Pneumoconiosis etc. (Workers’ Compensation) (Payment of Claims) (Amendment) Regulations 2013
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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.
Mesothelioma Lump Sum Payments (Conditions and Amounts) (Amendment) Regulations 2013
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Health: Cardiology
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Lord Storey
To ask Her Majesty’s Government what measures they are taking to detect and prevent sudden cardiac death.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, as the Cardiovascular Disease Outcomes Strategy published yesterday made clear, the national clinical director for heart disease will continue to work with all relevant stakeholders to develop and spread good practice in this area. Alongside this, the UK National Screening Committee is reviewing the case for screening for sudden cardiac death, and will begin a public consultation on this soon.
Lord Storey
I thank my noble friend the Minister for that Answer. He will no doubt be aware that hundreds of young people die as a result of fatal premature cardiac conditions each year. He may also have heard of the Oliver King Foundation, established in memory of a 12 year-old Liverpool boy who sadly died of sudden death syndrome at his school in 2011. Does the Minister not agree that despite many ambulance trusts having some form of community resuscitation department, it should be policy to install automated external defibrillators in all public buildings? Furthermore, will the Minister agree to meet with the foundation and others to discuss the feasibility of a national screening programme to identify those at risk and prevent further loss of life, particularly among young people?
Earl Howe
My Lords, I pay tribute to the Oliver King Foundation for its work, as indeed I do to Cardiac Risk in the Young, which for many years has been campaigning very tellingly and successfully in this area. I think that my initial Answer should have satisfied my noble friend on the screening question, because that is now being reviewed by the screening committee. Regarding defibrillators, we have to look at the need to improve survival rates in the most effective way. I understand that the majority of these deaths—possibly as many as 80%—occur in the home. While we agree that the wider availability of defibrillators could save additional lives, CPR skills—cardiopulmonary resuscitation—should save more lives. To that end, the outcomes strategy says that my department will work with the Resuscitation Council, the British Heart Foundation and others to increase the number of people who are trained in CPR.
Lord Turnberg
My Lords, will the noble Earl encourage all schools to incorporate training in CPR for all schoolchildren? A skill learnt there will carry on through the rest of a child’s life.
Earl Howe
My Lords, the noble Lord makes a very good point. Again, as the CVD outcomes strategy sets out, basic life-support skills could be more widely taught as part of volunteering programmes; for example, in schools and the workplace. I am aware that bystander CPR doubles survival rates yet is attempted in only 20% to 30% of cases. There is scope for all emergency service personnel to be trained in CPR, and for basic life-support skills to be taught more widely.
Baroness Finlay of Llandaff
Are departmental advisers working with the new chief coroner, whose appointment has been widely welcomed, to ensure that there are minimum standards at post-mortem, so that when a young person has had a sudden cardiac death the risk to other family members can be appropriately identified? It is important that specimens from the heart of a deceased young person are not lost because the post-mortem has not been done to a high enough standard.
Earl Howe
The noble Baroness makes a very important point. My department supported the formation of the UK Cardiac Pathology Network in 2006 to provide local coroners with an expert cardiac pathology service and to promote best pathological practice in sudden death cases. A national database on sudden arrhythmic death was launched in November 2008, allowing pathologists to record information on cases referred to them. In the longer term this could be very helpful in building a deeper understanding of the problem.
Lord Colwyn
My Lords, during 2011, 56 deaths were caused by fire in London. Legislation requires all public buildings to have fire extinguishers. In that same period in London, there were 9,657 out-of-hospital cardiac arrests. Why is there no similar legislation for public-access defibrillators?
Earl Howe
My Lords, as a general point, ambulance trusts are by far the best placed to understand the requirements of their local populations in terms of defibrillator distribution. However, I understand that the British Heart Foundation is looking into the need for more defibrillators in the community, so we will await that work with great interest.
Lord Glentoran
My Lords, can my noble friend tell us what effect in percentage terms obesity is having, particularly on the young? I read that a considerable percentage of deaths and heart problems are due to obesity. What programmes do we have running to reduce the level of obesity in the United Kingdom?
Earl Howe
My Lords, a variety of programmes is running, including Change4Life and the national screening programme. However, as my noble friend will be aware, the kind of sudden cardiac death mentioned in the Question is rather different from cardiovascular disease, which afflicts people in later life. We are talking in the Question about unexplained, very sudden cardiac death in the young, which we believe has little to do with lifestyles and much more to do with genetic susceptibility.
Lord Patel
My Lords, will the Minister explain a little bit more about the proposed public consultation on screening? The evidence for the screening of families where a cardiac death has occurred, particularly in a young person—which is linked to a gene—is conclusive, so what is the public consultation about?
Earl Howe
The public consultation is reviewing the policy position on screening for hypertrophic cardiomyopathy, but the noble Lord is absolutely right that better identification of families who are at high risk of inherited cardiac conditions is vital. That is stressed in the cardiovascular strategy.
Health and Social Care Act 2012 (Consequential Amendments) Order 2013
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Care Services: Elderly People
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, to do justice to a subject as vast and crucially important as this one is impossible to achieve during the course of an hour’s debate. However, I thank the noble Lord, Lord Turnberg, for introducing this question so succinctly and capably. I will address as many issues as I can in the time available but I undertake to write to those noble Lords whose questions I do not manage to cover.
