NHS: Healthcare UK
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, Healthcare UK will focus on high-value opportunities internationally for both industry and the NHS. Where NHS expertise is used, those NHS organisations will benefit financially, with the income being reinvested into patient care for patients here in the UK. Furthermore, any activity undertaken by Healthcare UK will be overseen by a board, which will be jointly administered by the Department of Health, UKTI and the NHS Commissioning Board.
Baroness Gardner of Parkes
Can the Minister tell me whether, with the establishment of Healthcare UK, there is a danger that some areas of this country might be advantaged at the expense of other areas of this country?
Earl Howe
My Lords, we are determined that that should not happen. We recognise that the whole of the UK healthcare sector, both private and public, has a great deal to offer internationally. This does not just apply to a few elite organisations. We want to support any NHS organisation that wants to work internationally by helping it to build its capacity and capability to do so. We also want to help industry. In doing that, I stress that we view it as of paramount importance that any work undertaken in no way harms or compromises the quality of patient care here in the UK.
Lord Hunt of Kings Heath
My Lords, the NHS clearly has much to offer other countries. Does the Minister find it puzzling, as I do, that, in one sense, we are promoting the NHS all over the world yet, when people from other countries want to come and study here, particularly in health and medical sciences, they find that the visa restrictions are obstructive? When will the Government review their whole policy on visas?
Earl Howe
My Lords, the noble Lord raises a pertinent issue in the context of medical trainees. We are addressing it. In particular, we are looking at a request from Saudi Arabia to send postgraduate medical trainees to this country. We believe that we have found a way through that, and will continue to work on that issue for the benefit of other countries as well.
Lord Walton of Detchant
My Lords, when the NHS began in 1948, most major hospitals had private wards and private consulting rooms. The great advantage of this was that they generated income which supported the care of NHS patients. The other advantage was that the consultants who were entitled to undertake private practice were geographically whole time. When the late Lady Castle was the Secretary of State, the Labour Government removed the private beds from NHS hospitals, resulting in a massive development of private wards outside the NHS. Are the Government now embarking on a programme to improve the facilities for private care in the NHS, thus generating more income for the support of NHS patients?
Earl Howe
I am sure the noble Lord will know that a number of our flagship hospitals already have private facilities which treat domestic and international private patients, including Great Ormond Street and the Royal Marsden. All such treatment of course takes place outside NHS provision. However, it is important to emphasise that Healthcare UK is about much more than private patients. In fact, that will not be its primary focus. It is about sharing this country’s expertise, technology and knowledge to support healthcare systems and infrastructure with international partners. Healthcare UK will provide support if there are NHS organisations wanting to bring patients in from overseas but that will not be its principal focus.
Baroness Jolly
My Lords, the NHS brand is the envy of the world and we welcome this enterprise. Will my noble friend tell me how many clinicians he expects might be involved and in what particular roles and disciplines?
Earl Howe
It is a little too early to say because the business plan for Healthcare UK has yet to be drawn up. We have appointed a managing director in the shape of Howard Lyons who I think will do an excellent job. It remains to be seen what requirements are needed. We are looking at certain target markets at the moment—in particular, the Middle East, the United Arab Emirates, Saudi Arabia, Libya, China and India. But it depends on the requests that we get from those countries as to what skills set might be needed.
Lord Harrison
Given that the National Health Service has much to learn from other health services and best practice elsewhere in Europe and the wider world, what methods will the Government adopt to promote that interchange? Will the noble Lord give an example of such an exchange which has benefited medical practice in this country?
Earl Howe
The noble Lord makes an extremely important point. This is not only a one-way street in terms of exporting British expertise. I know one very good example in which some of our trauma clinicians have been seconded to hospitals in South Africa where there is tremendous expertise on gunshot wounds, for example. That has been of direct benefit to clinicians in this country.
Baroness Hollins
There are some very rare conditions, such as Hunter syndrome, in which the United Kingdom is a world leader in developing treatments. These treatments are very expensive to deliver for the very small number of people who have the condition. Would they be more affordable for UK citizens if the treatments were offered to a wider population base, such as across Europe? Will Healthcare UK have this kind of initiative in mind?
Lord Brooke of Alverthorpe
My Lords, given that EU funds for investment and research will be increased between 2014 and 2020, and given the reluctance of British companies to participate in drawing down on that research money, will the Minister ensure that in the health service field we get involved, we partner with others and we use it to our best advantage?
Health: Healthcare Assistance
Earl Howe Excerpts(11 years, 2 months ago)
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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 interests in the register.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
The department notes the Health and Care Professions Council’s findings. Levels of assurance are already in place for healthcare assistants, including supervision by regulated professionals and registration of their employer with the Care Quality Commission. In addition, new training and conduct standards for healthcare assistants will be published shortly. We will review the need for further assurance of healthcare assistants in light of the recommendations of the Francis inquiry.
Lord Hunt of Kings Heath
I am grateful for that response. Does the Minister agree that the significance of the council’s report is that in relation to social care assistants it has concluded that a voluntary register is not sufficient? Does he agree that the same argument applies very much to healthcare assistants? With regard to the Francis inquiry recommendations, will he undertake for the Government to seriously consider reversing their policy on this matter?
Earl Howe
My Lords, we have made it clear that each and every one of Robert Francis’s recommendations will be considered extremely carefully, including the recommendation in relation to healthcare assistants. However, it is worth noting that while the Health and Care Professions Council has signalled some potential limitations to a statutory regulator holding a voluntary register, and we take account of that, nevertheless that does not mean that these potential limitations would apply to other organisations wanting to set up a voluntary register. Our view is that that avenue should be explored. The HCPC also flagged up some major limitations in attempting to regulate healthcare assistance. Those messages bear thinking about.
Baroness Gardner of Parkes
I ask the Minister again—I have asked him this so many times—whether he will ask the Nursing and Midwifery Council to look again at some intermediate training level, which I think is sadly needed since the abolition of the SENs, for which you could qualify without having to have academic university entrance.
Earl Howe
My Lords, the policy on nursing is clear: there is general acceptance that nursing should be a graduate profession. The problem with giving responsibility to the NMC for healthcare assistance is that that is not currently within its remit, and I think it would say that it has enough on its plate to deal with, without that added dimension as well.
Baroness Masham of Ilton
My Lords, what does the Minister think of the care assistant who posed as a nurse for four years, working in four different surgeries, before she was found out? She did several hundred vaccinations and cancer smears on patients.
Earl Howe
That story bears out the importance of employers fulfilling their responsibility to those who are in their care and ensuring that those whom they employ have the competences and skills that are required for the job. I do not want to prejudge that case, but there are systems in place that should ensure that patients are protected. We must deplore cases of this kind but they should not happen—safeguards are already in place.
Lord Turnberg
My Lords, many members of the public find it difficult to understand why healthcare support workers who deal with patients every day are not regulated and registered and do not have to be fully trained in order to take up a job. I, too, am puzzled. Will the Minister tell us whether it is purely a matter of finance?
Earl Howe
No, my Lords, it is not purely a matter of finance. Our view is that what really matters in this context is the competence and training of the individual involved. We are not oblivious to the concerns in this area. That is why we have already announced a number of further measures to support healthcare assistants. For example, we have just created an innovation fund of £13 million for the training and education of unregulated health professionals. The Care Quality Commission will undertake a review of inductions for care staff to make sure that nobody can provide unsupervised help without an appropriate level of training, and we have the work currently being done by Skills for Health and Skills for Care. Their report has now been received and embodies suggestions for a code of conduct and induction standards for health and social care workers.
Baroness Emerton
The Minister mentioned supervision. The voluntary register does not necessarily cover the total safety of patients unless they are supervised. There is an issue about the minimum levels of registered nurses who can supervise support workers. When will the Government look at minimum standards for the registered nurses to enable sufficient supervision? The evidence base is that effective care and cost-effective care are reliant on the number of registered nurses who can supervise support workers.
Earl Howe
The noble Baroness as ever raises an important issue. She will know that the code of conduct for nurses specifically covers supervision where necessary. My department has instigated a number of measures to support local decision-making to get skill mix profiles right. They include the QIPP programme, which is a key driver for getting the skill mix right through producing tools and programmes in that area. The NHS Institute for Innovation and Improvement supplies case studies and other resources to help NHS provider organisations deliver their QIPP strategies, and NHS employers also deliver guidance and support to help employers better plan their workforce.
Baroness Maddock
My Lords, given that the Care Quality Commission has highlighted the problems of people having too many different carers and of them not arriving at the right time—I can vouch for that; my mother is nearly 94 and has care twice a day—does he agree that managers of rosters need better training to enable them to make much better provision for carers and those they care for?
Earl Howe
I agree with my noble friend. It is an extremely important issue. Part of this relates to employers, part of it relates to those who are charged with supervising healthcare assistants, but part relates to induction training. The Prime Minister announced on 4 January that the CQC will undertake a review of induction training for care staff to ensure that nobody can provide unsupervised help without an appropriate level of training.
Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2012
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NHS: Private Companies
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Lord Winston
To ask Her Majesty’s Government whether they have plans to exempt private companies providing services to the NHS from corporation tax.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government will not be exempting private sector providers of NHS services from corporation tax. The purpose of Monitor’s fair playing-field review is to ensure that any providers, be they NHS, for-profit, community or voluntary sector organisations, that are able to improve the services offered to patients are given a fair opportunity to do so.
