Abortion
Earl Howe Excerpts(10 years, 2 months ago)
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Baroness Knight of Collingtree
To ask Her Majesty’s Government what action they intend to take in the light of recent analysis of the ratio of boys and girls in United Kingdom families suggesting that sex-selective abortion is taking place.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, it cannot be concluded from the recent analysis in the Independent newspaper that sex-selective abortions are taking place. We are absolutely clear that abortion on the grounds of gender alone is against the law and completely unacceptable.
Baroness Knight of Collingtree (Con)
My Lords, does my noble friend recall that when I last asked a Question on this matter in October, the House was informed that it was impossible to prosecute doctors known to be aborting on gender grounds because the evidence was not strong enough? However, has the Minister noted the findings of the national census of 2011, which show that between 1,400 and 4,700 fewer girls have been born recently? This, it was said, can be explained only by the fact that termination of girl babies is going on, even though my noble friend has said this morning and NHS spokesmen have warned that such operations are,
“against the law and completely unacceptable”.
When are the Government going to stop this practice, and what are the implications if they do not do so?
Earl Howe
My Lords, the analysis recently reported in the Independent newspaper was based on census data, as my noble friend pointed out, for households with usually-resident dependent children. The gender balance of dependent children in these households is affected by a number of events that occur after birth, such as the age at which dependent children leave the parental home. As there are a number of alternative explanations for these observations, it cannot be concluded from the Independent’s analysis that sex-selective abortions are taking place. The best available data on which to base gender ratio analysis continue to be births data, which were the basis on which we did our analysis last year. I can tell my noble friend that that analysis will be updated on an annual basis when new data are available.
Lord Singh of Wimbledon (CB)
My Lords, gender-selection abortions are an extreme form of gender discrimination. Sadly, it is all too prevalent in sub-continent communities. The Sikh guru, Guru Nanak, taught from day one the total equality of women; they can join in and lead any part of the Sikh service. Unfortunately, culture sometimes gets the better of religion; even in the Sikh community, that sort of discrimination can take place. Will the Minister ensure that funding given to sub-continent communities is conditional—indeed, is predicated—on promoting gender equality and respect for women because, at the moment, it often feels as if it is given to those who shout the loudest?
Earl Howe
My Lords, the provisions of the Equality Act 2010 must be adhered to by all who provide a public service. Any specific allegations about gender-selective abortions being undertaken will be reported to the police. Abortion on the grounds of gender alone is illegal, as I have said. The Abortion Act is very clear on that point.
Lord Steel of Aikwood (LD)
Have my noble friend and his department had any discussions with the General Medical Council on this matter? It needs to be made publicly clear that, as he said, whatever happens in other countries, this practice is not acceptable in this country.
The Lord Bishop of St Albans
My Lords, there is an opportunity coming up where this can be underlined. At the moment, the procedures for the approval of independent sector places for the termination of pregnancy are being revised. Will Her Majesty’s Government undertake to ensure that they spell out clearly and unequivocally that termination on grounds of gender alone is illegal and that an appeal on gender alone is insufficient to satisfy the mental health criteria of the Abortion Act?
Baroness Thornton (Lab)
The Minister has explained the issue extremely clearly. When the next tranche of research on live births comes through, will the Government undertake to dig deep into it to ensure that illegal sex-selective abortions are not taking place? Secondly, there is a statement in today’s Daily Telegraph about 36 abortion centres that are giving unreliable and misleading advice to women who wish to discuss terminations—for example, by telling them that if they have a termination they may get breast cancer. I know that the Department of Health has issued guidelines on this but I would like to know what the Government intend to do about it.
Earl Howe
On the noble Baroness’s first question, the detailed analysis that we did last year was quality-assured by the methodology team at the Office for National Statistics. I can tell her that the team will quality-assure the future analysis of data each year. On the story in the Daily Telegraph, patients should be able to expect impartial advice from the NHS. CCGs and NHS providers must account for the counselling services that they recommend. Guidance on the provision of non-judgmental counselling was included in the Government’s framework for sexual health improvement, published in March last year.
Food and Soft Drink Industry: Sugar
Earl Howe Excerpts(10 years, 2 months ago)
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Baroness Morgan of Ely
To ask Her Majesty’s Government what representations they have made to the food and drink industry about reducing levels of sugar in processed products in the United Kingdom.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, through the public health responsibility deal calorie reduction pledge, food and soft drink companies are taking a range of actions to reduce calories, including sugar, in their products. Currently 38 businesses are signed up to the pledge. We are working across the industry to encourage further sign-up.
Baroness Morgan of Ely (Lab)
My Lords, five out of eight members of the carbohydrate working group on nutrition which advises the Government have direct links to the food and drink industry. Does that explain why it has taken five years for this group to report? Can the Minister explain why we do not simply follow the position of the World Health Organisation, which is expected to report that people’s energy from added sugar should be reduced from the current recommended level of 10% to 5%?
Earl Howe
My Lords, the reason that we meet the food industry is to ask it to do more than it is doing at the moment. If that is what the noble Baroness means by the Government’s links to the food industry, then I make no apology for them. Our current emphasis is on overall calorie reduction, of which sugar can form a part. The scope for reformulation to reduce sugar levels varies widely depending on the food, and a reduction in sugar levels does not always mean that the overall calorie content is reduced. The Scientific Advisory Committee on Nutrition is currently undertaking a review of carbohydrates, as part of which it is looking at sugar. Its report will inform our future thinking.
Baroness Brinton (LD)
It is shocking that a 375-gram portion of Sharwood’s sweet and sour chicken with rice contains six teaspoons of sugar. Some of our supermarkets, notably Waitrose, are working with their suppliers to reduce the amount of sugar in processed food, but many are not. What steps are the Government taking to ensure that all supermarkets and suppliers follow those setting a good example and reduce the amount of sugar, as well as clearly labelling sugar, in their processed foods?
Earl Howe
My noble friend raises a series of important issues. I can tell her some encouraging news on this front. Sainsbury’s and Tesco, for example, have pledged to reduce the sugar content in their own-brand soft drinks. We are asking other supermarkets to follow suit. I think that the noble Baroness will be aware that Lidl made an encouraging gesture the other day in pledging not to display sweets at till exits. However, we are working across a range of areas, not just reformulation of food but pack size, introducing low-sugar or no-sugar alternatives, and looking at ways in which food is promoted.
Lord Brooke of Alverthorpe (Lab)
Will the Minister please explain why in his first Answer he referred only to the food and soft drinks industry? Why did he not refer to the alcoholic drinks industry? Is it not true that, in the 130 meetings which the Government have had with the drinks industry since 2010, no progress whatever has been made on persuading it voluntarily to show calorific effects and sugar content on the labels of its products?
Earl Howe
No, my Lords, that is not so. Ninety-two producers and retailers committed through the responsibility deal to having 80% of bottles and cans on sale in the UK displaying unit and health information and a pregnancy warning by the end of 2013. The three elements that industry has committed to display on labels are: the drink’s unit content, the Government’s guidelines for lower-risk drinking, and pregnancy warnings. I argue with the noble Lord that this is progress.
The Lord Bishop of St Albans
My Lords, while I support the need to reduce the level of sugar in processed food wherever possible, I am concerned that this alone will do little to improve the nation’s health or deal with the problem of obesity. What progress are the Department for Education and the Department of Health making on reducing the number of calories in meals served in schools, and what progress is being made on increasing the level of physical activities for the pupils in our schools?
Earl Howe
My Lords, tackling obesity calls for action by the widest possible range of partners, including the food industry but also including schools. That is what we are trying to do through the responsibility deal. Our National Child Measurement Programme, the School Food Plan, the School Games and the money that we are putting into school sports funding—£150 million a year—all contribute to the joint effort across government to influence the way in which calories are consumed by children. I have encouraging news on that front, which is that the level of child obesity is now the lowest that it has been since 1998, so we are moving in the right direction.
Lord Ribeiro (Con)
My Lords, I congratulate the noble Earl on leading on the successful amendment in this House which led to the vote going through the other place yesterday on smoking in cars. Can he further protect children by tackling the issues around obesity? What are the Government doing to encourage the soft drinks industry to take action on calorie reduction as part of the responsibility deal?
Earl Howe
My Lords, I think that the compliment should be paid to my noble friend Lord Ribeiro for the part that he played in bringing about the amendment on smoking in cars. A number of soft drinks companies have taken action to reduce calorie content in their drinks. Coca-Cola has reformulated its Sprite product. AG Barr pledged to reduce the average calorific content in its portfolio of drinks. I have mentioned Sainsbury’s and Tesco’s actions on their own brands. Premier Foods has reformulated various products and reduced sugar in those. Therefore, we are making headway and I think that the responsibility deal is proving its worth.
Lord Patel (CB)
Does the Minister think it might be advisable to ask the Government’s Scientific Advisory Committee on Nutrition to define a standard of added sugar that should not be exceeded in 100 millilitres of fluid or 100 grams of food?
NHS: Competition
Earl Howe Excerpts(10 years, 2 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I join other noble Lords in thanking the noble Lord, Lord Turnberg, for tabling this topic for debate. I will begin with three simple statements, to serve as mental marker posts, as it were, before I respond to the questions that have been raised.
First, amid the many changes that we made to NHS commissioning through the Health and Social Care Act, one area of the law that has not changed one iota is the law relating to competitive tendering. That law has been in place for a number of years; it has been governed by a European directive; and, as regards the rules governing NHS procurement, the Section 75 regulations change nothing at all.
Secondly, the noble Baroness, Lady Thornton, referred to “Mr Lansley’s agenda” on privatisation. There is no government agenda to privatise NHS services—quite the contrary. We made it illegal in the Health and Social Care Act for the Secretary of State, Monitor or NHS England to have a policy deliberately favouring the independent sector.
Thirdly, the noble Lord, Lord Hunt, spoke of a deliberate policy of enforced competition and marketisation. I must correct him. It is NHS commissioners alone who will decide whether, where and how competition in service provision should be introduced. There are no obligations on commissioners to create or promote markets; nor are they required to fragment services against the interests of patients.