We know from listening to care users, their carers and voluntary organisations how care and support needs to change, and how the system has yet to adapt properly to meet the new demands and expectations of modern Britain. I was very struck, as I always am, by the clarion call sounded by the noble Baroness, Lady Pitkeathley, on that theme. As the noble Lord, Lord Turnberg, highlighted, the system will face further demands with an aging population at a time when we face financial constraints.
Last year’s care and support White Paper is an important step in changing that. It will sustain and promote what works and challenge and change what does not. It will promote well-being and independence instead of waiting for people to reach a crisis point. The White Paper, together with the draft Care and Support Bill, will shape the care sector for years to come. The noble Baroness, Lady Greengross, was right to say that this is an opportunity. This is the most comprehensive reform of social care legislation in over 60 years.
We must all welcome the fact that we are living longer but, as the noble Lord, Lord Warner, reminded us, managing the fiscal consequences of this will be a key challenge of the coming years. However, we must recognise that for the foreseeable future government funding will be constrained and we must plan on that basis. We want to get the engine working as efficiently and effectively as possible so that the fuel that we put in gets us to where we need to be.
Effective reform of public services is central to our response if we are to meet the needs of an aging 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. The Government are providing an extra £7.7 billion over the spending review period to protect access and support vulnerable people.
We know that care and support needs to adapt to respond to changes in demand and expectation. These challenges create an opportunity for local authorities to innovate and explore new ways of working, better meet the needs of their local populations and optimise the use of available resources. Many local authorities are already innovating and we are committed to supporting them to deliver further service improvements and to helping other authorities learn from what works. We want local authorities to maximise the use of reablement services that help older people recover from acute episodes and reinvest money from high-cost residential and nursing home care into other services. We also want local authorities to embrace the potential of new technology because we know that at least 3 million people with long-term conditions and social care needs could benefit from the use of telehealth and telecare services.
One of the biggest changes that the White Paper sets out is moving from the reactive service that we have at the moment to a proactive service that helps people stay healthy and independent in the first place—change that better meets and manages future demand and, as the noble Baroness, Lady Greengross, and my noble friend Lady Jolly emphasised, prevents people needing to go into acute hospitals and supports them to regain independence after they leave. As people live longer, the advantages of that approach, focused on preventing or postponing care needs, are both immense and glaringly obvious. That approach is part of our mission to improve the health of the nation as a whole. That is why we have built an approach that will enable local authorities and GPs to innovate and devise local solutions to tackle not just the symptoms but the wider determinants of health. On my noble friend Lady Jolly’s three questions, the answer in all cases is yes.
To support this, we will include in the Bill a duty on local authorities to take steps to prevent delay and reduce needs for care and support in their area. The noble Lord, Lord Turnberg, mentioned the pooling of budgets between the health service and social care. All too often the discussion on integrated care is focused around the integration of structures, funding streams or processes rather than the perspective of patients and service users. This has led to excessive focus on the means to achieve integrated care rather than the end of a better experience for patients and service users. We want to encourage and support local experimentation to allow local areas to provide integrated care at scale and pace. We are working with the sector to support local initiatives and identify what needs to happen to drive this at a national level. We want to learn what works well, how to overcome barriers and promote best practice. For example, Torbay commissioned and provided care for local areas as a single organisation and has shown comparatively lower levels of emergency admissions, shorter hospital stays and minimal delayed transfers of care.
The noble Lord, Lord Turnberg, talked about the role of GPs in caring for elderly people. The quality outcomes framework, which is part of the contract with GPs, provides incentives that reward practices for how well they care for patients, including for long-term conditions that often affect elderly patients. The Government have proposed changes to the GP contract, and a stakeholder consultation has recently finished. Under these proposals, and in addition to the QOF indicators, we would invite GPs to participate in a new directed enhanced service that would further encourage GP practices to co-ordinate and manage the care of frail older people and other high-risk patients predicted to be at risk of unscheduled hospital admission.
The noble Lord, Lord Turnberg, also spoke about out-of-hours care. Earlier this year, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England including out-of-hours care.
The noble Baroness, Lady Emerton, focused on the social care workforce, its skills and the need to promote leadership. The care and support White Paper recommends increasing capacity, enhancing capability and developing leadership in the social care workforce. The department is working with partners to attract more people to, and increase apprenticeships in, social care, as well as raising standards and improving leadership. Working with the National Skills Academy for Social Care to publish the leadership qualities framework for adult social care is another important aspect of our programme. That framework sets out the attitudes and behaviours needed for high-quality leadership at all levels which, as the noble Baroness rightly said, is rather different from passing an exam. There is no single, definitive model of integrated care and support, as I am sure the noble Baroness will accept. Some localities are further advanced than others. We are developing the concept of pioneers to support rapid dissemination and uptake of lessons learnt, and are keen to maintain momentum and accelerate the adoption of new models of co-ordinated care and support across the country. Our ambition is for person-centred co-ordinated care and support to become the norm over the coming years.
