if they have a mind to do so.

[Lord Berkeley (Lab)]

Does the Minister agree that the link between cycling and the avoidance of obesity is extremely strong? Will he speak to his colleagues in the Department for Transport as his predecessor, whom I met at a conference a few years ago, said that the Department of Health would not encourage cycling because it was a transport matter?

[Earl Howe]

We are straying a little towards obesity in general rather than obesity in children. However, I concur with the noble Lord that cycling has an important place in the way in which we can take exercise, which is beneficial for our general health. I will, of course, take back the noble Lord’s message.

[Lord Walton of Detchant (CB)]

Will the Minister say what success, if any, the Government have had in persuading manufacturers to reduce sharply the sugar content of fizzy drinks? Has consideration been given to the possibility of restricting the sale of high-calorie-content drinks through vending machines?

[Earl Howe]

My Lords, our current emphasis is on overall calorie reduction, of which sugar forms an important part. The scope for reformulation to reduce sugar levels varies widely depending on the food that one considers and a reduction of sugar levels does not always mean that the overall calorie content is reduced. The issue is not black and white. An example of that is when sugar is replaced by starch or other ingredients. Nevertheless, we are discussing with the food manufacturing industry ways in which it can reformulate its food and the Scientific Advisory Committee on Nutrition is finalising its review on carbohydrates, looking at sugar as a particular component of that.

[Baroness Wheeler (Lab)]

My Lords, given the difficulty of ensuring effective cross-department co-ordination on childhood obesity, what is the Government’s response to a call by the Royal College of General Practitioners to set up a COBRA-style task force? Would that not be a key way of ensuring a joined-up approach that extended beyond the Department of Health?

[Earl Howe]

My Lords, as I mentioned earlier, we have set up the Obesity Review Group, which contains a multiplicity of experts to co-ordinate the efforts being conducted not only in government but also in local government and on the part of business and the wider private sector. While I buy into the central point made by the noble Baroness that this needs an overarching scrutiny, we believe that we have that already.

NHS: Cottage Hospitals

Earl Howe Excerpts

Monday 13th October 2014 Lords Chamber

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

My Lords, I first congratulate my noble friend on securing this debate. I know that the role that mutuals play within our society is a subject close to his heart, as he has indicated tonight, and of course the future of our hospitals is a subject of utmost importance to all noble Lords. Before I respond to the particular points raised by my noble friend, I should like to acknowledge the great benefits that cottage or community hospitals provide to those in their local area. I shall set out how the changes we have made to the NHS have provided protection to community hospitals wherever they are needed. Finally, I will describe the role that mutuals play in the delivery of our health services, including our community hospitals, both now and in the future.

Cottage hospitals, generally referred to as community hospitals, are local hospitals, units or centres providing a range of accessible healthcare facilities and resources. They can be invaluable assets that make it easier for people to get care and treatment in the community, closer to where they live. They allow large hospitals to discharge patients safely into more appropriate care, freeing up beds in major hospitals for people who need them, and they can reduce the need to travel long distances to larger facilities.

There are many excellent reasons why people are often extremely protective of their local community hospital. It may deliver a range of essential services, provide employment for local people and afford space for community groups. It is understandable that community hospitals are fiercely defended and inspire such loyalty. It is right that people think about their future place.

The changes that this Government have made to the NHS have given the power to local clinicians and patients to make improvements to their local NHS. Clinical commissioning groups, led by local clinicians, are now responsible for commissioning services. They are free to work out which services are needed and where they should be located to best meet local needs. I beg to differ from the noble Lord, Lord Hunt, about the accountability of clinical commissioning groups, which is real in the sense that they are accountable to NHS England for the outcomes that they produce and the plans that they put in place; they are accountable to the health and well-being boards on which they sit; and they are accountable to their local Healthwatch, which is the body that represents patients and the public in the local community. So I do not share the view of the noble Lord, Lord Hunt, in that sense.

It may be helpful if I explain the ownership of community hospitals. Ownership of the physical premises of many of our community hospitals changed when primary care trusts were abolished. Some were transferred to local NHS trusts and NHS foundation trusts. Other hospitals went to NHS Property Services, the Department of Health-owned property management company. I recognise that some noble Lords had concerns about these transfers when they occurred. We have been extremely clear that the conditions attached to these transfers mean that these hospitals will be retained unless local commissioners determine that they are no longer appropriate for delivering the local services that the community requires. As with all decisions about local patient services, it is right that these decisions are taken locally, taking account of local views. However, we must acknowledge that sometimes old infrastructure, although much loved, cannot keep up with the community’s needs. Changes in treatments and communities may require new and innovative models of care. Local commissioners should be able to explore a full range of options to ensure that services meet the needs of patients.

I now turn to the potential role that mutuals and staff ownership models could play in the future of our hospitals. However, I need to be clear from the outset that mutualisation is about the services that our hard-working NHS staff and their organisations deliver. It is not about the bricks and mortar where they work. I hope that will not disappoint my noble friend, but we are not considering the transfer of NHS property out of the ultimate ownership of the Secretary of State—unless, as I have said, it becomes surplus to NHS requirements.

Public service mutuals, as we define them, are organisations that originate in the public sector, deliver public services and involve a high degree of employee control. Over the last four years, this Government have worked tirelessly to ensure that citizens have access to effective and high-quality health provision. This is why we have broadened approaches to the delivery of healthcare, including through public service mutuals—a model which is revolutionising front-line provision and bringing benefits to staff, local commissioners and service users.

The Transforming Community Services programme, started under the previous Government, saw the separation of commissioning and provision within primary care trusts. As part of this programme, some organisations spun out of the public sector. We now have over 45 mutuals delivering community healthcare across the country, including in some community hospitals, transforming the quality of patient care through a more engaged and empowered workforce. To build on these successes, last year my right honourable friend Norman Lamb, alongside my right honourable friend Francis Maude, asked the highly esteemed Chris Ham, chief executive of the King’s Fund, to consider the options for strengthening the voice and the stake of employees in NHS provider organisations, always with the aim of empowering them to deliver efficient, high-quality services centred on the needs of patients. When he published his report in July of this year, he presented clear evidence that more engaged staff are linked to lower rates for some hospital-acquired infections and positive patient reports of dignity and respect. One study demonstrated that each increase of one standard deviation in levels of satisfaction was associated with a 2.4% drop in patient mortality.

We also know that mutuals can lead to greater job satisfaction, higher productivity and reduced absenteeism, and social enterprises and mutuals have a proven track record of delivering high-quality, responsive, cost-effective services. While there are significant numbers of mutuals delivering community services in a range of settings, a number of different opportunities and challenges arise when thinking about how these mutual principles can be applied to a wider range of acute hospital services where they do not currently operate. That is why, in response to Chris Ham’s report on staff engagement and empowerment in the NHS, we have established a pathfinder programme to support NHS trusts and foundation trusts in exploring the potential advantages of the mutual model. We have made available a £1 million fund to support a number of pioneering pathfinder organisations in understanding what mutualisation could mean for them and identifying solutions to practical barriers. We will use this pathfinder programme to explore and identify the benefits and risks of the mutual model in new areas of the health sector—which could include, but is not limited to, staff working in community hospitals.

I must be clear, however, that the establishment of a mutual model is not a panacea. Mutuals can succeed or fail, as can any organisation. Participation in our pathfinder programme, and any subsequent decisions by organisations to consider the benefits of the mutual model, must be on a voluntary basis, driven by the views of both staff and their patients and users in the local community. Therefore, while I can be clear that this Government understand the benefits of the mutual model and want to explore its potential across a range of health services, we do not anticipate that we would seek to roll this out across all staff working in community hospitals.

I now turn to some of the questions that have been posed. First, my noble friend queried whether we could look at international examples here. He may know that Sir David Dalton, on behalf of my right honourable friend the Secretary of State, is currently leading a review looking at new provider models. The review includes a detailed look at what we can learn from international examples, perhaps bringing those examples to bear in the NHS.

I was aware of my noble friend’s Private Member’s Bill. I am happy to take away his remarks and to discuss with my colleagues in the Treasury the ideas that he has put forward in relation to health services.