Those three points are key to understanding what the Government are doing and what we are not doing. I will now turn to the place and value of competition in the NHS, which has long existed. As the noble Lord, Lord Turnberg, pointed out, patients have long exercised choice over where they receive services from. I was pleased to hear the noble Lord, Lord Hunt, acknowledge that third sector and independent providers play an important part in providing NHS care; for example, in hospice care for terminally ill patients, mental health services and long-term nursing care for the frail elderly.
We have seen over the past decade the independent sector treatment centre programme and the introduction of payment by results in 2003, the advent of patient choice in 2006, and the transforming community services programme of 2008. I must point out to the noble Lord, Lord Turnberg, that it was this changing landscape that introduced greater competition to the NHS; it was not the Health and Social Care Act. There is robust evidence from a variety of sources that quality-based competition can work to the benefit of patients, and I shall come on to cite that evidence in a moment.
The previous Administration put in place a set of rules to manage that competition, known as the Principles and Rules for Co-operation and Competition, and the Government committed in their response to the NHS Future Forum report to maintain these and place them on a statutory footing so that they could continue to apply to commissioners. That is exactly what we have done; there has been absolute continuity in how the rules apply. Clinical commissioning groups work within this framework to secure the best services for patients that they can, from whichever provider best offers that prospect. In essence that is the value of this framework of rules. They will be supported in this activity by guidance from NHS England and Monitor, and through the work of commissioning support units.
The noble Baroness, Lady Thornton, asked me what I would regard as a reasonable proportion of NHS activity to be put out to tender. I have no view on this, and nor should I. The decisions on tendering are entirely up to commissioners and not Ministers. The noble Baroness also indicated that seven out of 10 NHS contracts have gone to the private sector since last April. I point out that that figure is highly misleading. It was quoted in a newspaper article, but the contracts in the sample that was quoted amount to a tiny and unrepresentative sample of the scale of NHS activity. In reality, spending on healthcare from private-sector providers equates only to around 6% of total NHS expenditure. It was roughly 5% at the end of the previous Administration.
My noble friend Lady Brinton asked whether there will be guidance from Monitor to clarify the duties on commissioners, and the noble Lord, Lord Hunt, suggested that commissioners are confused about that. Monitor has now published its guidance to support commissioners in understanding and complying with the Section 75 regulations. Monitor, along with NHS England, will undertake further engagement with commissioners to support them in understanding the requirements. I acknowledge that there is a degree of misunderstanding out there, but not everywhere. NHS England’s forthcoming procurement guidance will provide further guidance on the EU requirements.
The noble Lord, Lord Hunt, raised concerns about fragmentation and barriers to integration. To the extent that fragmentation exists, I say to him that it existed as greatly under his Government. I am proud to say that this Government are taking practical steps to make integration more commonplace throughout the country. We are supporting a number of integration pioneer sites, which will trailblaze new ideas to bring care closer together. They will be leaders of change—a change we have to see in the system if we want to offer the best-quality care.
We are also supporting the system through the £3.8 billion Better Care Fund, which will encourage organisations to act earlier to prevent people reaching crisis point, to offer seven-day services, and to deliver care that is centred on people’s needs. That idea and that fund have been widely welcomed. Therefore, our focus is for commissioners to innovate and to work with partners in the sector to design integrated care pathways for patients that allow for a seamless experience of care. I assure the Committee that the competition rules do not stand in the way of that. In fact, the Section 75 regulations explicitly allow for it.
Under the regulations, the objective of a commissioner must always be to secure the needs of patients, including through services being integrated. For example, in Milton Keynes, substance misuse services used to be delivered by several providers, resulting in fragmented care. Users found services difficult to navigate, which impacted on treatment entry and retention rates. In response to this, NHS Milton Keynes CCG and Milton Keynes Council developed an outcomes-based approach to commissioning. Existing services were brought together into one fully integrated, recovery-focused service, delivered by a third sector organisation, which enabled more effective delivery of care and efficiency savings of 15% to 20%. That is a clear example of good commissioning delivering improved services for patients.
I turn to the OFT’s role and the review of mergers. Again, it is important to realise that the NHS has long had arrangements in place to review mergers on competition grounds, and that in considering mergers the competition authorities are acting under their existing powers under the Enterprise Act 2002.
The noble Lord, Lord Turnberg, criticised Part 3 of the Health and Social Care Act. Repealing Part 3 of that Act would not remove the powers of the competition authorities. In fact, the 2012 Act was important in clarifying those powers in order to address the legal uncertainty for NHS bodies as to whether mergers between them would be considered by the OFT or the CCP. Without this clarification, providers would have been at risk of double jeopardy, with both bodies potentially seeking to undertake a review.
The noble Lord, Lord Turnberg, cited several examples of challenges being issued on competition grounds which he attributes to the existence of Part 3 of the Act. I do not want to comment on the detail of those cases—it would be wrong of me to do so—but I would point out that challenges of that kind would have been quite capable of being brought even if the Government had never introduced the Health and Social Care Bill.
Lord Hunt of Kings Heath
My Lords, I understand where the noble Earl is coming from in relation to the Enterprise Act. However, is it not a fact that essentially what happened was that the 2012 Act was a signal to the market that a market was being put in place? Why have a 300-page Act and why have the Section 75 competition regulations? In essence, the Government opened the door in this regard and that is why these challenges are now taking place. They did not take place before the 2012 Act.
Earl Howe
The market, however, did exist, which was the point that I made. The market was out there well before the 2012 Act and well before this Government came to office. It was incumbent on us to clarify and simplify the rules that the previous Government put in place. We did that through Part 3 of the Act. It was not a signal to anybody to marketise the NHS. Indeed, as I said, we explicitly provided for it to be illegal for Ministers or Monitor to prefer the independent sector over public sector providers. That is explicit in the Act, so the noble Lord cannot accuse the Government of enabling legislation to promote marketisation.
Baroness Thornton
My noble friend’s question was actually about the signal. If, as the noble Earl has told us, all these things existed before the Act, why did we have to have Part 3 of the Act? Why was it necessary? The only reason that it seems to have been necessary—we think that the evidence now shows that to be the case—is that it increased marketisation in the NHS.
Earl Howe
Let me be clear. Repealing Part 3 of the Health and Social Care Act, which is what the noble Baroness appears to be suggesting is desirable, would not stop competition law applying. It would not remove the powers that the OFT has, which were introduced by the previous Government. It would just mean that a health expert regulator—Monitor—would not be the body considering the application of competition law to the NHS. I do not believe that that is in the best interests of patients. That provision was widely welcomed by those who understood these matters.
I was asked about the case involving Blackpool and Spire. It would not be appropriate for me to comment on an ongoing investigation by the independent regulator but I stress that, in considering this case, Monitor is doing nothing that the Co-operation and Competition Panel could not have done under the principles and rules for co-operation and competition. As regards the Greater Manchester proposals which the noble Lord, Lord Hunt, raised, I can inform him that Monitor has closed that case and NHS England is pursuing its procurement of these services.
The noble Baroness, Lady Thornton, asked about Bournemouth and Poole. I want to be clear that there is nothing to stop two providers coming together if it is in the best interest of patients. The OFT has already cleared two out of three mergers. However, while in some places mergers have improved things for patients, there is evidence that some mergers can be costly and may not deliver the benefits that were intended. It is therefore right that these are examined. The competition authorities have listened to concerns raised in the system. That is why, in October last year, they set out their commitment to work together with Monitor to ensure that the interests of patients are always at the heart of the merger review process; that the process works quickly and predictably; and, importantly, that any costs can be minimised.
Monitor will take a more active role in supporting merging parties and advising the OFT. This means that some mergers may not need to go to the competition authorities at all, and that those which do can be dealt with more quickly. For example, the proposed merger involving Torbay and Southern Devon Health and Care NHS Trust—an integration pioneer—and the South Devon Healthcare NHS Foundation Trust is one of the first cases in which, with the help of Monitor, the trusts have been able to self-assess and conclude that they do not need to notify the merger to the OFT, as it would be unlikely to raise concerns from a competition perspective.
The noble Lord, Lord Turnberg, challenged me on the evidence for the value of competition. There is robust evidence, as I have already mentioned. A report of January 2012 by the Office of Health Economics states that,
“evidence both from the UK and internationally suggests that quality based competition with prices fixed by a regulator can be beneficial, producing higher quality care at the same cost on average and, importantly, not leading to increased inequity in access to care”.
Researchers at the London School of Economics have found that hospitals in areas where patients have more choice of provider have shorter lengths of stay in hospital and lower death rates than in less competitive markets. Research by York University found an increase in quality at a hospital stimulated local rivals to respond, as well as to increase the quality of their services. The research found improvements in relation to mortality rates, stroke readmission and patient satisfaction.
There are various other answers that I would like to give, but I have been advised that I am well over time, for which I apologise. I simply conclude by saying that this has been, as ever, a stimulating debate on a topic to which I am sure we will return in coming months. I hope that my comments today have at least partially clarified the legal position and wholly clarified our intentions regarding the place of competition in the NHS. I hope, too, that they have provided some measure of reassurance to noble Lords that the system is acting upon the concerns that it hears.
NHS: Black and Minority Ethnic Nursing Directors
Earl Howe Excerpts(10 years, 2 months ago)
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Lord Crisp
To ask Her Majesty’s Government how many Executive Directors of Nursing in the National Health Service are of black or minority ethnic background.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
Data from September 2012 estimate that there are 195 nursing directors. Of these, five, representing 3%, identified themselves as being from a black or minority ethnic background. The Government recognise that there needs to be better progress in promoting talented BME nurses to senior and influential positions. Last month, NHS England launched a coaching and mentoring scheme, and it is currently working on a strategy alongside the Chief Nursing Officer’s Black and Minority Ethnic Advisory Group.