Returning to the draft Care and Support Bill, it will introduce important powers and duties that will further integrated working, including a duty of co-operation, integration and ensuring that people have clearer entitlements. We are also committed to developing a measurement of people’s experience of integrated care to be included in future outcomes frameworks. This has been included as a placeholder in the NHS and Social Care Outcomes Framework 2013-14.
As I have said, we want to encourage local experimentation to allow local areas to provide integrated care tailored to people’s needs and preferences. We are working hard with partner organisations, including the NHS Commissioning Board, Monitor, the Local Government Association and the Association of Directors of Adult Social Services, to support those local initiatives and to identify what still needs to happen to drive this at a national level. This work will in turn be informed by the outcomes of the four community budget sites.
The noble Baroness, Lady Greengross, asked me some specific questions about self-funders. I undertake to look into the issues that she has raised. I certainly will study the Scandinavian model and I undertake to write to her about that.
I finish by reaffirming the Government’s aspiration to make this country one of the best places to grow old in, where older people get excellent treatment, care and support when they need it. Our biggest priority must be to transform what we offer to meet the challenge of an ageing population. If we fail to address this, our health and care system will not be sustainable for older people, or indeed for any of us. We must develop and promote a culture of compassion across the health and social care landscape, where quality of care is considered as important as quality of treatment and where every person can be confident that they will be treated with compassion, dignity and respect by skilled staff who are on top of their game and have time to care.
Health and Social Care Act
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I shall now repeat as a Statement the answer to an Urgent Question given in another place by my honourable friend the Minister for care services earlier today on the National Health Service (Procurement, Patient Choice and Competition) Regulations 2013. The Statement is as follows:
“I know that the right honourable gentleman and others have raised concerns about the effect of the regulations, and I would like to address these. First, however, I would like to make it absolutely clear that the regulations must be fully in line with the assurances given to this House during the passage of the Health and Social Care Bill.
The former Secretary of State said to clinical commissioning groups in 2012 that,
‘commissioners, and not the secretary of state, and not the regulators, should decide when and how competition should be used to serve patient interests’.
This absolutely must be the case. I made it clear in health Questions last week that we would review the regulations to ensure that this is the case and that they are not open to any misinterpretation.
The right honourable gentleman himself gave guidance to primary care trusts, which made it clear, in 2010—and again I quote:
‘Where there is only one capable provider for a particular bundle of services or the objective of the procurement is to secure services to meet an immediate interim clinical need there will be a case for Single Tender Action (ie uncontested procurement). By definition, an immediate’—
or urgent—
‘scenario will be exceptional and likely to only … arise on clinical safety grounds or, for example, where existing services have been suspended following intervention by the Care Quality Commission’.
The next bit is very important:
‘A decision to procure through a single tender action should always take account of the potential to secure better value by investing in a competitive process, as long as this is justified by the scale and importance of the opportunity (ie it has to be worth it)’.
As we committed in the Government’s response to the Future Forum report, we want to ensure that the regulations simply continue this approach. However, I fully recognise that the wording of the regulations has inadvertently created confusion and generated significant concerns about their effect. I have therefore listened to people’s concerns and my department is acting quickly to improve the drafting so that there can be no doubt that the regulations go no further than the previous set of Principles and Rules, inherited from the previous Labour Government. As we also committed in response to the Future Forum’s report, the Co-operation and Competition Panel has been transferred to Monitor and this will ensure consistency in the application of the rules.
Concerns have been raised that commissioners would need to tender all services. This is not our intention and we will amend the regulations to remove any doubt that this is the case and to clarify that the position remains the same as at present—and as stated in the former Secretary of State’s letters in 2012. Concerns have been raised that Monitor would use the regulations to force commissioners to competitively tender. However, I recognise that the wording of the regulations has created uncertainty and we will therefore amend them to put this beyond doubt.
Concerns have also been raised that competition would be allowed to trump integration and co-operation. The Future Forum recognised that competition and integration are not mutually exclusive. Competition, as the Government made clear during the passage of the Bill, can only be a means to improving services for patients, not an end in itself. What is important is what is in patients’ best interests. Where this is co-operation and integration there would be nothing in the regulations to prevent this. Integration is a key tool that commissioners are under a duty to use to improve services for patients. We will amend the regulations to make this point absolutely clear”.
My Lords, that concludes the Statement.
Earl Howe
My Lords, first, I understand perfectly the anxiety that has been voiced about the way the regulations are worded. This is a problem centring in almost every respect on legal drafting. Our intention and our instructions have been as they always have: to create a set of regulations—as expected under the terms of the Act, as the noble Baroness knows—which reflect in every way the assurances given by Ministers during the passage of the Health and Social Care Act, no more and no less.
However, to the lay reader, certain parts of the regulations which, in legal terms, do as they were intended appear not to do so. We took very seriously the fact that perception differed from reality—perceptions matter—and therefore, early last week, I put in train a programme of work to revise the regulations. However, we also determined that we could not come to Parliament with half a story and that we would have to present our fully formed response to the concerns by tabling a set of revised regulations. We were not in a position to do that until this week. It was therefore not the case that the Opposition’s Motion forced us into this position. I was well aware that we had to respond to the concerns voiced not only in this House but in the wider healthcare community.