Lord Winston
I am grateful to the noble Earl for that reply and deeply reassured that corporation tax will not be in the equation. Given that the NHS is not good at costing out its treatments, how can he be sure that the private sector will not charge what it thinks the market will bear rather than the actual cost of the treatment it is delivering?
Earl Howe
My Lords, the Government’s policy is that competition should never be deployed for competition’s sake but only in the interests of patients. Furthermore, competition should be on the basis of quality and not price. The answer to the noble Lord’s question is that we need to arrive progressively at a system of tariffs that fairly reflect the value and cost of the work that providers do, and that all providers should compete equally on that basis.
Baroness Jolly
My Lords, Parts 3 and 4 of the Health and Social Care Act were rigorously debated. Will my noble friend confirm that the regulations covering this will be laid down soon, as 1 April is less than two months away?
Lord Harris of Haringey
My Lords, it is gratifying that the private sector will be expected to pay corporation tax. However, can the Minister tell us how the private sector will make an appropriate and proper contribution to meet the needs of a full and broad range of training within the NHS, given that in some instances it will not be providing a full range of services?
Earl Howe
The noble Lord raises an important point. A great deal of work is currently being done on the way in which the education and training of NHS clinical staff is funded. Changes are being made this year in order to make funding fairer and more transparent generally, and the Government will consider any further recommendations that Monitor may choose to make in this area if they would bring about further benefits to patients.
Earl Howe
My Lords, the system will operate in a way that ensures that non-NHS providers who provide services to the National Health Service pass a quality test with the Care Quality Commission. They will be obliged after that, should they receive the benefit of contracts from the NHS, to demonstrate that they have abided by the terms of the contract.
Lord Brooke of Alverthorpe
My Lords, as the Government are contemplating introducing a new factor into contracts in which government work is let out to international companies to ensure that they are paying their tax properly, what will they do about the NHS? Have they any plans to apply that kind of system to letting contracts for NHS services?
Earl Howe
My Lords, the answer to that question will need to wait until Monitor has reported to the Secretary of State, which it has not yet done. I know that it is considering a number of aspects of the fair playing field generally, and that may well be one of them. When I am in a position to answer that question, I will be happy to do so.
Lord Flight
My Lords, what will the Government’s policy be towards the term of contracts? One of the big problems with PFI has been that the contracts were too long, but it is quite difficult to combine getting both commitment to service and investment and prices updated.
Earl Howe
My noble friend is absolutely right. Various contracts have been criticised for being too long: PFI is perhaps a good example. Other types of contract have been criticised for being too short because they do not enable providers to invest on a sufficient timescale in order to be able confidently to bid for work. I have little doubt, once again, that this is an area that Monitor will look at and make recommendations upon.
Lord Foulkes of Cumnock
My Lords, will the Government consider requiring companies providing services in the NHS to pay their employees at the very least the national minimum wage and preferably a living wage?
Lord Naseby
My noble friend mentioned tariffs. Will it be a tariff across the whole of England or will it reflect the differing costs, particularly in overheads, of, say, an operation in London and an operation further north?
Earl Howe
My Lords, there are tariffs that are nationally set and others that may be locally set, but there is scope to vary even the national tariffs if there is a good reason to do so on the grounds of local variation in costs. There is some flexibility in the system, but the main basis of the policy, as I stressed earlier, is that, where competition occurs, it should be on the basis of quality and not price.
Baroness Meacher
The CQC has an incredibly important job to do, but we know that it is very overstretched. What systems do the Government have in place to ensure that the CQC’s scope is adequate to monitor all private and NHS facilities and ensure that they are providing a sufficiently good service?
Earl Howe
I am aware that the board of the CQC is looking at that very question at the moment in the light of the Mid Staffordshire review. The noble Baroness is absolutely right. I think the essence of the answer to her question is that a risk-based approach must be adopted so that areas that are deserving of more attention from the CQC receive it and areas that are of lesser concern are allowed to act accordingly without interference.
Baroness Royall of Blaisdon
My Lords, the Minister spoke of the possibility of local tariffs. How does that translate into regional pay? Is the Minister in favour of regional pay for people working in health service?
Earl Howe
I am not sure what the noble Lord’s question about the living wage implies. I answered a question about the minimum wage, which is what the law entails. It is of course up to employers to ensure that they pay their employees in a way that is not derisory and that reflects the value of the work that they do.
National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2012
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Social Care Funding
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, with the leave of the House 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 funding of care and support in England. The Statement is as follows:
“With permission, Mr Speaker, I would like to make a Statement on the funding of care and support in England. As we get older, none of us can have any way of knowing what care needs we will eventually face. Some will be blessed with a long and healthy life, but many others will be less fortunate.
Today many older people and people with disabilities face paying the limitless—often ruinous—costs of their care, with little or no assistance from the state. While those with assets of less than £23,250 do receive support, those with assets above this level receive none. This is desperately unfair, particularly for those who have worked hard all their lives to pay off their mortgage, to save for their future or to have something to pass on to their loved ones, only to see their property sold and their savings wiped out—something that happens to more than 30,000 people every year or 100 people every day. The system we have also sends out the wrong message: that you are better off not saving for your future because any savings will only disappear in a puff of smoke.
Today I can announce this Government’s radical plans to transform the funding of care and support in England, bringing a new degree of certainty, fairness and peace of mind to the costs of old age, disability and living with long-term conditions, while ensuring that the greatest level of financial support goes to those with the greatest need. We propose to introduce a cap on an individual’s financial contributions towards the cost of care, and a significant increase in the level of assets a person may hold and still receive some degree of support from the state.
In 2010 this Government asked the economist Andrew Dilnot to look at the whole issue of funding for care and support. The independent Dilnot commission published its recommendations in July 2011. In response to those recommendations, and following extensive engagement with the care and support sector, we published the Care and Support White Paper and the progress report on funding reform in July 2012.
In the progress report, we accepted some of Andrew Dilnot’s main recommendations, including those around a consistent, nationally set eligibility threshold for care and support, and universal deferred payments—whereby no one will have to sell their home in their lifetime to pay for care costs. I would like to take this opportunity to thank Mr Dilnot and his team for their excellent work.
A core principle set out by the Dilnot commission was that people should contribute to the costs of their own care but that those costs should be limited and people should be protected against the potentially catastrophic costs of care. This should come through a cap on those costs, and an extended means test. One person in 10 will be faced with care costs in excess of £100,000, with a small number facing costs significantly higher still.
To give everyone peace of mind, from April 2017 we will introduce a cap on the amount that someone over state pension age will be liable to pay. The Dilnot commission’s original suggestion was for a cap of between £25,000 and £50,000 in 2010-11 prices, which is the equivalent of between £30,700 and £61,500 in April 2017 prices. Despite the extremely challenging economic situation we find ourselves in, we have come as close to this range as possible.
The cap will be set at £61,000 in 2010-11 prices, or £75,000 once it is introduced in April 2017. The intention is not that people should have to pay up to £75,000 for their care costs. But by creating certainty that this is the maximum they will have to pay, they can then make provision through insurance or pension products so that they are covered up to the value of the cap, thereby reducing the risk of selling their home or losing an inheritance they have worked hard to pass on to their family.
Young people who already have care needs when they turn 18 will now receive free adult care and support when they reach 18. People who develop a care need after 18 but before state pension age will be protected by a cap that is below the £75,000 threshold.
The other measure that we propose is significantly to increase the amount of assets that a person can hold and still receive financial support for their residential care- home costs. Currently, this is set at £23,250. If a person has assets valued above this level, including, in some circumstances, the value of their home, they receive no support. The Dilnot commission recommended that this threshold be raised dramatically to £100,000 in 2010-11 prices. We accept this recommendation.
From April 2017, the threshold will be increased so that those with assets worth £123,000 or less, equivalent to Dilnot’s recommended level, will all receive some degree of financial support for their care costs. People with the fewest assets will receive the most support. This will, for the first time, provide financial protection for those with modest wealth, while ensuring that the poorest continue to have all or the majority of their costs paid.
Everyone will benefit from the peace of mind that a cap brings. The introduction of a cap and the extended means-tested support will help many people in the most challenging circumstances—we expect up to 16% of older people who need care to face costs of £75,000 or more. But, of course, none of us knows whether we will be one of that 16%. Everyone will benefit from the peace of mind that these changes bring and, by 2025, up to 100,000 more older people will receive financial support for their care costs as a result.
My right honourable friend the Chancellor and the Treasury have rightly insisted that we identify how we pay for the additional costs of these proposals. In this day and age, making promises that you cannot pay for makes those promises meaningless. We have therefore identified exactly how to pay for them. These reforms will cost the Exchequer £1 billion a year by the end of the next Parliament. With the agreement of the Chancellor, they will be met in part by freezing the inheritance tax threshold at £325,000 for a further three years from 2015-16. The Chancellor and the Chief Secretary to the Treasury have agreed that the remaining costs over the course of the next Parliament will be met from public and private sector employer national insurance contributions revenue associated with the end of contracting-out as part of the introduction of the single-tier pension.