Lord Crisp (CB)
My Lords, I thank the noble Earl for that detailed response, and I am pleased to know that NHS England is taking some steps on this. This is a hidden problem, with fewer than 3% of nursing directors coming from black and minority ethnic backgrounds. This underrepresentation, which is mirrored elsewhere in the NHS, is particularly important because it affects morale, and staff morale in turn, as noble Lords will know, inevitably affects patient care and outcomes. In other words, this is a health issue and not just an equal opportunities one. Will the Minister say a bit more about his plans to deal with this problem and, crucially, whether he will arrange for progress to be monitored and reported on publicly by the Care Quality Commission, the Equality and Human Rights Commission or some other independent body?
Earl Howe
My Lords, I fully agree with the noble Lord about the importance of this issue. A strong focus on equality and diversity is essential to create services and workplaces that are equitable and where everyone feels that they count. The position at present is highly unsatisfactory. The Chief Nursing Officer has personally assured me that this is a priority for her, and she is working closely with BME nurse leaders to address how to support BME nurses to prepare themselves for promotion. Forty-six million pounds has been invested at the NHS Leadership Academy in schemes on leadership development being led by the Chief Nursing Officer. At last year’s BME nursing conference, she made a public commitment to renew efforts to develop BME nurses more effectively, and that will include monitoring.
Lord Mawhinney (Con)
My Lords, what figure, set by the Government or Public Health England, would constitute a success for the strategy that my noble friend has just outlined?
Earl Howe
We have to be a little careful about doing anything that appears to look like positive discrimination or setting quotas, because we stray into areas of dubious legality if we do that. Having said that, as I have indicated, the priority of the Chief Nursing Officer is extremely clear and substantial resources have been put behind this. I pay tribute to the work that the noble Lord, Lord Crisp, did when he was NHS Chief Executive. We have picked up a lot of the ideas that he promoted at that time. I would be very disappointed if there were not progress within a few years but one has to set a realistic time horizon.
Lord Hunt of Kings Heath
My Lords, I refer noble Lords to my health interests. One answer to the question raised by the noble Lord, Lord Mawhinney, would be to point out that 18% of the NHS workforce in England is from a BME background and 14% of the population of England is from a BME background. As 2.6% of nursing directors comes from a BME background, that shows that there is a very long way to go. Is the Minister confident that NHS England is acting in accordance with the Equality Act? If he is not confident, what is he going to do about it?
Earl Howe
My Lords, just to correct the noble Lord, the latest figure I have from 2012 is that total ethnic minority groups in nursing, midwifery and health visiting comprise 19.7% of the nursing workforce. That underscores the basic point that he made. One cannot aspire to 19.7% of those ethnic nurses becoming nurse leaders because there is only a limited number of leadership posts. However, we are clear that this should be a priority for the NHS.
The answer to the noble Lord’s second question is that the Equality and Diversity Council has published some refreshed guidelines. One of its goals is to have a representative and supportive workforce throughout the NHS. It is putting that in train by asking NHS organisations to monitor their equality performance jointly with their patients, communities and staff.
Baroness Brinton (LD)
My Lords, ten years ago, the noble Lord, Lord Crisp, described the NHS as being snow-capped—that is, all white at the top. Since his departure as Chief Executive of the NHS in 2005, there are now fewer leaders from visibly different backgrounds and, as we have heard, pitifully few executive directors of nursing. What are the Government doing to ensure that this matter is kept at the top of the agenda and to assure us that we will hear about the success of the programme as it continues?
Earl Howe
My Lords, I have already mentioned some of the initiatives that are in train. However, I can tell my noble friend that, within the NHS Leadership Academy, there are two programmes specifically for nurses and midwives that map to foundation, mid and executive level leadership development. There is the front-line leadership programme which is for staff who have leadership responsibilities—for example, ward sisters and nurses working in primary care. We expect 6,000 nurses and midwives to participate in that programme in the first year. There is also the senior operational leaders programme which provides senior nursing clinicians with an opportunity to enhance their leadership skills.
Baroness Manzoor (LD)
My Lords, a web audit found that only 80 NHS trusts publish annual staff data broken down by ethnicity. Will the Minister reassure the House that all NHS trusts meet their legal obligations under the Race Relations Act and that all workforce issues faced by black and minority ethnic staff are identified?
NHS: Seven-day Working
Earl Howe Excerpts(10 years, 3 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I congratulate my noble friend Lord Ribeiro on securing a debate on this important issue. I know that as a former consultant surgeon and former president of the Royal College of Surgeons this is a subject in which he takes a great deal of interest. I also take this opportunity to pay tribute to the work done on seven-day services by NHS England, the NHS Services Seven Days a Week forum, the Academy of Royal Medical Colleges and the Royal College of Surgeons, among others.
The historical five-day service model offered in many NHS hospitals no longer meets justifiable patient and public expectations of a safe, efficient, effective and responsive service. I very much echo the comments of the noble Lord, Lord Parekh, in that context. Over the past 10 years, a growing body of national and international evidence has emerged that links poor outcomes, including a higher risk of death, to patients admitted to hospital at the weekend, around the world. It is impractical and inefficient to continue to operate a five-day approach when our illnesses and conditions do not limit themselves to office hours. Patients are entitled to receive the same standard of care regardless of the day of the week.
As the largest and most comprehensive health service in the world, the NHS is well positioned to solve the issue of poorer outcomes and reduced levels of service provision at the weekend. That is why NHS England has set out a vision for the NHS which is of a service more closely organised around the lives of the public it serves. To develop this vision, NHS England established the NHS Services Seven Days a Week forum in February last year to consider how NHS services can be improved to provide a more responsive and patient-centred service across the seven-day week.
The forum’s work has been met with nothing but positive feedback and support from the public and patients, the Academy of Medical Royal Colleges and the British Medical Association, among other organisations. The immediate focus for improvement activity will be addressing the need for high-quality urgent and emergency care services, seven days a week. NHS England is also looking to make similar improvements across primary and community health services and social care, and the forum will report in autumn this year, setting out proposals for the creation of a fully integrated service. NHS England’s ambition is for seven-day services to be fully implemented in England by the end of 2016-17.
I recognise that we cannot talk about the idea of seven-day services without giving full consideration to questions of staffing and finance; many noble Lords have raised those issues. NHS providers and their commissioners already face difficult choices when deciding where to invest their resources in order to maximise the outcomes for patients and value for taxpayers. Early indications are that seven-day services have the potential to be part of the solution. However, more information is needed. NHS England is therefore conducting research which will provide a helpful indication of the likely costs providers and commissioners face when considering how to redesign their services to provide comprehensive seven-day care. In addition, to answer my noble friend Lady Brinton, NHS England intends to commission financial and system modelling and analysis of the implications of its strategy for achieving seven-day service provision in the NHS.
My noble friend Lord Ribeiro rightly highlighted the workforce implications of having a consistent, high-quality service seven days a week. The department, alongside NHS England, Health Education England, NHS Employers and a number of strategic partners, is considering that very issue. Its analysis is considering issues such as junior doctors feeling unsupported during weekend working and the resulting need to ensure that education contracts include appropriate seven-day senior supervision; and numbers of diagnostic and scientific staff, with NHS England intending to undertake a thorough assessment of the different roles needed in diagnostic and scientific services to support an extended service.
Of course, many commissioners and providers will need support to address the challenges presented by seven-day services. To that end, NHS Improving Quality has just introduced a new, large-scale transformation change programme, set up in collaboration with all healthcare commissioners and providers, to support the spread of seven-day services over a three-year period.
I realise that the move towards seven-day care will not be easy, but there are encouraging examples of pioneering NHS organisations that have moved to make healthcare services more accessible seven days a week to avoid compromising safety and patient experience. For example, Sheffield Teaching Hospitals NHS Foundation Trust has adopted seven-day service provision, improving patient flow of frail and older people through the emergency pathway. Bed occupancy for emergency care for older patients has now reduced by more than 60 beds. Other examples in my brief include Salisbury District Hospital and the Lancashire Intermediate Support Team, both of which have produced impressive results.
We know that across the country, more hospitals, primary and community care organisations and social care services are working together to break the link between poorer outcomes for patients and the reduced level of service provision at the weekend. We also know that patients and the public want us to act now to make seven-day services a reality in all parts of our NHS.
A number of noble Lords, including my noble friend Lord Ribeiro and the noble Lords, Lord Parekh and Lord Hunt of Kings Heath, raised the issue of cost. Interestingly, there is already evidence that seven-day services can be implemented in a way that does not increase the overall cost of healthcare. The average cost of implementation at trusts pioneering the service was 1.5% to 2% of their total income. Costs vary according to local service models, but research shows that they can be reduced by reconfiguring services and by trusts working collaboratively. Seven-day services at the front end—that is to say, A&E departments—could also pay for themselves by reducing admissions and lengths of stay.
Seven-day services would not work under a one size fits all model—a point made by my noble friend Lord Ribeiro. Local solutions need to be found and pioneering NHS providers and commissioners are already working to develop them.
In answer to the noble Baroness, Lady Masham, on the issue of safety at weekends, we expect all NHS services to be able to meet patients’ needs as they arise. To do this, trusts should adopt the clinical standards developed by the seven-day services forum to drive up clinical outcomes and improve patient experience at weekends.
My noble friend Lady Manzoor referred to the CQC. The CQC and the Chief Inspector of Hospitals are considering how implementation of the clinical standards could best be assessed by the CQC and how this might be reflected in its forthcoming ratings and the judgments it makes when it inspects.
As I said, workforce is a major issue. The noble Baroness, Lady Masham, was right to raise that point. There are over 12,200 more clinical staff in the NHS than there were before the election, thanks to the money we have invested in the service and to the reforms we have carried out. Nevertheless, there is an issue about motivating staff to work at weekends, as the noble Baroness rightly said. We understand that contractual levers and incentives are required to drive change. NHS England and a number of key strategic partners are already looking into this. However, in many cases seven-day services have reportedly already had a positive impact on individuals’ work-life balance, offering greater certainty in planning ahead and flexibility in time off. In addition, the medical royal colleges are all in support of seven-day services. Building seven-day service provision into recruitment, job planning and appraisal processes will help create a sense of common purpose to underpin organisational delivery.
