NHS: South London Healthcare Trust
Earl Howe Excerpts(11 years, 4 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I shall now repeat as a statement the Answer given by my right honourable friend the Secretary of State for Health in another place earlier today to an Urgent Question on the report of the trust special administrator to South London Healthcare NHS Trust. The statement is as follows:
“I have today published the final report of the trust special administrator to South London Healthcare NHS Trust and laid it before Parliament. I received the report yesterday and must now consider it carefully. I am under a statutory duty to take a decision by 1 February on how best to secure a sustainable future for services provided by the trust.
The trust administrator began his appointment on 16 July. He published his draft report on 29 October, and undertook a consultation on his draft recommendations between 2 November and 13 December. More than 27,000 full consultation documents and 104,000 summary documents were distributed during the trust special administrator’s consultation, sent to 2,000 locations across south-east London, including hospital sites, GP surgeries, libraries and town halls. A dedicated website was established to support the consultation, the TSA team arranged or attended more than 100 events or meetings and the consultation generated more than 8,200 responses.
I understand the concerns of honourable Members and, indeed, the people living in the areas affected by these proposals, especially the people of Lewisham. They have a right to expect the highest-quality NHS care, and I have a duty to ensure that they receive it. However, they will understand that it would not be appropriate for me to give a view now on the report’s recommendations, only one day after receiving the report. To do so would be pre-emptive, and would prejudice my duty to consider the recommendations with care and reach a decision that is in the best interests of the people of south-east London.
However, I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister and my right honourable predecessor with respect to any major reconfigurations. The changes must have support from GP commissioners; the public, patients and local authorities must have been genuinely engaged in the process; the recommendations must be underpinned by a clear clinical evidence base; and the changes must give patients a choice of good-quality providers.
The challenges facing South London Healthcare NHS Trust are complex and long-standing, but to fail to address them is to penalise other parts of the NHS from which resources must be taken to finance the biggest deficit anywhere in the NHS. To date, it has not proved possible to ensure that South London Healthcare NHS Trust is able to secure a sustainable future for its services within its existing configuration and organisational form. In appointing a trust special administrator to the trust, the Government’s priority was to ensure that patients continue to receive high-quality, sustainable NHS services. I will consider the special administrator’s report with that objective in mind”.
My Lords, that concludes the statement.
Baroness Wheeler
I thank the Minister for repeating the Answer to the Urgent Question. We commend the work of the trust special administrator and support a number of the recommendations developed from previous reviews. However, it is difficult to understand how the Government consider this report to constitute the full strategic review of the sustainability of services across south-east London that is required. The TSA has overstepped its remit under the Health Act 2009 by including service changes to Lewisham hospital; and the parallel work by King’s Health Partners on reconfiguration under three other south-east London trusts has yet to be completed.
Can the Minister explain why the rules on making changes to hospitals have been changed to allow back-door reconfigurations in this way without proper scrutiny and consultation? What public consultation will there be on the King’s Health Partners report? Can he reassure the people of Lewisham that they will have their full consultation rights to challenge the closure of their A&E services and the other major changes being proposed?
Earl Howe
My Lords, I am grateful to the noble Baroness and I understand the concerns that she has raised.
The first question she asked me was whether I considered the trust special administrator to have overstepped his remit. The clear advice that we have received is that no part of the NHS can exist in a vacuum. The independent trust special administrator is responsible for developing recommendations to deal with the severe failings at South London Healthcare Trust based on local discussions and consultation. I hope that the statement I read out gave the House a flavour of how extensive those consultations have been. His recommendations must secure high-quality care for local people in a financially sustainable way.
However, as I have mentioned, each NHS trust is part of a complex, wider health system, and it is quite clearly the view of the administrator in this case that it is not possible to find a solution without considering the possible impact on other hospitals in the areas. That conclusion is one that my right honourable friend will have to consider very carefully, but Ministers have received clear advice that it is within the powers of the administrator to make recommendations about necessary changes to other local providers if they are a necessary and consequential part of finding a long-term solution to securing high-quality services for patients at that trust. I emphasise that I do not in any way wish to pre-empt the decision that my right honourable friend has to take within 20 working days. However, he will have to consider advice on the clinical, legal and financial aspects of the administrator’s recommendations and I have no doubt that concerns raised by the noble Baroness will be central to his consideration.
Lord Warner
My Lords, I declare an interest as the former chairman of the provider agency in the London SHA area who grappled with some of these problems in south-east London which, to the best of my knowledge, have been around for at least 20 years. I congratulate the TSA on the work that he has done in trying to resolve this. Could the Minister explain a little more about the involvement of Guy’s and St Thomas’s Hospital and King’s College Hospital? The TSA is to be congratulated on involving them much more than has been the case in the past in finding solutions in this area because the failure of those two powerful hospitals to get involved in sorting out the mess in south-east London has bedevilled earlier solutions.
Earl Howe
My Lords, I am grateful to the noble Lord, who I know well appreciates the scale of the problem with which the administrator was grappling. This trust was losing more than £1 million a week. That is not a sustainable position in the current NHS, or even when times were rosier as regards the financial settlement. It is important for me not to say anything that will pre-empt my right honourable friend’s conclusion, but I am aware, from the press release issued today by the trust special administrator, that, as the noble Lord rightly says, the wider health economy has been taken into consideration, including the role of Guy’s and King’s College Hospital, in a number of areas, including, in particular, in emergency care and in obstetrician-led maternity care. I would commend to the noble Lord a summary of the recommendations, which is on the department’s website today. I hope he will find that helpful in giving him a sense of the breadth of the administrator’s purview.
Baroness Donaghy
Is the Minister aware of the extreme anxiety among the population in Lewisham about the possible future closure of the A&E department in Lewisham? The population of 250,000 is estimated to rise to 300,000 in a very few years’ time as a result of a huge increase in the birth rate. There are very deep social needs and there is no doubt whatever that there is unanimity among the professionals and the population about the importance of maintaining that hospital. Is the Minister also concerned that one report that was produced, which was supposedly a clinical report, in fact turned out to be written by the communications department? Is he satisfied that the process has been a fair one and that there has not been a prejudgment in the consultation exercise?
Earl Howe
My Lords, all questions of process must be for my right honourable friend to consider, including that one. I emphasise the Government’s approach to reconfiguration decisions. When the Government came into office, we took a very clear decision about four tests that needed to be applied to any sustainable reconfiguration within the NHS: the changes, whatever they were, had to command support from GP commissioners—that is to say, the clinical community; the public must be engaged in the process; the recommendations must be clinically sustainable and sound; and, as the statement mentioned, they must leave patients with a clear choice of good-quality providers. Those safeguards were not there before, but they are there now and my right honourable friend will be looking at those tests when he considers not just the matter of Lewisham but the totality of the administrator’s recommendations.
Baroness Jolly
My Lords, today it is the South London Healthcare Trust, and there is anxiety abroad that tomorrow it could well be another trust. Can the Minister tell the House how many trusts are in the “at risk” box today and what role is being played by Monitor and others in these cases?
Earl Howe
My Lords, it is important to stress to my noble friend that a trust will be put into special administration only when all other options have been exhausted. I think that the noble Lord, Lord Warner, is aware that that was the situation we faced in this instance. Where possible, NHS providers will be supported to return to sustainability in both the clinical and financial sense. Our priority is to do what is best to ensure that patients receive high-quality care and special administration is a last resort. However, as my noble friend knows, a number of trusts are facing financial challenges. The department is working with Monitor and the NHS Trust Development Authority to oversee the performance of those trusts. I would just say that while some organisations are in difficulties, currently there are absolutely no firm plans to trigger the regime for any other trusts at all.
Baroness Wall of New Barnet
My Lords, I am sure that the noble Earl recognises the experience I have had as chairman of the Barnet and Chase Farm Hospitals NHS Trust, which went through a similar exercise that took many years. First, however, I want to associate myself with the comments made by my noble friend Lord Warner, and I support the action that has been taken. I recognise what my noble friend said about the concerns of the local community, but that will always be the case. However, what is most important is to make the decision and secure the support of outlying hospitals. My own trust is working towards a partnership with the Royal Free Hospital, although we are not there yet. The move could have been considered much earlier, which would have prevented a lot of pain and heartache for many people. My advice and plea is to stick with what is being done. That did not happen for Barnet and Chase Farm. As noble Lords know, a number of holds were put on what we were doing that made things worse for the community and for the staff. They almost ensured that the services we were providing were harder to deliver.
Earl Howe
As ever, I am grateful to the noble Baroness for her perspective from the front line. I think it was with that in mind that the previous Government drew up the legislation which my right honourable friend now has to abide by, in that there is now a very tight timescale of 20 working days for him to take a decision. That is not a long time but it is indicative of the need for urgency in arriving at the right solution. The TSA has done his work and we must now judge whether the recommendations are the right ones.