These two new proposals join with others previously announced when we published the draft care and support White Paper last summer. They include, from 2015, the ability of people to defer the payment of residential care costs so that no one needs sell their own home to pay for them during their lifetime. Also from 2015, a national minimum eligibility threshold will be introduced to end the lottery of local access that can see support provided to someone in one area but not in another. Taken together, today’s proposals and those already set out in the draft care and support Bill represent a new era of support for the elderly and disabled in England.
Thanks to the certainty that these proposals will introduce, people should no longer feel that they have to hoard every penny in case the very worst happens or feel that they are powerless and that there is no point in saving at all. Rather, they will be able to plan and prepare sensibly for their future. This will be supported by a wider range of financial products becoming available in the market designed to help people to plan and prepare for their later years and to reassure them about how much they will pay. We will work with the care and support sector—with local authorities, charities, care providers and individuals, and with the financial services industry—to develop these plans and to introduce them practically.
Our society is ageing. By 2030, the number of people aged over 85 will double, and the number of people with dementia will exceed 1 million. As the number of older people with such long-term conditions increases, we need to become a society where people prepare and plan for their social care costs as much as they prepare and plan for their pension. Sadly, this is an issue that Governments of all colours have long failed to tackle. While there are many other things that need to be done to prepare for an ageing population, these reforms herald a historic change in the way that care and support is funded in this country.
The economic circumstances are challenging, but these commitments demonstrate our determination to help people who have worked hard, saved and done the right thing to prepare for the uncertain hand that fate deals to all of us in old age. By introducing these reforms within the timescale and at the thresholds set out, they will also be sustainable and consistent with our overriding priority to reduce the deficit inherited from the previous Government. We want our country to be one of the best places in the world to grow old. These plans will give certainty and peace of mind about the cost of care, making sure that we can all get the support we need without facing unlimited costs, while also ensuring that the most support goes to those in greatest need. I commend this Statement to the House”.
My Lords, that concludes the Statement.
Earl Howe
My Lords, first, I thank the noble Lord, Lord Hunt of Kings Heath, for his positive welcome for at least some elements of the Statement, which I know reflect the view of his own party on some of the principles enunciated by Dilnot and which have not been a matter of disagreement between us. I am very pleased that those principles are reflected in the structure that the Government have announced.
The noble Lord began by saying that we needed a holistic approach to the funding and delivery of social care. I could not agree with him more but it is important to remember that the remit given to the Dilnot commission focused on one particular aspect of social care funding. It never pretended to give it an instruction to solve every problem that faces us over the next 10 to 20 years in funding social care, or indeed to tell us how we raise the quality of social care or give life to the prevention agenda, which I know is as close to the noble Lord’s heart as it is to mine. He rightly said that the NHS has an important part to play in that.
The financing of local authorities is a major issue, which we still have to grapple with. I do not duck that and I would of course welcome cross-party consensus on that issue, if it can be reached. However, reading some of the public’s comments today on the Government’s announcement, they have been on the whole very measured. While some regret that we were not able to conform precisely to the parameters that Dilnot recommended in terms of the cap, nevertheless we have got reasonably close to them given the current economic circumstances that we face.
The noble Lord asked me whether the announcement we have made passed a key test, which is: will these arrangements help every person in the country? My answer is: yes indeed they will, because everybody in the country will now get the reassurance that, whatever their circumstances, they will get the long-term care and support that they need without facing financial ruin. People will benefit wherever they receive care, be that in a care home or in their own home, and they will be more in control—they will be more easily able to plan and prepare for the care and support that they might need at some time in future.
On that score, the noble Lord asked me about products that may be developed by the financial services sector. We have engaged very fully with the sector, and we are under no misapprehension that it has been as keen as anyone to see this announcement. The certainty that it gives firms in that sector will enable them to develop products that they can market to those who would like to provide for their old age and their care costs in an affordable way, and we are now giving them the freedom and scope to do that.
The noble Lord asked how the cap will actually work. It will cover eligible social care costs that the local authority assesses that it would meet at a price that the local authority would pay. Individuals would be responsible for meeting their eligibility care costs up to the cap. Where they cannot afford to do so, the local authority will provide financial support, as I have said, to those with less than £100,000 of assets in 2010-11 prices who are in residential care. This will rise to around £123,000 at implementation. The cap would cover the cost of social care. Someone in residential care will always be responsible for a contribution to their general living costs—that is, their heat, food and light—as they would when living at home. That amount would be set nationally at around £10,000 in 2010-11 prices, as recommended by Dilnot, but anyone who is unable to afford that will be helped by the local authority. We view that flat contribution to hotel costs, if I can describe them that way, as a fair way of implementing a rule around the country that is easy for everyone to understand and does not involve massive bureaucracy. Altogether, the design of the cap sets out what we believe is a fair partnership between the state and the individual that protects individuals from the prospect of catastrophic costs.
The noble Lord indicated that the Association of British Insurers was disquieted by this announcement, but in fact today the ABI said that the reforms were a potential step forward. Stephen Gay, their director of life savings and protection, said:
“This is potentially another positive step forward in tackling the challenges of an ageing society. The cap and the higher means test give people greater certainty and will enable them to plan ahead for later life. What is important now is to work through the implementation of what is a complex system, and we are looking forward to working with government and the care sector”.
I read that as a reasonably positive endorsement of this package.
The noble Lord asked me about draft clauses for the Care and Support Bill. It is not our intention to publish draft clauses designed to implement Dilnot. Instead, as and when the Bill is introduced to Parliament—and I cannot give any commitment as to when that will be—we will have inserted the relevant clauses for consideration by both Houses, and we believe that that is the right way to set about things. With regard to a debate in your Lordships’ House, I will willingly pass the noble Lord’s suggestion to our colleagues in the usual channels.
Baroness Northover
My Lords, I interrupt briefly to say that if noble Lords make brief contributions more of their colleagues will be able to get in this critical debate.
Earl Howe
My Lords, I am grateful to my noble friend for her remarks. She is of course quite right; many of us have heard for years the concerns of members of the public, friends and family about what might be the catastrophic burden of care costs in old age. If there is one thing that everyone should welcome, it is that aspect of this announcement. With regard to a rebate, no, that is not in our sights at the moment. If someone were to die in the circumstances posited by my noble friend, the arrangement would have to remain as set out to that person at the outset. We would not expect to move the goalposts after that person had died.
Lord Warner
My Lords, I should declare my interest as a member of the Dilnot commission. It would be churlish not to welcome the Government’s acceptance in large part of the Dilnot architecture for reforming the funding of social care for the medium and longer term.
I have a couple of questions for the Minister. As I understood what he was saying, the new capping system is likely to start in 2017-18. I understood him to be saying that a new national threshold for eligibility criteria would start at the same time. That would therefore mean that the present eligibility criteria, interpreted by local authorities, would stay in existence for another four years, so we would have four more years of the tightening of those eligibility criteria.
I remind the Minister of a paragraph in our report that drew attention to the fact that there was strong evidence of a major shortfall in the existing funding of social care that could not be put right by our recommendations, and that if those problems were not resolved on a cross-party basis, they would simply undermine the functioning of our recommendations in the medium to longer term.
Earl Howe
My Lords, I hope that I can put the noble Lord’s mind at rest. In doing so, I thank him once again for the work he did on the Dilnot commission. It is our intention that the eligibility criteria will be introduced from April 2015—so, in advance of the Dilnot arrangements. As he well knows, that national minimum eligibility will be set to make access to care more consistent around the country. In addition, carers will have a legal right to an assessment to care for the first time. I take his point about trying to achieve cross-party consensus on social care funding.
As for funding in the existing system, in the last spending review we made, as he knows, an additional £7.2 billion over four years available for care and support. Since then, we have provided local authorities with an additional half a billion pounds. We believe the challenge creates an opportunity for local authorities to innovate and to explore new ways of working better to meet the needs of their local populations and to optimise the use of the resources that they have. Many local authorities are already innovating, and we are committed to supporting them to deliver further service improvements.
Lord Sutherland of Houndwood
My Lords, I am pleased to welcome the Government’s Statement today. This has been a long time in the waiting, not simply from this coalition Government, who have done well to get this far, but from previous Governments. There has been prevarication for more than 10 years, and it is about time we got started. We have now started. As has been said, this is a first step on the way. There are many steps to be taken thereafter, and a great deal of discussion and, if possible, cross-party consensus would be useful.
Will the Minister confirm that an adequate length of time will be made available for that, not simply a Question for Short Debate, in the near future? Secondly, will he confirm that it would be open to any Government, perhaps his own Government, to look again at the financial thresholds that they are setting in this Statement as and when, as we all hope, the economy improves?
Earl Howe
I am grateful to the noble Lord, Lord Sutherland, and pay tribute to his work over many years in this field and in the royal commission some years ago. I will convey his wishes to my noble friend and other members of the usual channels. I agree that it would be unsatisfactory to have an unduly short debate on a complex and important subject.
As regards the thresholds, I hope I can reassure him. It is our intention, as I mentioned, to introduce clauses into the care and support Bill when it reaches Parliament that would embody the essence of the Dilnot proposals but to leave it to regulations to set the relevant numbers for the cap and the means test, for example, so that it would be a relatively easy matter for a future Government, if they so wished in brighter economic circumstances, to change those figures if they felt that that was the right thing to do.
