Care Quality Commission (Registration and Membership) (Amendment) Regulations 2012
Earl Howe Excerpts(13 years ago)
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Earl Howe
My Lords, I am most grateful to noble Lords who have spoken and shall endeavour to cover the questions and points they have raised in a moment. However, before I do so, perhaps I may briefly take the Committee through the purpose of this instrument.
The regulations before us today make changes to two areas of the legislation that affect the operation of the CQC. The first component of this statutory instrument makes two small amendments to the Care Quality Commission (Registration) Regulations 2009 to replace references to the National Patient Safety Agency, the NPSA, with references to the NHS Commissioning Board Authority. The second relates to the make-up of the commission’s board. I shall say more about the purpose of these changes in a moment but I should like to reflect on the importance of the Care Quality Commission as the independent regulator of health and adult social care services in England.
The commission plays a vital role in providing assurance that patients and service users receive the standards of care that they have a right to expect. All providers of regulated activities in England, regardless of whether they are public, private or voluntary sector organisations, are required to register with the commission. Providing a regulated activity without being registered is an offence. In order to be registered, providers have to comply with a set of registration requirements that set the essential levels of quality and safety. Where providers do not meet these essential levels, the commission has a range of enforcement powers that it can use to protect patients and service users from unsafe care, including, in the most extreme cases of poor care, closing down services. The changes to the commission effected through the Health and Social Care Act 2012 are to strengthen the CQC as the quality regulator of health and adult social care services.
I shall now explain why we need to make these changes to the regulations included in the instrument under debate. Under Regulations 16 and 18 of the CQC registration regulations, registered providers of regulated health service activities have been required to notify the CQC of unexpected deaths of service users or other serious incidents, except where such providers have already reported the death or incident to the NPSA. This exception was designed to reduce the reporting burden on providers, preventing the duplication of reporting to both the NPSA and the CQC. Notifications to the NPSA were processed through the national reporting and learning system, the NRLS, and notifications made in the circumstances described in Regulations 16 and 18 of the registration regulations were passed on to the commission by the NPSA. However, from 1 June, responsibility for oversight of the NRLS transferred from the NPSA to the NHS Commissioning Board Authority. Therefore, the amendments to which I referred were needed to reflect the changing ownership of and responsibility for the NRLS and to update the exception and allow it to continue from 1 June.
Relevant notifications to the NRLS will continue to be passed to the CQC under the new arrangements. To set this in context, as noble Lords are aware, the arm’s-length bodies review in 2010 recommended the abolition of the NPSA, and provision is made for the recommended abolition in Section 281 of the Health and Social Care Act 2012. Provision in the Act is also made for the NHS Commissioning Board to have responsibility for the patient safety functions formerly carried out by the NPSA. I shall briefly reiterate why we believe this to be entirely sensible and in the best interests of patients. Patient safety has to be the key priority for all those working in the health service. It can never be allowed to be seen as an add-on or an afterthought.
For that reason the Act puts safety at the heart of the NHS, not at arm’s length. Safety is, of course, a central part of quality and we believe that the board, as a body legally responsible for ensuring continuous quality improvement in the NHS, will be best placed to drive a powerful safety agenda throughout the NHS. Embedding safety across the health and social care system is vital. That is why oversight of the patient safety function has been conferred on the shadow body—the NHS Commissioning Board Authority—from 1 June. The NPSA did not have the authority or position to fully exploit the information gained from the NRLS. In contrast the board will have the necessary authority and, being positioned at the very heart of the system, will be better placed to lead and drive improvements. Patients rightly expect that all NHS services will be safe. We believe that by making the board responsible for safety, we are placing that responsibility at the centre of the NHS.
The second part of the regulations makes changes to the regulations setting out the composition of the Care Quality Commission’s board. These changes are in response to the recommendations of the Department of Health’s review into the performance and capability of the commission. The review recommended that the department should take steps to strengthen the board, including changing its structure to that of a unitary board, so that instead of comprising only non-executives, senior executives can also be appointed and held to account by the non-executive members. The model of a unitary board also potentially offers strength in combining the strategic views of the non-executives with the organisational knowledge of the executives. In addition, the performance and capability review recommended that the Secretary of State should strengthen the board by appointing new non-executive members to existing board vacancies. The regulations, therefore, remove the bar in the commission’s existing regulations stating that the Secretary of State cannot appoint an employee of the commission to the board, so allowing for the creation of a unitary board. The regulations also extend the number of members who can be appointed to the commission’s board so as to accommodate the senior executives. The upper limit is currently set at 10, and these regulations extend that to 12. That allows flexibility in the appointment of new executive and non-executive members to strengthen the board’s capability.