World Sepsis Declaration
Earl Howe Excerpts(11 years, 4 months ago)
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Baroness Greengross
To ask Her Majesty’s Government whether they intend to support the goals of the World Sepsis Declaration; and what action they are taking to improve knowledge and skills regarding sepsis.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government fully recognise the importance of addressing sepsis—a potentially life-threatening condition. We support the overall thrust of the World Sepsis Declaration. We have taken a range of actions to address sepsis, focusing on those interventions directly relevant to England—for example, the training of healthcare professionals in the awareness of sepsis. I commend the Global Sepsis Alliance for its initiative in raising the profile of this serious condition.
Baroness Greengross
I thank the noble Earl for that reply. However, given the problem of even adequate recognition of the problem of sepsis, and to ensure that the desired treatment improvements are fully underpinned by quality standards, can he assure the House that the Government are able to identify where sepsis sits within the NHS Outcomes Framework and the QIPP workstreams?
Earl Howe
Yes, my Lords. The NHS Outcomes Framework is, as the noble Baroness will know, a high-level document intended to drive improvements in the service generally. A condition such as sepsis would be covered in three separate domains of the framework, depending on which aspect of the condition was being considered—for example, safety, most obviously, or quality, or indeed the patient experience. The patient safety aspects are reiterated under Section 5 of the mandate as well, and under this general direction it will be for clinicians to take responsibility for delivering the clinical outcomes.
Lord Walton of Detchant
My Lords, can the Minister tell the House what research the Government are supporting for the development of new and effective antibiotics for the treatment of sepsis? Can he also comment on a recent report from Southampton, which is based on a huge controlled trial of treatment where antibiotics were prescribed for patients with minor respiratory tract infections, and showed that such treatment was of no particular value but inevitably leads to increased bacterial resistance to current antibiotics? What is the Government reaction to that report?
Earl Howe
My Lords, on the research on antibiotics, the noble Lord alights on a real problem. There is a dearth of such research; I am aware of at least one company engaging in it but in view of the increasing prevalence of antibiotic resistance it is a real issue. As the noble Lord will know, there are extensive guidelines to ensure that there is responsible prescribing of antibiotics. I am not aware of the Southampton example which he quotes, although I shall look into it and write to him as appropriate. He may like to know that the department has been developing a five-year antimicrobial resistance strategy—an action plan. It has an integrated approach and builds on a range of initiatives, such as the 2000 UK strategy and the 2011 EU strategic action plan.
Baroness Gardner of Parkes
My Lords, I believe it was the same report from Southampton that said the public have no idea of the difference between sepsis and septicaemia, which of course is a fatal condition if not treated. In view of the success of educating the public on strokes and how effective that has been, does the Minister think that as well as educating professionals there should also be a wider publicity campaign given to the general public to make people aware of the very important differences between these conditions?
Earl Howe
My noble friend makes an important point. Public awareness is a key focus of the Global Sepsis Alliance’s declaration. On raising awareness, the NHS Choices website has extensive information about sepsis, its causes, symptoms and treatment. I do agree, however, that it is important to empower both patients and the public to ensure that everybody is on their guard against this very serious illness.
Baroness Pitkeathley
My Lords, since sepsis accounts for more deaths than bowel, bladder and breast cancer put together and for one-third of all the expenditure on critical care in the NHS, would the Minister agree that early diagnosis is the key here? I declare an interest as someone who recovered from full-body sepsis, thanks to early diagnosis.
Earl Howe
My Lords, I absolutely agree with the noble Baroness. The need to rapidly identify sepsis when it occurs is vital to ensure that unnecessary death is prevented. A crucial measure to tackle sepsis when it appears is early treatment with broad-spectrum antibiotics. My understanding is that once the bacterium has been identified, the treatment of choice is to have a more focused antibiotic, but rapid reaction is of the essence.
Baroness Jolly
My Lords, every year sepsis kills 37,000 people and costs the NHS £2.5 billion. Can my noble friend please tell the House what research programmes are in place across the NHS into care pathways and diagnosis?
Earl Howe
My Lords, the department’s National Institute for Health Research is funding a range of research on sepsis, which includes a study into the clinical and cost-effectiveness of early resuscitation protocols for emerging septic shock. Other examples include a trial of vasopressin versus noradrenaline as initial therapy; a study on how risks associated with nutropenic sepsis are conveyed to and interpreted by patients undergoing chemotherapy; and there is also a very interesting project on a point-of-care test for sepsis.
NHS: Research and Development
Earl Howe Excerpts(11 years, 4 months ago)
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Baroness Gardner of Parkes
To ask Her Majesty’s Government what proportion of funding allocated by the National Health Service for research and development at major teaching hospitals is provided to (1) the researchers themselves, and (2) administrators of funding.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the National Institute for Health Research awards funding transparently and competitively for research of high scientific quality that has relevance to the NHS and represents value for money. We therefore expect that the maximum is spent on research rather than on administrative overheads. Trusts with teaching hospitals received a total of £500 million from the NIHR in 2011-12.
Baroness Gardner of Parkes
I appreciate that funds go directly to the researchers from the body that the Minister mentioned and from the Medical Research Council. What I am concerned about is that I am told by those working, and possibly doing research, in these teaching hospitals that the bulk of the money is paid to the person doing the governance of research and development, and not a penny of that money is actually going to the researchers, who are funded in the way that the Minister has said. Ever since 2006, when that was set up, there has been a great growth of these people doing nothing but checking on the work of the real researchers.
Earl Howe
My Lords, every NHS trust or foundation trust has to oversee the governance of the research taking place within it. That is an inescapable part of the process. I do not think there is any confusion in anyone’s mind between support for research governance and the actual research itself, which is done by academics and clinicians working in academic and clinical departments. It is up to each trust to determine how its budget for research is allocated, but I can reassure my noble friend that the money is getting to where it needs to go.
Lord Winston
My Lords, would the Minister agree that since Sally Davies took charge of how research is done within trusts, there has been a significant improvement in insuring that more of this money actually goes to serious translational research, which is an area that the health service really needs to concentrate on? I hope that the Minister will agree that that job has been done rather effectively.
Earl Howe
I do agree with the noble Lord. Before the creation of the NIHR, research allocations to NHS hospitals were made essentially on a historical basis, with no assessment of quality or value and no ability for the funding to move in response to competition. The NIHR undoubtedly changed all that. The NHS funding for research is now awarded transparently and competitively and robust systems are in place to ensure that it is used only to support research rather than being diverted for other purposes.
Lord Patel
Does the Minister agree that the biomedical research centres established by NIHR funding are more likely to develop and deliver on the Government’s innovation strategy in health science and on the life sciences strategy?
Earl Howe
I agree with the noble Lord. The Government are providing a record £800 million over five years for NIHR biomedical research centres and units as from April of this year. The centres are based within the most outstanding NHS and university partnerships in the country; they are leaders in scientific translation; and they will play an integral part in the life sciences strategy which the Government published last year.
Lord Ribeiro
My Lords, may I declare an interest as a surgeon and say that surgical research attracts less than 2% of the total funding that goes into research? There may be those in this House who feel that surgeons just cut and do not actually do an awful lot of laboratory work, but the truth is that research is an integral part of surgery. We are there to bring translational research from the lab to the patient and to produce results, particularly in the field of cancer. I would therefore be grateful if my noble friend could assure me that there will be much greater emphasis on providing support for surgery?
Earl Howe
I agree with my noble friend about the importance of surgical research. The NIHR funds extensive research in surgery across a wide range of funding streams. The most recent estimate of its spend on directly funded research relating to surgery was £7.3 million, but that is a rather historic figure which goes back to 2009-10. In February this year, the NIHR issued a call for research on the evaluation of technology-driven implanted or implantable medical devices and decisions will be made on that next March. Twenty million pounds has been invested in the NIHR Surgical Reconstruction and Microbiology Research Centre, which is an initiative between my department, the Ministry of Defence, the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. I hope that my noble friend will agree that that is a positive development.
Lord Davies of Coity
My Lords, the Minister said very clearly in his Answer to the first Question that it was a matter of “value for money”. Is there not a danger that the Government will cost the exercise at the expense of the care that should be had by patients in this country?
Earl Howe
No, my Lords. The very point that I made to the noble Lord, Lord Winston, was that by the creation of the National Institute for Health Research, we were avoiding the very thing which used to happen in the past. Now, we can be quite certain that research money from the NIHR will be used to support research and not be diverted into other places.
