Mid Staffordshire Foundation Trust Inquiry
Earl Howe Excerpts(11 years, 1 month ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I shall now repeat a Statement made earlier today in another place by my right honourable friend the Secretary of State for Health on the Government’s response to the Francis report. The Statement is as follows:
“With permission, Mr Speaker, I would like to make a Statement on the Government’s response to the Mid Staffordshire NHS Foundation Trust Public Inquiry. I congratulate my right honourable friend and predecessor on setting up the public inquiry, and on the many changes that he made foreseeing its likely recommendations. I would also like to pay tribute to Robert Francis QC for his work in producing a seminal report which I believe will mark a turning point in the history of the NHS.
Many terrible things happened at Mid Staffs in what has rightly been described as the NHS’s darkest hour. Both the current and former Prime Minister have apologised, but when people have suffered on this scale, and died unnecessarily, our greatest responsibility lies not in our words but in our actions—actions that must ensure the NHS is what every health professional and patient wants: a service that is true to the NHS values, that puts patients first and treats people with dignity, respect and compassion.
The Government accept the essence of the inquiry’s recommendations and we shall respond to them in full in due course. However, given the urgency of the need for change, I am today announcing the key elements of our response so that we can proceed to implementation as quickly as possible. I have divided our response into five areas: preventing problems arising by putting the needs of patients first; detecting problems early; taking action promptly; ensuring robust accountability; and leadership. Let me take each in turn.
To prevent problems arising in the first place, we need to embed a culture of zero harm and compassionate care throughout our NHS, a culture in which the needs of patients are central, whatever the pressures of a busy, modern health service. As Robert Francis said, ‘The system as a whole failed in its most essential duty: to protect patients from unacceptable risks of harm and from unacceptable, and in some cases inhumane, treatment that should never be tolerated in any hospital’.
At the heart of this problem, the current definitions of success for hospitals fail to prioritise the needs of patients. Too often, the focus has been on compliance with regulation rather than on what those regulations aim to achieve. Furthermore, the way that hospitals are inspected is fundamentally flawed, with the same generalist inspectors looking at slimming clinics, care homes and major teaching hospitals—sometimes in the same month. So we will set up a new regulatory model under a strong, independent chief inspector of hospitals, working for the CQC. Inspections will move to a new specialist model based on rigorous and challenging peer review. Assessments will include judgments about hospitals’ overall performance, including whether patients are listened to and treated with dignity and respect, the safety of services, responsiveness, clinical standards and governance.
The Nuffield Trust has reported on the feasibility of assessments and Ofsted-style ratings, and I am very grateful for its thorough work. I agree with its conclusion that there is a serious gap in the provision of clear, comprehensive and trusted information on the quality of care. So in order to expose failure, recognise excellence and incentivise improvement, the chief inspector will produce a single aggregated rating for every NHS trust. Because the patient experience will be central to the inspection, it will not be possible for hospitals to get a good inspection result without the highest standards of patient care.
However, the Nuffield rightly says that in organisations as large and complex as hospitals, a single rating on its own would be misleading, so the chief inspector will also assess hospital performance at speciality or department level. This will mean that cancer patients will be told of the quality of cancer services, and prospective mothers the quality of maternity services. We will also introduce a chief inspector of social care and look into the merits of a chief inspector of primary care in order to ensure that the same rigour is applied across the health and care system.
We must also build a culture of zero harm throughout the NHS. This does not mean that there will never be mistakes, just as a safety-first culture in the airline industry does not mean that there are no plane crashes, but it does mean an attitude to harm which treats it as totally unacceptable and takes enormous trouble to learn from mistakes. We await the report on how to achieve this in the NHS from Professor Don Berwick.
Zero harm means listening to and acting on complaints, so I will ask the chief inspector to assess hospital complaints procedures, drawing on the work being done by the Member for Cynon Valley and Professor Tricia Hart to look at best practice.
Given that one of the central complaints of nurses is that they are required to do too much paperwork and thus spend less time with patients, I have asked the NHS Confederation to review how we can reduce the bureaucratic burden on front-line staff and NHS providers by a third. I will also be requiring the new Health and Social Care Information Centre to use its statutory powers to eliminate duplication and reduce bureaucratic burdens.
Secondly, we must have a clear picture of what is happening within the NHS and social care system so that, where problems exist, they are detected more quickly. As Francis recognised, the disjointed system of regulation and inspection smothered the NHS, collecting too much information but producing too little intelligence. We will therefore introduce a new statutory duty of candour for providers to ensure that honesty and transparency are the norm in every organisation, and the new chief inspector of hospitals will be the nation’s whistleblower in chief.
To ensure that there is no conflict in that role, the CQC will no longer be responsible for putting right any problems identified in hospitals. Its enforcement powers will be delegated to Monitor and the NHS Trust Development Authority, which it will be able to ask to act when necessary.
We know that publishing survival results improves standards, as has been shown in heart surgery. So, I am very pleased that we will be doing the same for a further 10 disciplines: cardiology, vascular, upper gastro-intestinal, colorectal, orthopaedic, bariatric, urological, head and neck, thyroid and endocrine surgery.
The third part of our response is to ensure that any concerns are followed by swift action. The problem with Mid Staffs was not that the problems were unknown; it was that nothing was done. The Francis report sets out a timeline of around 50 warning signs between 2001 and 2009. Ministers and managers in the wider system failed to act on these warnings. Some were not aware of them; others dodged responsibility. This must change. No hospital will be rated as good or outstanding if fundamental standards are breached. Trusts will be given a strictly limited period of time to rectify any such breaches. If they fail to do this, they will be put into a failure regime which could ultimately lead to special administration and the automatic suspension of the board.
The fourth part of our response concerns accountability for wrongdoers. It is important to say that what went wrong at Mid Staffs was not typical of our NHS and that the vast majority of doctors and nurses give excellent care day in, day out. We must make sure that the system does not crush the innate sense of decency and compassion that drives people to give their lives to the NHS. Francis said that primary responsibility for what went wrong at Mid Staffs lies with the board. So, we will look at new legal sanctions at a corporate level for organisations that wilfully generate misleading information or withhold information that they are required to provide. We will also consult on a barring scheme to prevent managers found guilty of gross misconduct finding a job in another part of the system. In addition, we intend to change the practices around severance payments, which have caused great public disquiet. In addition, the General Medical Council, the Nursing and Midwifery Council and the other professional regulators have been asked to tighten their procedures for breaches of professional standards. I will wait to hear how they intend to do this, and for Don Berwick’s conclusions on zero harm before deciding whether it is necessary to take further action. The chief inspector will also ensure that hospitals are meeting their existing legal obligations to ensure that unsuitable healthcare support workers are barred.
The final part of our response will be to ensure that NHS staff are properly led and motivated. As Francis said:
“All who work in the system, regardless of their qualifications or role, must recognise that they are part of a very large team who all have but one objective, the proper care and treatment of their patients”.
Today I am announcing some important changes in training for nurses. I want NHS-funded student nurses to spend up to a year working on the front line as support workers or healthcare assistants, as a prerequisite for receiving funding for their degree. This will ensure that people who become nurses have the right values and understand their role. Healthcare support workers and adult social care workers will now have a code of conduct and minimum training standards, both of which are being published today. I will also ask the chief inspector to ensure that hospitals are properly recruiting, training and supporting healthcare assistants, drawing on the recommendations being produced by Camilla Cavendish. The Department of Health will learn from the criticisms of its own role by becoming the first department where every civil servant will have real and extensive experience of the front line.
The events at Stafford Hospital were a betrayal of the worst kind—a betrayal of the patients, the families, and of the vast majority of NHS staff who do everything in their power to give their patients the high-quality, compassionate care that they deserve. However, I want Mid Staffs to be not a byword for failure but a catalyst for change: to create an NHS where everyone can be confident of safe, high quality, compassionate care; where best practice becomes common practice; and where the way in which a person is made to feel as a human being is every bit as important as the treatment they receive. That must be our mission and I commend this Statement to the House”.
My Lords, that concludes the Statement.
Earl Howe
My Lords, I am grateful to the noble Lord, Lord Hunt, for his comments, and for the support that he was able to give to a number of the proposals that the Government have made. I will attempt to answer as many of his questions as possible. First, he asked why the Government’s response does not address all 290 of Francis’s recommendations. This report, which comes seven weeks on, is not and I think could not be a full response to each and every one of those recommendations. Francis himself notes in his report that:
“Some recommendations are of necessity high level and will require considerable further detailed work to enable them to be implemented”.
That work we will most certainly do. We accept most of the recommendations in Robert Francis’s report, either in principle or in their entirety, but I emphasise that there is much more to do. To rush ahead would mean that we would not give the full and collective consideration to the report that is clearly needed. It would also limit the clinical engagement and the patient and public involvement that is so important. Our response today is designed to be an overarching one, setting out our key early priorities.
The noble Lord asked me about the duty of candour. We recognise that attaching criminal sanctions to key areas of public service delivery can send an important message to the public about the expected standards of care and duty. That is why we will consider the introduction of additional legal sanctions at a corporate level where organisations wilfully generate misleading information, or withhold information that they are required to provide. I cannot be more specific about the extent and scope of that, but we do think there is an issue to be addressed there. I will take the noble Lord’s points on board as to how widely that should go.
However, we are concerned that the introduction of criminal sanctions on individual staff who provide NHS services could run counter to the creation of an open and transparent culture. It could instead create a culture of fear that could lead to the cover-up of mistakes, which is the very opposite of what we seek to achieve. That of course could in turn prevent lessons being learnt and could make services less safe. However, we agree that where staff are obstructively dishonest action will need to be taken to ensure that the quality of patient care is not jeopardised. We are asking the NMC and the GMC to look at how they might be able to strengthen professional standards and disciplinary measures to address those kinds of case. Registered clinical staff are, of course, already placed under a duty to be open through their professional regulators, but we will consider whether is a need to add to that duty in the light of the Berwick review on safety.