My noble friend Lord Framlingham, in his very powerful speech, signalled his concern about the paucity of facilities in some of our community hospitals and the threat of closure that might ensue from that. I hope that I can give him some words of comfort there. As I have indicated, the majority of NHS services, including those provided in community hospitals, are commissioned by clinical commissioning groups, so how those hospitals are funded is very much a matter for local determination rather than a national decision. However, NHS England expects CCGs’ commissioning decisions to be underpinned by clinical insight and knowledge of local healthcare needs, and that those decisions should have regard to the need to address health inequalities.

As I said, I do not think that mutualisation by itself would provide a panacea to prevent community hospitals closing. Where a community hospital is judged to be no longer viable—for example, because of the age of the fabric or a significantly diminished volume of services being provided—a change of organisational form or ownership alone is unlikely to affect local commissioning decisions. I shall come on in a minute to the issue of funding if I have time—although I suspect that I will not and that I will need to write to my noble friend further on that score.

My noble friend raised the possibility of external funding from the community, and I was interested in his remarks. Our view is that that kind of local levy should not be necessary. The Department of Health capital budget continues to rise in real terms, and indeed provider trusts are funded through the depreciation element of their income, with funds to cover their capital expenditure. Where trusts can prove their business case, the department will provide them with capital loans through the independent trust financing facility and may choose to provide public dividend capital directly in exceptional circumstances. Therefore, capital funding is available where it can be justified.

The noble Lord, Lord Hunt, suggested that CCGs should be reversing the flow of services away from hospital. To an extent, I agree with him, although I think that largely we are talking about acute settings rather than community settings. Simon Stevens, the chief executive of NHS England, has made it clear that there should be no national blueprint for this: CCGs have to be free to determine the services that they commission based on local needs. Of course, this issue does not bear upon NHS privatisation. Indeed, the pathfinder programme is there to explore the benefits of the mutual model and ways in which staff can be actively engaged. That is a million miles away from privatisation and, as I have said on a number of occasions, the Government have absolutely no agenda on that score.

In conclusion, as I have overshot my time, the Government have taken steps to secure the sites of community hospitals and ensure that they are used for the benefit of the community. Local clinical commissioners are best qualified to take decisions about the services required locally. We are supporting organisations that wish to explore in detail the feasibility and viability of the mutual model for their organisation or significant parts of their services and explore the benefits of mutualisation in a wider range of services within the health sector.

NHS: Cancer Diagnosis and Treatment

Earl Howe Excerpts

Monday 13th October 2014 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what is their assessment of the report by Cancer UK highlighting gaps in the provision of National Health Service cancer diagnostic and treatment services.

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

My Lords, there has been significant growth in the provision of cancer diagnostic tests and treatment over the course of this Government. For example, urgent GP referrals for suspected cancer have increased by more than 50% since October 2009. NHS England is taking action to support the NHS to improve performance, including establishing a cancer waiting times task force. We are investing an additional £750 million over four years to improve diagnosis and treatment of cancer.

[Lord Hunt of Kings Heath (Lab)]

My Lords, on the question of waiting times, can the noble Earl confirm that the 62-day target for cancer treatment has been breached in the last two quarters? Can he say why that is and can he confirm that it is really a result of the shambles that Mr Lansley’s changes have brought to the NHS?

[Earl Howe]

My Lords, the noble Lord is correct that although most waiting time standards are being maintained there has been a dip in the 62-day pathway standard in the last two quarters. However, survival rates are improving and we are treating a record number of NHS patients for cancer. Last year, 450,000 more patients were referred with suspected cancer than in 2009-10. That is an increase of 51%. In addition, campaigns such as Be Clear on Cancer have been exceptionally successful in raising awareness of symptoms. In large part, that is what has accounted for the pressure on the waiting time standards: in a way, the campaigns are a victim of their own success.

[Lord Sharkey (LD)]

My Lords, it is still true that the chances of surviving cancer can vary dramatically depending on where you live. Can the Minister say what progress has been made in understanding the reasons for those variations and what progress has been made in reducing them?

[Earl Howe]

My Lords, my noble friend is absolutely right. He will know that medical opinion is clear that a variety of reasons such as lifestyle and others account for regional variations. We want to see a uniformity of speedy diagnosis throughout the country. That depends on early presentation by the patient and speedy diagnosis when the GP first sees the patient. It is with those two things in mind that a lot of work has been going on, particularly to support GPs, but also to inform the public.

[Baroness Finlay of Llandaff (CB)]

I declare my interest as president of the BMA. Will the Minister outline what action has been taken? Given the crisis in recruitment in general practice, the increased pressures on GPs now that they are also involved in commissioning services and the pressures in emergency medicine, how will GPs have time to tackle obesity? In the obese patient, early diagnosis is much more difficult than in the less obese patient. Also, the incidence of some cancers such as breast cancer is higher in those who are obese.

[Earl Howe]

My Lords, the noble Baroness makes a number of important points. In August, my right honourable friend the Secretary of State announced a joint piece of work with Cancer Research UK and Macmillan, which will see GPs offered more support to ensure that cancers are diagnosed as quickly as possible. More generally, NICE is updating its referral guidelines for suspected cancer to ensure that they reflect the latest evidence. GPs already have a guide related specifically to direct referral for diagnostic tests, for which we have provided extra money, and early last year the department part-funded a six-month pilot run by Macmillan of an electronic cancer decision support tool for GPs. That pilot is being evaluated, but Macmillan is working with IT software companies to disseminate an updated version of that tool.

[Baroness Pitkeathley (Lab)]

My Lords, given the importance of early diagnosis and of the significant role that GPs play in that, is the Minister concerned that some patients facing the problems that many now have of finding a GP quickly will be put off presenting with those early symptoms? That will thus get in the way of the early diagnosis that is so important.

[Earl Howe]

My Lords, I am aware that in some areas of the country access to GPs is proving problematic and a number of work streams are under way to address that. But we are confident in the light of the statistics that patients are not holding back in presenting to their GPs. As I said, referrals have gone up dramatically over the last few years and the NHS is treating a record number of patients.

[Lord Avebury (LD)]

My Lords, I declare an interest as a cancer patient. What arrangements are made for determining eligibility for treatment by the CyberKnife at the Royal Marsden and UCLH and does it involve any financial assessment of the likely cost to the NHS of the treatment of a particular patient?

[Earl Howe]

My Lords, my noble friend mentions a particular type of radiotherapy, the CyberKnife. At present there is only limited research evidence of the clinical and cost effectiveness of stereotactic ablative body radiotherapy—the full name. Therefore, it is available only for certain patients with lung cancer. Having said that, NHS England has agreed to make £6 million available over the next few years for new clinical trials which will involve trials on prostate cancer, lung cancer, pancreatic cancer and biliary tract cancers. It is important that we generate that clinical evidence before encouraging the NHS to apply this form of radiotherapy to those cancers.

[Lord Brooke of Alverthorpe (Lab)]

Will the noble Earl give the House an indication of when the deteriorating waiting times for cancer treatment will be reversed?

[Earl Howe]

My Lords, clearly a lot of work is going on in the NHS to ensure that we are back on track with the cancer waiting times. Local area teams of NHS England are looking at the causes of those waits and whether there are diagnostic tests that are responsible for the dip in performance. But I can assure the noble Lord that we place a high priority on this area.

Ebola

Earl Howe Excerpts

Monday 13th October 2014 Lords Chamber

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

My Lords, with the leave of the House, I shall now repeat a Statement made earlier this afternoon by my right honourable friend the Secretary of State for Health on the subject of Ebola.

“With permission, Mr Speaker, I would like to update the House on the Government’s response to the Ebola epidemic in West Africa. I shall start with the Chief Medical Officer’s assessment of the current situation in the affected countries. As of today, there have been 4,033 confirmed deaths and 8,399 confirmed, probable and suspected cases of Ebola recorded in seven countries, although widespread transmission is confined to Liberia, Sierra Leone and Guinea. This number is doubling every three to four weeks. The UN has declared the outbreak an international public health emergency.

This Government’s first priority is the safety of the British people. Playing our part in halting the rise of the disease in West Africa is the single most important way of preventing Ebola infecting people in the UK. I would like to start by paying tribute to the courage of all those involved in this effort, including military, public health, development and diplomatic staff. I particularly commend over 650 NHS front-line staff and 130 Public Health England staff who have volunteered to go out to Sierra Leone to help in our efforts on the ground. You are the best of our country and we are deeply proud of your service.