Lord Lipsey
My Lords, better half a loaf than no loaf at all and, to that extent, I welcome the Government’s Statement. Does the Minister agree with all noble Lords who have spoken who have emphasised the importance of all-party agreement, if it can be obtained on this subject, so that old people know the background they have to plan against when looking to their futures? With that in mind, will he meet one of the points made by my noble friend Lord Hunt by trying to make this package slightly more favourable to the less well off and not, as it is, somewhat, at the moment tilted towards the better off, so that it is easier to achieve that all-party agreement and to go forward united to something that all old people will so greatly welcome?
Earl Howe
My Lords, I thank the noble Lord. I am with him in spirit. I say that because not only do I believe in cross-party consensus on a matter as important as this, but I hope he will accept from me that the way we have tried to structure this package, taking the cap and the means test in combination, has precisely been to target those of more modest means. Currently only those with assets of less than £23,250 and a low income receive help from the state with their care costs. Our changes will mean that those with property value and savings of £100,000 or less in 2010 prices will start to receive financial support. That means that the most support will go to those in greatest need. I am advised that had we, for example, opted for a higher means-test threshold, it would not in practice have brought into the net that many more people. We felt that the fairest way of cutting the cake was to try to concentrate the benefit on those of lowest means while also removing the fear of catastrophic care costs from everybody in the system.
Baroness Jolly
My Lords, we on these Benches are delighted that the Government decided to implement the principles of the Dilnot report. The care and support Bill places a duty on local authorities to provide information and advice. In addition, there will be a need to set up some sort of taxi-metering system in order to achieve that outcome. Has the Minister any idea about how that might be achieved?
Earl Howe
My noble friend is absolutely right. One of the tasks that faces us over the next two or three years is to ensure that every member of the public has easy access to information which enables them to make plans and take decisions about their own or their family’s future. We will therefore be working very closely with local authorities on that front. It is important that there are websites. My department is already devoting a section of its website to appropriate information on this front. More generally, we need to ensure that the system is not only fair to people, but clear to people.
Baroness Pitkeathley
Following the question from the noble Baroness, Lady Jolly, I believe it is the Chinese who say that a journey of a thousand miles starts with a single step. We have certainly made more than a single step today, on which I congratulate the Government. Two major problems remain, as other noble Lords have said. First, there is not enough money in the system, and secondly, people do not know about it. They do not know that they have to pay for social care, never mind up to £75,000. Is the Minister confident that what he said about information and advice—and this is yet another responsibility for local authorities, which are already strapped for cash—will enable people to plan in the way to which he is so clearly committed?
Earl Howe
I quizzed my officials very closely on that very point only this morning and received very firm reassurances on that front. I completely agree with the noble Baroness about how important this is. She is right; there is a widespread lack of knowledge among the general public about what they are entitled to and what they may not be entitled to. Collectively, we need to put that right. I take her point about additional burdens on local authorities, but ultimately I hope that they will see it as in their own interests to inform the public before they are inundated with questions that will take them a lot of time and effort to answer. I can assure her that work on these lines will be very vigorous, and I will be happy to keep her up to date on the work we are doing over the months ahead.
Lord Cormack
Does my noble friend agree that it is a pity that so many details were given to the media this morning before we had them in Parliament? Will he clarify one point that he made in his answer to the noble Lord, Lord Warner? He said that the eligibility criteria would change as from 2015. The new system will not be operative until 2017. What precisely does that mean?
Earl Howe
First, I completely agree with my noble friend that the leak to the media over the weekend was highly regrettable. I do not know how it occurred. It certainly was not of my making or that of my ministerial colleagues in the Department of Health. We wished to make this announcement to Parliament first of all, and I am sorry that that did not happen.
My noble friend’s second question relates to the national minimum eligibility threshold. We believe that that can be introduced in advance of the Dilnot package because what it is designed to do, as I explained earlier, is to give people greater certainty about their access to care wherever they live around the country, particularly for those who move from one place to another. That is a separate issue from those covered by Dilnot, although it was one of those which the commission considered. It is separate from the issue of the cap or the means test, which we believe can logically come in at a later date.
Baroness McIntosh of Hudnall
My Lords, as one of those in the Chamber today who is not an expert on social care matters, I ask the noble Earl whether he can reassure the great many people who are hearing about this for the first time as to what it means in practice for them when they have to start paying for social care—or, more particularly, when they become in need of social care. When we have a Budget, newspapers often produce ready reckoners, showing the impact of tax rises, reductions or whatever is being introduced on people in particular circumstances. Will the Minister encourage his department, and encourage his department to encourage local authorities, to produce the kind of information that ordinary people can understand, which will show them in easily understood, ready-reckoner terms what they will be in for if they need long-term care?
Earl Howe
My Lords, I absolutely agree with the noble Baroness on how important this is. It is quite complex to explain the whole system in words. The system will depend on the operation of a sliding scale which, by its nature, is difficult to describe other than pictorially. Nevertheless, the basics of the rules of these funding arrangements are straightforward and can be described. They are, as the Statement described, two essential elements, being the maximum level that people have to pay for their care—which we are setting at £61,000 in 2010 prices; £75,000 in 2017—and the means test, which is £100,000.
Of course, there are nuances around that, such as around couples and how the system will work for them. That is a question that the noble Lord, Lord Hunt, asked me which I did not answer. At present, a couple could potentially face two sets of unlimited care costs. By protecting them from these costs, the reforms offer them significant benefits which need to be spelt out. In most circumstances, even if a couple both had care costs at £75,000, the level of the cap, they would contribute less than this because housing assets do not count towards the means test if one of the partners remains resident in the home. All those sorts of things need to be made clear. We will do our very best to work with others to ensure that these messages have not only the greatest clarity but the greatest coverage.
Lord Pearson of Rannoch
My Lords, I do not want to make a European point so much as to ask the Government whether they have not got their spending priorities tragically wrong. In our previous debate, I asked the noble Lord the Leader of the House how he could justify sending £11 billion in net cash annually to Brussels to be filtered away. Here we are, with this debate on the Dilnot commission, and, from the remarks of the noble Lord, Lord Hunt, we have made a step forward. However, clearly this is not adequate to look after the needs of our old and infirm for many years.
How can the Government throw away £11 billion with one hand and then say that we cannot afford more than £1 billion by the end of the next Parliament to look after our old and infirm? Are we a civilised society?
Earl Howe
My Lords, I hope that we are a civilised society. While I understand the noble Lord’s point of view on the European Union, the fact is that if we are fully paid-up members of the European Union we have legal obligations to contribute to the Community budget. That is a given.
However, like any Government, we need to look at the totality of government commitments in the round. We have decided that, against competing priorities, this is a very high priority. That is why we have brought forward these proposals.
Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2012
Earl Howe Excerpts(11 years, 3 months ago)
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Earl Howe
That the Grand Committee do report to the House that it has considered the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2012.
Relevant documents: 15th Report from the Joint Committee on Statutory Instruments
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, these regulations make provision for three things: first, for local authorities to take certain steps in the exercise of public health functions; secondly, the making and recovering of charges in respect of certain steps taken by local authorities in the exercise of their public health functions; and, thirdly, a duty on certain providers of health and social care services to allow local Healthwatch organisations or contractors to enter and view their premises. The regulations are affirmative and apply to local authorities in England only.
I start by explaining the mandatory aspects of the regulations. Part 2 sets out certain steps which must be taken by local authorities when exercising their own, or the Secretary of State’s, public health functions. These include the provision of arrangements for weighing and measuring children, health check assessments, sexual health services, a public health advice service for clinical commissioning groups and information and advice in relation to arrangements for protecting the health of the local population.
Although the regulations are primarily concerned with steps to be taken by a local authority in the exercise of its own functions, in some cases the regulations require the local authority to exercise a Secretary of State public health function—for example, arranging contraceptive services as part of local authority sexual health services. Regulation 2 ensures that the authority can exercise the Secretary of State’s ancillary powers to assist the delivery of that function, for example, exercising the power to commission those services from a third-party provider.
Regulation 3 requires local authorities to provide for the weighing and measuring of certain children in their area by reference to the age of the children and the type of school which they attend.
Regulation 4 imposes a duty on local authorities to provide health checks to be offered to eligible persons in their area, the relevant criteria being a person’s age and existing health status. Regulation 5 makes provision for the conduct of the health checks, including the dissemination of information about dementia to older persons.
Regulation 6 requires local authorities to provide open access sexual health services in their area. That general duty does not extend to offering services to persons undergoing sterilisation or vasectomy procedures, or to services for treating or caring for persons infected with human immunodeficiency virus.
Regulation 7 creates a duty on local authorities to provide a public health advice service to any clinical commissioning groups in their area in order to assist CCGs to commission health services. The range of matters which the advice service covers will be kept under review and agreed between the local authorities and the CCGs.
Regulation 8 imposes a duty on local authorities to provide information and advice to responsible bodies and other relevant bodies within their area in order to promote health protection arrangements against any threat to the health of the local population, including infectious disease, environmental hazards and extreme weather events. We expect the local authority director of public health, with Public Health England, to lead the initial response to most public health incidents at the local level. When performing this duty, the local authority will be exercising the Secretary of State’s duty as to protection of public health, as set out in Section 2A of the National Health Service Act 2006.
Noble Lords may find it helpful if I describe the context of these regulations. The Health and Social Care Act 2012 gives upper tier and unitary local authorities a new duty to take appropriate steps to improve the health of their populations and certain other public health functions. In general, the intention is to permit the greatest degree of flexibility to local authorities to shape services to meet local needs. But there will be certain circumstances where a greater degree of uniformity is required—for example, where services must be provided in a universal fashion if they are to be provided at all, or where certain steps are essential to the efficient running of the new public health system.