Turning to healthcare support workers, as I have frequently said in your Lordships’ House, the Government’s mind is not closed to statutory regulation, but regulation as such is no substitute for a culture of compassion and effective supervision. Putting people on a national register does not guarantee protection for patients, as was sadly seen at Mid Staffs. Instead, we have decided to tackle this issue at its root, focusing on making sure that healthcare support workers have the right training and values and, most importantly, support and leadership to provide high-quality care.
As I repeated in the Statement, we are today publishing minimum training standards and a code of conduct for healthcare and care assistants. In addition, all healthcare support workers work under registered professionals who are responsible for the care provided to their patients. Camilla Cavendish has been asked to conduct an independent study of healthcare and care assistants to ensure that they have not just the right training but the right support to provide services to the highest of standards. She is due to report in May. We will consider further action following that review. Health Education England is working with employers to improve the capability and training standards of the care assistant workforce. Its strategy will feed into the Camilla Cavendish review.
As regards nurse training and the idea that every prospective nurse should have bedside experience before undertaking formal training, we believe that that idea should be piloted. The charge that we have heard for so many years that some nurses are too posh to wash must be got rid of. We must ensure that we are training nurses who have an aptitude for the role and who know what it is like to have hands-on experience as a healthcare assistant before committing themselves to training. Starting with pilots, every student seeking NHS funding for nursing degrees should, we believe, first serve for up to a year as a healthcare assistant to promote front-line caring experience and values, as well as academic strength. The current first-year dropout rate for nurses alone is 25%. For that reason also, it is important to ensure that we have the right sort of man and woman as a nurse trainee. We recognise that the scheme will need to be tested and implemented carefully to ensure that it is cost-neutral. Of course that is a consideration and the noble Lord was right to raise it. We will explore whether there is merit in extending the principle to other NHS trainees.
The noble Lord asked me a number of questions about the chief inspector. We think that having a chief inspector as part of the senior team of the CQC will provide us all with an expert judgment on the part of those who have walked the wards, spoken to patients and staff, looked the board of directors in the eye and made a rounded judgment of an organisation’s health, and thereby give true quality assurance, as opposed to what I fear that we have seen all too frequently, which is a tick-box approach. It will be a powerful role and it is very important that the data on which the chief inspector relies are representative of quality. That is a job of work that needs to be done.
The noble Lord also asked me about the National Patient Safety Agency. We continue to believe that it is absolutely right to place the national reporting and learning service within the Commissioning Board if we are to learn from safety incidents and near misses and to enable that information to be fed directly into commissioning behaviour. It is obviously important that we do not lose the expertise that the NPSA has built up. I hope and believe that we will not and that this is the right model. Nevertheless, the noble Lord is right to flag up that we need to learn from experience and we will do that.
As regards the CQC’s responsibilities, the noble Lord may be aware that the Health Select Committee of another place recently reported on the role of Monitor. One of the key criticisms that it levelled against the current system was that it is, in many senses, ambiguous. Sometime the roles of Monitor and the CQC appear to overlap and sometimes there appears to be a gap as to exactly who is responsible for what. Having thought very carefully about this issue, our judgment is that it is important to be crystal clear about who is responsible for what. The CQC’s powers, in terms of warning notices and improvement notices, will remain, but should the CQC find that there is an intractable case of quality failure in a provider organisation, it should not be the CQC’s job to sort that out. There should be a single failure regime triggered by Monitor, which is the body currently responsible for triggering the financial failure regime. The details are yet to be worked out, but clarity of roles is vital in this area.
I am aware that there are one or two questions that I have not covered, but I undertake to write to the noble Lord on those.
Baroness Jolly
My Lords, I thank my noble friend the Minister for repeating the Statement. I am sure that many noble Lords will welcome, in due course, a full and spirited debate on this issue. Will my noble friend clarify which of the recommendations that are being adopted will require primary legislation, what the timescale might be and what the mechanism might be for that?
We welcome my noble friend’s remarks on the duty of candour but, as with all these things, the devil is in the detail. My question is about the chief inspector regime in general. We are going to have a chief inspector of hospitals so it would seem sensible to have a chief inspector of social care. Will we then need a chief inspector for public health and another one for mental health? Is that the way to have all the bases covered?
Earl Howe
My Lords, it is a little early to say what legislation we will need, but I can tell my noble friend that we can deal with the duty of candour by secondary legislation. It may be that many of the follow-up actions to Francis can be done without any legislation at all. However, primary legislation would appear to be the obvious route when statutory roles are to be changed.
With regard to the chief inspectors, the only firm decisions we have taken so far are to appoint a chief inspector of hospitals and a chief inspector of social care. We are looking at the merits of a chief inspector of primary care but we need to make sure that there is a genuine issue that needs to be addressed by way of a chief inspector role rather than leaving the CQC to perform its role in the normal way. Further details will be forthcoming at an appropriate time.
Baroness Emerton
My Lords, I would like to mention nurse education. The suggestion of having some front-line experience before entering university is, philosophically and practically, very good if it can be worked, but it raises all sorts of questions. I spoke to a healthcare support worker a few weeks ago who said that all the students who come on to her ward tell her, “I wish we had had this experience that you are getting before going into training”, so there is evidence that many of them would like to have that kind of experience. However, this raises the question of their supervision during that time. Will there be adequate numbers of trained staff to supervise the continuing support workers as well as those who are pre-nursing apprentices, or whatever?
The logistics of this are going to be important to work on. We need to know whether the Government will look at minimum staffing levels. Where there are enough registered nurses and the minimum is stated, there should be means whereby registered nurses will be available whenever demands on patient care escalate, such as during a time of winter problems, rather than abusing and misusing the support workers. There is a tremendous amount of work to be done on that.
There is also the role of the Nursing and Midwifery Council, which has responsibility for regulating the pre-nursing standards. I hope the Government will ensure that the council takes an active part in this pre-nursing experience, because that will be important. I urge Ministers to have this minimum staffing looked at, if that is possible. I am extremely disappointed that the Government are not prepared to take on the regulation of these support workers because I fear that we may find ourselves having similar problems as in the past, unless we have some regulatory system.
Baroness Northover
My Lords, I remind noble Lords that brief questions only are called for after Statements, and that the briefer they are, the more colleagues will be able to get in.
Earl Howe
I reassure the noble Baroness that all the concerns that she rightly raised are very much in our sights, not least the need for proper supervision of nurse trainees and the practical aspects of having the right level of support on the ward. This is why we believe that this idea should be piloted first, so that lessons can be learnt. Yes, we will involve the NMC, and indeed the Royal College of Nursing, in these plans. As regards ratios, having the right staffing in terms of numbers and skills is clearly vital for good care, but minimum staffing numbers and ratios, if laid down in a rigid way, risk leading to a lack of flexibility or organisations seeking to achieve staffing levels only at the minimum level. Neither of those is good for patients. However, I do not dismiss the general concept. It is ultimately up to local organisations to have the freedom to decide the skill mix of their workforce, based on the health needs of those on the wards.
Baroness Pitkeathley
My Lords, the principle of putting the needs of patients first will be welcomed by every Member of this House. However, does the Minister agree that this means looking at care in an integrated way, since the patient experience is very rarely one of either hospital or social care but a mixture—sometimes a very haphazard mixture—of the two? Can the Minister therefore give the House more detail about how the government proposals will facilitate the integration of care services across health and social care, particularly as there will be two separate inspectors and as the ability of the CQC to put the shortcomings right is apparently going to be passed to Monitor?
Earl Howe
My Lords, the main drivers and levers for increased integration will come from other directions, such as: the systems we are putting in place at local authority level and health and well-being board level; more sophisticated tariffs; better commissioning arrangements between the NHS and social care; and the financial imperative that all commissioners and providers now face. That will mean an imperative to ensure that resources are not wasted and are deployed to the best effect of patients.
We must also remember that the NHS outcomes framework will be the benchmark by which the success of the service is judged, just as the social care outcomes framework will act in that sphere in an equivalent way. The major domain in both areas is the patient experience. If we believe that integration is above all to be defined by reference to the patient’s experience, we can expect commissioners across the piece to address commissioning in a way that avoids disjointed care.
Lord Cormack
My Lords, is my noble friend aware that many people in Staffordshire will welcome this report but will wonder whether the present chief executive is the best person to oversee the implementation of the many recommendations to which my noble friend has referred?
Earl Howe
My Lords, it was a signal feature of the Francis report that he consciously avoided pointing the finger at individuals. The chief executive of the NHS did not have the finger of blame pointed at him. The House may be interested to know that I regard Sir David Nicholson as a truly outstanding public servant who has done an enormous amount of good for the NHS since becoming chief executive.
The benefit of hindsight is wonderful but we must remember that in the years in which these dreadful events took place the National Health Service was held to account by reference to two main indicators: access to care and waiting times, and finance. Above all, it was the arrival of the noble Lord, Lord Darzi, as a Minister and the Secretaries of State whom he served that saw the transformation of the NHS from an organisation that was concerned just about numbers into one that really appreciated that quality matters. Therefore, to accuse those with positions of responsibility with regard to Mid Staffs of overlooking the fact that quality was poor is to place a wholly unfair retrospective expectation on them.
Lord Patel
My Lords, a great deal of importance and emphasis is being placed on introducing zero harm with regard to patient safety. I am delighted that the Government have asked Don Berwick to advise them how to do this. Do the Government intend to have zero harm in the NHS as a concept or as a requirement? If it is the latter, what legal framework will make that happen?
Earl Howe
It is much more a question of culture than anything else. However, the noble Lord will be aware that Robert Francis recommended that we look at the concept of fundamental standards below which care should never fall. We are determined to do that. Defining a fundamental standard is something for wide discussion. However, we take this recommendation very seriously. Robert Francis was clear that if individuals or an organisation were found guilty of breaching fundamental standards, serious consequences should ensue.