I was very grateful for the comments of the noble Lord, Lord Hunt, on the appointment of David Behan as chief executive of the commission. I am sure he will agree that David’s wealth of experience around adult social care and local government system reforms at the department as director-general for social care, local government and care partnerships will stand him in excellent stead for his new role as chief executive of the CQC. David’s previous experience as the first chief inspector of the Commission for Social Care Inspection and as president of the Association of Directors of Adult Social Services, as well as his other front-line experience, will also be a great advantage to the commission.
All noble Lords who spoke asked about resources and funding. It is important to recognise that the CQC recovers fees from providers to cover the cost of registration. In addition, it receives grant in aid to cover its other functions. Every year, the CQC agrees its business plan with the Department of Health and its financial position is kept under constant review. We have agreed that the CQC will receive additional funding for staff recruitment in 2012-13.
Allied with the question of resources was that about the CQC’s capability. We have every confidence in the CQC’s ability to provide the effective regulation of providers of health and adult social care. I welcomed what the noble Baroness, Lady Wall, had to say about that. As the noble Lord, Lord Hunt, has acknowledged, huge improvements are being made in the delivery of its core task of providing assurance that services for patients and service users are safe and of appropriate quality. The CQC leadership is now demonstrating greater confidence and challenge. The recommendations that we made in the performance and capability review are aimed at building on performance during the past 12 months to strengthen capability further and to improve accountability, including accountability with the department.
We are committed to supporting and strengthening the CQC. We are clear that the CQC should continue to focus on its core role of assessing whether providers meet the essential levels of safety and quality through its registration function. The department is assured that the CQC is delivering its core functions and learning from its implementation of the registration system, improving the way in which it carries out its core business to provide a better service. We have emphasised to the CQC the importance of ensuring that providers continue to comply with regulations and safety and quality requirements. The CQC continues to monitor closely the information on service providers that it receives and takes regulatory enforcement action if it finds the safety and quality of services to be lacking in any case.
We are committed to developing the role of the CQC as the quality regulator of health and adult social care services in England. The functions that the CQC will gain as a result of the Health and Social Care Act 2012—joint licensing with Monitor, information governance monitoring and hosting Healthwatch England—and the potential transfer of functions from the Human Fertilisation and Embryology Authority and the Human Tissue Authority, subject to consultation, are all aimed at strengthening its role in assuring the safety and quality of health and adult social care services.
I emphasise that these changes will not happen overnight. For example, the delivery of joint licensing is not expected until 2014, and any transfer of functions from the HFEA or the HTA will not happen until 2015. The CQC will have a number of years to prepare for these functions, including assessing the resources needed to carry them out. During this time, the department will work with the CQC to ensure that it is ready to take on the functions at a pace that avoids distracting the commission from its core responsibilities and placing the delivery of its current functions at risk.
The noble Lord, Lord Hunt, spoke about the CQC’s methodology and in particular the “generic model of regulation”. Professional regulation, as he knows, conducted through the GMC, the GDC and other professional regulators, focuses mainly on the competence of the individual professional. However, the way in which organisations are managed and their systems work, together with factors such as the suitability of premises, also affects the safety and quality of the services provided. CQC registration will ensure that competent individuals meet the needs of their patients without putting them at risk from potential system or premises weaknesses. It is encouraging that both the General Practitioners Committee and the Royal College of General Practitioners have issued joint statements with the CQC illustrating the profession’s acknowledgment of the need for CQC registration and the light-touch approach that the CQC is taking to bringing providers into registration.
I argue that there is a generic element to the regulation process, but that does not mean that the CQC approaches its task on a one-size-fits-all basis. I have accompanied CQC inspectors when visiting a dental practice, and I know that there are non-generic elements of its methodology that apply only to dentistry. The CQC has worked with stakeholders and trialled its processes to keep these to a minimum, but it is important that it has the capacity to take action where services do not meet essential standards.
NHS: Liverpool Care Pathway
Earl Howe Excerpts(13 years ago)
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Baroness Knight of Collingtree
To ask Her Majesty’s Government whether use of the Liverpool care pathway in NHS hospitals is consistent with the outcome of parliamentary debates and votes on euthanasia.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Liverpool care pathway is an internationally recognised framework to guide the delivery of high-quality care for people in their last hours or days of life. It is not a means of euthanasia and is therefore entirely consistent with the outcome of parliamentary debates and votes on the subject. The Liverpool care pathway helps to ensure that people die with dignity, respect and minimum distress.
Baroness Knight of Collingtree
My Lords, is my noble friend aware, however, that although the Liverpool care pathway is certainly not intended to be a tool for euthanasia, that is what a growing number of people now believe it to be, judging by their own experiences? Is he aware that consultants are not always informed that their patients have been put on this pathway, and that invariably neither those patients nor their relatives are told? Will he look into what is happening, since the very name “pathway” indicates that they are shortly to face induced death, as indeed they do?