Lord Stoneham of Droxford
My Lords, we welcome the greater emphasis that the Government are giving to NHS research and the commitment to the National Institute for Health Research. However, there is an acute shortage of clinical academics who are both medics and front-line researchers. What steps are the Government taking to rectify this situation so that we can get better links between research and patient outcomes?
Earl Howe
I share the concern of my noble friend, although he will be pleased, I am sure, to know that through its integrated academic training programme, the NIHR has taken a lead in reversing the decline that we have seen in recent years in clinical academic careers. Around 250 NIHR academic clinical fellowships and 100 NIHR clinical lectureships are now available annually for medics, which is good news. I also think that intercalated degrees play a very important part in developing the next generation of clinical academics, as does the INSPIRE programme from the Academy of Medical Sciences.
Baroness Masham of Ilton
My Lords, does the Minister agree that some exciting research is being done, such as that which treated a paralysed dachshund with stem cells and enabled it to walk?
Health: Hearing Loss
Earl Howe Excerpts(11 years, 4 months ago)
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Baroness Wilkins
To ask Her Majesty’s Government what plans they have to introduce a screening programme for hearing loss for those over the age of 65.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the United Kingdom National Screening Committee, UKNSC, advises Ministers and the National Health Service in all four United Kingdom countries about all aspects of screening policy. The UKNSC reviewed the evidence for screening for adult hearing loss in 2009 and recommended that there was currently insufficient evidence to warrant a screening programme. In line with its three-yearly review policy, the UKNSC is currently reviewing the evidence for screening for adult hearing loss.
Baroness Wilkins
I thank the Minister for that reply. He will be aware of the huge level of undiagnosed hearing loss in the UK and the impact this can have on other conditions. It is estimated that at least 4 million people who need a hearing aid do not have one. Not only does unaddressed hearing loss increase social isolation and depression, but there is increasing evidence that there is a link to dementia. People with mild hearing loss have nearly double the chance of developing dementia. Given that there is an average 10-year delay between someone identifying that they have a problem and seeking help, will the Government take early action to ensure that hearing loss is addressed early by introducing a screening programme?
Earl Howe
My Lords, the noble Baroness’s comments relating to the features that can often accompany hearing loss, such as depression and other forms of mental illness, are absolutely to the point and I recognise all that she said in that area. The national screening committee had a number of reasons for feeling that a universal screening programme would not be appropriate. First, it was not clear to it what the test should be. Secondly, it was unclear about what agreed time or schedule there should be for doing the testing. Thirdly, it felt that if there were a realistic proposal for screening, there should be randomised trials of screening beforehand. However, it is reviewing its decision of three years ago and we will have to await the results of that.
Baroness Bakewell
My Lords, the Minister referred to the screening authority, which recommends screening for many different ailments. Is he aware that screening notification, which goes out to all eligible citizens, stops at the age of 70 whereas it is necessary to be screened for many of these ailments after 70? Indeed, when you are over 70 you need reminding more often than when you are younger.
Baroness Howe of Idlicote
My Lords, as someone who has had hearing problems since the birth of our children—a hearing loss which is now being considerably worsened by my own ageing process—I know how important it is to persevere with actually using hearing aids, once the right ones have been agreed with a specialist. I very much hope that the national screening committee will agree to my noble friend’s suggestion that there should be a definite age, with a follow-up to the screening. What plans does it have to help those who have hearing aids assessed for them to persevere with the use of those aids, since that is absolutely vital to their well-being in the future?
Earl Howe
The noble Baroness is quite right. Clinicians have found very often that patients who receive hearing aids decide, for one reason or another, not to use them. That is of course very serious; it is a waste of resources but, perhaps more importantly, it is potentially damaging to or indeed dangerous for the patient. Compliance is undoubtedly an issue. In the end, however, nobody can be forced to wear hearing aids but, once again, we believe that there is a role for audiology specialists and general practitioners in encouraging the proper use of hearing aids.
Lord Trefgarne
My Lords, is my noble friend aware that of all the soldiers who went south to the Falkland Islands in 1982, approximately one-third came back with permanent hearing damage? Will he ensure that the arrangements he has described will fully take into account the needs of that group of people?
Lord Collins of Highbury
My Lords, I note what the Minister said in terms of the previous review but we now have an increase in retirement age and people are working longer. Hearing loss is not simply a personal health issue; it also becomes a bigger public health issue and a health and safety issue. Can the Minister therefore better understand the importance of national screening?
Earl Howe
My Lords, the Government fully recognise that hearing loss is not just a health issue. For example, it can lead to isolation and loss of independence; it can impact on education and employment; and it can impact in the various ways mentioned by the noble Baroness, Lady Wilkins, in her earlier question. We believe that health outcomes for people with hearing loss should be among the best in the world. To achieve that it is necessary to think and act differently. Therefore, we are developing a cross-government strategy to maximise the current effort to prevent hearing loss and to support those suffering from it. In particular, that will focus on identifying the potential better to join up services provided by the different agencies.
Lord McColl of Dulwich
We have a generation of deaf people in this country produced by loud noise and music. What about preventing it in the first place?
Baroness Tyler of Enfield
My Lords, given the prevalence of hearing loss among our ageing population, will the Minister say what is being done to ensure that hearing loss is being effectively managed in residential care homes for the elderly? What steps are the Government taking to work with the regulator to ensure that providers are being held accountable for responding to the needs of people with hearing loss?
Earl Howe
My noble friend raises a very important point about care homes. There have been considerable improvements in services for people with hearing loss over recent years. The waiting times for assessment and treatment for hearing problems in adults have been considerably reduced. The health and social care reforms provide opportunities to improve services further. For example, two-thirds of PCT clusters have chosen adult community hearing assessment services as a priority area in which to extend patient choice of provider. We expect that work to continue when CCGs take over.
Health: Active Lifestyles
Earl Howe Excerpts(11 years, 4 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I congratulate my noble friend on securing this debate, which though brief has been of a very high quality. I found myself agreeing with noble Lords from all sides of the House in many of the things that they were saying so powerfully. We are all aware of the distinguished contribution that my noble friend has made to English sport and helping to raise the profile of women’s participation. That wisdom and experience were amply demonstrated in her opening speech. The timing of the debate, as a number of noble Lords have said, is very appropriate following our extraordinary summer of sport.
Many of us would agree with the noble Baroness, Lady Massey, that we should be moving more as part of a healthy lifestyle—indeed, many noble Lords have spoken eloquently about the benefits of regular exercise—and commentators have started to argue that as a nation we are suffering from a physical activity deficit. Regular physical activity helps to prevent and manage over 20 chronic conditions. The noble Baroness, Lady Massey, was right to remind us of that as did the noble Baroness, Lady Billingham. Conditions include coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and muscular-skeletal conditions. The strength of the relationship between physical activity and health outcomes persists across the life course and highlights the potential health gains that could be achieved if individuals can be supported to become more active. Inactivity, on the other hand, is associated with coronary heart disease, breast and colon cancer, and diabetes. It is been estimated to lead to 9% of early deaths globally. It is a silent killer. Less well understood are the risks of sedentary behaviour—sitting for long periods and excessive screen time—which would appear to be independent of how much exercise we do.
My noble friend Lord Addington asked whether the Government were intent on making exercise and sport part of a lifestyle. In July of last year the chief medical officers of the four home countries published Start Active, Stay Active, setting out new guidelines for physical activity. For adults, the new recommendation for at least 150 minutes of physical activity spread across the week replaces the old “five times thirty minutes” message. Importantly, the guidelines address the whole life course from early years to older people and include advice on avoiding sedentary behaviour. Providing expert-led advice to individuals in this way to inform their own lifestyle choices lies at the heart of this Government’s approach to health promotion, one that provides information and enables choice without nannying or hectoring.
As I will set out in a moment, much is being done to encourage people to play sport and exercise more. However, the sad fact is that most of us are insufficiently active. In England, six out of 10 men and seven out of 10 women do less than the CMO guidelines. For children, the guidelines recommend at least 60 minutes of activity daily, but again participation levels are low, with less than a third of youngsters getting enough exercise. In the face of these statistics, we have established a national ambition for physical activity for a year on year increase in the number of adults doing 150 minutes of exercise per week and a similar reduction in those who are “inactive”. This represents what could be achieved if all sectors work together, supported by the new delivery system for public health. The ambition is reflected in the public health outcomes framework indicator for physical activity.
The London Olympic and Paralympics Games this summer have provided us with a once in a lifetime opportunity to address the “activity deficit”. Much has been put in place in the run up to the games to deliver a sport and physical activity legacy. For example, Sport England is investing £150 million into grassroots sport through the “Places, People, Play” programme. Following on from the Games we are determined to raise the proportion of young people playing sport at least once a week through the youth and community sport strategy. Indeed, increasing access to and participation in sport is one of the key themes of the Government’s ongoing legacy plans.