On a more general level, it is impossible to expect human beings never to make a mistake or never to fall down on the job. The point here is to create an attitude of mind in all those who work for and with the NHS that puts the patient’s well-being at the centre of their daily lives and thinking. That is where we want to be.
Lord Bilston
The recent pronouncements of Monitor seem to ignore the vast majority of the people of Stafford, who, as my noble friend Lord Hunt indicated, require a range of safe, sustainable and comprehensive health services rather than the delegation of a range of services, including elective surgery, to other hospitals such as New Cross in Wolverhampton. That hospital is already under considerable pressure and has inadequate facilities in many areas, including a very restricted site with inadequate car parking. Will my noble friend comment on that, because there is great concern and anxiety in Wolverhampton that many thousands of people will be allocated to New Cross and that it will be unable to respond that heavy need? As always in these cases, the balloon will burst and we will quickly find that New Cross Hospital itself sinks into the abyss and then has difficulty responding to the health needs of the people of Wolverhampton.
Earl Howe
I understand the noble Lord’s concerns and those of the people of Stafford. Unfortunately, this trust is losing a substantial amount of money. That is not a situation that anybody can be relaxed about, which is why Monitor has taken the action that it has. One of the tests by which any trust administrator’s report will be judged will be whether the solution offered delivers high-quality care and the prospect of good health outcomes to the patients of the area. This is not just a pounds, shillings and pence exercise; it is an exercise that is necessarily looking at services across the piece to see how they can be better and more cost-effectively configured to ensure that high-quality care is maintained.
Baroness Browning
My noble friend will be aware that the Mental Capacity Act was not mentioned or used at Winterbourne View and that we have seen one too many reports from Mencap about the deaths on hospital wards of young people who have a learning disability or autism. In the next 12 months, this House will carry out post-legislative scrutiny of the Mental Capacity Act. Will my noble friend ensure that his department is not just a passive observer of that process but communicates with those on that committee to ensure that people on hospital wards who lack capacity, albeit a fluctuating or temporary lack of capacity, are not only spoken to but treated like any other patient?
Earl Howe
My noble friend is right to raise this issue, and I pay tribute to the work that she has so consistently done to improve the lot of those with autism. I undertake to write to her about this, but I can give her the general reassurance that the Department of Health will certainly be involved in the scrutiny of these measures, as will the NHS Commissioning Board. I want to ensure that we learn the right lessons from the actions already taken.
Baroness Masham of Ilton
My Lords, does the Minister not think that, with the duty of candour, those who make mistakes should take responsibility and be accountable for them? Otherwise people will not learn from those mistakes and they will continue. I also want to ask about the 10 disciplines. I was very surprised that respiratory conditions are not included as nearly all death certificates have pneumonia on them.
Earl Howe
I undertake to look at the latter point made by the noble Baroness. The 10 disciplines were selected as ones that could reasonably and readily be subject to the kind of assessment process that we are looking to achieve. I will come back to her on that.
As regards the duty of candour, individuals should certainly take responsibility for their actions and be encouraged to do so. We fear, however, that criminalising individuals’ behaviour within an NHS organisation could risk doing the opposite of what we all want to see: a much more open culture, one that has made the NPSA and its work so successful; a no-blame culture, where people take responsibility for when things go wrong but do not feel that the heavy hand of authority is going to descend upon them at the merest mistake. However, it is important that people are held to account if they are dishonest or deliberately withhold information, and that is a different set of issues.
Lord Walton of Detchant
The appalling failings highlighted in the Francis report clearly demonstrated that the managerial virus—an obsession with meeting targets—infected many of the medical and nursing staff in Mid Staffs and diverted them from their primary standards of providing a high quality of patient care. Many of the proposals set out in the Statement are essentially welcome.
I learnt only last week of the new assessment method, PLACE, and I would love to hear where that fits in to the programme. Having said that, will the Government take note of the fact that there is a danger in creating a superfluity of regulatory authorities that would divert doctors and nurses from their primary bedside responsibilities? Is it not better to make certain that regulatory authorities function much more efficiently and effectively in controlling standards?
Earl Howe
I wholeheartedly agree with the noble Lord. One of the concerns at the back of our minds as we have considered Robert Francis’s report is the need to ensure that we do not create oppressive additional regulation to cure the problems that Francis has identified. Indeed, we need to look at doing the opposite: how can we lift regulatory burdens and ensure that the culture Francis spoke about can thrive? The NHS Confederation is advising us on this. It is looking specifically at burdens placed on NHS providers and organisations, and we shall take its recommendations to heart.
Food: Fast Food
Earl Howe Excerpts(11 years, 1 month ago)
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Lord Sharkey
To ask Her Majesty’s Government what is their assessment of the effectiveness of the Responsibility Deal for Calorie Reduction in achieving significant product reformulation in food sold by fast food operators.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the responsibility deal’s calorie-reduction pledge challenges businesses, including fast food companies, to take action to help people eat fewer calories. This includes product reformulation. Responsibility deal partners report annually on the progress that they have made against their pledges. Annual updates for 2012-13 will be published on the responsibility deal website in summer 2013.
Lord Sharkey
My Lords, the plain fact is that not a single fast food operator has signed up to the calorie-reduction pledge. I asked McDonald’s why and it said that it was because of concerns about the lack of clarity and vagueness in some of the Government’s definitions. If the calorie-reduction pledge does not work with fast food operators, how else can we make certain that they reduce calories in the 5.5 billion meals they serve every year in the UK?
Earl Howe
In fact, my Lords, 32 businesses have signed up to the pledge to help people consume fewer calories, which is a responsibility deal priority. They include seven of our major retailers and some of the nation’s biggest food manufacturers, as well as Subway, which is a fast food company—so we do have one. It is a deliberately wide-ranging pledge, allowing companies and their customers to reduce calories through a broad range of actions. I say to my noble friend, however, that we will have fast food companies very much in our sights over the coming months.
Lord Collins of Highbury
My Lords, helping people to make informed choices on what they eat is really important. However, we have learnt in recent times that what is on the label is not always what is inside. I have stated previously that so-called healthy products such as low-fat yoghurts and cereals are jam-packed with sugar, which has huge implications for the threat of diabetes. Will the Minister consider statutory food labelling which is easy to understand?
Earl Howe
My Lords, we certainly have not ruled out regulation in this area, but we can be encouraged by the progress that we have made to date through the responsibility deal in terms of calorie labelling. Some 47 businesses signed up to labelling calories at the end of 2012, while 5,000 fast food and takeaway outlets and around 9,000 high street outlets, including pubs, restaurants and coffee shops, will display calories.
Health: Diabetes
Earl Howe Excerpts(11 years, 1 month ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I congratulate the noble and learned Lord, Lord Morris of Aberavon, on securing this debate and on his authoritative speech and major contribution to raising the profile of diabetes, especially type 1. Diabetes is a major challenge for this country and that is why it is a key priority in the mandate for the NHS Commissioning Board. We are clear about the need to improve diabetes outcomes through better care, and we regard diabetes as a key marker of improvement in the NHS as a whole.
We are helped by having strong advocacy, as has been mentioned. I would like to commend the work of Diabetes UK in raising awareness of the early signs of diabetes in children, and support its new Ten out of Ten campaign: Type 1 essentials for children and young people.
Earl Howe
Type 1 diabetes is an autoimmune condition that causes failure of insulin production. It cannot be prevented or cured. Individuals usually develop the condition in childhood or early adulthood and require lifelong insulin treatment.
I therefore commend the Juvenile Diabetes Research Foundation for funding international studies in type 1 diabetes, having spent over £1 billion on research that seeks a cure or better treatment. It is a mark of the international standing of diabetes research in the UK that JDRF spends a relatively high proportion of its funding on type 1 diabetes research in this country.
We know that diabetes has a significant cost to society. The current payment systems in the NHS do not differentiate between the costs associated with type 1 and type 2 diabetes. The National Audit Office estimates that the NHS spends at least £3.9 billion a year on diabetes as a whole and its complications.
The noble and learned Lord asked what the obstacles were to counting the costs of type 1 diabetes separately. It is simply current accounting practice that prevents this. There will be new opportunities, with the NHS Commissioning Board and CCGs taking responsibility. I understand that as we speak work is under way that looks at the coding of diabetes care in primary care and how this is collected via computer systems.
The noble Lord, Lord Harrison, mentioned the indirect costs of diabetes. We know very well what those indirect costs look like in personal terms. One in 20 people with diabetes require support from social services. People with diabetes are twice as likely to be admitted to hospital than those without it. Complications increase the cost of NHS care fivefold. People can lose a leg, or their vision. Their kidneys can fail, they are vulnerable to infection, and their hearts can fail. These are serious complications. Diabetes is also a major factor in premature mortality.
We need more proactive management of the condition and its complications, starting with prompt diagnosis. Once diagnosed, people must have access to the best care and support in living with and managing this long-term condition. We need to make sure that management is in line with the latest clinical guidelines. To that end, the department has taken a number of steps to improve diagnosis and management of type 1 diabetes. We have collaborated with NHS Choices so that its website now has clear advice for parents on identifying the signs of diabetes and the actions required.
The NHS has clear statements of good-quality care for people with type 1 diabetes. These include the NICE quality standard and NICE clinical guidelines for all ages, which are being updated. The NHS is expected to follow NICE guidance as part of its general duty to secure continuous improvement in quality.
From April 2013, the best practice tariff for paediatric diabetes will ensure that the NHS offers all children and young people with diabetes appropriate education, support and management. All paediatric diabetes centres must belong to regional paediatric diabetes networks. Those paediatric networks will continue to function.