We have consulted widely on these mandatory functions and set out our conclusions in July 2011 in the document Healthy Lives, Healthy People: Update and Way Forward. We will also issue appropriate guidance to support local authorities in delivering these functions.
Turning to Part 3 of this instrument, Regulation 9 makes provision for a local authority to make and recover charges in respect of certain steps taken in the exercise of its duty as to health improvement. However, there are some circumstances where it is legitimate for local authorities to charge organisations—for example, for providing information and advice to local employers—and the regulations permit charging in such cases. The regulations also permit individuals to be charged for services that do not have the purpose of improving their health. This might include training in public health.
However, I should stress now that this regulation means that no individual can be charged for steps taken to improve their health, nor will local authorities be able to charge organisations or individuals for anything done in the exercise of the mandatory functions under Part 2 of the regulations. We have previously made clear our position on charging for health services: there will be no new charges during the current Parliament. Regulation 9 is entirely consistent with that commitment.
We have prepared guidance for local authorities which makes it clear that anyone who was receiving a health improvement service from the NHS free of charge will continue to receive it free of charge when responsibility for it transfers to local authorities. Conversely, the guidance also makes clear that the effect of the Act and these regulations is not to convert large swathes of existing activity that local authorities may charge for—such as leisure or social care—into health services that must now be provided free of charge.
On the regulations covering entry and viewing by local Healthwatch representatives, Part 4 imposes a duty on certain providers of health and social care services to allow authorised representatives of local Healthwatch or its contractors to enter and view certain premises owned or controlled by them. This gives local Healthwatch the ability to enter premises where health and social care services are being provided in order to observe activities and gather views from people who use those services. This will enable local Healthwatch to feed back evidence about the quality of care provided in a report with recommendations to providers and commissioners about how the quality of that care can be improved.
We are clear that local Healthwatch is not an inspectorate. It does not have the status of a regulator—that is the role of the Care Quality Commission. We need to avoid duplication of roles and confusion among service users or service providers as to the various roles and responsibilities within the system. We are giving local Healthwatch a role that is different from and complementary to that of the regulator. It is there to listen to the voice of patients, service users and residents on how their services can be improved.
Earl Howe
My Lords, I am grateful to both noble Lords, my noble friend and the noble Lord, Lord Collins, for their comments and questions, and in particular their overall welcome to these regulations. Quite a number of questions and issues have been raised, and I will endeavour to cover as many as possible now, but if noble Lords will allow I will follow up this debate with a letter on some of the more detailed comments, when I have not got the answers readily to hand.
I was grateful to my noble friend Lord Willis for his constructive opening remarks and for putting these regulations into their fuller context. He is right to flag up the wider dimension that the context of these regulations opens the way to. I begin where he did, on public health research funding. I quite agree about the importance of maintaining that work. Currently, PCTs and strategic health authorities fund public health research from their local spending allocations, in particular paying for public health academic posts, located within academic and research institutions. I can tell him that, in finalising spending plans, officials from the department, from Public Health England and the NHS Commissioning Board are working together to identify and continue this funding for the coming financial year. As soon as I have further news on that front, I will be happy to share it with my noble friend. He can be sure that it is very definitely on everybody’s radar.
My noble friend went on to discuss Regulation 4, which relates to health checks. First, the requirement to offer a health check is to offer the check within five years of a person becoming eligible for it. However, a local authority could, if it wished, offer checks to non- eligible persons, if it considered it appropriate to do so. Local authorities have that freedom; all the regulations do is to lay down the minimum requirements.
Both noble Lords spent some time discussing sexual health services. Improving sexual health is clearly a key part of improving public health and well-being. Our view was, and is, that local authorities are particularly well placed to commission sexual health services, as they will also be commissioning services for other public health issues such as drug and alcohol misuse, weight management and quitting smoking. They are also best placed to make the wider links between sexual health and well-being, such as to education, leisure and family support. Clearly, they will also want to work collaboratively with commissioners of sexual health and HIV services that will remain in the NHS. During our consultation there was strong stakeholder support for local authority commissioning of sexual health services. While it is important to get the arrangements absolutely right—we are clear that there are some issues of detail that we need to resolve—there is broad support out there for the decision that we have taken on this front.
The new commissioning arrangements will allow each organisation—local authorities, clinical commissioning groups and the NHS Commissioning Board—to play to their own strengths and to commission high-quality services for patients. Local authorities will commission most sexual health services: they will be able to make the crucial links between sexual health and other public health services, as I have mentioned. Clinical commissioning groups will commission abortion, sterilisation and vasectomy because these services need to be governed by robust systems of clinical governance, which currently exist in the NHS. HIV treatment will be commissioned by the NHS Commissioning Board, which has specialist expertise in commissioning high-cost, low volume services such as HIV treatment. At a local level, the health and well-being board will bring commissioners together to ensure that there is no fragmentation or gaps in service provision, a concern that the noble Lord, Lord Collins, understandably raised.
As noble Lords will know, these commissioning arrangements were set out in a local government fact sheet on commissioning responsibilities which we published at the end of 2011. However, I emphasise that we have worked, and will continue to work, closely with colleagues in the NHS and local councils to make sure that local authorities and other commissioners experience a smooth transition to their new responsibilities. We intend to conduct a further consultation in 2013 on whether clinical commissioning groups are best placed to commission abortion services in the longer term.
The noble Lord, Lord Collins, mentioned comorbidities, as did my noble friend. A person with comorbidity— let us say HIV and another condition—should clearly receive treatment from the most appropriate source. The two services will often be under the same roof in practice but it is important to ensure that the commissioning of those services is joined up for such patients.
On the issue of charging—both noble Lords asked about this—the first point to emphasise is that an individual who was receiving a health improvement service from the NHS free of charge will continue to receive it free of charge when responsibility for it transfers to local authorities. The kinds of activity that local authorities can charge for are as follows: providing information and advice; providing services or facilities designed to promote healthy living; providing or participating in the provision of training for persons working in, or seeking to work in, the field of health improvement; and making available the services of any person or any facilities—for example, providing staff and facilities to enable a company to conduct public health research.
Lord Willis of Knaresborough
Will the Minister state categorically that, in the event of a major public health incident within a local authority area, it will be the director of public health who has the lead responsibility in co-ordinating a response to that event?
Earl Howe
We expect that that will be the case but it will depend on the nature of the incident and how big a public health emergency we are dealing with. We might find, for example, that if it is an emergency that covers more than one local authority area, a particular director of public health will take responsibility on behalf of all the local authorities. We would expect Public Health England to be on the scene for any major incident and to advise, but the central point is that there has to be somebody with ultimate responsibility for what goes on on the ground. Clearly, who that person is will depend on how major or minor the incident is and the nature of that incident. It would be open to the director of public health to delegate certain functions but, again, we would expect the director of public health to retain an oversight role to make sure that functions were appropriately performed.
The noble Lord, Lord Collins, referred to the important area of prevention. He expressed concern about local authorities investing in prevention work. I was grateful to him for what he told me about the work currently being done in London on HIV prevention. The mandate to the NHS Commissioning Board does not specifically cover prevention, but local authorities will want to undertake prevention activity because this will improve the health and well-being of their population and reduce costs. Sexual health services are also a preventive activity in their own right—for example, the provision of contraception to prevent unplanned pregnancy and the testing and treatment for STIs to prevent onward transmission.
On HIV, one of the public health outcome indicators is to reduce late HIV diagnosis, and prevention activity can clearly play a crucial role in that. We are aware that in London, in particular, councils will be working together to review arrangements for pan-London HIV prevention work. The noble Lord may well be aware of the work going on to underpin the current pan-London HIV programme. The current programme comes to an end at the end of March and this has been known by all the providers and voluntary sector organisations for some time. Therefore, a needs assessment of pan-London HIV prevention was undertaken in 2011. London Councils and the mayor’s office are absolutely sighted on the need for effective HIV prevention in the capital and urgent discussions are under way about taking this forward from April.
HIV services will continue to be commissioned by the NHS. More generally, local authorities will be able to enter into cross-charging arrangements if they wish. In London, we introduced secondary legislation last year to allow the Greater London Authority to undertake public health activity in partnership with the boroughs, and that was obviously designed to facilitate co-operation across boundaries.
The noble Lord asked how we would ensure that HIV treatment was standardised across the country and whether we were intending to publicise HIV prevention. Local authorities will certainly be able to run awareness and information campaigns, and they will be funded to do so. HIV treatment will, as now, be commissioned by the NHS and be informed by the existing standards and guidance.
My noble friend mentioned the letter from my honourable friend Anna Soubry, which stated that there are no plans to do anything on the regulation of public health specialists at present. He sought reassurance on the regulation of public health specialists being in place by the end of next year. During the debate on the Health and Social Care Bill we made the commitment to regulate non-medical public health consultants after conducting a consultation. That remains the case. However, the process will take 12 to 18 months to complete and so, at this point, I am reluctant to commit to a particular date for implementation. I should be happy to follow up that comment in a letter to my noble friend.