A number of noble Lords, including my noble friends Lord Ribeiro and Lady Barker, referred to the role of GPs. To address that important role in the mix of services the NHS provides, we recently announced the setting up of a £50 million fund to support innovative GP practices in improving services, and in particular access for their patients, including seven-day week access and evening opening hours and the testing of a variety of services including Skype, e-mail and phone consultations.
However, as the noble Lord, Lord Hunt of Kings Heath, emphasised—as did my noble friend Lady Barker—community services and social care are absolutely integral to this as well, particularly when it comes to the care of the frail elderly. Social care and the NHS are priorities for the Government and we know that there is interdependency between the two systems. However, providing more resources is not enough on its own. We have provided more resources from the Department of Health but we need to do more. NHS England is currently working with the Local Government Association to create a health and social care system that is truly seamless so that people receive the right care at the right time and in the right place. The Seven Days a Week forum will report on that work in the autumn, setting out proposals for a fully integrated service.
The Better Care Fund is a key enabler for change, as my noble friend Lady Manzoor pointed out. As part of the process for accessing funding, clinical commissioning groups and local authorities will have to demonstrate, as part of agreed local plans, that they are addressing a number of national conditions, including seven-day services in health and social care.
The noble Lord, Lord Warner, asked whether the Government would expect A&E departments to have weekend consultant cover. We recognise that the consultant contract is a key enabler of seven-day services. In October last year the Government mandated NHS Employers to enter into formal negotiations with the BMA to deliver joint proposals for consultant contract reform, including changes that will support seven-day services.
My noble friend Lord Bridgeman focused on the working time directive. He may know that we asked the president of the Royal College of Surgeons, Professor Norman Williams, to chair an independent task force to look at the implementation of the working time directive, and the impact of the directive on the delivery of patient care and the training of the next generation of doctors. The independent review will provide its report during March 2014. Professor Williams is working with stakeholders from the Royal College of Surgeons, NHS organisations, the BMA, National Voices and others, and we ourselves are working with the task force to ensure that it has appropriate legal and analytical support.
There is a compelling case for healthcare services to be accessible seven days a week. To echo the noble Lord, Lord Parekh, if we were starting the NHS from scratch I very much doubt whether we would design a part-time system. We would surely create a seven-day service to better meet patients’ needs. Seven-day service provision is about equitable access, care and treatment, regardless of the day of the week. It is a cause for some pride that the NHS will be the global pioneer in providing equality of access to consistent, high-quality healthcare seven days a week.
Lord Hunt of Kings Heath
My Lords, before the noble Earl sits down, I was remiss in not declaring my interests at the start as chair of a foundation trust, president of GS1 and a consultant trainer with Cumberlege Connections. I know that we all know that, but I have to do it every time.
NHS Property Services Ltd
Earl Howe Excerpts(10 years, 3 months ago)
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Lord Warner
To ask Her Majesty’s Government what assessment they have made of the performance of NHS Property Services Ltd in disposing of surplus properties and operating within their working capital.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, NHS Property Services is on target to dispose of 97 properties by 31 March 2014 and a further 100 properties by 31 March 2015. The department has provided the company with a £350 million flexible working capital loan facility, of which £271 million had been drawn down as at 27 January 2014. This working capital support is in line with the department’s expectations for a start-up company of this size and complexity.
Lord Warner (Lab)
I thank the Minister for his Answer, but what action has been taken to improve the performance of this company in controlling its costs? What action has been taken to reduce its running costs, given the large number of staff that it inherited, and what action has been taken to improve the professional competence of those staff and to collect bad debts, which have been a rising problem for this organisation?
Earl Howe
My Lords, on administration costs, the company is already reviewing the way in which its strategic asset management and facilities management functions are structured. It is probably inevitable that the consolidation of 161 PCT and strategic health authority estates into one will throw up duplication, overlap and operational policies that conflict. These all need to be rationalised and a commercial ethos introduced. It is vital that the skills are imported into the organisation to match that challenge.
Lord Mawson (CB)
My Lords, for the past six years, we in St Paul’s Way in Tower Hamlets have been pursuing the Government’s policy of integration in health services, bringing together a school, housing, health and community services centre on one street. I was asked to lead this project following a murder and considerable racial violence on this housing estate. The overall transformation project has been very successful, and I must declare an interest. However, the primary care premises elements have stalled and we are going backwards in terms of dental outreach facility. Can the Minister explain how NHS England engages with NHS Property Services, the CCG, local GPs and local partners to deliver in an effective and timely manner the kind of innovative and integrated premises we all agree are essential?
Earl Howe
My Lords, I pay tribute to the work that the noble Lord does. However, it is important to understand that the decision as to whether a property in the NHS Property Services portfolio is surplus to requirements and should therefore be sold resides with the commissioners; that is, NHS England and clinical commissioning groups. It is up to the commissioners how they wish to utilise the estate.
Lord Brabazon of Tara (Con)
Is my noble friend aware of the situation of Putney Hospital, which closed about 15 years ago and has only recently been sold to Wandsworth Borough Council, but is still undeveloped?
Lord Hunt of Kings Heath (Lab)
My Lords, I refer noble Lords to my interests in the register; I should have done that yesterday on another health Question, for which I apologise to the House. Can the Minister confirm that the chairman of this organisation resigned early, that capital money was raided to cover a revenue shortfall and that, only months after the organisation formally started, an investigation has been mounted by the National Audit Office? Given that the shares in this company are owned by Ministers, will Ministers take responsibility and can the noble Earl confirm that this was forecast in the NHS risk register, which the Government have not yet published?
Earl Howe
My Lords, the noble Lord has painted rather a black picture of the company, which we believe has got off to an extremely good start, contrary to his impression. The company’s former chair asked to step down six months earlier than planned because the company had completed the transition phase early, and it was agreed that a chair with a different skill set was needed to oversee the rationalisation of the company.
As regards the company’s cash needs, we made £350 million available to the company as a working capital loan. That was planned some six months ago and was needed in large part due to the slow payment of invoices by the company’s customers, many of whom were themselves new organisations set up as part of the reforms, so it is not altogether surprising that cash flow initially was slow, but the situation is improving.
Lord Colwyn (Con)
My Lords, can my noble friend tell us what efficiencies and successes NHS Property Services has actually made?
Earl Howe
My Lords, it has been a good start for the company. It has generated £22 million from sales of surplus assets and savings of £2 million a year on the running costs of those disposed properties. The company is also harnessing economies of scale—for example, savings to date of £1.2 million by standardising the procurement of electricity across the whole estate. The company is now exploring how to make savings across other utilities and services, such as legal services.
Lord Turnberg (Lab)
My Lords, following the response to my noble friend Lord Hunt’s question, can the noble Earl tell us why the National Audit Office has decided to conduct an investigation so soon after the establishment of this organisation?
Earl Howe
My Lords, the National Audit Office is indeed looking at the company—only to assure us and itself that the company is properly organised and structured. We welcome that, as does the company. There was no sinister purpose or concern underlying that process; it is perfectly normal and natural.
Baroness Manzoor (LD)
My Lords, can the Minister confirm best value for money on all properties sold and that there has been proper consultation with local organisations on all NHS estates?
Earl Howe
My Lords, I can assure my noble friend of that. The company ensures best value by marketing through an arm’s-length open market process, which ensures that the market value is achieved in a sale. Where necessary, the sale price is supported by a district valuer or other third-party independent valuation.
Baroness O'Cathain (Con)
My Lords, I ask my noble friend: when people are appointing chairmen to such organisations, could they look at their skill sets in advance rather than getting rid of them because of their lack of skill sets?
Earl Howe
My Lords, it is important to understand that the chairman who has stepped down had a very good set of skill sets, but it is not the skill set that we now need to take the company forward. The task at the beginning was to consolidate a very complex portfolio of properties, and that was done very successfully. The task now is different: it is to manage those properties effectively and to get maximum value for the taxpayer for the properties that are sold.
Children and Families Bill
Earl Howe Excerpts(10 years, 3 months ago)
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“Regulation of retail packaging etc of tobacco products
(1) The Secretary of State may make regulations under subsection (6) or (8) if the Secretary of State considers that the regulations may contribute at any time to reducing the risk of harm to, or promoting, the health or welfare of people under the age of 18.
(2) Subsection (1) does not prevent the Secretary of State, in making regulations under subsection (6) or (8), from considering whether the regulations may contribute at any time to reducing the risk of harm to, or promoting, the health or welfare of people aged 18 or over.
(3) The Secretary of State may treat regulations under subsection (6) or (8) as capable of contributing to reducing the risk of harm to, or promoting, the health or welfare of people under the age of 18 if the Secretary of State considers that—
(a) at least some of the provisions of the regulations are capable of having that effect, or(b) the regulations are capable of having that effect when taken together with other regulations that were previously made under subsection (6) or (8) and are in force.(4) Regulations under subsection (6) or (8) are to be treated for the purposes of subsection (1) or (2) as capable of contributing to reducing the risk of harm to, or promoting, people’s health or welfare if (for example) they may contribute to any of the following—
(a) discouraging people from starting to use tobacco products;(b) encouraging people to give up using tobacco products;(c) helping people who have given up, or are trying to give up, using tobacco products not to start using them again;(d) reducing the appeal or attractiveness of tobacco products;(e) reducing the potential for elements of the packaging of tobacco products other than health warnings to detract from the effectiveness of those warnings;(f) reducing opportunities for the packaging of tobacco products to mislead consumers about the effects of using them;(g) reducing opportunities for the packaging of tobacco products to create false perceptions about the nature of such products;(h) having an effect on attitudes, beliefs, intentions and behaviours relating to the reduction in use of tobacco products.(5) Regulations under subsection (6) or (8) are to be treated for the purposes of subsection (1) as capable of contributing to reducing the risk of harm to, or promoting, the health or welfare of people under the age of 18 if—
(a) they may contribute to reducing activities by such people which risk harming their health or welfare after they reach the age of 18, or(b) they may benefit such people by reducing the use of tobacco products among people aged 18 or over.(6) The Secretary of State may by regulations make provision about the retail packaging of tobacco products.