Like all pupils, children and young people with diabetes deserve full educational opportunities unhindered by their condition and their daily medical care. It is worrying that so many pupils experience preventable problems at school because of their diabetes, whether through barriers to insulin administration or even being banned from school trips. I am glad to hear that the honourable member for Yeovil and my honourable friend for Central Suffolk and North Ipswich have considered this in the context of early years and the minimum health offer in schools.
From April 2013 we will also introduce a best practice tariff to ensure good specialist care for severe insulin lack, called diabetic ketoacidosis, and for insulin excess or hypoglycaemia. These are potentially fatal crises if you have diabetes and can usually be avoided.
The Quality and Outcomes Framework, or QOF, rewards general practitioners for providing the nine care processes for people with diabetes. Since 2003-04, QOF has encouraged steady improvements in these annual checks. At the same time, the percentage of people diagnosed with diabetes has more than doubled. We want this improvement to go faster. For this reason, NICE has been asked to review the Quality and Outcomes Framework and diabetes indicators within it, and we await its response.
Last year, the National Audit Office published its review of the management of adult diabetes services in the NHS. While this report acknowledged the progress made over the past 10 years, in particular in the information we have about diabetes, it also highlighted the extent of variation in services across the NHS and the significant challenges that we face over the next 10 years. The Public Accounts Committee subsequently made a number of recommendations. The Government accepted all but one. We also set clear objectives for the NHS.
For the last few years, this work has been led by Dr Rowan Hillson as national clinical director for diabetes. Since her appointment in 2008, Dr Hillson has made enormous strides to improve the care and management of all those with diabetes. She retires at the end of this month from this role and I take this opportunity to pay tribute to her and thank her for all she has done, which is a very great deal. From April, Dr Jonathan Valabhji will take up the challenge on behalf of the NHS Commissioning Board as the new national clinical director for obesity and diabetes. I wish him every success in his new role. I can tell the noble Lord, Lord Hoyle, that Dr Valabhji is a consultant diabetologist and fully aware of the needs of people with diabetes. He will give them appropriate attention in the balance of his work.
I also thank the NHS Diabetes team for all their hard work. NHS Diabetes has made a major contribution to improving diabetes care nationally. The team will be absorbed into NHS Improving Quality in the NHS Commissioning Board next month. It is good that the excellent work of the National Diabetes Information Service will continue in Public Health England. The prime objective of the NHS Commissioning Board will be to drive improvement in the quality of NHS services. The board will be held to account through the NHS mandate. Diabetes is relevant to all parts of the NHS outcomes framework, through which we will track progress. In the NHS, diabetes is everybody’s business.
I agree with the noble Lord, Lord Collins, that structured diabetes education is essential. NICE has specified this and I support its guidance. The noble and learned Lord, Lord Morris, asked what we were doing to increase the use of insulin pumps. The national clinical director chairs the Insulin Pump Working Group, which met today. It exists to increase pump use and provided the insulin pump audit showing that 8% of adults and children in the UK have pumps. Within that figure, it is 6% of adults and 19% of children, but the work of that group continues. I am happy to write with a full and detailed response, as the noble and learned Lord asked.
The noble and learned Lord also quoted from a letter he had received from my honourable friend Paul Burstow, which indicated that we in this country were in line with the United States. I confess that I am puzzled by that, as he is. The figures that I have are that the United States has around 30% coverage. That compares to Spain, Finland and Portugal at around 5%. We are, as I say, at 8%. I will look further into that situation and write to him as appropriate.
The noble Lord, Lord Harrison, referred to blood glucose monitoring, which is, of course, essential to managing type 1 diabetes safely and well. The national clinical director and the chief pharmaceutical officer wrote to all doctors to remind them of that this year. Dr Hillson recently wrote to the NHS on behalf of the Minister for Public Health, highlighting the Minister’s concerns, and reminded the NHS of the importance of appropriate prescribing and management.
The noble Lord, Lord Harrison, also asked about guidelines for type 1 patients. NICE produces patient-friendly summaries which I believe are very helpful, while NHS Choices includes information about type 1 diabetes. The National Clinical Director for Diabetes has worked with Diabetes UK to produce its guidance and we support the organisation’s 15 healthcare essentials checklist. He also asked why everyone with diabetes does not get an annual check. In the Government’s response to the Public Accounts Committee we set clear objectives for the NHS Commissioning Board and we will monitor them closely.
The subject of research was raised by the noble and learned Lord and the noble Lord, Lord Hoyle. Recently, the Government announced that £775 million would be invested over five years through the National Institute for Health Research to drive innovation focused on major diseases, including diabetes. The department is currently supporting more than 60 studies into type 1 diabetes through the Diabetes Research Network. Diabetes research in the UK punches well above its weight and the results are seen prominently in international diabetes meetings. The noble and learned Lord also asked why type 1 is not included in specialised commissioning. I will write to him with an explanation on that point.
I would like to support very strongly the remarks made by the noble Lord, Lord Hoyle, about children with diabetes. Children with the condition should have equal opportunities in schools. Collaboration between children’s diabetes services, children’s carers and education services is absolutely key to allow children to achieve their full potential. All local authorities and schools should be encouraged to read the Managing Medicines in Schools and Early Years Settings booklet. He asked how many people are getting the nine care processes. The answer is 54% of adults, but I regret to say that it is fewer than 10% of children. However, as I mentioned, we now have the Paediatric Diabetes Best Practice Tariff, which demands better care in regional paediatric diabetes networks.
My time is up. I have more to say and I will write to those noble Lords whose questions I have not answered. There is good and bad here. We have vast amounts of data for this condition. We know what needs to be done and where. The challenge is for clinicians and commissioners to ensure that everyone with diabetes has good care.
Homeopathy
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Lord Taverne
To ask Her Majesty’s Government why the Department of Health removed from the NHS Choices website the advice that there was no good quality evidence to show that homeopathy was more successful than placebo.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, NHS Choices consults the Department of Health as necessary to ensure the consistency of its information with government policy. A recent review of the homeopathy web pages led to a change in the way the evidence was presented. Following concerns that the changes were unclear, NHS Choices has further clarified this information.
Lord Taverne
My Lords, I am delighted to hear that the passage has been restored. However, it is disturbing that inquiries made under the Freedom of Information Act revealed that officials deleted the passage as it stood in response to lobbying by a charity founded by the Prince of Wales. They seemed to be more concerned not to offend that formidable lobbyist than to listen to the advice of their Chief Medical Officer, who declared in a recent statement to a House of Commons Select Committee:
“I am perpetually surprised that homeopathy is available on the NHS”.
I have only recently learnt that a BBC South West programme found that Prince Charles’s favourite pharmacy has been selling sugar pills as vaccines against some serious diseases. I am sure that my noble friend, to whom I could not give notice of this point, will look into the matter. Will he assure the House that the policy of the Department of Health is to promote evidence-based medicine and not treatment based on nothing but water?
Earl Howe
My Lords, I shall certainly look into the particular matter raised by my noble friend. The change in the way the information was presented on NHS Choices was as a result of a formal review, which happens automatically to all NHS Choices pages every 24 months. The page on homeopathy reached the formal 24-month review point in January 2011. The policy of NHS Choices is to provide objective and trustworthy information and guidance on all aspects of health and healthcare, and the page on homeopathy does exactly that.
Lord Walton of Detchant
My Lords, more than 10 years ago I chaired an inquiry conducted by your Lordships’ Select Committee on Science and Technology into the field of complementary and alternative medicine. We examined the evidence in favour of homeopathy, accepting that certain well qualified doctors believed in its use. However, at the time we did not discover any convincing research evidence to suggest that it was better than placebos. Over the centuries, many medicines have been used that have been shown to be no better than placebos. Therefore, has the time not come when it is appropriate for the Government to recognise that, in the light of recent research, there is no evidence whatever to support the continued use of homeopathy in the NHS?
Earl Howe
My Lords, we have been consistently clear that no treatments should be arbitrarily rationed on cost grounds. The NHS constitution sets out that patients have a right to expect local decisions on the funding of drugs and treatments to be made rationally following a proper consideration of the evidence. More importantly in this context, it is the responsibility of the NHS to make decisions about commissioning and funding of healthcare treatments and not for Ministers to second-guess that process.
Lord Winston
My Lords, perhaps I may be permitted to help the Minister. Many years ago, there was a very interesting study in Wales of a placebo-controlled trial that showed that, whatever was given, the best chance of a treatment working, placebo or not, was whether the doctor who was giving the medicine actually believed in it. Does the same apply for homeopathy and the Secretary of State?
Earl Howe
My Lords, the best way I can answer the noble Lord is to refer him to the page on NHS Choices that explicitly refers to the placebo effect. As he will know, the 2010 House of Commons Science and Technology Committee report on homeopathy said that homeopathic remedies perform no better than placebos. It is important to emphasise that message. On the other hand, many people have found benefit from homeopathic medicines and, in a way, that is their privilege and right.
Baroness Gardner of Parkes
My Lords, is the Minister aware that homeopathy started at a time when the one treatment they gave people was to bleed them? It was effective because they did not bleed them and allowed them to recover normally; I was on the board of the Royal London Homeopathic Hospital for a good many years, where I learnt that. Does the Minister not think that, faced with a situation where antibiotics have been used too casually, it is time to look at what we should not be taking? Does he think it important that patients should have the right to whatever treatment they choose provided that homeopathy does not allow them to escape proper diagnosis for cancer or some other tragic condition, which could be overlooked if it is not combined with ordinary medicine?
Earl Howe
My noble friend makes an important point. We are clear in recommending that patients should talk to their GPs before stopping any treatment that has been prescribed by a doctor in favour of homeopathy and before they start taking homeopathic remedies. It is important that people understand that homeopathy may not be effective in many situations.
Baroness Corston
My Lords, given that many GPs ask for training in homeopathy and become homeopaths using both conventional and homeopathic medicine, and speaking as someone who personally uses homeopathic remedies, will the Minister ensure that the views of people such as the noble Lord, Lord Taverne, with which we are all familiar, are not given such credence within the National Health Service that those who wish to use homeopathic remedies do not have that choice?