The noble Baroness said that she thought our competition policy lacked clarity. Our competition policy is based on competition law as it now appears and as it was during the previous Administration. There is no question of our changing that. The idea that we are trying to marketise the NHS is, as the noble Baroness knows, not true. In the Health and Social Care Act, we included a specific provision which prevents the Secretary of State or anyone else preferring independent sector providers over the NHS. That was something which the previous Government did not see fit to do.
The noble Baroness asked me what the programme ahead looked like. We intend to revoke the current regulations and substitute regulations with amended wording within a few days.
Baroness Jolly
My Lords, I thank my noble friend for meeting Members from these Benches on this issue nearly two weeks ago. Will he confirm for the House that, in line with assurances given during the course of the Bill last year, the regulations will promote integration of services in the best interest of patients?
Earl Howe
I think that everybody was agreed during the passage of the Health and Social Care Bill that we wish to encourage integration in the way that services are commissioned. Integration in this context should be taken as a term that reflects the experience of the patient. The patient has to feel that he or she is on a seamless pathway of care. That care may be provided by a number of agencies, if necessary, whether in the NHS or social care, but the patient’s experience should not be disjointed. Therefore, as my noble friend will remember, numerous provisions were inserted into what is now the Act to ensure that commissioning should be on that basis. Nothing in these regulations interferes with that, but it is very much in our minds to make it crystal clear that integration of services is one of the main factors which commissioners should take into account.
Baroness Morgan of Drefelin
My Lords, can the Minister reassure the House that the new draft regulations are consulted on before they are tabled—very swiftly, I am sure—to safeguard against misinterpretation again by lay audiences? Perhaps a very swift consultation programme could be developed with stakeholder organisations, royal colleges, patient groups, and so on, so that we can avoid the misunderstanding to which the noble Earl refers.
Earl Howe
I intend to meet some of the royal colleges, and I have met one already. I do not feel that a full-scale consultation is appropriate because the Government’s policy has not changed. It is the wording of the regulations that has given rise to anxiety. I therefore think that, having taken on board, as I hope I have, all the concerns that have been raised, a clarification of the regulations is all that is necessary and there is no need to consult on the policy yet again.
Lord Harris of Haringey
My Lords, is it not the case that the Government have form on producing regulations that are virtually incomprehensible as far as the lay reader is concerned, particularly in respect of these health service changes? We had the incident with Healthwatch only a few weeks ago. Even though there is a short timescale, is it therefore not imperative that there is proper consultation to make sure that whatever emerges reflects the very fine and helpful words that the Minister has given us this afternoon? Will he also tell us whether Ministers ever read these draft regulations before they are laid before the House?
Earl Howe
My Lords, it is my intention to issue an invitation to noble Lords to join me in a meeting so that we can discuss these matters. I am very happy to do that over the coming days. The answer to the second question is yes. We read these regulations in conjunction with the Explanatory Memorandum and the line-by-line interpretation that we have also published in this case which make it crystal clear that these regulations do no more and no less than reflect the law and the Government’s policy. However, others have chosen to misinterpret the regulations, and that was something that I could not predict.
Lord Warner
The Minister may know that I do not always see totally eye to eye with all my colleagues on these Benches on the subject of competition. Will he say how much discussion there has been with the voluntary sector and social entrepreneurs on these regulations? In my experience they have always struggled to make their presence felt when contracts are available within the NHS.
Earl Howe
My Lords, the department consulted on its proposals for these regulations between August and October last year on the basis of the commitments that had previously been given. All sectors had an opportunity to feed in their comments. Our proposals for the regulations did not give rise to any anxieties at that time.
Lord Whitty
My Lords, the Minister should have been made aware of the concern I expressed the other night in relation to the reference to Monitor in the Enterprise and Regulatory Reform Bill and to its supervision by the proposed Competition and Markets Authority which seems to some of us to introduce by the back door a situation where the CMA would override Monitor, making, in effect, competition trump integration and co-operation. Will he now advise the noble Viscount, Lord Younger, to delete the reference to Monitor in that Bill?
Earl Howe
My Lords, I took the opportunity to read the noble Lord’s comments a few days ago, and I am grateful to him for them. He will be receiving a communication in a few days’ time to clarify this issue. I thank him for raising it. The short answer to his question is that it is not our intention for competition to trump integration.
Medical Research: International Rare Diseases Research Consortium
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Lord Avebury
To ask Her Majesty’s Government what support, if any, they are providing for the International Rare Diseases Research Consortium.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the UK is a global leader in rare diseases research. The Government are pleased to be engaged with activities marking Rare Disease Day today. The Department of Health supports the International Rare Diseases Research Consortium. The National Institute for Health Research is a member of the consortium and has actively engaged with the work of the consortium from the outset. The Government are committed to providing faster diagnosis and better treatments for people with a rare disease. We recognise the importance of international collaboration in rare diseases research, and of its translation, in achieving this goal.
Lord Avebury
My Lords, I declare an interest as a sufferer from myelofibrosis, which is one of the 6,000-plus rare diseases that have been identified which affect 3.5 million people in the UK. May I ask my noble friend to comment on how the £100 million genome sequencing project is expected to contribute to the understanding of rare diseases? Secondly, will the rare diseases stakeholder forum that he announced yesterday consider the value to both patients and the NHS of care co-ordinators, which was emphasised by the NGO Rare Disease UK?