Among the three most affected countries, the UK has taken particular responsibility for Sierra Leone, with the US leading on Liberia and France focusing on Guinea. British military medics and engineers began work in August on a 92-bed Ebola treatment facility in Kerry Town, including 12 beds for international health workers. In total, we will support more than 700 beds across the country, more than tripling Sierra Leone’s capacity. With the World Health Organisation, we are training more than 120 health workers a week and piloting a new community approach to Ebola care to reduce, and hopefully stop, the transmission rate. We are also building and providing laboratory services, and supporting an information campaign in-country. We are now deploying the Royal Navy’s RFA “Argus” and its Merlin helicopters along with highly skilled military personnel, bringing our military deployment to 750. They will support the construction of the Kerry Town Ebola treatment centre and other facilities, provide logistics and planning support, and help establish and staff a World Health Organisation-led Ebola training facility to increase training to over 800 health workers a week.

Taken together, the UK contribution stands at £125 million plus invaluable human expertise and is the second-highest bilateral contribution after the US. But we need other countries to do more to complement the efforts of ourselves, the US and France. On 2 October, the Foreign Secretary held an international conference on defeating Ebola in Sierra Leone, during which over £100 million and hundreds of additional healthcare workers were pledged.

I will now move on to the risks to the general public in the UK. The Chief Medical Officer, who takes advice from Public Health England and the Scientific Advisory Group for Emergencies, this morning confirmed that it is likely that we will see a case of Ebola in the UK, and that this could be a handful of cases over the next three months. She confirmed that the public health risk in the UK remains low and that measures currently in place, including exit screening in all three affected countries, offer the correct level of protection. However, while the response to global health emergencies should always be proportionate, she also advises the Government to make preparations for a possible increase in the risk level.

Therefore I can today announce that the following additional measures will take place. First, on screening and monitoring, rapid access to healthcare services by anyone who may be infected with Ebola is important, not only for their own health but also to reduce the risk of transmission to others. While there are no direct flights from the affected region, there are indirect routes into the UK. Therefore in the next week Public Health England will start screening and monitoring UK-bound air passengers, identified by the Border Force, coming on the main routes from Liberia, Sierra Leone and Guinea. This will allow potential Ebola virus carriers arriving in the UK to be identified, tracked and given rapid access to expert health advice should they develop symptoms.

Those measures will start tomorrow at Heathrow, which receives around 85% of all such arrivals, beginning with terminal 1. They will be expanded by the end of next week to other terminals at Heathrow and Gatwick and on the Eurostar, which connects to Paris and Brussels-bound arrivals from West Africa. Passengers will have their temperature taken and complete a questionnaire asking about their current health, recent travel history and whether they might be at potential risk through contact with Ebola patients. They will also be required to provide contact details. If neither the questionnaire nor the temperature reading raises any concerns, passengers will be told how to make contact with the NHS should they develop Ebola symptoms within the 21-day incubation period, and allowed to continue on their journey. It is important to stress that a person with Ebola is infectious only if they are displaying symptoms.

Any passenger who reports recent exposure to people who may have Ebola, or symptoms, or who has a raised temperature will undergo a clinical assessment and, if necessary, will be transferred to hospital. Passengers identified as having any level of increased risk of Ebola, but without any symptoms, will be given a Public Health England contact number to call should they develop any symptoms consistent with Ebola within the 21-day incubation period. Higher-risk individuals will be contacted on a daily basis by Public Health England. Should they develop symptoms, they will have the reassurance of knowing that this system will get them first-class medical care, as the NHS demonstrated with nurse William Pooley, and the best possible chance of survival.

We expect these measures to reach 89% of travellers we know have come to the UK from the affected region on tickets booked for the UK. However, it is important to note that no screening procedure will be able to identify 100% of the people arriving from Ebola-affected countries, not least because some passengers leaving the countries will not be ticketed directly through to the UK. So today I can announce that the Government will ensure, working with the devolved Administrations, that there is highly visible information displayed at all entry points to the UK asking passengers to identify themselves, in their own best interests, if they have travelled to the affected region in the last 21 days. This information for travellers will be available by the end of this week.

We are also taking other important measures. We have tested operational resilience with a comprehensive exercise that took place on Saturday, modelling cases in London and the north of England. Local emergency services across England are holding their own exercises this week and will share lessons learnt.

It is vital that the right decisions are made on Ebola following any first contact with the NHS. So we have put in place a process for all call handlers on NHS 111 to ask people reporting respiratory symptoms about their recent travel history so that appropriate help can be given to higher-risk patients as quickly as possible. The Chief Medical Officer has also issued a series of alerts over recent months to doctors, nurses and pharmacists setting out what to do when someone presents with relevant symptoms. We will also send out guidance to hospital and GP receptionists.

The international profile of the UK as a favoured destination inevitably increases the risk that someone with Ebola will arrive here, so a great deal of planning has also gone into procedures for dealing with potential Ebola patients in the UK, working closely with the devolved Administrations. All ambulances are equipped with personal protective equipment, PPE. If a patient is suspected of having Ebola, they will be transported to the nearest hospital and put in an isolation room. A blood sample will then be sent to Public Health England’s specialist laboratory for rapid testing. If they test positive for Ebola, they will be transferred to the Royal Free Hospital in North London, which is the UK’s specialist centre for treating the most dangerous infectious diseases. We also have plans in place to surge Ebola bed capacity in Newcastle, Liverpool and Sheffield, making a total of 26 beds available in the UK.

We will always follow medical advice as to whether any measures we adopt are likely to be effective and are a proportionate response to risk. However, I believe that we are among the best and most prepared countries in the world.

Lastly, we are harnessing the UK’s expertise in life sciences to counter the threat from Ebola. The UK Government, alongside the Wellcome Trust and the Medical Research Council, have co-funded clinical trials of a potential vaccine which could be pivotal in the prevention effort. We are actively working with international partners to explore how we might appropriately make further vaccine available.

Finally, we should remember that the international community has shown that if we act decisively, we can defeat serious new infectious disease threats such as SARS and pandemic flu.

The situation will get worse before it gets better, but we should not flinch in our resolve to defeat Ebola both for the safety of the British population and as part of our responsibility to some of the poorest countries on the planet. Our response will continue to develop in the weeks and months to come, guided by advice from the Chief Medical Officer, Public Health England and the Scientific Advisory Group for Emergencies.

I commend this Statement to the House”.

My Lords, that concludes the Statement.

--- Later in debate ---

[Earl Howe]

My Lords, I am very grateful to the noble Lord for his comments and questions. I shall endeavour to cover as many as I can. First, let me turn to the advice that we have received in recent days from the Chief Medical Officer. It is important for me to underline that she has made it clear that we can expect a small number of cases over the next few months but that the degree of risk to the UK remains low. That is the point which noble Lords should keep in mind. It makes sense that we should identify people who have been to the affected areas and give them clear advice, making sure that they know exactly whom to call to get access to the best possible advice and care. The evidence from the Texas case, which the noble Lord cited, is that early identification of cases is absolutely critical and screening will help with that.

The noble Lord mentioned that the position of the Department of Health has changed over recent days. He is right; the Chief Medical Officer has been very clear that we are in uncharted territory so far as Ebola is concerned. We will learn as we go and base our policy on the best possible advice but we took the view that, as a Government, we would be failing in our duty if we did not take proportionate and targeted steps to safeguard the UK. The situation is developing all the time. No system of screening, as the Statement made clear, can offer 100% protection against an imported case of Ebola but our aim is to ensure that as many people as possible arriving from affected countries know the symptoms and how to get access to healthcare services as quickly as possible. We can be entirely confident in our ability to isolate and treat a case in this country, should it emerge, and we believe that the measures which we have announced will help to improve our ability to detect and isolate Ebola cases.

The noble Lord asked what modelling had been done on the number of cases. I am advised that a great deal of work has been done in an endeavour to predict numbers. I cannot give a precise number but the CMO’s advice is based on a risk assessment from Public Health England and she has been clear that, although the risk remains low, we should be prepared for a handful of cases over the coming months.

The noble Lord asked whether we had been planning for a worst-case scenario. As I said, the NHS has capacity available to cope with a number of cases. We are confident that the NHS’s capacity is adequate. We have two specialist beds available using the Trexler system at the Royal Free. There is further capacity at the Royal Free itself and surge capacity at a number of other units around the country. It is important, however, to understand that Trexler beds are not the only type of beds that can be used; other beds are appropriate for treating Ebola patients, given that the staff have appropriate PPE.