(7) Regulations under subsection (6) may in particular impose prohibitions, requirements or limitations relating to—
(a) the markings on the retail packaging of tobacco products (including the use of branding, trademarks or logos);(b) the appearance of such packaging;(c) the materials used for such packaging;(d) the texture of such packaging;(e) the size of such packaging;(f) the shape of such packaging;(g) the means by which such packaging is opened;(h) any other features of the retail packaging of tobacco products which could be used to distinguish between different brands of tobacco product;(i) the number of individual tobacco products contained in an individual packet;(j) the quantity of a tobacco product contained in an individual packet.(8) The Secretary of State may by regulations make provision imposing prohibitions, requirements or limitations relating to—
(a) the markings on tobacco products (including the use of branding, trademarks or logos);(b) the appearance of such products;(c) the size of such products;(d) the shape of such products;(e) the flavour of such products;(f) any other features of tobacco products which could be used to distinguish between different brands of tobacco product.(9) The Secretary of State may by regulations—
(a) create offences which may be committed by persons who produce or supply tobacco products the retail packaging of which breaches prohibitions, requirements or limitations imposed by regulations under subsection (6);(b) create offences which may be committed by persons who produce or supply tobacco products which breach prohibitions, requirements or limitations imposed by regulations under subsection (8);(c) provide for exceptions and defences to such offences;(d) make provision about the liability of others to be convicted of such offences if committed by a body corporate or a Scottish partnership.(10) The Secretary of State may by regulations provide that regulations under subsection (6) or (8) are to be treated for the purposes specified in regulations under this subsection as safety regulations within the meaning of the Consumer Protection Act 1987.
(11) The Secretary of State may by regulations make provision amending, repealing, revoking or otherwise modifying any provision made by or under an enactment (whenever passed or made) in connection with provision made by regulations under any of subsections (6), (8), (9) or (10).
(12) The Secretary of State must—
(a) obtain the consent of the Scottish Ministers before making regulations under any of subsections (6), (8), (9) or (10) containing provision which would (if contained in an Act of the Scottish Parliament) be within the legislative competence of that Parliament;(b) obtain the consent of the Welsh Ministers before making regulations under any of those subsections containing provision which would (if contained in an Act of the National Assembly for Wales) be within the legislative competence of that Assembly;(c) obtain the consent of the Office of the First Minister and deputy First Minister in Northern Ireland before making regulations under any of those subsections containing provision which would (if contained in an Act of the Northern Ireland Assembly) be within the legislative competence of that Assembly. (13) For the purposes of this section a person produces a tobacco product if, in the course of a business and with a view to the product being supplied for consumption in the United Kingdom or through the travel retail sector, the person—
(a) manufactures the product,(b) puts a name, trademark or other distinguishing mark on it by which the person is held out to be its manufacturer or originator, or(c) imports it into the United Kingdom.(14) For the purposes of this section a person supplies a tobacco product if in the course of a business the person—
(a) supplies the product,(b) offers or agrees to supply it, or(c) exposes or possesses it for supply.(15) In this section—
“enactment” includes—
(a) an Act of the Scottish Parliament,(b) a Measure or Act of the National Assembly for Wales, or(c) Northern Ireland legislation;“external packaging”, “internal packaging” and “wrapper” have the meanings given by regulations under subsection (6);
“packaging”, in relation to a tobacco product, means—
(a) the external packaging of that product,(b) any internal packaging of that product,(c) any wrapper of that product, or(d) any other material attached to or included with that product or anything within paragraphs (a) to (c);“retail packaging”, in relation to a tobacco product, means the packaging in which it is, or is intended to be, presented for retail sale;
“retail sale” means sale otherwise than to a person who is acting in the course of a business which is part of the tobacco trade;
“tobacco product” means a product consisting wholly or partly of tobacco and intended to be smoked, sniffed, sucked or chewed;
“travel retail sector” means retail outlets in the United Kingdom at which tobacco products may be purchased only by people travelling on journeys to destinations outside the United Kingdom.”
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I am very pleased to have tabled government amendments that introduce regulation-making powers to enable the Government to bring in standardised tobacco packaging, if such a decision is made.
I would like to acknowledge the support and positive responses that we have had to the Government’s action on tobacco and its packaging. We have seen support in both your Lordships’ House and in the other place. I have also had discussions with a number of noble Lords. I was pleased as well to see the welcoming comments from the public health community. I wrote to all noble Lords on 17 December explaining the key elements of this new clause. I will summarise the main provisions.
Amendment 57B will provide the Secretary of State for Health with the power to make regulations to standardise packaging of tobacco products, should such a decision be taken by the Government. The regulation-making powers would enable Ministers to regulate internal and external packaging and any other associated materials included with a tobacco product. This would include, for example, not just the outside and the inside of a cigarette pack but also the cellophane or other outer wrapper of a pack.
Ministers may also specify requirements for the products themselves, for example to regulate the appearance of, or branding on, individual cigarettes. The powers will extend to other forms of tobacco, such as hand-rolling tobacco. If standardised packaging is brought into place, we will think carefully about the type of tobacco to which the requirements should apply.
The amendment is clear that before deciding whether to introduce regulations, Ministers must consider that regulations may contribute at any time to reducing the risk of harm to those under 18 or promote their health or welfare. This includes harms that do not appear until later in life because, as we know, the harm to the health of a smoker may not be immediate but may manifest after several years of addiction. Ministers may also consider whether regulations may contribute to reducing the risk of harm to those aged 18 or over, so we could also take into account whether standardised tobacco packaging might help adults who want to quit.
The amendment sets out the elements of the tobacco packaging that could be regulated—for example, the use of colour, branding or logos, the materials used and the texture, size and shape of the packaging. It also sets out the aspects of the tobacco product itself that could be regulated. The Government would not necessarily use all these powers, and if we proceed we will need to decide which aspects to include in any regulations. However, it is prudent to take a comprehensive approach now so that we are prepared for possible future developments and do not inadvertently create loopholes that could be exploited.
The requirements would apply only to the retail packaging of tobacco products, which means the packaging that will or is intended to be used when the product is sold to the public. Manufacturers, distributors and retailers would still be able to use branding such as logos and colours on packaging, provided that they were used only within the tobacco trade—for example, on boxes used for stock management in a warehouse that were not seen by the public.
These provisions will apply on a UK-wide basis, provided that legislative consent Motions are passed by the Parliament or Assemblies of the devolved Administrations. The Governments in Wales and Scotland have already obtained the necessary Motions, and Ministers in Northern Ireland are progressing this.
The Government have also tabled two technical amendments, one making the regulations subject to affirmative resolution procedures and the other extending the provisions to the whole of the United Kingdom. If regulations are made, they will be enforced by local authority trading standards as safety regulations under the Consumer Protection Act. In reviewing the detail of the amendment, we have identified a small gap that we wish to address. As it is currently drafted, Ministers would not be able to take enforcement action if none was taken by a local authority. As a precaution, and in line with other tobacco control legislation, we think it sensible for Ministers to be able to do this and so intend to make a technical amendment to the new clause at Third Reading to allow for this.
I wrote to noble Lords on 27 January about the Government’s intention to table amendments at Third Reading on the proxy purchasing of tobacco and the sale of nicotine products, primarily e-cigarettes, to children. I hope that both measures will be welcomed by your Lordships. I recognise that these amendments come at a late stage in the Bill’s passage, and I apologise for this. I want to be able to give noble Lords as much information as possible, so have invited all Peers to a meeting to discuss the amendments on 3 February and would be happy to meet on an individual basis as well, so that there is time to consider them before the debate at Third Reading.
I shall summarise these amendments. We intend to create a new offence of the proxy purchase of tobacco, which is buying tobacco on behalf of someone underage. Nicotine is highly addictive and it is wrong in principle for adults to be buying cigarettes on behalf of children. We need to close common routes of supply to children. We know that proxy purchasing is a common problem and we need to take clear action to tackle it. There was considerable support for tackling proxy purchasing when it was debated in the Anti-social Behaviour, Crime and Policing Bill. We have also listened carefully to the views of retailers and their representative organisations on this issue.
In addition, we have decided to table an amendment to enable us to make regulations to prohibit the sale of electronic cigarettes to people aged under 18. E-cigarettes deliver nicotine, a highly addictive substance, albeit in a safer way than smoked tobacco. We know that some young people in England are using these products and there is nothing stopping their sale to people under 18. Some in the public health community are very concerned that e-cigarettes could act as a gateway into smoking tobacco, and that their use and promotion can undermine our efforts to reshape the social norms around tobacco use. The revised European tobacco products directive, which achieved political agreement in December last year, covers e-cigarettes but does not include an age of sale restriction. We therefore want to do this domestically through the Bill.
The amendments will apply to England but we are in discussions with the Welsh Government regarding the possibility of extending the provisions to Wales, subject to the necessary legislative consent Motion being secured.
Baroness Hughes of Stretford
No, that is true. I know that the noble Lord is very exercised by these issues, and I respect his point of view. A baby of itself could not move to another room. However—we have these arguments in many ways—the fact that we cannot remove the harm to all children in all situations presented by passive smoking is not an argument in itself for not taking the action that we could take to reduce the harm to the majority of children in the most dangerous situations. That is the argument in support of this amendment.
The third argument we heard was about enforcement. Again, we had some helpful contributions which I was going to make myself, but I shall just mention them. This is primarily not about enforcement, and we have precedence here with the ban on using mobile phones in cars, the mandatory use of seat belts and the ban on smoking in public places. All of those were hotly contested before legislation came in. I particularly remember the ban on smoking in public places because I was involved in it. That measure not only established smoke-free common areas for people but, equally importantly—and it is true of the other two measures—precipitated the biggest reduction in smoking we have seen: a significant and beneficial change in behaviour on a massive scale. That is the issue here, as the noble Baroness, Lady Tyler, pointed out. I have no doubt that this would precipitate a very significant change in behaviour in relation to smoking in cars with children. Particularly when we see so much public support for the measure, I think that we could anticipate that.