The focus of this debate is about raising awareness of the importance of an active lifestyle. During the summer, the Department of Health ran a highly successful Games4Life campaign, which built on the success of the 2011 really big summer adventure campaign and targeted children, their families and adults. The central theme of Games4Life was for families to get up off the couch and join in the summer of sport. A quarter of a million people received personalised activity plans as a result of the campaign and 88,000 signed up to receive Games4Life follow up e-mails. Alongside Change4Life, NHS Choices offers a great deal of extra information for those who want to learn more about activity. A cornerstone of Change4Life is partnership. The public health responsibility deal physical activity network also takes a partnership approach to engage a range of organisations in the promotion of physical activity to employees, consumers and communities.
My noble friend Lord Addington spoke powerfully about the need to encourage the young into sport. Change4Life recognises that healthy behaviours are forged in the young and we make no apologies for placing children and young people at the centre of our plans for driving up sports participation. The School Games represent a major legacy commitment, creating the opportunity for every school and every child to play competitive sport all year round. Over 15,000 schools have registered to be part of the games, with a reach of around 4 million pupils. We are also working with the Youth Sport Trust to deliver Change4Life sports clubs in schools. These are targeted towards children and young people who are at risk of dropping out of sport and have already seen a 166% increase in participation by those youngsters. All this should of course be seen in the context of our support for PE and school sport and the wider youth sport strategy.
My noble friend prompts me to mention that central to our ambition and commitment to have a lasting legacy from the Olympics is our determination to put competitive sport firmly on the agenda in all schools. Competitive team and individual sports will be at the heart of the programme of study. In addition, through the School Games, we will make sure that a range of competitive sporting opportunities are in place for all schools that sign up to be a part of the Olympic aspiration to “inspire a generation”. My own department remains committed to this agenda for all youngsters, irrespective of ability.
The noble Baroness, Lady Massey, indicated that changes to the school curriculum might remove opportunities for young people. We are aware that some pupils would prefer to take part in non-competitive activities such as dance. We are supportive of that wish. However, our aim is that all pupils, regardless of ability, should have the opportunity to experience both individual and team-based competitive sports. The Change4Life sports clubs in schools are targeted at the least active children, and the independent evaluation has shown that they are particularly effective at engaging girls, which is very positive.
Incidentally, the noble Baroness, Lady Billingham, mentioned my right honourable friend Mr Gove’s policies, in particular what she described as his decision to scrap two hours of compulsory PE. This issue has been subject to frequent misunderstanding. The previous Government’s targets for physical education were wholly aspirational and could not be enforced. The law specifically prevents the Secretary of State for Education dictating to schools how much time they should devote to PE or, indeed, to any other national curriculum subject. That is for schools to decide. PE will remain a compulsory subject at all four key stages following the review of the national curriculum. I believe that is positive.
The Government’s youth sport strategy is intended to encourage everyone, but particularly young people, to take up sport and develop a sporting habit for life. This will deliver at least 6,000 partnerships between schools and local sports clubs, an additional £160 million on new and upgraded sports facilities and £250 million for communities, including our work with county sports partnerships and local authorities.
I have spoken a great deal about sport, but my noble friend Lady Byford has reminded me to mention that the Department for Transport and my own department are working across government to give a strong boost to walking and cycling for travel purposes. Most recently, the Chancellor’s Autumn Statement included an additional £42 million investment in the sustainable transport fund for cycling infrastructure, including cycling safety.
Healthcare professionals are in a unique position to encourage their patients to exercise as part of a healthy lifestyle. As early as 2006, NICE advised that brief advice in primary care was a cost-effective way of promoting physical activity. “Let’s Get Moving” is one way for GPs to build on this guidance.
My noble friend Lady Byford invited me to say a little about the Government’s investment of £30 million to develop the new National Centre of Excellence for Sport and Exercise Medicine. The national centre will build on research into sport science and current expertise to translate this knowledge into benefits for patients and to enable more people to be more active. The primary role of the centre is to provide the best possible evidence base for sport and exercise health for our elite athletes, but also for the general population, particularly those with chronic, long-term conditions, which can be improved by exercise, safely supervised. The £30 million funding that we have made available will allow researchers to work alongside clinicians to quickly translate research into clinical practice. I hope that that will be music to the ears of my noble friend Lord Addington as well.
I am receiving strong messages that my time is nearly up. I have, however, one minute left and I would like to turn to some of the excellent questions posed by my noble friend Lady Heyhoe Flint. In response to her comments on Start Active, Stay Active, I think it is fair to say that there remains a disappointing lack of awareness of the UK physical activity guidelines among health professionals. We are committed to the dissemination of the messages contained in Start Active, Stay Active, both to the public and to doctors. For example, this summer’s Games4Life campaign included summaries of the guidelines in personal activity plans provided to families. My noble friends referred to specific funding streams to help disabled people take up sport. These are only part of the bigger, long-term approach being taken by Sport England in its youth and community sports strategy. Forty national governing bodies of sport have presented plans to make sport a practical choice for disabled people as part of the wider whole-sport plan investment programme, which is funded and overseen by Sport England.
I turn to the teaching of PE and swimming in primary schools. Initial teacher training should prepare newly qualified primary teachers to teach the full range of curriculum subjects to the required standard. This would include the national curriculum for PE, which currently requires all pupils to be capable of swimming 25 metres unaided by the end of key stage 2. Ofsted will inspect swimming, as well as PE and sport, if it is one of the lessons encountered during the inspection.
With the leave of the House, I will continue for another minute or so, as there is theoretically time in hand. With regard to the Government’s plans for 4,000 secondary schools to host a link with a community sports club, which I have already mentioned, I can confirm that progress in this huge undertaking has been very promising. There are currently 380 satellite clubs already up and running, and this will increase to 700 by March 2013. We are monitoring delivery very closely to ensure that we maintain progress throughout the lifetime of the strategy.
My noble friend asked what would replace the Cabinet sub-committee on public health. Public health issues will now be brought into the broader domestic policy committees rather than sitting with a separate sub-committee. This will allow public health issues to be discussed and decisions to be taken by a wider group of senior Ministers across government.
The noble Baroness, Lady Massey, asked me about women in sport. Sport England continues to fund the Women’s Sport and Fitness Foundation, which campaigns to make physical activity an everyday part of life for every woman and girl.
The noble Baroness, Lady Billingham, rightly drew attention to the public health problem of obesity. She will, I am sure, recall that our call to action on obesity in England, published in October last year, sets out how obesity will be tackled in the new public health and NHS system. Clear ambitions are set out in that strategy, which bear on much of the debate this evening.
I have tried to demonstrate how we are using the London Games as a springboard to raise everyone’s awareness of the importance of exercise for health—in short, how we can turn a winning summer into an active future.
NHS: Clinical Networks
Earl Howe Excerpts(11 years, 5 months ago)
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Baroness Thornton
To ask Her Majesty’s Government how they will address any shortfall in the funding of clinical networks.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, national funding for clinical networks has been maintained at £33.6 million since 2009. Forty-two million pounds has been allocated by the NHS Commissioning Board to support strategic clinical networks and clinical senates in 2013-14. It is for local health communities and the board to determine the number and size of networks, based on patient flows and clinical relationships, and to deploy their resources appropriately.
Baroness Thornton
I thank the Minister for that Answer. His boss, the Secretary of State, is on the record as saying that clinical networks funding is increasing and will continue, yet on Monday a freedom of information survey revealed severe cuts to budgets and staff in clinical networks, so I wonder who is right. Cancer networks are cut by 26% and stroke and cardiac by 12% in the same period—2009-13—with the loss of hundreds of experienced and motivated staff. Do the figures that the Minister has given to me also cover clinical senates? Will those cuts be restored? What incentives are the Government putting in place to ensure that local health organisations contribute to the additional funding of cancer networks? Indeed, how will the local diabetes networks be supported in the new commissioning regime? We know that these networks work.
Earl Howe
My Lords, I agree with the noble Baroness’s last comment. These networks are extremely valuable. I confirm that the figure I gave her in my Answer of £42 million covers clinical senates as well. It is perfectly correct that the share of the pot which cancer networks will be able to avail of is likely to be smaller next year than it is this year. However, I can categorically confirm that, as I said in my Answer, national funding has not been cut to date and is going up next year very considerably. Furthermore, we should recognise that the Commissioning Board’s announcement amounts to a ringing endorsement of the value of networks in improving patient outcomes. Not only will funding be increased but for the first time there will be nationally supported networks for mental health, dementia and neurological conditions as well as maternity and children’s services. I say to the noble Baroness that recruitment to the networks is proceeding very smoothly and encouragingly.