Turning to the prospects for treatment of Ebola, we are using our position as a global centre of research to understand Ebola better and help prevent a future outbreak. Working with the Wellcome Trust, we have launched a global call for research which could produce evidence to better manage the current outbreak and any that occurs in the future. The UK, alongside the Wellcome Trust and the Medical Research Council, has also co-funded clinical trials of a potential vaccine, as was mentioned in the Statement, which could be pivotal in preventing outbreaks. At the moment I am not in a position to give further details of that work.

The reassurance to the House is that there is now an expert group, chaired by the Chief Medical Officer, alongside Jeremy Farrar of the Wellcome Trust. The Chief Medical Officer and Sir Mark Walport, the Government’s Chief Scientific Adviser, have agreed that this group should be a SAGE group—that is, a Scientific Advisory Group for Emergencies. This will include the best experts that we have available.

The noble Lord asked me about international support for the effort in Sierra Leone on top of the support that we are providing from this country. As a result of the conference held in London on 2 October, a number of countries and organisations have made pledges. Australia has pledged £6.2 million, Canada £18.6 million and Switzerland £3.25 million. Cuba has pledged a significant number of staff. At the African Development Bank a further £94.9 million package of grants and loans has been approved, of which £31 million will go to Sierra Leone. Save the Children is launching a £44 million appeal, with £25 million for Sierra Leone.

Turning back to the UK, the noble Lord asked me about GPs and whether they know how to identify Ebola and what to do. As the Statement mentioned, the CMO has sent out a number of alerts, including to GPs. We are not at all complacent about this. We are asking the Royal College of General Practitioners and the BMA about how we could get messages out more effectively to their constituent members, as they have very good channels of communication.

Finally, I hope that I have sufficiently conveyed to the House that there is clear responsibility for the efforts that we are making in this country and in Sierra Leone to contain this outbreak. Ultimately, Ministers are accountable but, as I said, we have a SAGE group in operation; we have Public Health England providing advice to that group, along with the advice of other experts. The lines of accountability are clear.

[Lord Patel (CB)]

My Lords, I thank the noble Earl for his Statement. I have two quick questions. One relates to the staff who have volunteered to go out to Sierra Leone and to all soldiers. If any of them get infected while they are working there, will they be brought back to the United Kingdom for treatment? My second question relates to the treatment. While there are likely to be early trials of the vaccine that is being developed, it may well prove ineffective. But there are other companies developing other treatments. Are there plans to fast-track approval of these drugs if they are found to be effective? We know that the stock of ZMapp is now exhausted; further monoclonal antibodies development is likely to take some time.

[Earl Howe]

There is a limited amount that I can say to the noble Lord about his second question. A general answer is that we would naturally want to give as fast a passage as possible through the regulatory process to any breakthrough treatment for Ebola. It should be borne in mind, however, that safety is the paramount concern. This is why it is important that the vaccine, which is now in clinical trials, is thoroughly tested for safety as well as efficacy. If there is further news on this that I can impart to the noble Lord, I will be happy to write to him.

The noble Lord asked whether staff who volunteer will be repatriated if they contract the disease. My advice is that decisions on repatriation would be taken on a case-by-case basis, taking into account the clinical condition of the person and the benefit they may gain from repatriation. Repatriation involves a long journey that can potentially be dangerous for the patient. Once there is high-quality treatment available in Sierra Leone, it will not necessarily be in the best interests of the patient to be repatriated. That is why we are building the 12-bed unit specifically for national and international healthcare workers.

[Lord Fowler (Con)]

My Lords, I totally support the measures set out by the Minister. It is obviously sensible, as it has been in past events, for the Government to follow carefully the guidance of the Chief Medical Officer. Is not the real long-term task permanently to strengthen the inadequate and underfinanced health systems in so many parts of Africa? Would that not be to the benefit of tackling not just Ebola but other life-threatening conditions such as malaria, TB and HIV/AIDS?

[Earl Howe]

My noble friend has immense experience in this area and I completely agree with him. I attended a conference in Washington a few days ago which was called by the President of the United States at which 44 Health Ministers from around the world were present. I emphasised the very point my noble friend has made: yes, it is important to provide assistance to deal with the current emergency—everybody is agreed about that—but we must not lose sight of the need for the health systems in those poor countries to be bolstered in the way my noble friend mentioned and for there to be adequately trained clinicians and healthcare staff on the ground as well as diagnostic facilities so that in future those countries are capable of some resilience if they are hit by such an emergency again. I can tell my noble friend that DfID funding is going into that effort, as it has been systematically over the past few years.

[Lord Boateng (Lab)]

My Lords, the President of Ghana and chair of ECOWAS—the affected region—will be visiting the United Kingdom next week. He will be received graciously by Her Majesty the Queen, and he will come to this House on 22 October in order to address Members of this House and the other place. The success of the welcome measures outlined by the noble Earl will depend on the active engagement and involvement of West Africa and the whole of the affected region. Will the Minister ensure that the request that the President has put in to meet the Prime Minister and Cabinet members in order to discuss the appropriate co-operation between West Africa and the United Kingdom on these measures will be granted? The President has already made clear, and will make it clear to Members of this House next week, the appalling shortage of PPE and safety equipment on the ground in West Africa as we speak. There is a vital need for further resources and increased co-operation. The Prime Minister and Cabinet Ministers need to hear that message.

[Earl Howe]

My Lords, I am grateful to the noble Lord for giving me prior notice of his question. We very much look forward to the visit of the President of Ghana. His wish to discuss the Ebola emergency with the Prime Minister or a member of the Cabinet has been fed through at the highest governmental level. I cannot yet confirm whether or with whom such a meeting might be arranged, but I have asked that a response be forthcoming to the Ghanaian High Commission as soon as possible.

[Baroness Hamwee (LD)]

My Lords, the noble Earl mentioned information to GPs, pharmacists and so on. Can he tell the House anything about information to be given to the general public about the symptoms that we should be looking out for? Obviously I appreciate that one does not want to cause alarm, although I think the public are likely to be alarmed anyway, nor to overwhelm the services, but I imagine the Minister would agree that information is important.

Secondly, can he say anything about advice to air passengers? I do not mean those coming directly from the countries that we know are affected, but all air passengers. I imagine that all of us after a plane journey have got off thinking, “Hmm, with all that stale air, I think I’m about to go down with something—I can feel it at the back of my throat”. Are there precautions that air passengers generally should be taking? If so, will there be advice about this?

[Earl Howe]

My Lords, we are reviewing those very questions all the time. Our position at the moment is that it would be disproportionate to alert the general public to the risk of Ebola, because it remains low. As for air passengers generally, it is important to understand that the virus is transmitted only by direct contact with the blood or bodily fluids of an infected person. It is not an airborne infection. So while I do not in the least belittle the importance of a public health campaign should that prove necessary, we do not consider that it is warranted at the current time.

[Lord Winston (Lab)]

My Lords, I am slightly concerned—I hope the noble Earl will forgive me for not giving him advance notice of this question—about the possible risk of seeming a little complacent about saying that this is low-risk. We know that viruses mutate, for example, and we know that the Ebola virus can mutate. We know perfectly well that it is not airborne at the moment, and we know that the pharyngeal and upper respiratory tract cells are unlikely to harbour the virus. However, can the noble Earl assure us that people are looking at the risk of mutation of this virus so that we can make certain that its mode of transmission does not change and that, therefore, it will continue to be low-risk?

[Earl Howe]

I can give the noble Lord that assurance. There is very close monitoring of the virus itself and the way in which it mutates. I repeat that the official advice is that risk to the public in this country remains low. That advice is based on the fact that we have robust, well developed and well tested systems for managing infectious diseases when they arise, supported by a wide range of experts. The Chief Medical Officer has estimated that we should expect Ebola in the UK, but not more than a handful of cases, and we would be able to cope with those cases.

[Lord Alton of Liverpool (CB)]

My Lords, does not the handful of cases to which the noble Earl has just referred contrast very sharply with the prediction that 1 million people may die in West Africa? Given the fetid conditions and grinding poverty in places such as Monrovia and Freetown, does he not agree that this public health epidemic has been brought about because of the conditions that we have allowed to fester for so long?

Would the noble Earl not agree that the WHO was very slow in responding when this was first identified? Does he not also agree that an immediate problem is the disposal of corpses, which carry the risks of contagion? Furthermore, when will the 700 beds in Sierra Leone to which he alluded actually come on line?