Earl Howe
My Lords, we have just announced the establishment of a rare diseases stakeholder forum. As my noble friend rightly mentions, it will be established shortly to bring together a wide range of stakeholders, including organisations representing those with rare diseases, to ensure that the patient voice is part of the discussion that we must have leading up the publication of the UK plan for rare diseases. The 100,000 genomes initiative, which my Department is funding, is about pump-priming—the sequencing of the genomes of 100,000 NHS patients—with the purpose of translating genomics into the NHS. This capacity will be allocated specifically to cancer, rare diseases and infectious diseases. The service design work will be completed by June and we aim to put contracts in place by April next year.
Lord Walton of Detchant
My Lords, does the Minister accept that recent research in genomic medicine has led to the progressive introduction of orphan and ultra-orphan drugs, some of which are capable of reversing partially or completely the genetic effect of many such rare diseases—not least, for example, muscular dystrophy? However, these drugs are extremely expensive and are therefore likely to be commercially unsuccessful because they help only a relatively small number of patients. Now that the Government have abolished the Advisory Group for National Specialised Services, can the Minister assure the House that, when responsibility for providing those drugs on the NHS falls to the national Commissioning Board on the advice of NICE from April this year, those rare diseases and their drugs will be given appropriate priority?
Earl Howe
My Lords, yes I can give that assurance. As the noble Lord will know, we laid regulations specifying those specialised and highly specialised conditions which the NHS Commissioning Board will be responsible for commissioning. I can also reassure him that the focus on research into rare conditions will not be lost. Indeed, I am sure that he will be aware that the National Institute for Health Research has recently specifically invited submission of research proposals into interventions for very rare diseases. The call encouraged multidisciplinary research proposals as well as study designs and approaches to recruitment of patients.
Lord Hunt of Kings Heath
My Lords, I declare my interests in the Register in the health service. Following on from the previous question, I understand that the commissioning costs of rare diseases will be met nationally by the NHS Commissioning Board. However, when patients require regular medication, which would presumably be prescribed by their GP, will funding responsibility fall on local clinical commissioning groups? If so, will they be given specified resources to fund what are often very expensive treatments?
Earl Howe
My Lords, the funding for expensive treatments will be very much the responsibility of the Commissioning Board. However, of course the noble Lord is right, because a patient with a rare disease will need to be treated along a pathway of care, some of which will be specialised and some of which will be more routine. It is therefore important that we build into our UK plan for rare diseases an awareness of that pathway so that this is a seamless process. The commissioning must be joined up between the board, clinical commissioning groups and, indeed, local authorities that provide social care.
Lord Cotter
My Lords, I thank my noble friend the Minister for his interest in rare conditions. I declare an interest as my wife, like many others, has suffered from birth from arthrogryposis, a neuromuscular condition. She received a correct diagnosis only at the age of 52 years. Even now, in her 70s, she is struggling to receive appropriate treatment. Would the Minister consider seriously Rare Disease UK’s recommendation for designated care co-ordinators to oversee the situation to ensure consistent treatment and to provide single oversight to help patients and to avoid wasting resources and duplication within the NHS?
Earl Howe
I am grateful to my noble friend and I extend my sympathies to his wife. Unfortunately, with many very rare diseases, it often takes a great deal of time for a fully fledged diagnosis to be arrived at. I welcome the suggestion put forward by Rare Disease UK for co-ordinators and we will certainly look at that idea positively. I can tell him that the imperative to look at rare developmental disorders in children is the focus of a project that the NIHR and the Wellcome Trust are funding through the Sanger Institute in Cambridge. Scientists are analysing the genomes of 12,000 children with developmental disorders who could not be diagnosed following routine genetic evaluation. We are hopeful that that will produce some interesting results.
Lord Patel
My Lords, I declare an interest in that my university is involved in finding treatments for some rare diseases. An international collaboration has set the ambitious goal of finding treatments for 200 rare diseases by 2020. One of the important research areas has already been mentioned, which is the sequencing of the genome of patients with rare diseases. The other area, which alludes to the question asked by the noble Lord about the care of those patients, is that of finding new diagnostics so that we can diagnose those diseases early. What are we doing through the NIHR or through biomedical research centres to encourage the development of new diagnostics for those diseases?
Earl Howe
My Lords, most of the NIHR biomedical research centres are conducting research on rare diseases, including on diagnostic biomarkers, and I have a rather long list of projects which the NIHR is funding. The diagnosis of a rare disease, as the noble Lord rightly mentioned, is often key to ensuring early intervention and the correct treatment. I can tell him that my department is directing considerable resources towards that, and I would be happy to write to him with the details.
NHS: West London Hospitals
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the reconfiguration of front-line health services is a matter for the local NHS. Any decisions regarding changes to services are taken locally and are subject to the four tests for service change. On 19 February, the NHS North West London Joint Committee of Primary Care Trusts decided to proceed with a “Shaping a Healthier Future” service reconfiguration programme in north-west London.