Earl Howe
My Lords, I take the noble Baroness’s point. Again, we have consistently said, in this and in other areas, that clinical responsibility for an individual’s health condition rests with their GP, who must therefore be able to justify clinically any treatment to which he or she refers someone. As she said, there are GPs who have a speciality in homeopathy. We recommend that a patient who is interested in homeopathic treatment should go to such a GP.
UK: Ageing Population
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Lord Filkin
To ask Her Majesty’s Government whether they will publish their assessment of the implications of the ageing of the United Kingdom’s population and their response to those implications; and, if so, when.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
We welcome the committee’s report on the ageing population that was published last week. We will consider its recommendations carefully and respond in due course. Effective reform of public services is critical if we are to meet the needs of an ageing population and ensure long-term sustainability. We have put in place an ambitious programme of reform across a wide range of government policy areas, including pensions, health, social care, housing and employment.
Lord Filkin
I thank the Minister for his reply. As the House may know, the committee found that our society and Government were woefully underprepared for this major social change. To focus the supplementary question on health, out of courtesy to my colleague, the report found a massive increase in demand and cost driven by the increase in long-term conditions. In the committee’s view, this posed perhaps the biggest challenge the NHS has ever had to face. Will the Secretary of State set out his assessment of these challenges and what he proposes to do about them?
Earl Howe
My Lords, we know that to adapt and respond to future need, the health and care system needs to change. The conclusions of the noble Lord’s report correlated in many ways with our own analysis in this respect. The challenges that the report sets out create an opportunity for the NHS and local authorities to innovate and explore new ways of working together to meet the needs of their local populations better and to optimise the use of resources, which is of course critical. We think the NHS and local authorities are best placed to understand the opportunities that exist in their areas, and we are committed to supporting them in that regard.
Lord Mawhinney
My Lords, will my noble friend undertake to intercede with the usual channels so that your Lordships’ House can have an early and full debate on the report from the Select Committee on Public Service and Demographic Change, given the highly significant consequences that would flow if the committee, of which I was a member, even got it half right?
Baroness Greengross
My Lords, does the noble Earl agree that social care has been the poor relation for so many years and that we need integration as soon as possible with health and housing? To achieve that, would he commit to the Government mandating integration and earmark sufficient funds so that this care can be a reality as soon as possible for older people with chronic conditions?
Earl Howe
My Lords, I very much agree with the noble Baroness. It is our ambition that people should receive high-quality, integrated, person-centred services that deliver the best outcomes to the service user. Making the service as a whole more efficient is the other benefit of integrating service. There is no single definitive model of integration. Some localities are further advanced than others in thinking about new ways of delivering it. We are developing the concept of pioneers to support the rapid dissemination and uptake of lessons learnt across the country, but we want to encourage local experimentation as much as we can to allow local areas to provide integrated care at scale and pace.
Baroness Jolly
My Lords, there are several common themes between the report from the noble Lord, Lord Filkin, and his group, and that of the scrutiny committee of the draft Care and Support Bill, which was published today. One of those themes is the funding of personal care, which has to be shared between the individual and the state. As recommended by the Dilnot commission, will the Government invest in an awareness campaign to inform people of this situation and the importance of planning ahead?
Earl Howe
I am sure my noble friend is right that there is a job of work to do to inform people about the new arrangements that we are bringing in to implement the Dilnot recommendations. My right honourable friend the Chancellor’s announcement at the weekend confirms that we will introduce a cap on care costs and extend the means test upper capital threshold at the earlier date than previously announced, namely on April 2016. The reason for the change in date is to bring it into line with changes to single-tier pensions. We will need to disseminate this information sooner than we would otherwise have done.
Baroness Bakewell
My Lords, when I was appointed the voice of older people in 2009, these issues were already well appreciated. It is now 2013. This is an excellent report from the House committee, which everyone recognises, but I am afraid that it joins many other reports on my shelf that have been published since 2009. Will the noble Earl please tell me why he thinks change is so slow?
Earl Howe
My Lords, change is an increasing imperative, at least in my judgment, at local level. I talk not only to professionals in the health service but to local authorities, which will very soon be charged with looking in the round at the needs of patients and service users in their area. They know that with the financial constraints that are upon us, services need to change in order to remain sustainable and affordable. That will be a very strong driver to ensure that some of these very good recommendations are driven forward at pace.
Lord Hunt of Kings Heath
My Lords, the Opposition warmly welcome the report. I am sure that it will be influential in the way we develop policies in the future. I was interested in the noble Earl’s response when he talked about public sector reform. Does he agree that the overwhelming message of the report is the need for a fully integrated health and social care system? Is he not as worried as I am that the changes in the NHS that he is introducing on 1 April will in fact lead to a disintegrated system in which, instead of co-operation and integration, competition will become the name of the game?
Earl Howe
No, I do not agree with that. We have always said that competition is but one tool in the armoury of commissioners. It is not a panacea by any means. As for disaggregation, I see the opposite at local level. Health and social care, public health and patient organisations are getting together for the first time to break down silo barriers and the traditional divisions that have existed.
Care Quality Commission
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Baroness Wheeler
To ask Her Majesty’s Government what actions they propose to take in the light of the findings of the Care Quality Commission’s home care inspection review Not Just a Number.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government were encouraged that almost three-quarters of the domiciliary care agencies inspected by the CQC for the review were found to be meeting essential standards.
As the regulator of health and adult social care, the CQC has a range of powers to ensure that services are safe and of good quality. The CQC has the Government’s full support to take firm action where it finds services are unacceptable or failing.
Baroness Wheeler
I thank the noble Earl for his response and welcome the CQC’s positive findings on the 75% of home care services it inspected. However, the 25% of failing providers are a cause for deep concern, particularly as regards the number of late or missed calls and their complete failure to have systems to document, assess or monitor the quality of care they are supposed to deliver. Where there is a live-in carer, late or missed calls can at least be managed in some way, even if the cared-for person cannot be got out of bed. However, if people are on their own, the consequences are deeply distressing and can be very serious. What information does the department have nationally across the sector about this very worrying issue? What action is being taken to address the problem? Should we not ensure that all providers are required to keep records of the numbers, reasons for and remedial actions taken for missed and late calls, including refunding charges to self-funders or to the local authority?
Earl Howe
My Lords, the noble Baroness is quite right: there is no room for complacency in this area. Care has to be right every time, not just three-quarters of the time. I noted from the CQC’s report that, although it recorded a number of common issues undermining the majority of good home care from a significant minority of providers, many of these were fairly minor. However, the noble Baroness has alighted on a very important failing among several of the agencies inspected. I do not have national information on late and missed calls but in the work that we are doing with local authorities, providers and, indeed, the CQC, all of whom share responsibility for driving improvement in services, this will inevitably be an area of focus for it.
Baroness Howarth of Breckland
My Lords, does the Minister agree with me that while the examples of good practice are very welcome, what was most surprising was the comment on safeguarding, which noted that many services are not meeting the requirements of good practice in relation to reporting to local authorities and have out-of-date procedures? Bearing in mind the plethora of advice from the Department of Health, what do the Government intend to do to bring these services into line as these are the most serious cases, where people are in real danger?
Earl Howe
My Lords, strengthening adult safeguarding arrangements is a key priority for the Government. We are committed to preventing and reducing the risk of abuse and neglect to adults who are in vulnerable situations and generally to supporting people to maintain control over their lives. As the noble Baroness may know, we are legislating to put safeguarding adults boards on a stronger statutory footing. That will better equip them both to prevent abuse and to respond to it when it occurs.
Baroness Knight of Collingtree
My Lords, does my noble friend recall occasions within recent years when the Care Quality Commission discovered blatant breaking of the law and was unable to take any steps? What happens when that occurs and no repercussions follow?
Earl Howe
My Lords, the Care Quality Commission has a full range of powers open to it which enables it to take action where it discovers a major failing in the quality of care. We are not aware that that menu of options needs to be expanded. I will write to my noble friend as regards specific instances, having consulted the CQC, but I do not think that there is a general call to expand the CQC’s powers in this area.
Baroness Wall of New Barnet
My Lords, I am sure that the noble Earl will welcome this report, as my noble friend has, because there are many good news stories in it. I am sorry that I have had time to read the report only quickly. In the inspection, the Care Quality Commission looked for opportunities to maintain older people in their homes, rather than have them come into hospital; that is hugely important. The evidence is that if an elderly person turns up at A&E at 8 pm, they will be in hospital for many days, and that is not always necessary. Can we look more closely at how, in the care that is given, we can prevent people coming into hospital?
Earl Howe
The noble Baroness is right to focus on that issue. There are a number of things that we can do. We will shortly introduce new minimum standards to improve training for care staff, which will help in that regard. We aim to double the number of apprentices in care services by 2017 because there is clearly a workforce imperative here. We are proposing to expand the current care ambassador scheme, which promotes a positive image of the sector. That again will assist in recruitment. We are also launching an online tool to support recruitment and provide information about working in care and support, all of which is designed to address workforce concerns and concerns around skills.
Lord Laming
My Lords, will the noble Earl assure the House that the Government, when considering the report referred to by the noble Baroness, Lady Wheeler, will look at it in the context of another report published today by a House of Lords committee chaired by the noble Lord, Lord Filkin? Together, these reports pose one of the greatest challenges to our society, and it is very important that the Government take these matters as seriously as possible, for the benefit of us all.
Baroness Barker
My Lords, last year the Government announced their intention to end the practice of domiciliary care visits being planned on the basis of a few minutes. In the current economic circumstances, can the Minister say how the Government plan to make that intention a reality?