[Earl Howe]

My Lords, I believe that the WHO itself has acknowledged that its response could have been swifter. It is easy to say this in hindsight, but I am sure that the noble Lord’s view on that is shared by others. Nevertheless, the WHO has not been slow in rallying support for efforts in the three countries affected. It is now working energetically with many developed countries to provide support, and I would not wish to criticise the WHO in those respects.

On the disposal of corpses, the noble Lord makes an important point. We know that many cases of Ebola in the three countries have arisen as a result of people being in contact with the corpses of people who have died from the disease. That has been as a consequence of the cultural traditions in those countries, which are very hard to displace or persuade people not to follow. It is nevertheless part of our effort in Sierra Leone that we should inform people there that their burial customs need to be set to one side for the duration of the epidemic. This is a very difficult thing to do, for understandable reasons, but that is the effort we are making and it is bearing fruit.

As to the programme for building 700 beds, I do not have a precise date to give the noble Lord but if I receive advice before the end of this debate, I shall tell him.

[Lord Reid of Cardowan (Lab)]

My Lords, manifestly, this is a terrible disease, not only in its nature but in its scale. According to the rate of growth indicated by the Minister, within around six months we could be looking at between 150,000 and 500,000 deaths, and between 2 million and 5 million suspected cases. Let us hope that that does not occur. However, in view of that, may I ask him one question about screening and entry? I welcome the fact that there is to be extended screening at Heathrow, Gatwick and the Eurostar terminal—two airports and one train station. Manifestly, this does not cover anything like the potential entrants to this country from those regions. With cheap travel and so on, I understand the difficulties in covering every airport, particularly as people break their journeys and do not come directly. However, is it not possible, given the use of so many biometric passports and the technology introduced to UKBA, somehow to target at least people from that area as potentials for screening, wherever they arrive in this country, rather than limit the coverage to three geographical in-ports? Does the Minister have any information on whether this hypothesis has even been tested?

--- Later in debate ---

[Earl Howe]

My Lords, I am grateful to the noble Lord. Existing technology used by the Border Force can inform it about individual passengers coming to this country and identify those who have recently travelled from Liberia, Sierra Leone and Guinea on routes with onward connections to the UK. Systems are therefore in place. We know that fewer than 1,000 passengers arrived by air from the affected countries in September. We are not therefore dealing with huge numbers. We know that around 85% of such people arrive at Heathrow, which is why we are starting there. However, it is important to look as widely as we can; the noble Lord is right. Again we should be reassured by the fact that there is screening on departure from Liberia, Sierra Leone and Guinea but we are starting the in-country screening in the UK at the three ports I mentioned, with the intention of scaling up screening, based on our experience. Plans are in place for a further rollout to other UK ports, if that should prove necessary.

[The Countess of Mar (CB)]

My Lords, my noble friend Lady Finlay of Llandaff has asked me to apologise to the House for her absence; she had to go to Wolverhampton. I hear the noble Earl saying that the department will consult the BMA and the RCGP about getting the message across to GPs. My noble friend asked me to ask whether a diagnostic algorithm was going to be posted on all appropriate websites, including those of the royal colleges and the BMA.

[Earl Howe]

I am not aware that the system being conveyed to GPs, which is not for diagnosis but for the referral of patients, can be called an algorithm, but there is a checklist of questions that we are recommending GPs use. That advice has been adapted for use in all healthcare settings, including NHS 111, as I mentioned in the Statement. Naturally, we shall take advice on whether the questionnaire and the sequence of questions are adequate. If it needs amending, we shall certainly not hesitate to do that.

[Baroness Andrews (Lab)]

The Minister mentioned SARS in his Statement. We have very few precedents, and he has already described this as being uncharted territory in relation to Ebola. What lessons were learnt after the SARS epidemic, particularly in relation to the organisation of global research? It was a different case because the virus was unknown but the same issues of mutation came up as those to which my noble friend referred. How will the lessons learnt be applied?

[Earl Howe]

The main lesson learnt from SARS, which in general was a very successful exercise, was that there are two keys to this. The first is informing people what to do if they think that they have symptoms, and the second is making sure that the NHS knows what to do if presented with a possible case of the illness. I hope my comments have conveyed that those two things are the focus of our activity in this country. We also need to make sure that adequate isolation facilities are available for patients with these highly transmittable conditions. That work has been done in the mean time, hence the isolation facilities at the Royal Free and other hospitals to which I have referred.

[Baroness Warnock (CB)]

With regard to research, could the noble Earl reassure us that the clinical trials will be speeded up by waiving the normal practice of control procedures? It seems unethical to use blind control in a case where the consequences of not being treated are fatal.

[Earl Howe]

I completely take the point of the noble Baroness, and there are processes on which we can draw to ensure that breakthrough treatments are fast-tracked. There are, however, certain necessary stages in testing any new vaccine or treatment that comes forward to make sure that it is safe. It may be clinically effective in its own way but have unacceptable side-effects, so we need to test that. I can reassure her that regulation will not stand in the way of making a breakthrough treatment available.

To answer the earlier question of the noble Lord, Lord Alton, I shall write to him with further details, but the 700-bed facility is under construction now. The first facility as part of that will be open by the end of October in Kerry Town.

Learning Disabilities: Premature Deaths

Earl Howe Excerpts

Wednesday 30th July 2014 Lords Chamber

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

My Lords, actions are under way with a range of national delivery partners and at local level in response to the inquiry’s recommendations, including improvements in the identification of people with a learning disability, the auditing of reasonable adjustments, and the provision of health checks. Progress is monitored through the Learning Disability Programme Board.

[Baroness Hollins (CB)]

My Lords, I welcome the commitment in the NHS business plan and the Department of Health mandate to try to reduce premature mortality in people with learning disabilities, and in particular to establish a national mortality review function, but until the necessary data linkages have been made, the review cannot begin. What action is being taken to ensure that the Health and Social Care Information Centre will prioritise the collection of the data required, such as identifying people with learning disabilities and their causes of death, so that the review can indeed begin?

[Earl Howe]

My Lords, the specification for the mortality review function is under development, and we all wish to see that work proceeded with rapidly. Data to support the function will be needed from both national and local sources. Work is under way with NHS England, the Health & Social Care Information Centre and Public Health England to derive data to underpin both the mortality review function and the NHS Outcomes Framework. However, it is important that this should take full account of wider developments in the collection and sharing of patient data, and this will inevitably impact on the pace of progress. As I am sure the noble Baroness recognises, it is vital that we get that right.

[Lord Addington (LD)]

My Lords, my noble friend will undoubtedly remember that we had a discussion in this House on the problems of the deaf in trying to access healthcare, and how that leads to other problems. Will there be a pan-disability look into this problem? It is clear that those who have problems communicating in forms of consultation with the NHS get bad results from it.

[Earl Howe]

My Lords, many of the issues that apply to those with learning disabilities also apply to others with different disabilities, and the work currently going on in the context of the noble Baroness’s Question will, I think, have a beneficial impact across the piece.

[Lord Wigley (PC)]

Does the Minister accept that a number of the points arising out of the confidential inquiry were touched upon by the earlier DRC report published more than six years ago, Equal Treatment: Closing the Gap, and that progress since then has been patchy? In the light of that, will he give a commitment that there will be an annual review of progress made on the confidential inquiry recommendations and a report to Parliament?

--- Later in debate ---

[Earl Howe]

My Lords, I can assure the noble Lord that there is currently a whole-system response to the recommendations in the review. As I said earlier, this is a response from NHS England, Public Health England, local organisations and, indeed, Ministers overseeing the Learning Disability Programme Board. I shall take away the noble Lord’s question about a formal annual review, consider it carefully, and write to him.

[Lord Hunt of Kings Heath (Lab)]

My Lords, does the noble Earl recognise that the confidential inquiry showed that there are great failings in the health treatment given to many people with learning disabilities, which probably contributes to their very poor life expectancy? He will be aware that my own former trust, Heart of England, appointed specialist liaison nurses who could help people with learning disabilities find a pathway through their healthcare. Would he advise other NHS trusts to follow that example?

[Earl Howe]

My Lords, the noble Lord makes a good point. Following the recommendations of the UK review of learning disabilities nursing, we have set up an independent collaborative to address that workforce’s needs. We are also working with Health Education England’s 13 local education training boards to develop greater links with the independent and voluntary sector which will help with workforce planning. This year Health Education England increased its national commissions for student learning disability nurses by 4.5%. We are working on a number of initiatives to raise the profile of learning disabilities nursing and promote the profession as an attractive career choice.