Lord Dubs
My Lords, will the Minister confirm that A&E waiting times are increasing in the areas covered by the four hospitals even before the closures have taken place? There is enormous local concern about a plan to, as it were, reduce services in a series of hospitals more savagely than anything else in the history of the NHS. In particular, the plan includes the proposed demolition of Charing Cross Hospital and its replacement by a handful of beds. Is it not the case that the Minister or the Secretary of State has the final decision and that it is quite possible for the Secretary of State to say, “No, I do not accept this. Think again.”?
Earl Howe
My Lords, we believe very firmly as a general principle that the reconfiguration of services works best when there is a partnership approach between the NHS, local government and the public. That is why we are strengthening local partnership arrangements through the health and well-being boards. To answer the noble Lord’s question, it is entirely possible for a reconfiguration decision to be referred upwards to the Secretary of State by the overview and scrutiny committee of a local authority, and in that event it is customary practice for the Secretary of State to receive independent advice from the independent reconfiguration panel. However, we have not reached that stage yet. We have agreement locally as to what these arrangements should look like and I think that we should wait to see how the plans develop.
Baroness Hussein-Ece
My Lords, is my noble friend aware that the Whittington Hospital, which serves a densely populated area of Islington and of Haringey, where there is no other hospital, suddenly announced in January without any proper consultation its major plans for reconfiguration, including changes to buildings and services? Those plans include the downgrading of the A&E department of the hospital, where I have spent many an unhappy hour with my children and other family members but receiving an excellent service, to an emergency care service. Does he think that it is appropriate to do this without proper consultation and explaining the plans to local people?
Earl Howe
My Lords, I cannot comment specifically on that particular set of proposals. However, I can say that we made it very clear nearly three years ago that reconfiguration proposals, wherever they arise, should be underpinned, as should the arising decisions, by four reconfiguration tests. Local plans must demonstrate support from GP commissioners; a strengthening in public and patient engagement, which is the issue raised primarily by my noble friend; clarity on the clinical evidence base for whatever is proposed; and support for patient choice. We expect that where proposals of this kind arise, those four tests need to be met.
Lord Hunt of Kings Heath
My Lords, again I declare my interest in health. On that, I am puzzled because of what has happened in the case of Lewisham A&E where the clinical commissioning group itself is clearly absolutely opposed to the downgrading of that A&E service. Why has the Secretary of State determined to go ahead with those changes?
Earl Howe
Five out of the six clinical commissioning groups involved in that area were supportive of the changes. It is true that Lewisham CCG was not. However, the four tests were looked at and it was clearly determined by the trust’s special administrator that those tests had been met.
Baroness Wilkins
My Lords, will the Minister recognise that parking needs of both visitors and patients need to be fully taken into account when making this sort of decision? I declare an interest as being an only-too-frequent visitor to Charing Cross A&E over the last year. It would have been impossible to get to Chelsea and Westminster hospital where the parking is appalling, both for myself and for my visitors.
Earl Howe
I agree with the noble Baroness that this is most certainly a factor. In the case of north-west London, an independent equalities impact assessment was undertaken to check how the proposed options would affect all strata of local population under the Equality Act in particular. The assessment found that the impact on travel times by car, and indeed by blue light ambulance, would be minimal under all three of the options that were being looked at. The point that I am making is that in any context, it is important to factor in the effect on travel for all patients likely to be affected.
Lord Dubs
My Lords, I am shocked that the use of the word “reconfiguration” by the Government has brought into the English language an alternative to “cuts”. Will the Minister not accept that what is being proposed in the four hospitals in the north-west London region are savage cuts which will damage services for local people? That is the bottom line.
Baroness Masham of Ilton
My Lords, does the Minister agree that the downgrading of anything is very depressing, worst of all for patients when they want upgrading?
Earl Howe
My Lords, I think that often when plans are explained to patients, they realise that the word “downgrading” is inappropriate. For example, in north-west London, there has been a lot of unnecessary worry about urgent care centres as substitutes for A&E units. The majority of people who attend A&E can very well be treated in an urgent care centre on the same site, and patients who dial 999 will be taken by ambulance straight to the appropriate hospital. Therefore, I think there is, in some senses, a false debate going on here.
Health and Social Care Act 2012 (Consequential Amendments) Order 2013
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we had many debates in the House and in this Committee on the Health and Social Care Act, and the noble Lord will remember the lengthy debates on the Bill itself. In this Session debates have taken place on secondary legislation that puts in place key elements of the new system. Most recently, we debated the NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations on 5 February and the draft Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations on 7 February.
This draft order, however, is very different from those sets of regulations. It is short, and it raises no new issues of substance. Since it seeks to amend primary legislation, it is right and proper that it is subject to affirmative resolution. But it is made under a narrow power to,
“make provision in consequence of the Act”.
I cannot claim that the amendments it makes are of significant interest. They are minor adjustments, needed as a direct consequence of the Health and Social Care Act 2012. They help to keep the statute book up to date and coherent, but they involve no new policies. Consistently with this, neither the Joint Committee on Statutory Instruments nor the Secondary Legislation Scrutiny Committee has seen a need to draw special attention to the draft order. That confirms that the amendments in the order are indeed consequential on the Act.
Because the order is brief and amends only a few pieces of legislation, it may be helpful if I explain the reason for the amendments to each Act in turn. I will start with the simplest. Section 403 of the Education Act 1996 refers to an NHS body within the meaning of Section 28(6) of the National Health Service Act 2006. Following the amendments to the 2006 Act made by the Health and Social Care Act, this is now Section 275(1). The draft order amends the cross-reference in the Education Act accordingly.