I say again that Amendment 57BB is enabling. It would entail further discussion about the practicalities and the detail of the regulation. We fully accept the need for that and welcome it. However, it is an important measure for children and I hope that the House will support it.
Earl Howe
My Lords, this has been a fascinating and very helpful debate and I am very pleased with the support that I have heard for the government amendments on standardised packaging. I would like, if I may, to commend noble Lords for their continued work in supporting tobacco control. We all want to drive down rates of smoking in this country and, in particular, to stop young people from taking up smoking in the first place. Let me address the points on standardised packaging first.
The noble Baroness, Lady Finlay, the noble Lord, Lord Faulkner, and my noble friends Lady Tyler and Lord McColl tabled a revised amendment following discussion in Grand Committee, and I see that they reflected the comments that I made in redrafting it. I particularly welcome their support for the Government’s amendments and can reassure them that our amendments would achieve all of the things that they seek to do.
My noble friend Lord Naseby raised a number of legal issues. I would like to reassure him that we have given very careful consideration to the legal situation. We believe that the government amendment gives us sufficient room to proceed with the regulations, should we choose to do so, and introduce standardised packaging, if that is what is decided. He queried the fact that the amendment is drafted in such a way that the devolved Administrations and Assemblies have to give consent, but it is the Secretary of State and not Parliament who gives consent in England. We do of course want Parliament to have a say, which is why we have introduced Amendment 63B to make the regulations subject to the affirmative procedure.
The noble Lord, Lord Stoddart—whose robust state of health I very much welcome—indicated that there has been no proper consultation on standardised packaging. In fact, in 2012 the Government ran a full public consultation and received almost 2,500 substantive responses and well over half a million postcard and petition responses. The consultation asked 15 specific questions and invited comments on the consultation stage impact assessment, which was also published. So it was a very thorough exercise.
The noble Lord, Lord Stoddart, suggested that this was the thin end of the wedge, if I can put it that way, and might herald similar measures in relation to junk food. I think we need to remember that tobacco is a uniquely harmful consumer good. Tobacco kills one in two long-term smokers. There is no safe level of smoking. That is why we have a range of specific legislation and an international treaty around tobacco control.
My noble friend Lord Naseby referred to illicit tobacco. We received a wide range of responses to the question in the consultation on illicit tobacco. They are summarised in the consultation report. In 2000, around 21% of the UK cigarette market was illicit. The latest estimate from HMRC, for 2012-13, is that this has dropped to around 9%. It is too high, I concede, but we are heading in a positive direction.
The noble Baroness, Lady Howarth, asked about the timetable for the regulations. I emphasise here that I do not want to pre-empt any decision that the Government may make on whether to proceed with standardised tobacco packaging, and I know that the noble Baroness understands that; but equally for that reason, it would be premature to set out a detailed timetable. What I can confirm is that the regulations would be subject to the affirmative procedure to ensure an appropriate opportunity for parliamentary scrutiny in both Houses. She may like to be aware that before being laid in Parliament, any draft regulation that seeks to regulate tobacco packaging would need to be notified to the European Commission and member states. There is a process that goes with that, which would mean that we would not be able to lay regulations instantly after taking a positive decision. I am happy, however, to reiterate the Government’s commitment to make a decision quickly when we receive Sir Cyril Chantler’s independent report. Tabling these amendments is, I hope, evidence of our commitment to act without delay if we decide to go ahead. But the Government, as I am sure she appreciates, must rightly consider the wider issues raised by this policy, and I can assure her that we will do so.
I can understand the intention of the noble Lord, Lord Hunt, in tabling both of his amendments, Amendments 57BA and 61, which seek to compel Ministers to introduce standardised packaging. However, I am sure that he will not be surprised to hear me say that we cannot accept provisions that tie our hands in this way. One of the amendments imposes an arbitrary timetable for government action, and both pre-empt Ministers’ proper and careful decision-making, involving consideration of all the relevant issues. Litigation by the tobacco industry is always a risk when introducing tobacco control legislation. Indeed, the World Health Organisation says that one of the six main forms of tobacco industry interference in public health is the intimidation of Governments with litigation or the threat of litigation. Government must have time and space to give proper consideration to the wider issues raised by standardised packaging of tobacco, and demonstrate that it has done so. Doing so will also reduce the risk of successful litigation. I do appreciate the desire to go faster but we must follow the proper decision-making process to enable us to arrive at the right policy decision. It is right that we should wait for Sir Cyril’s report. Once we do, I say again, we will make a decision quickly.
The noble Lord, Lord Hunt, asked me to put on the record that we will definitely introduce the regulations should the case be made and should we be persuaded of the case that Sir Cyril presents. I hope that I have been clear about that. I will repeat the comments made by my honourable friend the Minister for Public Health when she announced the review:
“The Government will introduce standardised tobacco packaging if, following the review and consideration of the wider issues raised by this policy, we are satisfied that there are sufficient grounds to proceed, including public health benefit”.—[Official Report, 28/11/13; col. WS 96.]
I thank the noble Lord, Lord Faulkner, the noble Baroness, Lady Finlay, and my noble friends Lady Tyler and Lord McColl for having made clear their intention not to press their amendment on standardised packaging. I hope that the noble Baroness, Lady Hughes, and the noble Lord, Lord Hunt, will do the same with theirs.
I turn to smoking in cars. Since we considered the issue at the previous stage of the Bill, I have met a number of noble Lords who support the idea of legislating to stop smoking in cars with children present. I have also listened very carefully to the debate as it has proceeded this afternoon. One thing is clear from those meetings and the debate—we all want to eradicate smoking in cars carrying children. None of us wants to see children continuing to be exposed to harmful second-hand smoke, whether in the home or the family car. However, although we agree on the destination, I have to acknowledge that there are differing views on the most effective route. As your Lordships will know, the Government believe that encouraging positive and lasting behaviour change by making smokers aware of the significant health risks of second-hand smoke will be more effective than resorting to the use of legislation—which is of course a blunt instrument—to tackle the problem. I believe very clearly that we should consider resorting to the use of legislation only if our work to promote positive changes in behaviour is shown not to have had the desired effect.
When we debated this issue in Grand Committee, a good deal of time was spent considering the practicalities of enforcing an offence of smoking in cars carrying children. I do not propose to rehearse those arguments in detail again today. Nevertheless, I want to encourage your Lordships to reflect on just how difficult it would be to enforce such a provision. My noble friend Lord Cormack referred to this. In my view, there would be substantial challenges in enforcing any such legislation, particularly with respect to vehicles travelling at speed. Currently, local authorities enforce smoke-free legislation, but they do not have the powers or the means to require moving vehicles to pull over. We would need therefore to set up a complex and probably resource-intensive enforcement regime, which would need to involve the police. These remaining questions of how to achieve effective enforcement undermine the credibility of the measures that have been proposed. If it were known that there was little chance of enforcement action, I have to ask whether individuals would comply with the law.
Lord Hunt of Kings Heath
I am most grateful to the noble Earl. Would he accept that my amendment has been drafted in a way that allows your Lordships to vote on the principle but then allows for work to be done, hopefully cross-party, and for the Government to bring in regulations, during which some of these matters could be talked out thoroughly?
Earl Howe
I have noted the way the noble Lord’s amendment has been drafted. However, we need to be very careful before accepting it, for the reasons that I am explaining now. One of the points made about enforcement was that we could make a useful comparison with seat-belt legislation. I understand why that comparison has been made but it needs to be borne in mind that we are not comparing like with like. Seat-belt legislation is a road safety measure which is properly enforced by the police; smoking in cars is a public health matter and the police have no public health role or functions. That is part of the reason that the issue is so complex. Before launching into the kind of amendment that the noble Lord, Lord Hunt, invites us to accept, we need to take stock of these questions. There is no point in putting something on the statute book if it is impractical to implement.
Baroness Masham of Ilton
Can I just ask the noble Earl whether the police have a duty in respect of alcohol abuse and violence in the streets?
Lord Faulkner of Worcester
With the growing number of jurisdictions now adopting measures of the sort that are proposed in the amendment, will the Minister at least give an assurance that the department will look at the experience in countries where smoking in cars when children are present has been banned and look particularly at the way in which it is being enforced there, and by whom?
Earl Howe
I am coming in a minute to talk about consultation, which is one of the questions that my noble friend Lord Ribeiro asked, and I hope I can at least utter some words of comfort to the noble Lord, Lord Faulkner, as regards his question.
I will focus for a moment on why the Government prefer to achieve behaviour change without recourse to imposing the law. We believe that our approach is making a distinct impact, both in terms of raising awareness and, more importantly, changing behaviour. There is a very simple point to be made here, which was made by my noble friend Lady Tyler. I cannot believe that any parent would want, knowingly, to expose their child or children to harm. I am convinced that smoking in family cars and the home is much more likely to be due to a simple lack of understanding among smokers about how damaging to health second-hand smoke can be. Our social marketing campaigns remind us that more than 80% of cigarette smoke is invisible. Our campaigns have used the strap-line:
“If you could see what’s really there you wouldn’t smoke”.
That is why we are focusing our efforts on raising awareness of the harm caused and on encouraging smokers to modify their smoking behaviour.
The noble Baroness, Lady Masham, referred to pregnant women and whether we would regulate to protect them. I understand of course how vulnerable the child is when still in the womb, and the noble Baroness rightly raised the issue of how harmful second-hand smoke can be, especially for people with respiratory conditions such as asthma.
Baroness Hughes of Stretford
Does the Minister not agree that the impact of the legislation prohibiting smoking in public places, to protect the public and people working in common areas, had a much greater and more immediate impact than all the public awareness work that was done before then?