[Baroness Browning (Con)]

The report identifies 37% of deaths that could have been prevented. People with learning disabilities and those on the autistic spectrum, some of whom are included in the report, experience communication problems at hospital level. Will my noble friend please put government force behind the issuing of hospital passports for people with learning disabilities and those with autism? The autism hospital passport was launched two weeks ago and is on the NAS website. However, these very important documents can help to prevent death only if clinicians and hospital staff read them, take note of them and act on them.

[Earl Howe]

I take my noble friend’s point. The specific needs of people with learning disabilities are being considered as part of the overall work programme to provide people with online access to their GP practice and GP-held e-record. That is being done in the wider context of the development of a fully comprehensive patient-held record. NHS England plans to hold a meeting later this year to look at developing a national standard for a hospital passport. This will be a patient-held document that will detail key information to be shared with any contact in the NHS.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, what is the Minister doing to ensure that comprehensive community learning disability teams are available in all areas and that GPs are proactively referring patients with a learning disability to these vital services?

--- Later in debate ---

[Earl Howe]

My Lords, the learning disability teams are of crucial importance in ensuring that those with a learning disability are able to access the services that they need. I have a long list of things that are relevant to that subject and I am happy to write to the noble Baroness with that information.

Mental Health: Beds

Earl Howe Excerpts

Tuesday 29th July 2014 Lords Chamber

[Lord Bradley]

To ask Her Majesty’s Government what action they are taking to stop patients being unnecessarily sectioned because of shortages of mental health beds.

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

My Lords, we are not aware of any incidents of patients being unnecessarily sectioned. In June 2013, the Care Quality Commission asked for notification of such cases. It is for local clinical commissioning groups to commission the right number of in-patient beds to meet the mental health needs of their local population.

[Lord Bradley (Lab)]

I am grateful to the Minister for that reply, although I am slightly surprised. Does the Minister agree that it is wholly unacceptable that, according to the Royal College of Psychiatrists, doctors are still being forced to section patients to get them their in-patient care? That follows a warning by the Health Select Committee last July on the need to investigate urgently whether patients are being sectioned for them to access psychiatric units, and report to Parliament on the prevalence of that practice. What action have the Government taken on that committee report? Will the Government, if they look carefully at those findings, consider making emergency funding available, similar to that which they made available to A&E departments in the winter, to immediately ease the mental health crisis in beds for adults and children?

[Earl Howe]

My Lords, I am certainly aware that a number of concerns have been raised about the lack of mental health beds and that there are occasions when patients do not receive care quickly enough because approved mental health professionals cannot locate an appropriate bed. As I said in my original Answer, that is essentially a failing of local clinical commissioning. However, AMHPs—approved mental health professionals—should not be put in that position. We are consulting at the moment on a revised code of practice for the Mental Health Act. That consultation includes a specific question which asks what additional guidance should be included to ensure that AMHPs are not put in that position.

[Lord Laming (CB)]

Does the Minister accept that depriving a citizen of their liberty is one of the most serious matters that can be undertaken in our society and that it should be done only for very sound reasons, certainly not because of the absence of provision for their needs? When the Minister kindly replied to a Question for Written Answer from me earlier in the year, he said:

“Local areas are expected to … deliver their own ‘Mental Health Crisis Declaration’”.—[Official Report, 18/6/14; col. WA70.]

Can he tell the House how many local areas have signed up to a declaration, and more particularly, how many have failed to do so?

[Earl Howe]

My Lords, on the very last point, I do not have up-to-date figures, but I will certainly write to the noble Lord. However, on his main question, detention as a mechanism solely to secure access to hospital treatment would not be lawful. If hospitals or local authority staff think that that is happening or feel pressurised to admit people in that way, they should report it to their trust and, if necessary, to the Care Quality Commission. Sectioning under the Mental Health Act, which denies people their liberty, is a very serious matter. It should be done only when a person is a risk either to themselves or to other people and, as the noble Lord knows, it is a legal process. A patient cannot be sectioned merely to secure a bed.

[Baroness Brinton (LD)]

My Lords, the survey referred to by the noble Lord, Lord Bradley, was of junior doctors in the Royal College of Psychiatrists. If it was somewhat anecdotal and they felt that they were unable to report it formally, can Ministers ask NHS England to ensure that there is a survey of how many doctors are having to use sectioning, to prevent this continuing?

[Earl Howe]

It certainly is important that we get to the bottom of what is really happening. We take this issue very seriously. The Care Quality Commission intends to explore the issue of people being detained in order to access psychiatric units in its ongoing review of emergency mental health care. The findings of that review will be published later this year. The CQC’s Mental Health Act commissioner regularly and routinely looks at the lawfulness of detention. In fact, the Care Quality Commission is currently developing a new approach to its responsibilities as a regulator of the 1983 Act.

[Baroness Uddin (Non-Afl)]

My Lords, as a former social worker I know all too well the real cost of sectioning people, the impact that it has and, of course, the immense cost to the overall economy. How will the Government ensure that communities are equipped to look after those with moderate needs, some of whom will have learning disabilities and conditions such as autism spectrum disorder, before a crisis point is reached?

[Earl Howe]

The noble Baroness referred to people with moderate health needs, which is departing slightly from the Question on the Order Paper. However, I can tell her that mental health policy and its delivery is now a major focus. We have a mental health system board to ensure that all the elements of the health and care system work as effectively as possible together. There is a ministerial advisory group in operation. Parity of esteem is reflected in the NHS constitution and in the Health and Social Care Act 2012. We have challenged NHS England through the mandate to make measurable progress this year towards achieving parity of esteem between mental and physical health.

[Baroness Hollins (CB)]

My Lords, in 2013 a census found that three-quarters of people with a learning disability admitted to a specialist in-patient facility were subject to the Mental Health Act. For a third of these, learning disability was the only reason given for their admission, without any of the additional requirements under the Act for detention being met. What action are the Government taking to ensure that the Act is being used correctly in the care and treatment of people with a learning disability?

[Earl Howe]

My Lords, if people with a learning disability are detained under the Act, this must be for assessment or treatment of mental illness. The person must satisfy the strict criteria laid down in the 1983 Act. When a learning disability is identified as well as a need for assessment or treatment of a mental disorder, the important thing is that alternatives to the use of the Mental Health Act are considered—for example, use of the provisions of the Mental Capacity Act and whether reasonable adjustments would assist the person with learning disabilities fully to access the assessment and treatment. This is an area we have explicitly covered in the draft code of practice, which is currently out for consultation.

[Baroness Manzoor (LD)]

My Lords, more black and ethnic minority people continue to be detained under the Mental Health Act. Can my noble friend the Minister say what is being done to address that issue?

[Earl Howe]

Yes, my Lords, we know that BME groups are overrepresented in the detained patient population. The reasons for that are quite complex. Research studies indicate that rates of detention reflect the needs of patients at the time of detention. We know that the rates of psychosis, for example, are higher in some BME communities, and they often access mental health services in a crisis. The reasons for that are not entirely clear. We recognise that more work needs to be done to establish the causes of higher rates of mental illness in some communities.

Health: Stroke

Earl Howe Excerpts

Wednesday 23rd July 2014 Grand Committee

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

My Lords, I express gratitude to the noble Baroness, Lady Wheeler, for raising this very important issue, and to all noble Lords who spoke for their valuable and excellent contributions. It will be difficult if not impossible to do justice to the points and questions in the time available, but I undertake to write on those that I am unable to cover today.

Strokes in children are thankfully uncommon, but the effects of a stroke can be devastating both for those who have one and for their families and loved ones. This is particularly the case with children, where a stroke may have a lasting impact on their development and educational attainment, with grave implications for their future.

It is important therefore that there is awareness of childhood stroke. Public Health England is responsible for awareness campaigns and has run the Act FAST campaign to raise awareness of stroke for the last six years. It is its most successful campaign. The Act FAST campaign depicts older adults, and, while there is no specific focus on children, the message remains the same. However, as many noble Lords will know, the signs of a stroke in infants and young children may be less obvious, and Public Health England will want to consider whether a specific campaign aimed at raising awareness of strokes in children is needed.