He also raised the issue of the interface between Healthwatch England and services providers. Part 4 refers to the duty on services providers to allow entry to local Healthwatch rather than Healthwatch England. If local Healthwatch representatives observe anything that might be unsafe or poor care of any kind, they can report those matters directly to the Care Quality Commission to investigate. I hope that that addresses an issue also raised by the noble Lord, Lord Collins, because it is clearly very important for local Healthwatch not only to have a hotline to the CQC where necessary but to co-ordinate its work, where relevant, with that of the CQC—exactly as LINks do at the moment.
The noble Lord, Lord Collins, asked me about local Healthwatch in the context of the Francis report, published yesterday. All I can say at this point is that, as the Leader of the House said yesterday, my right honourable friend the Secretary of State will be considering all the recommendations in Robert Francis’s report in detail over the coming weeks. Clearly, we will need to reflect very carefully on the implications of his recommendations and we will be providing an initial response next month.
Finally, the noble Lord, Lord Collins, raised the issue of local Healthwatch being able to enter and view premises and, in doing so, access all areas in those premises—for example, areas being renovated, kitchens and so on. Local Healthwatch representatives will be able to access communal areas but there are restrictions based on the privacy of residents or patients and the need to respect that, and on intruding on the provision of care while it is being delivered. The enter-and-view powers are activities for the purposes of Section 221 and relate to service improvements. These regulations support local Healthwatch’s role in that respect.
On the issue of the reasonableness of local Healthwatch’s enter-and-view activities, the service provider’s view has to be one that is held reasonably; otherwise the provider would be acting unlawfully. Regulation 13 requires local Healthwatch, when on any premises, not to act in a way that would compromise “effective provision of care” or the,
“privacy and dignity of any person”.
These terms bear their ordinary meaning and, in our view, they are clear. They have worked well on the ground so far. They are, of course, based on the 2008 regulations and we are confident that they will serve the new system well.
I am aware that there are several matters of detail that I have not covered but I shall, as promised, look carefully once again in Hansard at all the questions posed by both noble Lords and write accordingly.
Children: Obesity
Earl Howe Excerpts(11 years, 3 months ago)
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Lord Sharkey
To ask Her Majesty’s Government what assessment they have made of the factors contributing to the rise in childhood obesity.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, obesity is a complex issue, and there are many factors that contribute to children becoming obese. We are committed to tackling obesity in children. Our call to action on obesity sets out the actions that everyone needs to take. For our part we will continue investing in the Change4Life programme, the national child measurement programme, and the School Games.
Lord Sharkey
My Lords, one-third of our children are already obese, and the fact is that cheap fast food can be a major contributor to obesity. The Government’s responsibility deal for calorie reduction has signed up 31 companies, which have promised to reformulate their products to make them less fattening. However, according to the Department of Health’s website, not one of these signatories is a fast-food operator. Does this not suggest a failure of the voluntary approach and that we need regulation, as the BMA says, to make food companies play their proper part in reducing obesity?
Earl Howe
My Lords, I am grateful to my noble friend. In fact, the responsibility deal has led to a number of very important gains and benefits, not least from food companies: food retailers as well as food manufacturers. Calorie labelling, for example, has expanded rapidly in out-of-home settings; we now have labelling in around 9,000 outlets across the country, which is to be welcomed. As my noble friend said, 31 companies, some of them household names, have signed up to the responsibility deal calorie reduction pledge. However, this is an area that we continue to work on, and I think my noble friend’s comments are well placed.
Lord Wigley
My Lords, will the Minister accept that in Wales the figures for childhood obesity in those aged between 2 and 15 are three percentage points worse than those in England? As responsibility for some aspects of these matters is devolved and for others is not, can his department take up with the Government of Wales in Cardiff how a coherent plan can be undertaken to tackle this?
Earl Howe
My Lords, the noble Lord will understand that we tread warily when it comes to interfering in the affairs of the devolved Administrations. However, I take his point, because on serious public health messages such as this we need to have a co-ordinated approach. Members of my department are in regular contact with their counterparts in Wales.
Baroness Massey of Darwen
My Lords, the Minister mentioned sport. Beneficial as it is, does he accept that obesity is caused overwhelmingly by overeating and eating foods that cause obesity? Are there any media initiatives to direct young people to what is healthy to eat and to foods that cause less obesity, as well as to sports programmes?
Earl Howe
I completely agree with the noble Baroness that for children especially, exercise and sport are vital, which is why there are a number of initiatives in that area. She asked about media campaigns. Change4Life continues to support families to make simple changes to adopt a healthier diet and increase their physical activity levels. We are currently planning a summer campaign to encourage physical activity in children. The campaign remains subject to formal approval but is very much in our minds. Change4Life, I would just add, uses the full range of communication channels, including TV advertising, press, and local supporter activity. It is a well known brand and we intend to stick with it.
Lord Eden of Winton
My Lords, does not the Answer to the first Question on the Order Paper really depend upon the plans that the Minister will deploy before the House in his Answer to the second Question?
Lord Collins of Highbury
My Lords, I am going to take two bites of the cherry because I shall also briefly address the second Question. The noble Lord, Lord McColl, constantly reminds me that eating too many calories, not simply not exercising, is what causes me to be overweight, although I do exercise. However, when I pick up and eat a tub of low-fat yoghurt, which I have been doing for the past few years, thinking that I am eating healthily, I have not been able to read the very small print that states that this “low-fat, healthy” tub of yoghurt is packed full of sugars and calories. Actually, just before Christmas, I stopped eating low-fat yoghurts and I hope that noble Lords will appreciate the effect it has had on me. However, my specific question is: when will the noble Earl take the necessary statutory steps to ensure proper food labelling?
Earl Howe
My Lords, as the noble Lord will know, food labelling is largely governed by EU law and, at the moment, the EU directive is permissive about front-of-pack labelling. However, I take his point that it is very important that consumers are properly informed about what they are eating, and we are working with food manufacturers and retailers to ensure that there is much greater transparency in this area, across the piece, whether it relates to sugar, fats or salt.
Baroness Trumpington
My Lords, perhaps I may ask the Minister two questions. First, does he not agree that cheap food has become far more delicious than it was in the youth of most people in this Chamber? Secondly, children like to copy their heroes. Could not the media be persuaded to make greater use of physical heroes, such as footballers, tennis players or any kind of sporting hero, in order to promote less obesity?
Earl Howe
My noble friend makes a very good point about role models. To a certain extent, that has been tried and tested in the past with some success. As regards food and its taste, I would say each to their own, but she is right that we are encouraged in all sorts of subtle ways to eat more than we used to in years gone by. The responsibility deal calorie reduction pledge specifically enables businesses to contribute to our challenge to the nation in this area, which we issued as part of the call to action on obesity in 2011, to reduce total calorie consumption by 5 billion calories a day.
Health: Sugar Consumption
Earl Howe Excerpts(11 years, 3 months ago)
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Lord Rennard
To ask Her Majesty’s Government what plans they have to help people reduce their sugar consumption.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we have challenged business, through our responsibility deal calorie reduction pledge, to take action to help people eat fewer calories. This can include helping reduce sugar consumption. Businesses are already taking action; for example, soft drinks manufacturers which are signed up to the calorie reduction pledge are reducing sugar and calories in their drinks, and we are looking to others to join force.
The Government are also helping consumers to reduce their calorie intake by providing practical advice through NHS Choices and via the Change4Life campaign.
Lord Rennard
My Lords, does the Minister agree with the Secretary of State for Health that legislation may be required in this area if other measures do not succeed? In the mean time, does he think consideration needs to be given to changing tax regimes so that the tax may be rather higher on very sugary soft drinks, and rather lower on drinks that are less full of sugar? Does he also think that we may need to restrict the amount of sugar provided in some products, such as breakfast cereals targeted at children, so that parents either as consumers themselves or watching their children can see how many spoons of sugar are going on to their cereal, rather than simply accepting the amount of sugar already produced by the manufacturers?
Earl Howe
My noble friend asks a number of questions. I am sure he will have welcomed, as I did, the announcement a few days ago by two major manufacturers of sugary drinks that they were substantially reducing the sugar content of their drinks. This is in part a result of the engagement that we have had with the food industry, which, in public health terms, is taking on responsibility for the products that it makes.
While there are advocates for taxation, in 2012 my department reviewed the international evidence of the effect of taxation on people’s consumption of food and drink. There is very limited empirical evidence, certainly from literature, but also in practice that that has an effect on body weight or health outcomes. There is a range of possible unintended consequences, including swapping for other foods which may be even less healthy than the ones that we are trying to cut out.
Lord McColl of Dulwich
My Lords, is the Minister aware that the overeating habits of pregnant women can be programmed into the foetus, so that when born the children will not stand a chance unless people accept that the answer to the obesity epidemic is to eat less? Although exercise is important in reducing cholesterol, for well-being and so on, it has very little to do with the control of the obesity epidemic.
Earl Howe
My noble friend makes a good point, but in healthy children exercise is very important as a preventive measure for obesity and diabetes. The central point he makes is absolutely right. We look to healthcare workers, not only health visitors but also midwives, through programmes such as the Healthy Child programme and Start for Life, to get families and children off to the right start, so that they eat properly and live healthy lifestyles.
Baroness Masham of Ilton
My Lords, does the Minister think sweeteners are a good substitute for sugar or do they have side effects?