Earl Howe
I am the first to say that legislation passed by the previous Administration has had a marked and profound effect and has been widely welcomed. However, we are now dealing with something that we know can be influenced by public marketing campaigns. I shall mention how effective those have been in a moment.
With regard to pregnant women, there is a need to encourage everybody to be aware of the risks to health from second-hand smoke. We are achieving high levels of awareness as well as changing attitudes and behaviours. Almost three-quarters of those surveyed said that our campaigns had made them realise that smoking out of an open door or window was not enough to protect children from second-hand smoke. More than a third of those who saw the adverts reported that they had taken action to reduce their children’s exposure to second-hand smoke after seeing them. Those results emerged from the evaluation of last year’s campaign and the campaign that we ran in 2012.
I have to say that I am slightly surprised to hear how strongly the Opposition feel about creating legislation to end smoking in cars, because that is at odds with the position that they took on this issue when in government. The 2010 tobacco control strategy included commitments on smoking in cars that align entirely with my Government’s current approach. That strategy said:
“By increasing the level of awareness of the harms of secondhand smoke, particularly to children, we will encourage people to voluntarily make their homes and private cars completely smokefree”.
That is the stance that the party opposite took when in government and, to pay a little tribute to them, we have followed their lead. Your Lordships will recognise that there is a long way to go. Achieving behaviour change in public health takes time but we are heading in the right direction and the key is maintaining the momentum we are generating.
That is why I am pleased to announce that the Government will run another smoke-free homes and cars campaign this year, as explained in my letter to noble Lords earlier this week. We are finalising the details with colleagues in Public Health England, but our intention is that the campaign will take place in the spring. In addition to a mix of TV and digital advertising, we will work with local and commercial partners to spread the message through their networks. The campaign will be designed to maximise the potential of social media in making our messages clear and accessible to as many people as possible. I hope that that serves to reassure your Lordships that the Government are working hard to make progress in this important area. Our approach is to change smoking behaviour in both the home and family car.
In addition to the campaign activity, we will look at what more we might do to speed up the pace of change. Some local authorities are taking forward excellent work with their local communities to promote not only smoke-free homes and cars but also smoke-free environments such as playgrounds. Working with Public Health England, we will encourage more of this good practice to denormalise smoking, particularly in settings where children are present. I have asked Public Health England to look at what more we can do to spread this good practice.
This year’s smoke-free homes and cars campaign will be the Government’s third successive one, as I mentioned. At its conclusion, we will undertake a complete analysis of the progress that we have made through the campaigns. At that point the Government will give careful consideration to whether our action has had a meaningful impact in reducing smoking in cars carrying children. If health Ministers are not satisfied with the progress made, we will give serious consideration to what more can be done. I can tell my noble friend Lord Ribeiro that we will, if need be, conduct a public consultation so that we can understand how others feel about this issue, and to enable us to consider further the practicality and likely effectiveness of other measures to tackle smoking in cars carrying children, including legislative measures. I do not rule out legislation if our current course does not deliver the desired effect.
The Government take this matter extremely seriously, particularly the issue of reducing the uptake of smoking by young people. We have tabled the amendment today on standardised packaging. We intend to make proxy purchasing of tobacco an offence and prohibit the sale of electronic cigarettes to people under 18. If the Government are not satisfied with progress after this year’s smoke-free homes and cars campaign, we will give serious consideration to what more could be done, including a public consultation. I hope that that indicates our seriousness of purpose.
On the amendments that have been tabled by the Opposition I repeat what I said in Grand Committee. If we cannot credibly enforce the law, the law loses credibility. I appreciate the strength of feeling on this matter. I can assure noble Lords that we will continue to work with all interested parties to protect children from second-hand smoke. I hope that in the light of the assurances that I have given that the noble Lord will not press his amendment on that topic.
NHS: Cancer Treatment
Earl Howe Excerpts(10 years, 3 months ago)
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Baroness Pitkeathley
To ask Her Majesty’s Government what action they propose to take to ensure that older people receive equal access to NHS cancer treatment.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
In December, the national clinical director for cancer at NHS England launched a call for action on the treatment for older people. NHS England is now setting up an advisory group to identify where improvements in cancer services for older people can be made. It is also supporting an initiative to ensure that patients are better informed about the options available to them and that they are fully involved in decisions about their treatment.
Baroness Pitkeathley (Lab)
I thank the Minister for that welcome Answer, but is he aware of the recently published Macmillan Cancer Support report, which shows that up to as 10,000 cancer patients die needlessly each year because of blatant ageism among doctors? For example, recommendations for chemotherapy diminish by as much as half if you are over 70. Since we are an ageing population and half of all new cancer diagnoses are in people over 70, does the Minister agree that it is of the utmost importance that we ensure that people are treated as individuals regardless of their age? How will he ensure that this view is held also among GPs and hospital consultants?
Earl Howe
My Lords, I completely agree. The noble Baroness is right that a series of reports has shown that the NHS has too often failed to provide the best possible services to older people. We cannot save lives without tackling inequalities. The NHS has a statutory duty to reduce health inequalities and to improve the health of those with the poorest outcomes. A ban on age discrimination in the NHS services was introduced in 2012, meaning that NHS services need to do everything they can to ensure that they do not discriminate against older people. We will hold the NHS to account for that through the mandate and the NHS outcomes framework.
Lord Turnberg (Lab)
To what extent are these shocking figures due to lack of funding for cancer services? In that light, what is the Government’s plan for the cancer drugs fund?
Earl Howe
My Lords, the noble Lord may recall that the Government pledged an additional £750 million to support the cancer strategy. We are doing that, and a range of actions are proceeding there. On the cancer drugs fund, we initially pledged a total of £600 million for the first three years of the fund and we recently pledged another £400 million, making £1 billion in all. I am pleased to say that the cancer drugs fund has so far helped more than 38,000 patients.
Lord Walton of Detchant (CB)
My Lords, some two weeks ago, the Minister agreed that, when NICE recommends that a particular form of treatment should be given to patients with cancer, rare cancers and other rare diseases, it is incumbent on clinical commissioning groups to see that those drugs are prescribed. Does the Minister agree that clinical criteria must be employed in reaching decisions as to which patients are to receive those drugs and that age alone must never be a barrier to the prescription of drugs in patients with cancers of that type?
Earl Howe
My Lords, I agree. The noble Lord may recall that in December 2012 we worked on a project with Macmillan Cancer Support and Age UK to improve uptake of treatment in older people. That established some key principles for the delivery of age-friendly cancer services. In December 2013, NHS England published an analysis of chemotherapy uptake in older people, and that report reaffirmed those principles and set out some new recommendations around improving the uptake of chemotherapy.
Baroness Gardner of Parkes (Con)
My Lords, in the previous reply the Minister said he had looked at figures for chemotherapy for older people. Has he looked at the figures for radiotherapy for cancer patients of an age, in particular for intensity-modulated radiotherapy, which is not reaching its target but is considered a great improvement on the previous type of radiotherapy being used for cancer cases?
Earl Howe
My Lords, the Government invested £23 million aimed at increasing the capacity of radiotherapy centres in England to deliver intensity-modulated radiotherapy. The latest analysis shows that the median average of IMRT activity in England is at 29%, with the vast majority of centres delivering at 24% or above. That 24% was the magic figure recommended a few years ago by the national radiotherapy implementation group. We continue to monitor progress and local action plans closely.
Baroness Masham of Ilton (CB)
My Lords, I declare an interest as vice-chair of the all-party cancer group. Does the Minister agree that many older people develop cancer and, therefore, to stop treatment would ensure that many Members of your Lordships’ House would not get treatment? Will he therefore take this really very seriously?
Earl Howe
My Lords, I am with the noble Baroness all the way in wishing to see your Lordships live a healthy and long life but, as regards the population generally, I hope that I have made clear the Government’s determination to see that all citizens of this country receive treatment according to their ability to benefit from it.
Lord Hunt of Kings Heath (Lab)
My Lords, I am sure we are all with the noble Baroness in those sentiments. Can I refer the noble Earl back to the research that my noble friend referred to? The report seems to show that survival rates for cancer patients over the age of 75 are very poor in this country compared with other European countries. The noble Earl has said that he will ensure that action is taken through the mandate to NHS England. Should he not give instructions to clinical commissioning groups to start commissioning cancer services with no age discrimination?
Earl Howe
My Lords, commissioning is an important ingredient in this, but there is a range of actions that we can take and have taken. We know that low levels of awareness and late diagnosis are particular problems for older patients, so it is welcome news that Public Health England is to run a national campaign to raise awareness of breast cancer in women over the age of 70. We are also raising the screening age for breast cancer to include women aged 71 to 73, and the extension of the NHS bowel cancer screening programme to men and women aged 74 is now complete.
Health: Confidential Patient Information
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Lord Hunt of Kings Heath (Lab)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I refer noble Lords to my interests in the register.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, while we have concerns about the EU proposals, there has been no cause to conduct an assessment of the sort suggested at this stage. The Government do not sell confidential patient information to companies. Drug and insurance companies can receive patient confidential information only where they have a legal gateway, either consent of the patient or some form of statutory authority. In these circumstances the cost of providing information may be recovered, but it is not sold.
Lord Hunt of Kings Heath
My Lords, clearly there is great advantage in using patient research in large-scale research projects. However, can the noble Earl assure the House that patient confidentiality can be assured? Also, is it right that projects such as the UK Biobank could be put in jeopardy were the proposed European legislation to be enacted in its current draft form?
Earl Howe
My Lords, under the 2012 Act, the Health and Social Care Information Centre cannot release data that could be used to identify an individual without a legal basis to do so. As a result, there are strict controls about how such information is released. As regards the UK Biobank, the noble Lord is right to be concerned because the proposed text from the so-called LIBE committee would rule out the work of the UK Biobank, in that it would need explicit and time-limited consent for any research project that it undertook, instead of being able to support a range of research purposes, as it now can, using its existing consenting mechanism. So there is cause for concern if this text is adopted, but that is not yet clear.