Lord Sharkey
My Lords, I declare an interest as a lay member of a cancer network lung cancer group. I know the Minister is aware that our survival scores for lung cancer need improvement and that early diagnosis is the key to that improvement. In the light of that, what steps are being taken to make absolutely certain that any reduction in the number, staff or funding of cancer networks does not damage the efforts to improve early diagnosis?
Earl Howe
My Lords, I am grateful to my noble friend. As regards cancer, it is important to look at what the Government are doing across the piece. As the noble Lord may recall, the cancer strategy that we published a while ago is backed by more than £450 million of investment. This is specifically to target earlier diagnosis of cancer; to give GPs increased access to diagnostic tests; to allow for the increased testing and treatment costs in secondary care; to support campaigns; and so on. That is a large sum of money and it is committed.
Lord Kakkar
Does the Minister envisage a role for the to-be-designated academic health science networks in delivering clinical networks in the future? I declare my interest as chair for quality, University College London Partners academic health science partnership.
Earl Howe
My Lords, yes. National guidance is being produced by the NHS Commissioning Board, setting out the different areas of focus for academic health science networks, health and well-being boards, local education and training bodies and clinical senates. The defined geographies of the 12 network support teams have been developed precisely to gain close alignment and therefore promote close relationships and co-operation with the other structures in the new system—including academic health science networks.
Baroness Masham of Ilton
My Lords, how are clinical network members recruited? Are they advertised?
The Countess of Mar
My Lords, the people with CFSME were greatly heartened in 2008 when the Chief Medical Officer ring-fenced £8 million to set up clinical networks on their behalf. They have become disillusioned as the funding of these networks has gradually been cut. There is also no provision for children in the clinical networks. What priority is given to CFSME?
Earl Howe
My Lords, strategic clinical networks are only one category of network in the new system. There is nothing to stop professional groups coming together to share best practice and support professional development. In addition, clinical commissioning groups may well wish to establish networks to support local priorities and ways of working; and providers may use a network model to enable the joint delivery of a service, such as pathology. The noble Baroness, Lady Thornton, rightly referred to the extent to which local providers and commissioners already support strategic clinical networks. So there is a variety of ways of doing this.
Lord Patel
Does the Minister recognise that reducing funding for cancer networks will lead to a reduction in staff and therefore a reduction in the effectiveness of cancer networks?
Earl Howe
My Lords, Professor Sir Mike Richards, the national cancer director, said the other day:
“Although cancer networks will have a smaller proportion of the budget in the future, there are still backroom efficiencies that can be made to make things work more effectively. Increasing the footprint of each network will make them more cost-efficient”.
I have spoken to him personally and he is confident that the available budget can still be used to ensure that there is at least equal cost-effectiveness of networks.
Nursing Quality and Compassion: The Future of Nursing Education
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the noble Baroness, Lady Emerton, has been a tireless champion of the values and standards that underpin good nursing. This debate, on which I congratulate her, is therefore no surprise. Listening to her excellent speech reminds us once again of her long-standing expertise and wisdom in the field of nurse education and the regulation of the nursing profession.
My noble friend Lord Willis published his very comprehensive and helpful report into the future of nurse education in November. The report was the result of deliberations by his independent commission, which was established by the Royal College of Nursing under his consummate chairmanship. On publication, the report was handed to the chair of the RCN for her consideration. It was not a report to the Government and we will therefore not be formally responding to it. However, I recognise that its 29 wide-ranging recommendations are important and, as this debate has shown, need to be given due weight and consideration by leaders of the nursing profession.
As part of government changes, a new Secretary of State for Health was appointed this year. He has clearly stated that he has four priorities for his term in office: to improve the general quality of care, including nursing care; to rise to the challenge of caring for people with dementia; to improve the management of long-term conditions; and to reduce avoidable deaths from the major diseases. These priorities, importantly, impact on nursing care and nurse education and come as national nursing leaders have also changed significantly during the year. As part of the Health and Social Care Act, which passed through your Lordships’ House earlier this year, the NHS Commissioning Board was established, alongside the separate creation of Health Education England, both of which have prominent nurse leaders.
The noble Baroness, Lady Emerton, asked for some assurance that these bodies will take full account of the Willis report. Jane Cummings has been appointed chief nursing officer for England on the NHS Commissioning Board and Lisa Bayliss-Pratt is director of nursing for Health Education England. Both have significant leadership roles in the education and training of nurses, and I can tell the noble Baroness that they are looking at the Willis report in detail. Health Education England takes over the Secretary of State’s duties for ensuring an education and training system fit for purpose, and the chief nursing officer for England and the director of nursing for Health Education England will collaborate very closely in that regard.
My noble friend Lady Cumberlege asked what would make the report really live. It has a high degree of resonance across the profession already, with nurse leaders in the vanguard who will help ensure that it does not gather dust. Earlier this month, Compassion in Practice, a vision and strategy for nurses, midwives and care staff in the NHS, public health and social care, was published jointly by the chief nursing officer and the director of nursing in the Department of Health and lead nurse for Public Health England, Viv Bennett. Compassion in Practice articulates the values and behaviours expected of nurses, midwives and care staff. These values and behaviours are expressed as the “six Cs” of care, compassion, competence, communication, courage and commitment, each of which resonates with findings and recommendations of the Willis report.
This is not a vision without action. One area for specific action will be to ensure that the NHS, public health and social care services have the right staff with the right skills in the right place. This means that staff will be recruited for their values and behaviours as well as their capability to be lifelong learners. This point was made by a number of noble Lords. Importantly, the Willis report recognises how demanding and rewarding the practice of nursing is. It states very clearly that it found no evidence that revealed any major shortcomings in nursing education that could be held directly responsible for poor practice or the perceived decline in standards of care.
My noble friend and his commission are unequivocally supportive of degree-level registration for new nurses. This commitment by the Nursing and Midwifery Council will be fully implemented by September 2013. I am aware that the noble Baroness, Lady Emerton, too, is fully supportive of that. When it comes to achieving this change to nurse education, my noble friend Lord Willis rightly emphasised that educating nurses is a partnership between the NHS and universities. The noble Lord, Lord Hunt, was right to emphasise that. Student nurses cannot qualify and register if they have not satisfied both the university and, in practice settings, their NHS mentors, who formally assess them for their practical skills and knowledge as well as for their values, behaviours and ability to give care with compassion.
The compulsory state regulation of currently unregulated health and social care support workers in England is a topic that has arisen throughout the debate. It is a live issue in the nursing profession. We recognise the need to drive up standards among health and social care support workers, and have commissioned Skills for Health and Skills for Care to develop a code of conduct and national minimum training standards by January 2013. In addition, the Professional Standards Authority will have powers to accredit voluntary registers from this month. The Skills for Health and Skills for Care work will, for the first time, set clear national expectations about standards for these workers.
Health and social care assistants already work in environments that are subject to regulation by the Care Quality Commission. The Independent Safeguarding Authority can take action to bar them from working in regulated activity. Further, the work they do should be delegated to them and managed by staff—usually nurses—who are themselves subject to professional regulation and should not be asked to undertake a task for which they are not trained. The care given by health and social care support workers is at the heart of NHS-funded services. We plan to keep this under review in the light of the findings and recommendations in particular of the Francis inquiry, which is due to be published in the new year, to ensure that the system and process remain fit for purpose. I will repeat what I said yesterday at the Dispatch Box. The Government’s mind is open but we need to ensure that there is a good, evidence-based case before proceeding with mandatory regulation.
The noble Baroness, Lady Emerton, asked whether there had been a more recent cost analysis than the 2009 data of registering healthcare support workers. The answer is, not to my knowledge. Clearly, the cost of regulating 1.8 million health and social care support workers would be significant, but the basis of our decision not to regulate was not cost. Those who advocate regulation of support workers sometimes speak as if regulation were a panacea. I do not believe it is in any way a substitute for performance management. The duties of a support worker are always delegated from a responsible registrant, usually a nurse, as I have mentioned, and that fact could not, and should not, change.
If the concern is that we are somehow exposing patients to unacceptable risk by not regulating, then again, I do not think the assumption underlying that suggestion—that regulation would be the answer—is valid. It implies that support workers are inherently dangerous, which I do not accept at all. If a support worker were to be seen as a danger then, as I have mentioned, the Independent Safeguarding Authority has a vetting and barring scheme which can prevent unsuitable support workers being employed.
My noble friend Lord Willis asked about research as part of a nursing degree. I absolutely agree with what he said in that regard. It is already, in fact. Nurses, as undergraduate nurses, will be able to critically appraise research. Some will wish to become researchers and there are nationally funded clinical academic training schemes to support this.