The provision of stroke care by the NHS necessarily embraces a wide range of different services. There are different causes of stroke in children—including disorders of the heart, blood and vascular system, as well as infections—and the effect of strokes will also be different. As noble Lords will know, there is a heightened risk of childhood strokes from certain variants of sickle cell anaemia, for which all newborn babies in England are screened with a heel-prick test. I will write to my noble friend Lord Smith in answer to his questions on this subject.

The risks of stroke for children with these variants of sickle cell disease can be assessed using a test known as a transcranial Doppler scan, and those deemed at high risk can be treated with blood transfusions. An annual scan is recommended for children with these variants of sickle cell disease, and NICE guidelines and a national screening programme for sickle cell are already in place.

Not all strokes can be prevented, though, and where a child does suffer a stroke it is important that they get the right treatment. Where a stroke leaves a child with complex or specialist needs, their treatment will normally be delivered through specialised paediatric neurology services commissioned by NHS England. Noble Lords will be pleased to hear that NHS England is running a number of pathfinder projects looking at the care processes for paediatric neurosciences through its Paediatric Neuroscience Clinical Reference Group. This work seeks to define the best arrangements for paediatric neurology patients and encompasses children’s strokes. In addition, the Royal College of Physicians is currently updating its 2004 guidelines on childhood stroke and I would expect these standards to be considered by the Paediatric Neuroscience Clinical Reference Group in due course.

I understand the call to integrate childhood stroke into the cardiovascular diseases outcomes strategies. NHS England is currently leading a group to implement the 10 key actions to improve outcomes for cardiovascular disease. It would be for NHS England, working with key stakeholders, to consider whether childhood stroke should be included in this work, and I will ensure that it is made aware of noble Lords’ views on this issue. I am sure that NHS England will look to encourage an integrated and life-course approach to stroke care, ensuring that paediatric care is appropriately aligned with adult strategies.

Mainstream services, including ongoing care, for supporting children who have had a stroke—and their families—are commissioned by clinical commissioning groups. It is worth recognising that clinical commissioning provides an effective basis for ensuring that children who have suffered a stroke are effectively supported: CCGs are under a duty to obtain appropriate advice from persons who, taken together, have a broad range of professional expertise in the prevention, diagnosis or treatment of illness. This is essential for such a complex area of clinical practice which must be informed by emerging evidence.

The noble Baroness, Lady Wheeler, and the noble Lords, Lord Patel and Lord Imbert, referred to the need for research. As far as evidence is concerned, the National Institute for Health Research currently funds two studies on childhood stroke through its biomedical research centres at Imperial College and Great Ormond Street Hospital, including one looking at the outcomes of childhood stroke. The NIHR welcomes funding applications for research into any aspect of human health, including the needs of children and young people who have had a stroke.

A number of noble Lords, including the noble Baroness, Lady Wheeler, mentioned the need for good rehabilitation services for children. We are aware that there is a significant issue around capacity in paediatric neurological rehabilitation in England. I understand that NHS England is currently undertaking work to assess future capacity needed. Any expansion of capacity would, of course, have cost implications. In addition, in April 2014, NHS England established the specialised commissioning task force to make immediate improvements to the way in which NHS England commissioned specialised services, and put commissioning arrangements on a stronger footing for the longer term.

I mentioned the pathfinder projects looking at end-to-end care processes for paediatric neurosciences. In addition, I am advised that NHS England has indicated that it will ensure that due consideration is given to the Royal College of Physicians guidelines for treating children who have suffered strokes.

My noble friend Lord Rodgers made the telling point that GPs should be required to do training in child health. As part of the mandate to Health Education England, it committed to ensuring that GP training produces practitioners with the required competences to practise in the new NHS. To support this, Health Education England has been asked to work with the devolved Administrations and the Department of Health on responding to the recommendations of the Shape of Training report on postgraduate specialty training, and the provisional findings of NHS England’s review of primary care services. The case for a fourth year and enhancements to GP training will be explored further as part of this response, including specific training in that extra year in child health and paediatrics.

The noble Baroness, Lady Wall, and my noble friend Lord Rodgers raised concerns about the time until diagnosis. We are committed to working to improve the health outcomes delivered by the NHS for children. That is why we set up the Children and Young People’s Health Outcomes Forum in 2010. Its report set out a number of recommendations. One which we are working on is to develop a new indicator which would report the time from the first presentation to the NHS to definitive diagnosis and start of treatment.

As part of our response, we made a pledge alongside key partners, including NHS England, NICE, Health Education England and the Society of Local Authority Chief Executives, to work together to improve health outcomes for children. Our shared ambitions are for children, young people and their families to be at the heart of decision-making. Together, the organisations who signed the pledge are making progress towards meeting those ambitions. However, there is much work to be done and the Children and Young People’s Health Outcomes Forum will continue to actively monitor progress on the action taken as a result of the recommendations made in its initial report published in July 2012. This work will help to improve the outcomes and experience of children who suffer strokes and their families.

In reply to the noble Lord, Lord Patel, I say that the new integrated arrangements for children and young people with special educational needs, which the Children and Families Act introduces from September, are the ideal basis for ensuring that special educational services and social care can be planned in a joined-up way with the healthcare that a child needs arising from a complex condition. Children with SEN will have an education, health and care plan, which different sectors will come together to assess and plan for, focusing on the outcomes which make the biggest difference to the child. We are committed to ensuring that staff who work with children have the right skills and experience. That is reflected in our mandate to Health Education England.

There are therefore a number of opportunities on the horizon which could contribute significantly to improved outcomes for childhood stroke, and I again thank all noble Lords who have spoken in this excellent debate.

Health: Dental Implants

Earl Howe Excerpts

Wednesday 23rd July 2014 Grand Committee

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

My Lords, before I respond to the particular points raised by my noble friend on the issues to which she drew our attention, I begin by paying tribute to the way she has consistently championed the commitment of members of her profession to improving the oral health of the population and the quality of dental care provided in this country.

The oral health of the nation has been transformed since the creation of the NHS in 1948, and the rate of improvement has picked up pace since the introduction and widespread use of fluoride toothpaste in the late 1960s and early 1970s, and the growing awareness of the need for good oral hygiene.

The coalition made two key commitments in relation to dentistry in 2010: to increase access to NHS dentistry and to improve oral health by reforming the NHS dental contractual system. We are making solid progress on that reform. As noble Lords know, there is currently an engagement exercise aimed at dentists and the wider dental community. As part of this I took part last month in a web chat, and I was encouraged by the positive—though, of course, rightly robust—questioning and debate from those dentists who took part.

However, we are not waiting for this more fundamental reform before starting to tackle access and oral health. We are already making progress on delivering on those commitments. The people of this country appreciate the ability to access dental care when it is needed, and the number of people seeing a dentist under the NHS since May 2010 has increased by 1.5 million. We are also committed to working with our partners, including those in the profession, to improve the oral health of the population—with a particular focus on children. The latest epidemiological data published by Public Health England demonstrates that progress is being made. Like the noble Lord, Lord Hunt, I follow with interest the decisions being taken locally about fluoridation of water.

These decisions are best taken locally and the arrangements we made under the Health and Social Care Act 2012 are intended to increase democratic legitimacy of decisions on fluoridation; I am pleased that the noble Lord attended the 50th anniversary of the city of Birmingham’s fluoridation scheme. Dental caries continues to affect a sizeable proportion of the population and is a common cause of children being admitted to hospital, as my noble friend mentioned, for the removal of decayed teeth. Public Health England recently published a health monitoring report which showed lower rates of tooth decay and hospital admission in fluoridated areas compared to non-fluoridated areas. In March, Public Health England published guidance for local authorities on improving oral health for children and young people. That guidance advises on the range of measures, including water fluoridation, that local authorities might consider as part of their oral health improvement strategies.

One of the real drivers of this improvement in oral health has been the greater appreciation by the public of the value and importance of both good oral health and acceptable appearance. With this value now placed on oral health has come significant technological development, and again the dental profession must be congratulated on the way it has researched and developed new techniques and procedures to improve oral health and functionality; the use of implants, which my noble friend focused on, is a case in point. We recognise that inequalities still exist and my officials are working with colleagues in Public Health England, NHS England and local authorities to tackle those inequalities; nevertheless, the overall trend is positive.

My noble friend pointed out that smokers are more at risk of peri-implantitis. Public Health England’s Smoke-free and Smiling guidance supports dentists to make brief interventions to help patients who want to stop or cut down to access dedicated stop-smoking services. Dental surgery is a key opportunity to get across brief messages of issues that have implications for oral health—and in this case, of course, the patient’s wider health.