Earl Howe
My Lords, we are clear that artificial sweeteners are safe if taken as intended. That is the advice of the European Food Safety Authority and we take that advice. However, encouraging people to take low-diet fizzy drinks, for example, in preference to sugary drinks is problematic because all fizzy drinks have an adverse effect on tooth enamel. We need to be balanced in our messages but we think that artificial sweeteners have a role in a proper calorie-controlled diet.
Lord Berkeley
My Lords, are the Government aware of a study by the Dutch Government which links obesity with exercise—in particular, walking or cycling—in inverse proportion? Given that the same study says that we are the most obese country in Europe, will he encourage cycling to be taken up by more children and persuade the Department for Transport to take this a bit more seriously by get moving in encouraging more children to cycle to and from school and for leisure?
Lord Roberts of Llandudno
My Lords, we have already heard mention of the importance of the proper labelling of foods. Could that labelling be such that even the youngest child, perhaps with type 1 diabetes, would be able to understand it without having to go into some mathematical equation to decide exactly what is good for him to eat?
Earl Howe
My Lords, my noble friend may know that a UK-wide consultation on front-of-pack labelling was held last year. We published a formal response to it at the end of January. The responses identified a number of issues which we need to consider further and officials are working on those. However, my noble friend is absolutely right that not just the calorie content but the clarity of the messages around calories need to be clear not only to adults but to children.
Lord Brooke of Alverthorpe
Does the noble Earl know that drinking alcohol is a big factor in introducing sugar into the body? The drinks industry is totally exempt from any requirement to show the calorific effect of alcohol, or indeed its energy factors. Is the Minister happy that the partners in the responsibility deal within the drinks industry are taking no action on that issue, or is he prepared to say that the Government will push through the responsibility deal to try to bring about some change?
Earl Howe
My Lords, our alcohol strategy includes a commitment for the Responsibility Deal Alcohol Network to seek to make further progress on including energy information as part of the responsibility deal alcohol-labelling pledge. We have already secured provisions in recent EU labelling legislation that will enable companies to provide this information on a voluntary basis. The pledge on improving information for consumers in the off-trade area already includes a commitment to raise awareness of the energy content of alcoholic drinks, and we will continue along those lines.
NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012
Earl Howe Excerpts(11 years, 3 months ago)
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Baroness Cumberlege
My Lords, I suspect that my noble friend has got the message now that we are not totally enamoured of these regulations. I think back to when we had the White Paper, which was published in July 2010. I remember, as my noble friend Lady Jolly has said, how excited I was then by the fact that in local Healthwatch we were to have an organisation that really would be the collective voice of patients. There was a mechanism so that it would have a very strong infrastructure at the local level.
So far so good, but throughout the passage of the Bill Members of your Lordships’ House fought strongly to get that policy enacted. We were given assurances, as noble Lords have said, and they were given in good faith. Yet now we have the regulations in this statutory instrument, we are not only disappointed but deeply concerned. I share the grave concern of the House’s Secondary Legislation Scrutiny Committee, which says that there is a very real possibility that local Healthwatch is in danger of being manipulated, but our concerns do not stop there.
The Government are right to want local people to have control of local Healthwatch but there is a genuine fear about it being subjected to such complex and draconian restrictions on what it will be able to say and do. It is not entirely clear to us what value local Healthwatch can add to the accountability framework of the NHS. This view is shared by Healthwatch England which, as the noble Lord, Lord Collins, has said, suggests that this could be dealt with by guidance. However, the trouble with guidance is that it does not have any statutory force. However, it could use its powers to sharpen the way in which local Healthwatch operates—as an independent champion through the trademark which all local Healthwatches must have and have to own. I have not given my noble friend any notice of this, but perhaps he might like to think about that and take it away.
Paragraph 36 of the regulations prohibits local Healthwatch from opposing or promoting changes to any national or EU law, any national policy, any policy by a local public authority—including both local authorities, the NHS or “any organ or agency” of either—and any planned or actual changes in any of these. In addition, it prohibits influencing,
“voters in relation to any election or referendum”.
These prohibited activities may be undertaken only if they are incidental to what could be called the core purpose of local Healthwatch—that is, giving people a say in local health and social care—unless that core purpose is incidental to the prohibited activities. This is mind-stretching. That seems to be something of a circular definition whereby X is allowed if it is incidental to Y, unless Y is incidental to X. This is pretty difficult. I have said that it is mind-stretching but I really fear that it will be unworkable. What is certain is that it will be incomprehensible to local people, who are expected to participate in local Healthwatch.
The impact of this provision is likely to have a chilling effect and to negate the aims of Healthwatch. Why should any committed volunteer get involved in local Healthwatch, giving freely of their time and energy to try to influence things for the better, if they risk being penalised for doing so?
I shall describe three situations to the Minister to test this with him, and I hope that he will reassure me on these points. First, say that there was a controversial policy to close an A&E department in order to save money. Would local Healthwatch be permitted to provide evidence to campaigners of how good the patient experiences had been at that threatened department? Would that be banned under Regulation 36 as the promotion of changes to a policy that a public authority proposes to adopt? If the Minister says no, how could local Healthwatch be confident that the local NHS decision-makers would share this view?
Secondly, could people who had been active in a national campaign to improve quality and accountability in the NHS be decision-makers in local Healthwatch? Would local Healthwatch have to avoid any connections to an organisation seen as intending,
“to affect public support for a political party”,
that was in power? Again, if the Minister says no, and decisions on such matters are to be delegated to local authorities, how could local Healthwatch be confident of that?
Thirdly, during a local election campaign, would local Healthwatch be subject to purdah, like democratically elected bodies such as local authorities or the Government themselves? Would that apply even if it discovered serious abuses of vulnerable people with learning disabilities in a residential home during this period? Such a discovery would not reflect well on the local authority commissioners, who are “an organ or agency” of local government under the regulations. Would the local Healthwatch have to keep such concerns secret or risk being penalised by that very same local authority?
The very fact that we have to ask these questions demonstrates that we do not have the right set of safeguards for the independence of local Healthwatch. The fact that local Healthwatch is funded and controlled by local authorities, which it is supposed to be scrutinising, is pretty uncomfortable. The added constraints of Regulation 36 threaten its freedom to speak and to act in the interests of patients and the population. These very complex restrictions seem designed to protect those in politics or in the provision of services who have something to hide. They impoverish the debate on health and social care, whether it is about controversial reconfigurations or a Baby P tragedy. Patients could not care less about politics and just want someone to speak up for them when they themselves cannot.
I urge my noble friend to consider modifying, redrafting or, if possible, removing these restrictions, or to find a mechanism to ensure that they are not implemented in the way that I have outlined and the way that I fear. To me, it is not clear whom they are really designed to protect, but I fear that it is certainly not patients.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I thank the noble Lord, Lord Collins, for raising his concerns and other noble Lords for following in his footsteps in sometimes very trenchant terms. A number of concerns have been raised about these regulations during the course of the debate and I will now do my best to address them in turn. A number of noble Lords reminded us of the critical importance of lay involvement in local Healthwatch and questioned why the wording of the regulations does not therefore prohibit employees of a local authority or indeed of the NHS from taking roles in the leadership and governance of a local Healthwatch. Indeed, your Lordships’ scrutiny committee suggested that this might leave a local Healthwatch in some way vulnerable to manipulation or threaten its independence. That concern was picked up by one or two noble Lords. I can, I hope, provide reassurance on this. Indeed, I am sorry that despite the department’s clarificatory submission to the scrutiny committee, it still remains a source of concern.
We completely recognise the importance of local Healthwatch being truly local organisations that are led by local people and involve volunteers. That policy aim is reflected in the way the regulations are drafted. They impose explicit requirements relating to the involvement of lay persons and volunteers. Both those terms are defined. The definitions of “lay” and “volunteer” are designed to be as inclusive as possible. Essentially, they aim to cover those who wish to give up their time for something they feel passionately about to influence change and service improvement. In practice, very often lay people and volunteers are the same group of people, but we thought it important not to frame a definition in a way that would exclude other people who might not define themselves in precisely those terms. The definition should, and does, apply as much to those who have paid jobs but who wish to do their bit for the community in their spare time as to those who do not work or who are retired.
Lord Harris of Haringey
The noble Earl has been extraordinarily helpful in telling us what Regulation 36 is meant to mean. My first question is: why does it not say that, as opposed to producing a formulation? Your Lordships are used to this sort of stuff. If every noble Lord who has spoken in this debate apart from the noble Earl has found it difficult to follow, I find it difficult to see how people around the country are going to be able to interpret this with the clarity with which the noble Earl has provided us.
Secondly, the noble Earl then said what local Healthwatch organisations can do. He said that they can campaign provided it is evidence-based and draws upon the opinions of local people. Who is to decide that? Is it, for example, the local authority, which might not like the campaign that is being mounted? Is it then going to say, “Well, you are not actually speaking on behalf of the communities you claim to be”?
Earl Howe
The noble Lord’s first point is a fair one. I was coming on to address it as it is quite clear that at least part of the wording of these regulations has seemed complicated and unfathomable to many noble Lords. I have to acknowledge that that is the case.
To address the noble Lord’s other point, we are talking about the difference between being a genuine voice for local people and simply being an adjunct of a political party. Local Healthwatch organisations should not be swayed or influenced by the activities of any political party. They must act independently. The only influence that matters to them is that of local patients and the public in seeking ways to improve the quality of care for people.