A number of noble Lords, including the noble Lords, Lord Hunt and Lord MacKenzie, spoke about nurse education. Planning the number of nurses and the size and shape of the workforce has to be based on the needs of the people in our care. Services must be properly designed around the care and treatment that people need and these decisions could result in the need for nursing numbers to change, and very often they do.
At present, SHAs work with local employers to determine nurse training commissions. From April next year, Health Education England assumes national leadership for a new system of planning and developing the entire healthcare and public health workforce. HEE will ensure that the shape and skills of the future health and public health workforce evolve to sustain high-quality health outcomes in the face of demographic and technological change.
From 2013 all nurse education programmes will need to meet the new education standards set by the NMC and we support the NMC’s decision, as I have mentioned. It is the right direction of travel if we are to make all nursing degree level and if we are to fulfil our ambition to provide high-quality care for all.
Time is against me, so I will endeavour to cover just a few more questions but I will write to noble Lords with answers to other points.
The noble Lord, Lord Kakkar, asked me about preceptorship and I listened to his remarks with interest. Preceptorship is a development framework for newly qualified practitioners which, as he outlined, aims to ensure the smooth transition from student to qualified, accountable practitioner through a programme of bespoke support. It is predominantly administered through employment. We plan to develop the preceptorship framework further during 2012-13 within a clinical leadership framework. Work has commenced on that project and should be delivered by next April.
The noble Lord asked about deans of nursing schools signing off candidates after a period of preceptorship. That is an interesting idea which I do not believe has been fully discussed across the profession. I will ask officials to test the proposal with the Nursing and Midwifery Council and the Council of Deans of Health.
Will we support schemes for the fast-tracking of nurse leaders? That idea is most definitely supported and we have committed to £40 million in 2013-15 for leadership development that will assist aspiring and talented nurse leaders. Unfortunately, time prevents me from expanding on that, which I would like to have done.
The noble Lord, Lord Hunt, asked about monitoring standards of care by students. It is right that nurse education is a partnership between the NHS and universities, as I have mentioned, and it is true that the NHS must be more involved with the selection of students. Health Education England will work on that.
I think my time is now up. I thank noble Lords for a very rich and rewarding debate which, as I have mentioned, I will follow up in writing to all noble Lords who have spoken.
Care Services: Winterbourne View
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Earl Howe
My Lords, I am very grateful to the noble Lord for his constructive comments and I welcome his commitment to a shared agenda for improving care for those with learning disabilities and autism. I agreed with a great deal of what he had to say.
As to his individual questions, he first asked whether I could articulate the number of in-patient places we expect to be reduced during the coming months and years. My answer is that we want to see a rapid reduction in the number of people with learning disabilities, autism and challenging behaviours who are in hospitals or residential care and who are away from their home areas. That is not to say that there is no role for assessment-and-treatment centres, which clearly have a role—but it is limited. It is important to ensure that everyone has a care plan built around their individual needs, rather than to say that there should be some kind of top-down national target for the number of units. We believe that plans should be in place and put into action as soon as possible. All individuals should be receiving personalised care and support in the appropriate setting for them no later than 1 June 2014, and we shall work towards that end. It is very much a case of defining the appropriate care for the individual.
To pick up the noble Lord’s final question about the involvement of carers and the vulnerable adults themselves, yes, they should indeed be involved in the planning of care. It is families, carers and the individuals themselves who know best what they need. It was one of the besetting failings of this terrible saga that families and carers were not listened to, and not only about the whistleblowing to which they wanted to alert the authorities. They also had a very good idea of what type of setting and care their loved ones would best respond to—and they were not listened to on that score, either.
The noble Lord asked about clinical commissioning groups and the extent of their expertise in commissioning appropriate treatment for those with learning disabilities. I agreed with a great deal of what he said. Commissioning expertise for this group of people is, frankly, in short supply, and that is why the department will fund the joint improvement programme being organised jointly by the NHS Commissioning Board and the Local Government Association. They will be tasked with working closely with clinical commissioning groups and their local authority partners over the next two years, to share and implement best practice. There has to be, as the noble Lord said, a cohesive approach. Joint working here is vital because we are looking at determining not only the right setting for an individual but what the right treatment for that person should be. That necessitates a joint approach. I should add that we would set an expectation that there be pooled budgeting arrangements to drive that forward.
The noble Lord asked me who on the Commissioning Board was leading in this area. Sir David Nicholson has made clear his personal commitment to take action on this. Indeed, the board is meeting people with learning disabilities this Thursday, but the lead director on the board is Bill McCarthy.
The noble Lord asked me what the Care Quality Commission intended to do by way of ongoing work. The CQC will continue to carry out unannounced inspections, which will involve people with learning disabilities and their families, as I mentioned when I repeated the Statement. That will be based on risk, and the CQC has made it plain that these particular settings are a priority for it. We expect it to take account of all the recommendations arising from the serious case review, including the views and statements of those who have left establishments of this kind.
The noble Lord asked me about Castlebeck and the liability that it should have for the ongoing costs of patients who were at Winterbourne View and, indeed, the cost of the serious case review. My reaction is that Castlebeck should give serious consideration to that suggestion. However, there are currently no powers to make that happen, and the Government are keen to ensure that in extreme cases such as this there are consequences for providers of care that is of poor quality.
As regards a requirement for companies to be more open about their board structure and corporate structure, this is something that we shall be looking at over the next two or three months, and we will come forward in the spring with our conclusions on how companies and their boards can better be held to account.
Baroness Hollins
My Lords, I welcome the report and the detailed actions that are listed in it. Indeed, it fills me with some hope after so many years of commissioning failure. The proposed change support programme is to be led by the NHS Commissioning Board and the Local Government Association. There is something ironic in responsibility for leading this change being vested in those who primarily have been responsible for the current failure. The evidence is that local authority and NHS leadership do not have the skills or knowledge to effect change. Indeed, my former colleague Jim Mansell’s first report on challenging behaviour was published 20 years ago and made similar recommendations to those in today’s report. Can the Minister confirm that the programme board will indeed be expected to engage with those from the learning disability sector, who understand the issues involved in the design and delivery of the support programme? Finally, why does the report make little or no mention of the need to provide access to the same range of mental health treatments that other citizens have access to, including psychological therapies?
Earl Howe
The noble Baroness brings us to a set of key points. She said that in her view the NHS and local government simply do not have the capacity to address these issues properly. In many respects we would agree with that, although it would be wrong to make a blanket statement about the whole country because we know that very good pockets of commissioning and provision exist. One of the tasks of the joint improvement team will be to identify those areas of best practice, and to enable those operating in those areas to go out and mentor other areas. Part of the sum of money that we set aside will be devoted to enabling those high-performing areas to backfill the places while they are engaged in that mentoring exercise. Her basic point is well taken. We think there is a job to do here but it is one of those things that the Board and the Local Government Association need to oversee on a national basis.
That is only a short extension from the function of the Commissioning Board in general, which will be to support commissions. We are grateful to the Local Government Association for its overseeing role for local authorities. I fully expect that they will engage with the learning disability sector. I commend to her the concordat, which is accessible on the department’s website, and she will see from that that the 50 organisations that have signed up to it include a number of voluntary organisations in this sector. Jointly, these bodies have committed to a programme of action. It is not just about defining what needs to be done but about how it will be done. It is an impressive set of commitments that those bodies have signed up to.
Lord Pearson of Rannoch
My Lords, the Minister spoke about the need for a fundamental change of culture but I heard nothing in the Statement about training, so I hope that he will forgive me if I ask again a question I have been asking for over 20 years about the training of our teachers, social workers and, in this case, care workers. I do so from my background in the 1980s and 1990s on the body that validated all our teacher training courses and from having taken quite a close look at the curriculum then offered by the Central Council for the Education and Training in Social Work. At the former, I was shocked to find that our mission statement was “to permeate the whole curriculum with issues of gender, race and class”.
Since then we have seen Nursing 2000 put the training of nurses away from hospital wards and into the social science departments of the former polytechnics, with results that I predicted at the time. Have the Government looked into the curricula of the training of care workers and of those responsible for this and similar disasters? What training do they get, if indeed they are trained at all? What genuine qualifications do they have before they commence training? Are they proud of what they do, or are they just in it for the money? I hope I am very out of date, but I look forward to the Minister’s reply.