Dental implants can be used in a range of situations. They can play a key role in reconstruction, post-trauma or major surgery. They can sometimes be used, as my noble friend mentioned, as a support for a more extensive prosthesis following surgery for head and neck cancer, and can also be used to retain restorations in the mouth where teeth are missing. I know that the vast majority of cases where implants have been used to replace missing teeth have historically been provided in the independent sector, outside the auspices of the NHS. There are, of course, many other treatment options to be considered, including bridges or dentures, depending on the individual clinical circumstances.

The NHS has a duty to commission services which are both clinically appropriate and cost effective and it is important when discussing the replacement of missing teeth that all those options are discussed. We also need to be aware, as my noble friend mentioned, that some patients choose to travel abroad to have implants fitted because the initial treatment might be available abroad at a lower cost. The General Dental Council has good guidance available on its website for members of the public considering travelling abroad for dental treatment. It is important that people travelling abroad for this sort of treatment understand that, without the ongoing clinical care and support that this type of treatment requires, what looks like a low-cost option initially might ultimately turn out to be high-cost—both financially and from a health outcome perspective.

I am aware that NHS England is providing a series of commissioning guides to give clarity to commissioners and clinicians when discussing treatment options with patients. For dentistry, four such guides are in development, focused on specific areas of dental care. One of these is a restorative commissioning guide and the appropriate use of implants is, I understand, included as part of that work. As my noble friend quite rightly mentioned, appropriate post-placement care is vital if these restorations are to be successful in the long term.

There has been a significant increase in the placement of intra-oral implants in the last 20 years and, although the immediate result can be instantly impressive, it is vital that patients receive good aftercare, including the periodontal checks my noble friend referred to and instruction on how to maintain a healthy interface between the implants and natural tissue. Indeed, in the third edition of Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention, published recently by Public Health England, there is a section on peri-implant health which focuses on these very issues. This provides detailed guidance for clinicians on what they should do at each visit for patients who have had implant treatment. We would expect clinicians to carry out procedures only where oral health is good enough to support the treatment being provided—the point made by our noble friend Lord Colwyn, who cannot unfortunately be with us—and to provide aftercare advice to patients, including advice on self-care and the need for regular check-ups.

However, we know that there is more to do. My noble friend will also, I hope, be pleased to hear that my officials and the Chief Dental Officer have already recognised the issue she raises as a potential area for growing concern. A UK-wide working group, which includes representation from the dental faculties, has been established. Chaired by the Chief Dental Officer, it will look at developing clear and consistent cross-system guidance relating to treatment planning prior to the placement of implants, the education and training required by the clinicians—a point raised by the noble Lord, Lord Hunt—and best practice for aftercare, as referred to by my noble friend. It will also look at how appropriate, easily understood information can be made available to members of the public considering this form of treatment. I am pleased that this group has been set up and understand that it met for the first time earlier this month.

I hope that my noble friend is reassured by the fact that we have already recognised this as an area where public awareness needs raising and that we are taking action to address this. At the end of her excellent speech, my noble friend mentioned the recent data regarding the admission of young children for the administration of a general anaesthetic for removal of teeth. This is unacceptable as dental caries is a preventable disease which can be almost eliminated by the combination of good diet and correct tooth-brushing, backed up by regular examination by a dentist. NHS England is working with colleagues within and outside the profession to educate and inform the parents of these young children so that they are not subject to this extremely unpleasant experience at such an early age.

Committee adjourned at 8.12 pm.

Learning Disabilities: Community-Based Support

Earl Howe Excerpts

Tuesday 22nd July 2014 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what action they are taking in the light of the events at Winterbourne View hospital to ensure that people with learning disabilities inappropriately placed in hospital are able to move to community-based support.

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

My Lords, the Government are working with health and care system partners, self-advocates, family carers and other stakeholders to improve safety, quality of care and outcomes for people with learning disabilities, including reducing significantly reliance on in-patient care, by reviewing people’s care and moving them to alternative, community-based support where appropriate.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the noble Earl for that. Can he confirm that the Government set a deadline of 1 June for the transfer of thousands of people with learning disabilities out of institutions such as Winterbourne View? The latest figures show that only one in 10 such residents has actually been so moved. Will the noble Earl accept responsibility for this and tell the House what the Government intend to do about it?

[Earl Howe]

My Lords, the Government’s mandate for NHS England in the current year includes an objective which covers Winterbourne View concordat commitments. He is right that the deadline was missed. We are not satisfied with that and we are working very hard with NHS England to set out our expectations for progress and improved rates of discharge from in-patient settings. NHS England is going to produce an action plan this August but, in the mean time, it is doing three things. It is complying with the transforming care and Winterbourne View concordat commitments, which we have tasked it to do. It will set out what progress it expects to make and by when, with milestones, and it will provide real clarity on what success looks like—an important issue if we are trying to hold it to account—and how progress will be measured.

[Baroness Hollins (CB)]

My Lords, is the Minister aware that in the first six months of this year, 544 new people were admitted to assessment and treatment units and only 338 were transferred? Does he agree, therefore, that prevention is as important as discharge, and that in order to achieve both of these, skilled community support and skilled specialist support in the community are urgently needed and need to be funded?

[Earl Howe]

I do agree with the noble Baroness. For people who, with the right support, could and should be living in community-based settings, there is a variety of reasons why sometimes that does not happen. The lack of appropriate housing can be a barrier. For others, we know that clinical decisions are preventing discharge. NHS England is looking very carefully at how to strengthen second opinion to support people in in-patient settings to challenge the reasons for their placement as and when they need to. We are looking at making some capital funding available to support the transfer of people from in-patient care to community-based support.

[Baroness Tyler of Enfield (LD)]

My Lords, given the figures we have just heard about the number of people with learning disabilities being admitted to costly assessment and treatment units rather than leaving them, will my noble friend the Minister say what action the Government are taking to ensure that local commissioners—in both local government and the NHS—have the necessary skills and competence to deliver the high-quality local services that are needed to allow as many people as possible to return to their communities?

[Earl Howe]

My noble friend is absolutely right to focus on the role of commissioners. The Winterbourne View joint improvement programme has already stepped up its activity in working with local areas, including identifying 35 areas for in-depth review. NHS England is engaging with commissioners to reinforce the importance of ensuring appropriate services for people with learning disabilities close to their homes and families. That includes looking at how funding streams can be shared with local authorities so that there is no procedural blockage in the way that money moves across the system.

[Lord Wigley (PC)]

My Lords, on that very point of funding, how will the Government ensure that funding in fact follows the individual and does not, as so often currently occurs, remain locked into the funding of the wrong kind of provision? In asking this, I draw attention to my registered interest as vice-president of Mencap.

--- Later in debate ---

[Earl Howe]

Lessons are being learnt almost by the day by the NHS and local government on how to pool funding and share responsibility in areas of this kind. Admittedly, most of the effort at the moment is on the vulnerable elderly but the lessons apply equally to those with learning disabilities and to ensuring that we do not have any artificial walls forming between the NHS and local government as regards the flow of money. I can tell the noble Lord that this is a major area of focus for both NHS England and the Local Government Association at the moment.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, given the recent resignation of the director of the joint improvement programme, which was tasked with delivering the Winterbourne View action plan only 18 months ago, will the Minister let us know what the future of the programme holds and how it will work with the new group, also tasked in a similar way, led by Sir Stephen Bubb?

[Earl Howe]

My Lords, I have every confidence that the programme will continue as we had hoped it would, and indeed with a renewed momentum. The noble Baroness is right that NHS England has asked Sir Stephen Bubb, the chief executive of the charity leaders’ network ACEVO, to head a new group of experts and advisers to develop a national guide on how we provide health and care for those with learning disabilities. We have every confidence that Sir Stephen, with his immense experience in these areas, will be able to bring everybody together to a good result.

[Lord Laming (CB)]

My Lords, will the Minister assure the House that the only criteria that will be used in making these arrangements is the way to improve the quality of life of the user of the services rather than any bureaucratic processes set by NHS England?

[Earl Howe]

The fundamental principle that must underpin and inform all decisions in this area is about ensuring that we respect people with learning disabilities as individuals who have the same rights as everyone else, including the opportunities to make informed choices about where and with whom they live. The noble Lord is absolutely right.