Earl Howe
My Lords, my noble friend will know that in the care and support White Paper we set out our intentions to improve quality standards in social care, increase the capacity and enhance the capability of the social care workforce, ensure that people have better information about care providers, and improve the performance of the regulator. Within that spectrum of actions, we will be looking carefully at how precisely to deliver that ambition to which my noble friend rightly refers.
Health: Cancer Drugs Fund
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Lord Hunt of Kings Heath
My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and refer noble Lords to my health interests.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we will ensure that there are arrangements in place from 2014 to protect individual patients receiving treatment with drugs funded by the cancer drugs fund. From April 2013, the NHS Commissioning Board will take on oversight of the fund. For the longer term, we are considering ways in which patients can continue to benefit from drugs provided through the fund, at a cost that represents value to the NHS.
Lord Hunt of Kings Heath
My Lords, my understanding is that the Government’s original intention was that the fund would be replaced from January 2014. Can I take it from the Minister’s response that the Government are no longer continuing with the introduction of value-based pricing for drug remuneration in future?
Lord Clement-Jones
My Lords, as regards the introduction of value-based pricing, can the Minister confirm whether cancer patients will be consulted about the definition of value within that concept? Can he confirm that the impact on quality of life will be included in the assessment of value?
Earl Howe
My Lords, we consulted on our proposals for value-based pricing between December 2010 and March 2011, and as part of that process a number of patient organisations contributed their views, which were reflected in the Government’s response to the consultation, published in July 2011.
Lord Turnberg
My Lords, what will happen to the panels of cancer experts that gave such valuable advice to SHAs about which drugs should be provided?
Earl Howe
My Lords, when the arrangements for the cancer drugs fund pass to the NHS Commissioning Board in April, there will be standard operating procedures for the fund, which will provide greater consistency of access across the country while also preserving the right of clinicians to request any drug that they think will help a patient. The standard operating procedures will be published very shortly, and the noble Lord will then receive a fuller answer to his question.
Lord St John of Bletso
My Lords, can the Minister elaborate on what reports, if any, have been produced from the Chemotherapy Intelligence Unit in Oxford on the efficacy of the cancer drugs fund? What will be done for those patients who have received relief from this fund for their treatment in future?
Earl Howe
My Lords, the noble Lord raises a very important point because clinical audit of the drugs in the cancer drugs fund and their use will be extremely important in informing the use of these drugs going forward and, indeed, in determining their price under a value-based pricing scheme. As yet we have not heard from the Oxford Cancer Intelligence Unit although I understand that we will receive a preliminary report quite soon. However, as I mentioned earlier, when the current fund comes to an end we will ensure that those patients who are receiving drugs under it will continue to do so.
Baroness Masham of Ilton
My Lords, does the Minister agree with me that the cancer drugs fund has been very helpful? Will he find some way of getting more orphan drugs for the very rare cancers, because that is a problem?
Earl Howe
The noble Baroness raises another important point about orphan drugs and indeed ultra-orphan drugs as they are termed—drugs which are efficacious and helpful for patients with very rare conditions. It is likely that we will need to put special arrangements in place for the pricing of those drugs. Overall, however, I agree with the noble Baroness that the cancer drugs fund has been immensely helpful. So far, since October 2010, the funding has helped more than 28,000 patients in England to access the cancer drugs that their clinicians recommended, which they would not have done otherwise.
Lord Patel
Will the Minister confirm that whatever new arrangements are put in place will be on the same principle and basis as the current cancer drugs fund?
Earl Howe
I cannot confirm that we will replicate the current cancer drugs fund in its entirety—no decision has been taken—but we are clear about the principle behind the fund. The reason for creating it in the first place was to help the thousands of cancer patients and clinicians who were having difficulty accessing some cancer drugs mainly as a result of funding constraints. I assure the noble Lord that we will continue to retain that thought very much at the front of our minds.
Lord Hunt of Kings Heath
My Lords, can the noble Earl assure the House that the introduction of a value-based pricing system will not delay the introduction of new drugs into the UK, given that the current system of remuneration for drug companies provides a clear incentive for early introduction in this country as opposed to other countries in Europe?
Pneumoconiosis etc. (Workers’ Compensation) (Payment of Claims) (Amendment) Regulations 2013
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NHS: Mid Staffordshire NHS Foundation Trust
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, in thanking the noble Lord, Lord Patel, for his excellent and incisive introduction to the debate, it is right for me to begin by reiterating the Government’s apology to the patients and families of Stafford Hospital for their suffering and for the way that the system allowed such horrific events to go on unchecked and unchallenged for so long. It is also right to remember that the vast majority of staff in the NHS are dedicated and committed to providing high-quality and compassionate care for patients. I, for one, have much admiration for the work that they do.
We are very grateful to Robert Francis QC and his team for their hard work. It is now our responsibility to use these findings to improve the NHS and the way that we work. We are currently giving careful thought to the key messages in the report and reflecting deeply on what we need to do. I regard this debate as an important ingredient in that process. I listened particularly to the salutary warnings from the noble Lords, Lord Warner and Lord Hunt of Kings Heath, in this area.
The overriding theme of the report is about culture and the need for everyone across the health and care system to reflect on the report’s findings and recommendations and act to challenge and change the culture of the NHS to place patients and compassionate care at its heart. We are absolutely clear that this report needs to be a catalyst for change. We need to ensure that the quality of a patient’s care is given as much weight as their clinical treatment.
We are also in a far better position than before to prevent the sort of catastrophic failures of care seen at Mid Staffs because we now have a system which is working together to protect the patient in a way that did not happen before. Francis’s report outlines the serious consequences that occur when regulators do not communicate with each other properly and work in silos rather than in partnership. The reforms will enable us to allow for stronger and better regulation. From April 2013, Monitor will be the sector regulator for healthcare in England, and with the Care Quality Commission it will jointly license providers of NHS-funded care. Both have new duties to work more closely together and promote the interests of people who use healthcare services. The Care Quality Commission will have a new chief inspector of hospitals with powers to ensure that the system acts quickly to tackle unacceptable care. We are currently considering Francis’s specific recommendations on regulation in more detail, including their legal and financial implications. I say to the noble Lord, Lord Patel, that we have not rejected Francis’s recommendations to merge Monitor and CQC; that is still being considered.
We intend to provide an initial response to the report by the end of this month. The intention is that it will be a collective response across the system to demonstrate that we are working together with partners about the way in which we are doing that. It will focus on themes rather than being a line-by-line response to each of the recommendations. It will reflect the importance of the focus on culture and patient voice. It will begin to demonstrate that national partners, including the Department of Health and arm’s-length body partners, are acting together and taking action to ensure a greater focus on quality of care as well as quality of treatment, greater clinical input into policy making and a closer connect to patients. The whole system needs to put patients at the heart of what it does above all else.
In Francis’s letter to the Secretary of State, he states that the failings at Mid Staffs were,
“primarily caused by a serious failure on the part of a provider Trust Board”.
My noble friend Lady Tyler was right that the role of the trust board should not and cannot be underestimated. The board is key to ensuring that staff have the right support to be able to provide the very best care for patients. Board members need to provide good leadership and be able to model compassionate care so that it can be felt throughout the organisation. Members of the board therefore have an integral and challenging role in making sure that quality and safety is at the forefront while ensuring the care is patient-centred.
It is not surprising that the theme of safety has been prominent in this debate. Patient safety is paramount, but managing safety and developing a culture around this is a real challenge given the number of people the NHS treats on a daily basis. We are looking at how we need to do things differently. The patient safety expert Don Berwick will review our approach to patient safety and advise on how we can create the zero-harm safety culture that Francis was talking about and indeed, Cure the NHS, the patient group instrumental to ensuring that Mid Staffs was looked at in the first place, has also championed ideas on this.
It is clear from this report that during previous times of change in the NHS patient care and safety have suffered. What is also clear from the Francis report is that the system needed to be restructured precisely because patient safety was falling through gaps. I take the point made by a number of noble Lords about regulatory burdens, and we have commissioned a review by the NHS Confederation to consider how bureaucratic burdens on providers of NHS care can be reduced. The focus of the review is to consider how to reduce the burden of inspection and data collection on the providers of care so that they can focus more on the delivery of safe and effective compassionate care. That is why one of core objectives for the NHS Commissioning Board, as set out in the mandate, is to ensure the NHS provides safe care for patients, and it will be developing a new patient safety strategy to deliver on this.
The noble Lord, Lord Patel, talked about safety to a large extent and referred to Don Berwick’s work. The national reporting and learning system, as he knows, is now owned by the NHS Commissioning Board and allows the board to fulfil its legal duty in the 2012 Act to establish and operate systems for collecting and analysing information relating to the safety of the services provided by the health service. I think that is integral to its role. Don Berwick will review our approach to patient safety and the Francis report, and his job is to advise the NHS on the delivery of a sustained and robust patient safety culture.
The noble Baroness, Lady Hayman, to whom I listened with great care, spoke very appropriately about people recommending a hospital to their relatives. That was a point well made. The friends and family test, which has been designed, is a simple and comparable test that provides a mechanism to identify poor performance. It is designed to encourage staff to make improvements where services do not live up to expectations. It should prove a useful mechanism.
The noble Lord, Lord Patel, asked in what respect the work of the chief inspector would impact on the CQC. The CQC has already said that it will move to a differential approach to inspection, with the better use of experts and with more attention paid to what patients say. The chief inspector post will focus this work so that performance is better understood and more easily identified and then acted upon quickly, which is particularly important.
The noble Lord, Lord Rea, spoke about whistleblowing. The Government’s reforms will deliver an emphasis on local clinical leadership and oversight, clinically led commissioning, greater transparency on outcomes, and oversight by local health and well-being boards and local Healthwatch. These reforms will make it much less likely that trusts will either want or be able to behave in a way that does not promote the highlighting of concerns or issues by staff, patients or the public. In turn, that should promote a culture where concerns are not just raised but acted upon.