Earl Howe
My Lords, the noble Lord is not out of date, because this is a key issue and I am grateful to him for raising it. It is crucial that staff who work with people with challenging behaviour are properly trained in essential skills. Contracts with learning disability and autism hospitals should be dependent on assurances that staff are signed up to the proposed code of conduct that the Department of Health has commissioned from Skills for Health and Skills for Care and that there should be minimum induction and training standards for unregistered health and social care assistants. Those standards should be met. I would say that owners, boards of directors and senior managers of organisations that provide care must take responsibility for ensuring the quality and safety of their services. There are requirements set out in law in that regard, and they include safe recruitment practices, which necessarily involve selecting the people who are suitable for working with people with learning disabilities, autism and challenging behaviour, and appropriate training for staff on how to support people with challenging behaviour.
From April next year, Health Education England, which is the new, national, multi-disciplinary education and training body, will have a duty to ensure that we have an education and training system across the piece but including a system that can supply a skilled and high-quality workforce for this sector.
Baroness Browning
My Lords, my noble friend said that families’ concerns were ignored, but would he accept that there is huge push-back across all the public services involved with this group when anyone who is a family member of someone over the age of 18 tries to make representations on their behalf? I experienced that again personally, yet again, only this week. Paragraph 3.9 of the department’s response makes reference to:
“Where an individual lacks capacity and does not have a family to support them, the procedures of the Mental Capacity Act 2005 should be followed”.
I am appalled at the way in which the Mental Capacity Act, an excellent piece of legislation, is virtually ignored by many professionals who not only do not advise people of their rights under the Act but just ignore it. If ever a piece of legislation cried out for post-legislative scrutiny, it is this Act of Parliament. It is a strong, good piece of legislation but it needs to be enforced; we need more people to know about it and to use its powers to protect the vulnerable.
Earl Howe
My Lords, my noble friend is absolutely right. Over the coming months the Department of Health will be working with the Care Quality Commission to agree how to improve the understanding of the deprivation of liberty safeguards and to ensure compliance with them. We are very clear that this work is necessary to protect individuals and their human rights. We will report the results of that work by spring 2014. During 2014 the Department of Health will update the Mental Health Act code of practice, and this will also take account of findings from the review.
Baroness Wall of New Barnet
My Lords, I also congratulate the Minister on repeating this Statement made earlier in the other place, and I welcome the report itself. I want to refer to a couple of areas and follow up his reassurance about the patient care pathway. The importance of that pathway, I am sure he knows, is not only in having it but ensuring that it is carried out with regular updates, and that the progress being made is taken into account to make sure the pathway is staying in touch. That does not always happen, so having the patient care pathway is only one part of what I hope he would ensure would happen.
The other part, and the Minister may not be surprised at this, is Part 7 where again, as my noble friend Lord Hunt has done, I urge him to think again about another area. With regard to the expectation as far as training goes—while Skills for Health and Skills for Care, as mentioned in the document, are doing a great job—it is absolutely crucial to recognise that just the induction for health care assistants in social care really is not enough. I have pleaded with the Minister on many occasions in the context of hospitals. It is equally if not more important that healthcare assistants have the confidence given to them by being registered and qualified in the way that registration ensures, so that the very difficult and important job that they do—and more of them are doing it than are working in any other area—is suitably recognised. I urge the Minister to take away that request in the context of this report, and to look again at ensuring registration for these particularly important workers.
Earl Howe
My Lords, I am grateful to the noble Baroness for what she has said. She is right to point out that the patient pathway is integral to any proper planning process for individuals, and that it should be built around the particular individual’s needs and preferences if possible. This brings us back to the role of an assessment and treatment centre: namely, as its name implies, to assess the needs of a person and to define what their care plan should be over a future period of time. As I mentioned, the care plan is best when it is drawn up with the benefit of advice from the individual, their family and their carers. Therefore, if we want more community care, we need to ensure that there is the capacity in the community to deliver good patient pathways to individuals. We are clear that some areas of the country are ill equipped to do that. Part of the task of the joint improvement programme will be to look at the facilities and resources that are required in local areas to enable commissioners to plan those patient pathways with confidence.
On the issue of the training of care assistants, I take the noble Baroness’s point. I think that it is common ground between us that those who lack a recognised qualification should nevertheless be enabled to upskill themselves and get themselves on a register to prove that they are familiar with and abiding by a code of conduct that has been recognised, with the register itself being duly accredited. Our position is that the system of voluntary registration, almost by definition, will result in an upskilling of the workforce, but it is not the whole story. There is a role for employers to ensure that there is proper supervision of care assistants, and that proper delegation takes place that does not require a person to do more than he or she is skilled to do. There is no single answer here, but I believe that voluntary registration is a good start.
Baroness Masham of Ilton
My Lords, following from the question about registration and regulation, is the Minister aware that people such as nurses and care assistants who have been sacked for dishonesty or undertaking dangerous procedures with patients can take a job anywhere as a care assistant? Without regulation, how will he control the matter? It is very dangerous for vulnerable patients because these establishments are so hard-pressed to get staff to work in their centres that they will take almost anyone, without even taking up references.
Earl Howe
My Lords, the noble Baroness raises another important point. In this country we have a list that acts as a check on those who have abused or otherwise maltreated adults or children and have been dismissed on that basis, to ensure that the scenario that she has painted in which someone who has committed such an offence is re-employed cannot occur in practice. I am not sure that I recognise the situation that she outlined because the POVA system is designed to ensure that dangerous people are not employed to look after the vulnerable. However, I will gladly drop her a line in writing to set out what we propose in this area.
Lord Willis of Knaresborough
My Lords, I echo the comments around the House that this Statement is appropriate. The fact that it has support across the House demonstrates that there is unity in terms of tackling the issue. I spent a significant part of my professional life working with young people with severe behavioural issues. As the head of a school, I, together with my governors, would be held responsible for what happened to those young people—and rightly so. The weakness in the Statement is that it does not go far enough.
The Minister was right to make clear, and I am glad he did, that it was the management and the corporate owners of the home who were principally responsible, yet it was the staff who were prosecuted and jailed. I would like to hear what steps are going to be taken with the CPS to deal with corporate responsibility, and why that is not the priority here. Without it, frankly, a lot of the things that appear in this report will not have the necessary teeth.
I respectfully but fundamentally disagree with the noble Lord, Lord Pearson, on the training of nurses and other health workers. The more that we demand of staff in terms of their education and other opportunities, the better the staff we will ultimately get. However, I agree with him and with the noble Baroness, Lady Masham, that it cannot be right that the most vulnerable people in our society are looked after by people whom we cavalierly say do not require qualifications. How unacceptable is that in the 21st century? A voluntary register of an organisation that is disreputable is utterly and totally meaningless. We need a commitment on this from the Government. I agree that this will be over a period of time; it will not happen tomorrow. However, simply stating, as recommendation 15 does, that by 2013 there will be a voluntary register will not give parents and carers of these very vulnerable adults and young people the support and comfort that they need. I plead with the Minister to make the case in the department for mandatory registration, to ensure that there is appropriate regulation and that nobody works with these young people or adults who does not have appropriate qualifications and training.
Earl Howe
My Lords, I am very happy to recognise the excellent work done by my noble friend in the report that he published and submitted to the Royal College of Nursing, which we will debate later this week. He rightly drew attention to the responsibility that lies with leaders of organisations and boards of directors. They should be fully held to account for poor quality or for creating a culture in which neglect or abuse can happen. I completely agree with that. He was right to say that despite convictions for some front-line staff, Winterbourne View has revealed weaknesses in our ability to hold to account those who were higher up. Owners, boards of directors and senior managers must take responsibility for the quality and safety of their services.
We are determined to strengthen the accountability of boards of directors and managers, but we are not yet in a position to say exactly how that should be done. It is not as easy to define a legal route as it might first appear. It is perhaps easier to do so in the area of financial irresponsibility or negligence than it is where value judgments have to be made over the quality of care delivered to a group of individuals. However, I can tell my noble friend that this is one of the priorities that we have set ourselves. I listened with respect to his suggestions on the compulsory registration of care workers. I repeat what I have said in the past: the Government’s mind is not closed to this suggestion.
Department of Health: Budget
Earl Howe Excerpts(11 years, 5 months ago)
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Lord Hunt of Kings Heath
My Lords, in asking the Question standing in my name on the Order Paper, I remind the House of my health interests.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the department underspent against its budget by 1.7% in 2010-11 and by 1.3% in 2011-12, or by 1.5% combined across the two years.
Lord Hunt of Kings Heath
My Lords, I think that is about £3 billion; perhaps the noble Earl will confirm that. This Government promised to protect the NHS and to cut the deficit. In fact, they are cutting the NHS and the deficit is rising. How can the department justify handing back so much money to the Treasury when large parts of the NHS are under great financial pressure at the moment?