Baroness Pitkeathley (Lab)
My Lords, many noble Lords will have received recently a leaflet through their letter box, saying that their records are going to be made available unless they opt out. The means of opting out is to contact your GP. First, has anyone noticed how difficult it is to contact your GP in some circumstances? Secondly, would it have been beyond the wit of the department to include a simple, tick-box form for people to use? Does the absence of such a simple process lead us to conclude that the Government do not actually want people to opt out of making their records available?
Earl Howe
My Lords, everybody in the country has a right to object to their data being shared. Those objections will always be respected. A practical way had to be found to enable that process to happen, and we believe that it is not unreasonable to expect a patient to have a conversation with their GP. I will, however, take the noble Baroness’s suggestions on board and feed them in.
Lord Willis of Knaresborough (LD)
Does my noble friend agree that while patients can object to having their records sent, they cannot, in fact, legally prevent the GP sending those records to the central repository? It is at that point that the discussion as to whether those records should be sold on and used by pharmaceutical companies and others is important. Does he agree that it is important that companies carrying out research into new drugs and compounds can access patient records, because they are an important dataset for making sure that we have better healthcare for our people?
Earl Howe
My noble friend is correct. The UK has a unique advantage in being able to link patients’ data records for the purposes of research and for effective healthcare commissioning. It would be extremely concerning if European law prevented that. I believe and hope that patients will be encouraged that there will be no abuse of identifiable information. The controls around this are very strict and, in the main, only anonymised data are required for research purposes.
Baroness Finlay of Llandaff (CB)
Can the Minister explain if there are circumstances in which personal confidential data might be used and analysed, such as in a public health emergency, and what the safeguards are surrounding that access?
Earl Howe
My Lords, there are circumstances in which potentially identifiable data can be released, but they are very severely circumscribed. A public health emergency is one, but Section 251 of the National Health Service Act 2006 could also allow identifiable information to be shared for specific purposes. However, the controls around that are extremely strict and the only people who can take that decision are the Secretary of State and the Health Research Authority—and then only after expert advice from the Confidentiality Advisory Group.
Baroness Manzoor (LD)
My Lords, some patients do not understand the implications and possible effects of the proposed EU legislation. What steps are being considered to ensure that those patients have full understanding?
Earl Howe
My Lords, until we are clear about the text that is agreed at European level, it is difficult to issue public advice on what the effect of that proposed measure would be. The text is still being argued over. While my noble friend is absolutely right that a public information exercise would be advisable once we are aware, we are not at that point yet.
Health: Dementia
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, this has been an excellent short debate. I thank all contributors but, in particular, my noble friend Lady Gardner for having tabled this important subject and for having introduced it with such insight.
As has been said, dementia is one of the biggest challenges society is facing, but it is a challenge that we are determined to get to grips with. That is why dementia is a major priority for the UK Government, and my right honourable friend the Prime Minister launched the dementia challenge last year. We must fight back on an international scale, which is why we hosted the first G8 summit on dementia in December, as the noble Baroness, Lady Greengross, kindly mentioned, and we will continue to provide global leadership.
Five years ago, the national dementia strategy was developed. It has achieved a lot and laid the foundations for real change in how people with dementia and their carers are helped to live well with the condition. However, we recognised the need to build on the strategy and that is why the Prime Minister’s challenge on dementia is the main vehicle driving change and improvement across health and care in the community and for research. The Prime Minister’s challenge runs to 2015, not just outliving the dementia strategy but broadening its vision and providing better accountability. The challenge sets out the Government’s commitment to increase diagnosis rates, raise awareness and understanding, and double funding for research into dementia by 2015.
There are 670,000 people in England with dementia, a number expected to double in the next 30 years. Dementia costs society an estimated £19 billion a year, and currently less than half of all people with dementia have a formal diagnosis. One of the main aims of the Prime Minister’s challenge is to improve awareness of the condition by creating dementia-friendly communities. If we are to help people to live well with dementia, we need all areas of society to become dementia-friendly—not just health and social care but banks, supermarkets, bus stations, post offices and all the different forms of local public services. All those places can become more dementia-aware and supportive of people with dementia and, if they do, people with dementia will benefit enormously, continuing to connect with society in ways we all take for granted.
Last October, Lloyds Bank and the Alzheimer’s Society launched a charter encouraging banks and building societies to join them in becoming dementia-friendly, and we need other companies to follow suit. I was impressed by all that I heard from the noble Lord, Lord Jones, about Airbus. The noble Baroness, Lady Turner, in her moving speech, referred to the importance of local support for people with dementia, and I wholeheartedly agreed with what she said.
The Dementia Friends scheme, which aims to make 1 million people more aware and understanding of dementia, is helping to break down the barriers between people with the condition and their local communities, with funding from the Department of Health and the Cabinet Office. The noble Lord, Lord Jones, was absolutely right in all that he said on this subject. My right honourable friends the Prime Minister and Deputy Prime Minister and Ministers at the Department of Health are all Dementia Friends, as are more than 500 Department of Health staff. I myself am a Dementia Friend. It has helped me to understand the impact that this condition has not just on the individual but on their families who care for them. Dementia Friends is one of several components in creating dementia-friendly communities. Alzheimer’s Society guidance sets out the criteria for becoming a dementia-friendly community, and already 34 communities, from York to Plymouth, have signed up to the scheme, with others having expressed an interest in doing so.
This spring, Public Health England, working with the Alzheimer’s Society, will launch a three-year £12 million social movement to make the nation more aware of dementia and enable people to understand how they can help those with the condition. The “Dementia Movement” will aim to do three main things. The first will be to reduce fear and stigma through activity that improves public attitudes towards dementia and gives more people the confidence to engage with those with dementia. It will also aim to increase social connectedness—for example, by prompting and supporting conversations between people in the early stages of dementia and their families, friends and neighbours. It will aim, too, to improve skills by recruiting people into the Dementia Friends programme so that more people know how to help those with dementia. The movement will target business partners in the private, public and voluntary sectors, and urge them to continue to implement the Dementia Friends programme within their organisations, giving their employees an understanding of the supportive action that they can take to help people with dementia.
The noble Baroness, Lady Greengross, spoke with great authority about the importance of diagnosis, co-ordinated care and support, and I very much agreed with what she said. The noble Lord, Lord Jones, also laid emphasis on timely diagnosis. Raising awareness of the signs and symptoms of dementia is the first step towards getting a formal diagnosis—one that will lead to people being able to access advice, information, care and support. The number of people with a diagnosis is increasing year on year, but the noble Lord, Lord Hunt, was right: still only just under half of all people with dementia have a diagnosis. That is simply not good enough and it is why NHS England has committed to raising the diagnosis rate to two-thirds by 2015.
Clinical commissioning groups are working with their local councils and other partners to better understand how widespread dementia is in their communities, including among people living in local care homes. This will mean that they can identify and support people with dementia in a timely way. GPs are now able to use the new directed enhanced service to improve the diagnosis of dementia by asking people in certain at-risk groups about their memory. This proactive approach should help to identify patients who are showing the early signs of dementia.
The noble Baroness, Lady Greengross, and the noble Lord, Lord Hunt, asked about steps being taken to ensure the identification and treatment of comorbidities in people with dementia. If I may say so, that question is extremely pertinent. NHS England has committed to increasing the dementia diagnosis rate, as I mentioned. A diagnosis of dementia is vital in accessing support and treatment across the board, not just for dementia but for all comorbid conditions.
Once people have a diagnosis. they need to understand the implications of the condition and how they can access advice, information and support to help them and their carers to live as well as they can with the condition. If the condition is advanced, some people will need care and support immediately, but those diagnosed at an earlier stage may need only advice and information. The noble Lord, Lord Hunt, rightly stressed the need to provide information post-diagnosis.
My noble friend Lady Gardner mentioned the important role of charities, as did the noble Lord, Lord Jones, who rightly praised the work of the Alzheimer’s Society. The dementia guide is given to a person with dementia when they receive a diagnosis, and almost 100,000 copies have been distributed since last July. The NHS Choices website has dedicated pages for dementia, highlighting the range of services and support available to people with dementia and their carers. Regional NHS websites, such as myhealthlondon.nhs.uk provide details of healthcare and voluntary services available locally. A free national helpline helps carers to access information about local and national services and individual advice and support.
My noble friend referred to the need for good nursing. Services are no good without a skilled workforce. That is why Health Education England is ensuring that staff are dementia-trained. In November, it hit its target to deliver dementia training to 100,000 staff ahead of schedule, and it will continue to roll out training to improve the skills of the workforce. We want people with dementia to receive a better quality of care from informed and trained staff through the CQUIN programme. NHS England has asked all hospitals to identify a senior clinical lead for dementia, to ensure that carers of people with dementia are adequately supported, and that this is reported at board level. Every person joining the social care workforce will undertake common induction standards, which include aspects of dementia awareness. In addition, a number of units and qualifications at vocational levels 2 and 3 have been developed by Skills for Care and Skills for Health to support the development of the social care and health workforce, working with people with dementia.
The noble Lord, Lord Hunt, and my noble friend Lady Gardner asked about research. Doubling funding for research, as I mentioned, is part of the Prime Minister’s challenge, and the quality and quantity of research proposals for dementia are improving. Last year £20 million was awarded to six proposals which will look at areas such as Living Well with Dementia and dementia-associated visual impairment. All the G8 countries signed up to the communiqué at the end of the conference and one of the pledges was significantly to increase the amount spent on dementia research.
As I have outlined, there are a range of services and information sources available to support people with dementia and their carers, but this is only the beginning and we have a long way to go until everyone with dementia is able to live as well as they can with the condition. We are not resting on our laurels. The Government are committed to doing more. We are currently working with our partners in the NHS, social care, local government, public health and the Alzheimer’s Society on a call to action to improve post-diagnosis support for people with dementia and their carers—support on which the noble Lord, Lord Jones, rightly laid emphasis. The work is at an early stage but, over the next couple of months, we will be developing an offer of what should be available to everyone to ensure that we have achieved the Government’s goal of people with dementia and their carers having access to services to help them live well within our society for longer.