The order amends two other Acts by removing references to primary care trusts. These bodies are being abolished by the Health and Social Care Act 2012 on 1 April 2013, so it makes no sense to keep references to them on the statute book.
The first of the Acts in question is the Vehicle Excise and Registration Act 1994. Schedule 2 to this Act identifies the vehicles that are exempt from vehicle excise duty. Currently a vehicle is exempt when it is being used or kept on the road by, among others, a primary care trust or by,
“a health service body, as defined in section 60(7) of the NHS and Community Care Act 1990”.
The definition of “health service body” in Section 60(7) currently includes strategic health authority.
Schedule 5 to the Health and Social Care Act already removes the reference to “strategic health authority” from the definition of “health service body” in Section 60(7) of the NHS and Community Care Act 1990. Consistently with that, the draft order now removes the reference to primary care trust from the Vehicle Excise and Registration Act.
The second Act is the Welfare Reform Act 2012. Section 130 of this Act identifies circumstances in which local authorities may use or disclose information about certain benefit claimants, including when the claimant is in hospital accommodation provided by an NHS trust, a foundation trust or a primary care trust. Again, the draft order removes the reference to “a primary care trust” without replacement. The Health and Social Care Act creates no new provider bodies, so it is not necessary to replace this reference to a primary care trust.
I turn next to the Audit Commission Act 1998. The amendments to this Act look more complex because they amend a number of provisions, but their purpose is very simple. The Audit Commission Act is best known for setting out the audit framework for local authorities, which also applies, with some differences, to health service bodies. As matters currently stand, however, the Health and Social Care Act provides for clinical commissioning groups’ accounts to be audited by the Audit Commission in accordance with the Audit Commission Act, but the Audit Commission Act itself does not apply to clinical commissioning groups. These are the new bodies that are being established under the Health and Social Care Act to commission the majority of secondary healthcare. The draft order therefore amends the Audit Commission Act to ensure that its requirements for health service bodies apply to clinical commissioning groups. The amendments also recognise the role of the NHS Commissioning Board in relation to clinical commissioning groups. For example, if an auditor of a clinical commissioning group thinks that there has been unlawful expenditure, the auditor must notify the Commissioning Board in addition to the Secretary of State.
Earl Howe
My Lords, if the Committee will allow me, I think it is probably helpful if I complete my remarks. Our normal procedure is that the noble Lord, Lord Hunt, as opposition spokesman, will speak first, followed by other noble Lords. I will answer all questions at the end, if that is acceptable.
I turn now to the amendments to the Local Government Act 2000 and to the Local Government and Public Involvement in Health Act 2007, which I shall refer to as the 2000 Act and the 2007 Act. In both cases, the draft order removes references to primary care trusts and replaces them with references to the NHS Commissioning Board and to the relevant clinical commissioning group. The context here is one of commissioning services rather than providing them, so it is appropriate to make this substitution. To explain this in more detail, Section 104 of the 2007 Act sets out persons who are “partner authorities” of certain local authorities. The list currently includes primary care trusts. The definition of “partner authority” is relevant for a number of provisions in both the 2000 Act and the 2007 Act. For example, Section 9FF of the 2000 Act applies, with some exceptions, where an overview and scrutiny committee or its sub-committee makes a report or recommendation to the local authority or its executive on certain functions of a “relevant partner authority” that are exercised in relation to the committee’s area or residents of that area. In such a case, Section 9FF(2) enables the committee to require the relevant partner authority,
“to have regard to the report or recommendation in question in exercising its functions”,
and Section 9FF(4) requires the relevant partner authority to comply.
Lord Jones
My Lords, I am grateful to the noble Earl for his patient and detailed explanation of what the order entails. I had intended an early intervention so that he might be able to give the answer to my query during the debate. Does this order, which refers to social care, presage a better deal for those this with Alzheimer’s disease? In the context of my question, is the noble Earl able to give the briefest definition of social care?
Earl Howe
I am grateful to both noble Lords for their comments and questions. I turn first to the question posed by the noble Lord, Lord Hunt, around the Audit Commission and its role. The noble Lord is right: the Government’s intention is to bring forward legislation, as soon as parliamentary time allows, to replace the Audit Commission. The legislation will abolish the Audit Commission and establish a new framework for the audit of local public bodies in England. The Commons committee that undertook pre-legislative scrutiny of the Draft Local Audit Bill published its report on 17 January. The Government are considering the report very carefully and we will publish a response in due course. I think that that is all I can say in the context of the noble Lord’s question about fees, but if I have any further points to add I will, of course, write to him.
The noble Lord also asked me about the procurement regulations, and I congratulate him on taking the opportunity to do so. We remain absolutely committed to the undertakings given during the passage of the 2012 Act, and we are clear that the regulations we have laid adhere to both the letter and the spirit of those undertakings. However, we understand the concerns that have been raised by noble Lords and stakeholders, and we are making a public commitment to engage intensively with Members of Parliament and Peers to understand their concerns. We will look again at the regulations to see how we can explain them better, clarify our position and address the concerns that have been raised.