Earl Howe
My Lords, the deficit is not rising. The Government are putting £12.5 billion extra into the NHS over the course of the spending review. The noble Lord, Lord Hunt, will know from his ministerial experience that government departments have an absolute requirement to manage expenditure within the financial controls that are set by Her Majesty’s Treasury and voted on by Parliament. For the Department of Health that means that the net expenditure outturn, which incidentally stems from around 400 organisations, all of whose accounts have to be consolidated, must be contained within the revenue and capital expenditure limits. Given those circumstances, it is sensible to plan for a modest underspend to mitigate against unexpected cost pressures.
Lord Mawhinney
My Lords, why does my noble friend believe that he will be able to tell your Lordships’ House that all the PFI hospital projects undertaken under the previous Administration, some of which are in a serious financial mess, will be deemed to be financially sustainable? How many of them are likely to require extra expenditure from his budget to achieve that desired end?
Earl Howe
My noble friend raises a very important issue. The analysis that we have done on hospitals financed by private finance initiative has indicated that there are seven trusts that are basically unsustainable as a result of their PFI commitments. The Department of Health has therefore undertaken to support those trusts to enable them to make up the shortfall which is beyond their control. It would be wrong to suggest that PFI was a solution that did not deliver benefits. Clearly it did, but I am afraid that some of the sums that were done initially were sadly wanting.
Lord Warner
My Lords, what consideration was given by the Government before they repatriated, as my noble friend said, £3 billion to the Treasury? What consideration was given to using some of that money to buttress social care, which makes great demands on the NHS and which has suffered on average a 7% cut in each of the past two years?
Earl Howe
My Lords, we did, as the noble Lord would expect, look at the anticipated surplus this time last year and we channelled an extra £150 million into social care then in the near-certain knowledge that the department would generate a surplus during the year. However, as he will know, it is an inexact science to predict in December what the outturn will be in April, and one has to be prudent at that stage.
Lord Alderdice
My Lords, my noble friend gave a reassuring Answer a week or two ago about the balancing of expenditure and resources between mental health services and physical health services within the NHS. Is it possible for my noble friend’s department to look to the possibility of any surpluses in the future being used to achieve greater parity between mental health services and the rest of the NHS, given the decisions made in your Lordships’ House regarding the Health and Social Care Act 2012 and the mandate for the NHS Commissioning Board that has flown from it?
Earl Howe
My noble friend makes an extremely important point. He will know that the Government have made it clear that mental health problems should be treated as seriously as physical health problems. That commitment has now been made explicit in the Health and Social Care Act 2012. As he mentioned, the Government’s mandate to the NHS Commissioning Board explicitly recognises the importance of putting mental health on a par with physical health. It tasks the NHS Commissioning Board with developing a collaborative programme of action to achieve that and it will be held to account accordingly.
Lord Laming
My Lords, does the Department of Health and its Ministers monitor the number of people who today are in hospital and whose treatment is being completed, but who are there because alternative arrangements have not been made for them?
Earl Howe
Yes, my Lords. As the noble Lord will know, the problem of delayed transfers of care is not new. We have seen a drop in delayed transfers in terms of the number of days but there has been a levelling off in recent years. However, it is up to the NHS and social care services to collaborate to ensure that proper and appropriate community services are available to patients when they are discharged from hospital. That planning process begins the moment the patient enters hospital.
Baroness Farrington of Ribbleton
My Lords, the Minister very unusually failed to answer my noble friend Lord Warner’s question as to why the money that has gone back to the Treasury could not have been used to meet the needs of the patients to whom the noble Lord, Lord Laming, referred.
Earl Howe
My Lords, I apologise. I addressed part of the noble Lord’s question in relation to the issue around social care. The important point to make about the surplus is that none of the underspend is lost to the NHS. Under Treasury rules, the NHS is allowed to carry forward all underspends to the next year. It is not a case of the NHS having to give up any money and thereby depriving patients of treatment.
Lord Flight
My Lords, will the Minister say how much NHS spending has risen in the past 20 years in cash and real terms? I believe that in cash terms it is of the order of about £11 billion to well over £100 billion.
Earl Howe
My Lords, I would be happy to write to my noble friend. I do not have the figures for the past 20 years in front of me but I can tell him that, unlike the party opposite which promised to cut NHS expenditure had it been re-elected last time, we are protecting the NHS budget. It is now well over £100 billion. As I said earlier, it will be increased by £12.5 billion over the course of this Parliament.
NHS: Hospital Services
Earl Howe Excerpts(11 years, 5 months ago)
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Lord Warner
To ask Her Majesty’s Government what progress they are making with the reconfiguration of NHS hospital services.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government’s policy is that front-line NHS reconfigurations should be locally led and clinically driven. Changes to services should be led by those who know their patients’ needs best. That is why we are empowering clinical commissioners to design the services that will make the greatest difference to improving healthcare and improving people’s lives.
Lord Warner
I am grateful to the Minister for that reply so far as it goes. In the light of yesterday’s Autumn Statement, will the Minister and his colleagues study carefully the recent Nuffield Trust report, which cogently suggested that we are facing a decade of austerity within the NHS with the need to secure 4% efficiency savings on a yearly basis, not just to 2015 but up to 2021-22? Will Health Ministers engage in a serious dialogue with the Academy of Medical Royal Colleges whose new chairman, Professor Terence Stephenson, suggested in July that we had far too many acute centres trying to provide 24/7 services across too wide a range of medical specialities? Will he accept, particularly in the light of the Answer that he gave to the previous Question, that we should be doing more to take money out of acute hospitals that are performing indifferently and putting it into community-based services?
Earl Howe
My Lords, I think it is common ground between the noble Lord and the Government that we need to see care delivered more in the community and less in acute settings; that was a policy that his Government espoused. I agree with the noble Lord and with Terence Stephenson that we need to deploy clinical leadership, evidence and insight as a driving force behind service change. Service change is not new; it has happened all the time throughout the NHS’s history. Clinical commissioning groups on the ground will be the driving force for this, but the NHS Commissioning Board will be there in support and the wisdom of the royal colleges will clearly need to be tapped to provide the board with expert clinical advice. Indeed, that is the theme behind the board’s aim to establish clinical networks and senates to help build the clinical evidence for change.
Lord Walton of Detchant
My Lords, is the Minister aware that too many patients are still being admitted to hospital solely to undergo investigations and tests that could perfectly well be carried out on an out-patient basis? Is it not therefore time to reconfigure out-patient services so that individuals will be in a position to attend hospital in order to have a clinical consultation and all the relevant tests on a single visit? That would avoid a great number of unnecessary hospital admissions.
Earl Howe
My Lords, I agree with the noble Lord. He is right to say that many hospital admissions prove to be unnecessary, wasteful and expensive and we need to ensure that those who do not need to go to hospital can be appropriately looked after in the community. We also need to reduce the level of unplanned, emergency admissions to hospital. There is huge scope to do this. Many trusts are already succeeding in bringing more services into the community, but we need to accelerate the process.
Baroness Williams of Crosby
Does my noble friend agree that one thing that emerges very clearly is that real difficulties arise from not having a 24/7 primary care service, which means that figures for weekends and holidays are of course much worse than they are for the normal level of health service provision? Does he agree that it is well worth looking at bringing into the work of CCGs the contribution that can be made by ancillary services to medicine, in order to move towards a 24/7 primary care service?
Earl Howe
I agree with my noble friend and that is why work is currently being done under the leadership of Sir Bruce Keogh in the Department of Health to examine the scope for greater 24/7 working. She is right that this is important, not just for the benefit of patients but also to make the NHS more efficient and effective in deploying its staff and assets.
Lord Campbell-Savours
If services are carried forward as the noble Earl suggested, how does that influence estimates?
Earl Howe
We have reverted to the previous Question, if I am not mistaken. The departmental expenditure limit is set by the Treasury. My own department is in the fortunate position of knowing that it has real-terms increases every year of this Parliament; however, if the department has an underspend that cannot be carried forward, yes, some money has to be returned to the Treasury.
Lord Hamilton of Epsom
Does my noble friend accept that if he takes the advice of the noble Lord, Lord Warner, and moves resources from acute services to other services in the NHS, that will lead to the closure of many general hospitals that were built under the previous Government under PFIs, and even more of them will get into financial trouble than there are already?
Earl Howe
I do not anticipate that there will be widespread closures of hospitals, and it is important to reassure people about that. The NHS has always had to respond to patients’ changing needs and advances in medical technology. Reconfiguration that ensues from that is about modernising the delivery of care and facilities with a view to improving patient outcomes and developing services, as I have mentioned, in a way that makes them available closer to people’s homes. While we will see changes in service configuration, I trust and hope that we will not see widespread hospital closures, although the possibility of a hospital having to downsize can never be eliminated.