This theme was picked up by my noble friend Lord Ribeiro. We recognise that there is work to be done to ensure that all staff are empowered to speak out and protect patients without the fear of victimisation for doing so. The noble Baroness, Lady Masham, reminded the House of her championing of a duty of candour. We are looking very carefully at that recommendation.
My noble friend Lady Tyler made the very good point that board members have to be engaged on this and to the fullest extent. My right honourable friend the Secretary of State has written to all trust chairs highlighting the seriousness of the report and asking them to hold listening events with all staff to talk about the lessons that we can learn from Francis.
The noble Baroness, Lady Hayman, emphasised the important role of managers, and I listened with equal respect to my noble friend Lord Eccles on that score. The Professional Standards Authority for Health and Social Care recently published national standards of behaviour and competence and a code of conduct for top NHS managers. I believe that patients and the public expect them to embrace those standards and indeed to live by them.
The theme of leadership was picked up by many noble Lords. Good leadership in the NHS embraces many things such as compassion and care and places quality and safety at the heart of all decisions. Leaders are needed at all levels. We are doing more to ensure that all staff have the opportunities to become leaders or to demonstrate leadership skills in their existing roles. The government reforms will deliver an emphasis on local clinical leadership and oversight, as I have mentioned.
My noble friend Lord Cormack and the noble Lord, Lord Kakkar, also picked up the theme of leadership. The Leadership Academy is one organisation that has been established to train and develop new leaders and to run a number of core programmes to support clinicians, nurses and managers in leadership roles. I hope the noble Baroness, Lady Emerton, will take comfort from the fact that, as we consider Francis’s 290 recommendations, we are engaging with a range of key stakeholders, including the professional bodies, such as the royal colleges, to identify what more we need to do in response to Francis, including the values that pertain to good leadership.
We will consider very carefully the recommendations of the inquiry in the area of nurse training. We are particularly keen to establish whether more vocational ways of becoming a nurse can enrich the nursing workforce while maintaining the high academic standards that modern nursing requires. I say to my noble friend Lord Willis that we want to be guided by the profession. The country’s top two nurses, Jane Cummings and Viv Bennett, will do two things in this area: they will make sure that recruitment to university undergraduate programmes is based on values and behaviours, as well as technical and academic skills, and will work with national organisations to agree stronger arrangements to ensure effective training and recruitment.
My time is up, although I have much more to say. If noble Lords will allow, I will follow up this debate with letters to those noble Lords whose points I have not had time to address. Meanwhile, once again I thank all speakers for some extremely important contributions, which will in form the Government’s thinking over the weeks ahead.
Pneumoconiosis etc. (Workers’ Compensation) (Payment of Claims) (Amendment) Regulations 2013
Earl Howe Excerpts(11 years, 2 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I beg to move that the Pneumoconiosis etc. (Workers’ Compensation) (Payment of Claims) (Amendment) Regulations 2013 be considered. I shall speak also to the Mesothelioma Lump Sum Payments (Conditions and Amounts) (Amendment) Regulations 2013. I am required to confirm to the Committee that these provisions are compatible with the European Convention on Human Rights, and I am happy to so confirm.
These two regulations increase by 2.2% the lump sum amounts payable under the Pneumoconiosis etc. (Workers’ Compensation) Act 1979 and the mesothelioma scheme set up by the Child Maintenance and Other Payments Act 2008. These increased payments will be paid to those who first satisfy all the conditions of entitlement on or after 1 April 2013.
There is no legislative requirement to review the level of payments in these two schemes as they are separate from the main social security benefits uprating provisions. However, the Government have agreed to increase the amounts payable for 2013 using the same 2.2% rate that is being applied to industrial injuries disablement benefit and other disability benefits under the main uprating provisions.
The draft pneumoconiosis regulations also remove references within the Pneumoconiosis etc. (Workers’ Compensation) (Payment of Claims) Regulations 1988 that are no longer relevant. The references related to the two schemes that covered those whose industrial accident or disease was as a result of work before July 1948 and who did not qualify under the main industrial injuries disablement benefit scheme. These pre-July 1948 schemes—the so-called “old schemes”—were abolished under the Welfare Reform Act 2012, with all existing cases and new claims transferred to the industrial injuries disablement benefit scheme. No one lost out as a result of this change and, in fact, the majority of people received an increase of up to £5 per week.
The two schemes before us today are important in compensating those people who unfortunately suffer from diseases as a direct result of being exposed to asbestos or to one of the other listed causes of the diseases covered by these schemes. Because of the very long latency period—in some cases stretching back decades—between the time a person was exposed to asbestos and when the symptoms of the disease become apparent, a successful civil damages claim may be difficult to achieve.
These two compensation schemes provide payments on a no-fault basis and therefore aim to ensure that sufferers can be compensated while they are still able to benefit from it. In some cases, civil litigation may still be pursued, but these payments allow a payment to be made irrespective of the outcome of the case. I will briefly summarise the specific purpose of each of these lump-sum compensation schemes.
The Pneumoconiosis etc. (Workers’ Compensation) Act 1979—referred to as the 1979 Act—applies to those who have contracted one of the five dust-related respiratory diseases covered by the scheme through their occupation, who are unable to claim damages from employers after they have gone out of business and who have not brought any action for damages. It can be paid only if someone would have been entitled to industrial injuries disablement benefit for the disease in question. The five diseases are diffuse mesothelioma, bilateral diffuse pleural thickening, pneumoconiosis, byssinosis and primary carcinoma of the lung if accompanied by asbestosis or bilateral diffuse pleural thickening.
The 2008 mesothelioma lump-sum payments scheme was introduced to compensate those who contracted mesothelioma but were unable to claim compensation for that disease under the 1979 Act. It covers those whose exposure may have been due to environmental causes, instead of being a result of their work, and it means that sufferers can get a payment quickly to meet their needs. Under both schemes, dependants can make a claim when the sufferer died before being able to do so.
The rates of payment under the 1979 Act are based on the percentage level of the disablement assessment and the age of the sufferer at the time the disease is diagnosed for a claim to industrial injuries disablement benefit. The earlier the age of the sufferer at diagnosis and the higher the level of disability, the higher the level of payment that is made. All payments as a result of contracting mesothelioma are made at the 100% rate of disablement—the highest rate available. The 2008 mesothelioma scheme mirrors this as all payments under that scheme are made at the 100% rate of disablement, variable only by the age of the sufferer at the time of diagnosis.
Noble Lords may like to know how many claims we received and the amounts paid out under these schemes. In the last full year from April 2011 to March 2012, 2,750 people received payments under the 1979 Act at a cost of £37.7 million, and 480 people received payments under the 2008 scheme at a cost of £9.3 million. The total amount of compensation paid out under both schemes during this period amounted to £47 million.
In the current financial year from April 2012 to September 2012, 1,610 people received payments under the 1979 Act, amounting to £21.9 million, and 250 people received payments under the 2008 scheme, amounting to £4.9 million. The total compensation paid in the first six months of this year amounts to £26.8 million.
The forecast for next year is that 3,100 people will be paid under the 1979 Act, and 500 people will be paid under the 2008 scheme. The estimated amount of compensation likely to be paid is £53.7 million.
Over 60% of 1979 Act payments made are as a result of contracting mesothelioma—a terrible and fatal disease caused almost exclusively by asbestos exposure. People diagnosed with mesothelioma will usually have a short life expectancy of around nine to 13 months, and it is likely that they will become severely disabled shortly after diagnosis.
I can advise noble Lords that the number of deaths from mesothelioma in Great Britain continues to rise. In 1968, there were 153 deaths from mesothelioma. The disease has a long latency, taking decades for symptoms to become apparent. Today, more than 2,300 men and women each year are dying from the disease. The information currently available suggests that mesothelioma deaths in men will plateau at around 2,100 by 2016. Accepting that accurate predictions are difficult, the current thought is that deaths in women will peak at a later period than they do in men, but the number of deaths will be lower. The total number of deaths will likely be around 4,500 each year if we include other asbestos-related deaths such as asbestosis and lung cancer.
It is clear that the government schemes we are debating today provide valuable help for people suffering from mesothelioma. However, the Government are planning to do more to help those unfortunate people who have contracted the disease. I am able to tell the Committee that the Government are working with the Association of British Insurers and other stakeholders to develop a scheme to help mesothelioma suffers who cannot trace an employer or insurer against whom they can make a claim for damages.
My noble friend Lord Freud announced in July last year that the Government would introduce legislation when parliamentary time allowed. Until such time as the Government can introduce legislation, we are unable to provide noble Lords with specific details of the scheme. However, the Government’s intention remains that anyone diagnosed on or after 25 July 2012 who meets the eligibility requirements will be able to bring a claim against the mesothelioma support scheme.
These regulations increase the level of help provided by the Government through these compensation schemes to support those people unfortunate enough to have contracted these diseases, as well as their dependants. Of course, we are all aware that no amount of money will ever compensate individuals and families for their suffering and loss caused by these diseases, but those who are suffering rightly deserve some form of monetary compensation, and it is only right that they receive it before it is too late.
I commend to noble Lords the increase of the payment scales and ask for approval to implement them.
Lord Wigley
My Lords, I am grateful to the Minister for outlining in some considerable detail the statistics relating to these two schemes. I will come back to a question that I would have put to him had I been able to intervene earlier. The regulations under consideration today make provision, as has been outlined, for the uprating of the amount payable to sufferers of pneumoconiosis and mesothelioma in line with inflation. As the Minister reminded us, there is in fact no statutory obligation to do this. However, the previous Government did so and I am very glad that the present Government are doing likewise, so that the value at least comes somewhere close to keeping up with inflation.
A lump sum is payable under the Pneumoconiosis etc. (Workers’ Compensation) Act 1979 for sufferers of lung diseases including, as the Minister said, byssinosis, pneumoconiosis—including asbestosis—diffuse pleural thickening, asbestos-related lung cancer and mesothelioma. When the Minister quoted figures relating to the past year, I was wondering in that context whether, under the 1979 Act payments, he can differentiate between those relating to mesothelioma and those related to the other sources of lung disease which qualify under that Act.