In that sense, the regulations tie down a local Healthwatch no more and no less than any other social enterprise. The wording of the regulations has been constructed in a very similar manner to the wording applied to other social enterprises in regulations. Regulations 36(1) and (2), against which so many missiles have been hurled this evening, are designed simply to reflect the standard community benefit test.
Lord Collins of Highbury
My Lords, if I have read Healthwatch England’s briefing correctly, it says that social enterprises are being treated differently in this statutory instrument, particularly as regards the 50% that could be retained. Perhaps the Minister could clarify that.
Earl Howe
I am surprised to hear that. My understanding is that that is not so and that local Healthwatch, as a social enterprise, is being treated on the same footing. My advice is as any other, but if I am wrong about that, naturally I will write to apologise to the noble Lord and copy all speakers into my letter. As I have said, I completely understand that the wording of parts of these regulations appears complicated. In answer to the noble Lord, Lord Collins, I should say that for that reason I can commit to my officials working with Healthwatch England and the Local Government Association to publish clarificatory material on this.
Having said that, I was slightly surprised that the noble Lord, Lord Warner, cast aspersions on Regulation 41. He asked how small organisations could understand the requirements set out in it. The matters set out in Regulation 41 are matters to be included in local authority contracts with local Healthwatch. In fact, these are based largely on the existing regulations on LINks. I have to say that it has not been previously suggested to us that these have been difficult to understand or are disproportionate.
The noble Lord, Lord Collins, asked me who was consulted before the draft regulations were published and whether Healthwatch England was consulted. We consulted a range of stakeholders, including LINks, local authorities, voluntary and community organisations, NALM, Social Enterprise UK, the Charity Commission and providers on the issues relating to the drafting of the local Healthwatch regulations. That included the Healthwatch England interim team.
Baroness Farrington of Ribbleton
I have listened very carefully to the Minister, who I know is trying to be helpful to your Lordships’ House. But I still do not understand who exactly judges, in the cases to which he has referred, whether particular campaigns are appropriate, local or acceptable, or whether it would refer to anyone apart from those who may have a role in funding or developing policy to which Healthwatch may object.
Earl Howe
The activities of Healthwatch will be governed by a contract with the local authority. The local authority’s duty will be to hold the local Healthwatch to account according to that contract. If the local Healthwatch were to stray outside the boundaries that I have set out as to what a reasonable person would interpret as legitimate activities and stray into the territory of being a political party adjunct, it would be the duty of the local authority to make a judgment about that. It would be a matter of judgment, but it would be important for the local authority to make its views rapidly known to the local Healthwatch to ensure that it retained the role that it should have, which is a role that primarily involves community benefit. There are checks and balances in the system, and those responsibilities are held primarily by the local authority.
Lord Warner
I am sorry to interrupt the Minister, but I must follow up my noble friend’s comments. The noble Earl seems to be saying that if the local authority takes agin what a particular Healthwatch is doing locally, the local authority can say, “Hey guys, your contract’s up and we’re going to retender”.
Earl Howe
That is not what I am saying. As I said earlier, it will be important for a local Healthwatch in any campaigning or public statements to assure itself that it is truly representing local people and patients, and has the evidence to back that up. If it does, and if it can show that what it is saying is genuinely supported by local people, it has nothing to fear. It is only where the Healthwatch may latch on to one or other political party without reference to local people that it may be vulnerable.
Baroness Farrington of Ribbleton
I am sorry, my Lords, but the noble Earl is not answering the point about who makes the judgment. The noble Lord, Lord Greaves, and I have served on the same local authority. I can think of occasions when, had he or I joined Healthwatch and formed a campaign, it is quite possible that either he or I on the local authority could have taken a totally different view about what was happening. I want to know who the independent arbiter is of whether the local Healthwatch is actually doing something that it should not do, or something that the noble Lord, Lord Greaves, or I did not happen to like, because they are two very different things.
Earl Howe
They are two different things, and I say to the noble Baroness that we are dealing here with a relationship that she may characterise as overly arm’s length. It is in the direct interests of a local authority to make sure that it has a good, thriving relationship with its local Healthwatch but that it is not tarnished by party political considerations that are irrelevant to the concerns of local people. The very fact that a local Healthwatch comes out with a political statement is not to damn its activity. What makes it vulnerable is if that local Healthwatch cannot show that it is truly representing local people as it speaks out. That is a matter of evidence and of fact.
The independent arbitration that the noble Baroness talks about should not be necessary. The matter could, in the final analysis, be decided in a court, although one hopes that that would never happen. However, in the end, the local authority has to exercise its judgment, and in doing so has to act reasonably and in good faith as a public authority. If it does not, it is acting unlawfully. I hope that that is of help to the noble Baroness.
I was asked a number of other questions by my noble friends Lady Jolly and Lady Cumberlege. My noble friend Lady Cumberlege asked me whether, if there were a controversial policy, say, to close an A&E department, a local Healthwatch would be permitted to provide evidence about patient experiences to campaigners on that issue. Yes. In that scenario, we would envisage a local Healthwatch taking those very views and evidence of good standards of service directly to the commissioners or decision-makers. A local Healthwatch can also make a referral to the health scrutiny function of the local authority, which would be required to keep a local Healthwatch informed of any action taken. If a local Healthwatch thought, as part of its Section 221 activities—patients’ public involvement activities—that local people need to know what their community’s experience of its A&E is, we would certainly expect the local Healthwatch to be transparent and make that evidence known.
My noble friend asked whether people who had been active in a national campaign could be decision-makers in local Healthwatch organisations. The regulations do not set out membership of a local Healthwatch, so it will be down to the local Healthwatch to decide whether such people can add value to the outcomes that it wishes to achieve for its local people. Local Healthwatch has to be different; it has to build up its reputation and credibility in order to secure the public’s confidence that it can have a mature relationship with local authorities, which was the point that I made just now. The regulations seek to ensure that local Healthwatch does not carry out the relevant political activities as its only or main activity. That would not meet the community benefit test.
Would local Healthwatch be subject to purdah? No, it would not. I repeat that it has been set up to be the local consumer champion, and as such its role becomes very important in getting people’s serious concerns listened to and acted upon.
My noble friend Lady Jolly asked me several questions. She expressed the fear that the regulations would render local Healthwatch a mere proxy voice. I emphasise to her in the strongest terms that that is not so. As I have explained, we have sought through the regulations to be as inclusive as possible of people who may wish to give up their time to do what they feel passionately about doing. To be frank, LINks, which is the arrangement that we have at the moment, have all too often been associated with white, middle-class men, and we need local Healthwatch to embrace diversity much better.
Could the manager of a care home sit on its local Healthwatch? Yes, he or she could get involved in their local Healthwatch, but it would be good practice for the Healthwatch in its governance arrangements to have procedures for a code of conduct, and, as set out in Regulation 40, it would be required to have and publish procedures before making any relevant decisions. That is essentially about transparency.
Could a local profit-making provider of primary care be a local Healthwatch contractor, and could its manager sit on the local Healthwatch decision-making group? Again, it would be up to the local Healthwatch whom it wishes to contract with for their expertise to help it deliver its statutory activities.
On the role of local Healthwatch to provide information and signpost people to choices, the decision rests with that individual seeking out the options available to them. We would expect local authorities’ arrangements with local Healthwatch to be robust so that it acts effectively. The local authority will be under a duty to seek to ensure that the arrangements are operating effectively and provide value for money.
My noble friend suggested that the department’s interpretation of lay involvement boils down simply to the foot soldier role. I do not agree. It would be a wrong picture to paint to the public about how a local Healthwatch discharged its obligations. The obligations are quite clear. Engagement, consultation and participation are all words that can be used to describe different types of involvement activity. Referring to “involvement” therefore provides for flexibility, as I indicated earlier.
Could the decisions listed in Regulation 40(2) be made by a decision-making body within a local Healthwatch composed of a majority of people who happen to be health or social care managers? No. Regulation 40(2) must be read with Regulations 40(3), 40(4) and 40(1)(a). The requirement to be imposed on local Healthwatch in the contracts is to have and publish a procedure for involving lay persons or volunteers in such decisions. As stated in the advice to the Secondary Legislation Scrutiny Committee, the plain provision of information would not in most cases comply with the obligation to involve; the involvement has to be in the making of the decisions.
I hope that I have covered satisfactorily all the questions put to me, and I hope that the noble Lord, Lord Collins, will be sufficiently reassured to withdraw his Motion.
Lord Collins of Highbury
I thank all noble Lords and particularly my noble friends for their comments. I also express my appreciation to the noble Baronesses, Lady Jolly and Lady Cumberlege, who drew attention to some fundamental issues here. They are fundamental in relation to the conflicts of interests, particularly in local authorities. The noble Baroness, Lady Cumberlege, referred to the draconian restrictions and reminded us that guidance does not have statutory force. Here I take the words of Healthwatch England: the Department of Health could and should have done better with these regulations. In my opinion, they have failed. I am afraid that the Minister has not given me satisfactory reassurances, certainly not in relation to the issues that the noble Baronesses, Lady Jolly and Lady Cumberlege, raised. In the light of that, and of the briefing we had from Healthwatch England itself, it is important that the department should think again. The only way I can do that is to ensure that we pass this Motion of Regret, and therefore I would like to test the opinion of the House.