The noble Lord asked me about the definition of social care in the context of this order. I am perhaps not the best person for making up definitions on my feet. However, in terms of care of the elderly, social care is that activity which is characterised by the service provided by local authorities and their contractors to look after elderly people, both in residential accommodation and in their own homes by way of domiciliary care. The noble Lord mentioned patients with Alzheimer’s disease. I would perhaps sound a slight caveat because people with Alzheimer’s disease can, of course, be looked after in a variety of settings, including a healthcare setting. However, there are very many individuals who are looked after in their own homes and in residential care as well. Social care tends to be characterised as care that does not involve a specific health input, but rather the care of an individual for their day-to-day living needs.
Lord Jones
The noble Earl has been very courteous and helpful. Since I held, many years ago, a position like his in three Administrations, I know that to ask a question early enough enables the Minister to have the answer prepared by officials. I thus rise again to my feet simply to say that my original intervention was well intended because I knew that, notwithstanding the elegance and brilliance of the noble Earl’s ministerial reputation, it would have been more helpful if I had spoken earlier than I did.
Health: Midwives
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Baroness Cumberlege
My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In so doing, I declare an interest as a fellow and vice-president of the Royal College of Midwives. My other interests are in the Lords register.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, there are some 1,381 more midwives in the NHS than there were in May 2010, and there are a record 5,000 in training. The Government have committed to ensuring that the number of midwives matches the needs of the birth rate. Most women already have choice and one-to-one maternity care, and we are working closely with the Royal College of Midwives to ensure that personalised, one-to-one maternity care is available for every woman across the country.
Baroness Cumberlege
My Lords, I thank my noble friend for that very encouraging reply. I suspect that every single Member of your Lordships’ House has been touched by a midwife. They are a remarkable and very committed profession. Is my noble friend aware that although there is what the Royal College of Midwives describes as a tipping point in the increase in the number of midwives attending women in labour, the real crisis is in postnatal care, where new mothers require advice, support and help in cherishing and feeding their newborn baby? Is he also aware that this requires continuity of a midwife? He has just told us that continuity is being carried through, but a recent survey shows that 40% of new mothers always see a different midwife. How does he propose that we put this situation right?
Earl Howe
My Lords, women should expect to have one-to-one care from a midwife during labour, birth and immediately after birth, and to continue to have the support of their midwife after the birth. This is especially important for those women who are susceptible to, or have, depression during pregnancy or postnatal depression. My noble friend is absolutely right about continuity. This depends on each woman having an individualised postnatal plan of care, taking into account her circumstances. To assist the NHS, the department has asked the National Institute for Health and Clinical Excellence to develop a quality standard for postnatal care, which it is anticipated will be published in July this year.
Lord Avebury
My Lords, my noble friend may have had a chance to look at the report published today by the Refugee Council and Maternity Action on the deficiencies in the support for pregnant asylum seekers. Will his department hold discussions with the Home Office on amendments to the guidance for those women to make it compatible with NICE guidance on the maternity care of women with complex social factors? Will the department and the UK Border Agency jointly look into the negative impact of the current dispersal and relocation policies on the healthcare of women asylum seekers?
Earl Howe
My noble friend raises a number of complex and important issues. My department provides approximately £1 million a year for health assessments of asylum seekers in UKBA initial accommodation in England. The aim of the health assessment is to identify and address immediate healthcare needs, including pregnancy, and to recognise ongoing and non-urgent care needs for attention in the dispersal areas. The use of experienced health teams and interpreting services to record medical history also avoids more expensive arrangements at GP-registration stage later on. My officials met Maternity Action on 19 February to discuss the report’s recommendations and were assured that the maternity care provided by NHS midwives was appropriate and in accordance with NICE guidelines. Following that meeting, officials have briefed the Home Office.
The Lord Bishop of Ripon and Leeds
My Lords, the fact that Edge Hill University, for example, had nearly 900 applications for 22 midwifery places shows considerable enthusiasm for acquiring this skill. However, experience shows that many midwives withdraw during training or the early years of practice. Has the Minister any statistics on such withdrawals and does he know any of the reasons for them?
Earl Howe
My Lords, as regards the statistics on trainees who drop out, I am advised that the average rate is around 22%, which is quite high, but that can be for a number of reasons. I am, however, encouraged by the statistics that I have on the number of commissions that are currently in train across the country. On conservative assumptions, this year and next, we should see about 1,900 midwives emerging from training.
Baroness Afshar
My Lords, how many midwives are familiar with the minority languages that are spoken by British women in areas such as Leeds and Bradford? Are there sufficient numbers who know the local language, rather than having a general notion which does not really suit the language that the women are speaking?
Earl Howe
The noble Baroness raises another important point. This will be a particular issue for the local education and training boards, which we are setting up under the auspices of Health Education England, to get a local feel for the needs of patients in an area. The language skills of midwives will be a very important ingredient of that.
Baroness Farrington of Ribbleton
My Lords, in the light of the original Question of the noble Baroness, Lady Cumberlege, would the Minister advise the House as to whether NICE will be asked to produce guidelines based on what it believes is needed or based on the current shortfall in midwives? If it is based on the current shortfall, we will suffer the same problems.