The 1979 Act was one in which I and my party, Plaid Cymru, had some considerable involvement, as some colleagues may recall. That was because the legislation had considerable significance for the slate-quarrying industry, as well as for some aspects of coal mining. I was also involved in issues relating to mesothelioma associated with working with asbestos, as a number of cases in the old Ferodo factory in Caernarvon were arising then. There is still a tale that leads out of that period. More recently, I have become quite alarmed by the potential number of mesothelioma sufferers from a range of industries, particularly construction industries. Even among those who have been working in schools, including teachers, some of the answers received indicate the worry that may arise in that context.
None the less, the payment is made to claimants who are awarded industrial injuries disablement benefit and is geared to the age of the claimant. If the claimant dies before submitting a claim, dependants of course receive a lower rate of payment. This can lead to increasing stress on the very individuals who are ill, who feel forced to rush through their claims to maximise the compensation available to their families. If these people are too sick to make a claim before their death, their families will be left with the lesser amount.
It is now widely accepted that the differential payments between the living claimants and the dependants of those who have died is, frankly, not fair. The annual uprating of these payments is debated each year in both Houses, and in 2010, Committees from both places agreed that this was especially pertinent to mesothelioma cases, where claimants often pass away shortly after diagnosis. I think the Minister acknowledged that in his opening speech. This means that their families will not have had sufficient time to submit a claim prior to their relative’s death. Both Houses thus decided in 2010 that the Government should reduce the difference between payments that year, with the eventual aim of eliminating the differential. Despite this commitment, since 2010 no ground has been made on ending this inconsistency, as I understand it. Bearing in mind that dependency claims represented only 8% of all claims in 2011, and only 5% of the total cost of all claims, surely the Government can see the expediency of ending this anomaly.
Ending the differential would also mean extending the upper age limit for dependency payments from 67 and over to 77 and over. This would bring payments in line with those for in-life claimants—yet another inconsistency that unfairly disadvantages the families of individuals who, for the most part, were too ill to make claims before their death. I urge the Government to commit to finally ending this anomaly. The same should apply to the scheme set up under the Child Maintenance and Other Payments Act 2008, which provides for a lump sum to be paid to mesothelioma sufferers who did not qualify for payment under the 1979 Act, due to being self-employed or having not had occupational exposure. With this scheme, too, dependants of those who died before submitting a claim are paid a lower rate.
Claimants will be at a further disadvantage due to a mistake which the Department for Work and Pensions made in 2010 in calculating the dependency payments for all ages at 50% plus disablement. As a result of this mistake, the department has overpaid since 2010 and, as I understand it, is now in the process of correcting that mistake. The result of all this is that payments have been cut from £7,915 in 2012 to £7,180 in 2013. So as well as failing to equalise the in-life and dependency payments, the Government have also reduced the amount available for dependants in mesothelioma cases because of this mistake. I understand that mistakes have to be corrected. None the less, it has that effect. Surely the Government accept that this position is not ideal.
Before concluding, I ask whether in mesothelioma cases the Government can make every effort to speed up decisions and payment, for the obvious reasons on which I do not need to expand. Perhaps I may also flag up that there is grave misgiving that using the portal process will prove to be wholly unsuitable for complex mesothelioma cases and is unlikely to speed up decisions in such cases. I would be very grateful for the Minister’s response on these important aspects of pneumoconiosis and mesothelioma issues covered by the two orders before us today.
Earl Howe
My Lords, I am grateful to all noble Lords who have spoken. In answer to the noble Lord, Lord McKenzie, as to why a Health Minister is responding, I am, at least for this afternoon and for the first time, proudly wearing my DWP hat in the absence of my noble friend Lord Freud, who is unavoidably on government business abroad. I should not say abroad: he is in Scotland.
I shall begin with the statistics, which have prompted questions from a number of noble Lords. The noble Lord, Lord Wigley, asked about payments made under the 1979 Act related to mesothelioma, as opposed to other diseases. I do not have the actual figures to hand, but I can say that over 60% of payments made under the 1979 Act are in relation to mesothelioma, and the rest to other conditions. My noble friend Lord Avebury asked whether I could supply an estimate of the net cost of payments over the next 10 years, including equalisation, if that were to occur. I shall gladly write to my noble friend; it would not be right for me to come out with a figure this afternoon, because it is likely to be incorrect.
My noble friend also asked me for a forecast of payments from 2013 to 2016. We have not formally forecasted figures for these schemes, but the split for the last financial year, 2011-12, is: under the 1979 Act, 2,480 sufferers and 270 dependents claimed; and under the 2008 scheme, 450 sufferers and 30 dependents claimed.
The noble Lords, Lord Wigley and Lord McKenzie, asked me to comment on the proposal that payments to dependents and sufferers should be equalised. First, I share the concerns about the plight of dependants. I understand the difficulties that families face when their loved ones suffer illness. That is why the department is always working to improve the processes to ensure that claims are dealt with as quickly as possible: as the noble Lord rightly said, sometimes sufferers and dependants struggle to make claims before the person dies. At the same time, we need to fulfil our obligation to ensure that all claims are appropriate and legitimate. Ministers have to balance competing priorities, and because of the current financial situation, it is our duty to ensure that all available resources are well targeted. As around 85% of payments made under these schemes are paid to those who are suffering from the disease, I believe that they are currently rightly targeted on the sufferer to help them and their families to cope while living with the stress that illness inevitably brings.
The noble Lord, Lord McKenzie, asked me about the disparity of payments and when an assessment was last made. I simply say to him that we keep these schemes under review. While in the current economic situation we have no plans to make changes to the scheme at present, naturally we will revisit this issue at regular intervals.
The noble Lords, Lord Wigley and Lord McKenzie, and my noble friend Lord Avebury referred to the error that caused some people to have been overpaid lump-sum payments and they asked what the situation was regarding that overpaid amount. Before last year’s debate, officials in the department identified an error in the rate tables for a specific subset of dependants resulting in a dependant receiving a higher award than a sufferer would have received. Even though this error would apply to only very few people, it did not reflect the policy intention that available resources should be focused on the sufferers of the disease rather than dependants. Consequently, the position was rectified and the amended regulations were debated and approved last year. However, an operational error was made to the effect that the revised figures were not input into operational systems and this resulted in a number of dependants being overpaid. The department is currently considering how to deal with these cases, and I am advised that no decision has yet been taken.
I understand the point made by the noble Lord, Lord McKenzie, concerning the amount of compensation recovery that the department receives in relation to payments made under the 1979 Act and the 2008 scheme, and the suggestion that this should be used to offset the cost of increasing the number of dependant payments. The total amount of compensation recovered from civil compensation claims in respect of payments made under both schemes exceeds the cost of making the payments under the 2008 scheme. However, these recoveries are also used to offset the cost of payments made under the 1979 Act, which still results in an overall cost to the department of making these valuable lump-sum payments. I have some figures in front of me on the amounts recovered in recent years. The noble Lord may like to note that in 2010-11 the amount was £18.4 million, and in 2011-12 it was £21.3 million, which is considerably less than the overall outlay made by the department.
The noble Lord, Lord Wigley, asked about the use of a portal. I am advised that the Ministry of Justice announced on 18 December last year that it would consult on the use of a portal and other related matters, and we expect this consultation to commence this spring.
The noble Lord, Lord McKenzie, asked me about clinical trials for mesothelioma. The British Lung Foundation has undertaken work looking at mapping the genome. We continue to engage with all research organisations on this. If I have any additional information to give him on this having consulted my officials in the Department of Health, I shall be happy to send it to him. He also asked me about the pre-1948 scheme and whether it is correct that no one will lose out as part of the transition from one scheme to another. That is correct. Where any existing pre-1948 payments were lower than the IIDB payments, they were brought up to a higher level at that time.
Lord Wigley
I am very grateful to the Minister for going through these matters in such great detail. Am I not right that the pre-1948 cases could also receive lump-sum payments? He referred to £5 a week, which of course is a Revenue payment. Is there any danger of people losing out on the entitlement to lump sums?
Earl Howe
I am advised from the highest authority that the answer to that question is no. If I can supply the noble Lord with any further information, I would be happy to do so. The noble Lord, Lord McKenzie, asked me whether I could give him any further information on the progress for the new meso scheme. The Department for Work and Pensions is actively working with stakeholders, including the Asbestos Victims Support Group to develop this scheme. Unfortunately, I am not in a position to say anything ahead of the gracious Speech—but we might or might not hear something to our advantage on that occasion.
However, I can say that we fully understand that people who develop diffuse mesothelioma as a result of their negligent exposure to asbestos at work and who are unable to trace a relevant employer or their employers’ liability insurance policy to claim against would be eligible to claim from this scheme. We appreciate the urgency of the situation. As I have mentioned, eligible claimants diagnosed with diffuse mesothelioma from 25 July 2012 onwards will be able to receive a payment once the scheme commences.
I am aware that there may be one or two questions I have not been able to answer, some of which I have already referred to. However, I hope that in the main I have covered the issues raised and I commend the regulations to the Committee.
Lord McKenzie of Luton
Before the noble Earl sits down, I should like to thank him because he has gone through a lot of detail for us today. As regards the potential impact of the debate we are having generally about changes to the Health and Safety at Work etc. Act, civil liability and negligence, has there been any assessment of the relevance of that to compensation recoveries that are factored into the funding of the schemes that we are talking about today?
Earl Howe
My answer to that would be expressed in general terms. It is a longstanding principle that people should not be compensated twice. Usually, where social security benefits have been paid, they are recovered from compensation where people have been successful in a subsequent civil claim. That is the underlying thinking that is guiding us. But again, if I can enlighten the noble Lord further, I will do so in a letter.