Earl Howe
My Lords, I recognise that some people who have been on the Liverpool care pathway have received poor care. The pathway is not of itself a guarantor of best-quality care. It has been consistently made clear in the guidance for the implementation of the Liverpool care pathway that it is in no way a replacement for clinical judgment and should not be treated as a simple tick-box exercise. Rather, it should be seen as a useful framework to guide the delivery of care in a way that complements the skill and expertise of the practitioner using it.
Lord Hunt of Kings Heath
My Lords, I refer the House to my health interests in the register. Does the noble Earl agree that the noble Baroness, Lady Knight, has done sterling work in bringing to the attention of Parliament issues to do with the appropriate feeding and nutrition of patients in hospitals, but that on this issue she is wrong? Will he confirm that the national care of the dying audit shows that in fact the vast majority of patients on the care pathway in the last 24 hours of their life were reported to be comfortable and receiving good clinical care, and that his department will continue to recommend the care pathway as good practice?
Earl Howe
My Lords, we will continue to do so. The Liverpool care pathway has sometimes been accused of being a way of withholding treatment, including hydration and nutrition. That is not the case. It is used to prevent dying patients from having the distress of receiving treatment or tests that are not beneficial and that may in fact cause harm rather than good. The noble Lord was right that the recent national care of the dying audit of hospitals, run by Marie Curie in collaboration with the Royal College of Physicians, notes that in 94% of documented cases discussions explaining the use of the LCP were held with relatives or carers. That audit process gives clinicians an opportunity to feed in their views about how well, or not so well, the pathway is working in practice.
Baroness Finlay of Llandaff
My Lords, given that the Government have recognised that the Liverpool care pathway has been designed to bring the best of hospice care into other care settings, such as hospitals, nursing homes and patients’ own homes, and that it is a tool—and a tool is often only as good as the person using it—will the Government ensure that Health Education England includes in its remit comprehensive education around the appropriate care of dying patients?
Earl Howe
Yes, my Lords. To ensure that it is used properly, the Liverpool care pathway emphasises the importance of staff receiving appropriate training and support in its use as well as accessing relevant end of life training and education programmes. A range of activity has been undertaken to support staff education and training and end of life care by the national end of life care programme and others. That includes the development of an extensive package of e-learning, which is free to access for health and social care staff.
Baroness Browning
Will my noble friend tell the House whether there is ongoing monitoring of patients who are sedated but not hydrated? Looking at people who are dying can take a long time. My noble friend mentioned a few hours or a few days. If you are not hydrated for days on end, inevitably death will come. What analysis is there?
Earl Howe
My Lords, one key feature of the Liverpool care pathway is regular monitoring of the patient—every four hours at a minimum, I believe. That regular monitoring process gives clinicians and nursing staff an opportunity to reassess the patient’s condition to see whether they are in fact responding to treatment, whether they require a different form of treatment or whether the treatment they are being given is unduly burdensome. That regular monitoring should, I think, take care of the point my noble friend raises.
The Lord Bishop of Liverpool
My Lords, I have some contact with the Liverpool care pathway in Liverpool. Does the Minister agree that not just palliative care professionals but all healthcare professionals should receive education and training in caring for dying patients? Would he also agree that in the relationship between the two, trust is paramount?
Earl Howe
My Lords, the right reverend Prelate is absolutely right. Audits that have been carried out, particularly the recent audit published in December last year, provide us with important information about the current quality of care provision. The recent audit makes a series of recommendations, including mandatory training in the care of the dying for all healthcare staff involved and a seven day, nine to five, face to face palliative care service.
Baroness Crawley
My Lords, is the Minister aware that my own dear mother spent her last days on the Liverpool care pathway? Is he further aware that our family experience was of extraordinary care and sensitivity on the part of all the healthcare professionals involved, enabling us to be with my mother peacefully at home at her death? Confusion reigns over the title. A family friend, hearing that Mum was on the Liverpool care pathway, thought that a miraculous recovery had taken place and that she was taking a leisurely stroll in one of our great northern cities.
Earl Howe
My Lords, I am pleased to hear that the noble Baroness’s mother was well looked after with the benefit of the Liverpool care pathway. I take the point about the name. Indeed, the noble Baroness, Lady Finlay, can probably give us some instructive examples from Wales, where the word “pathway” has not been adopted and the process has, I believe, been refined.
Baroness Masham of Ilton
My Lords, is the noble Earl aware that some relatives and loved ones have to fight to stop their loved ones being on the Liverpool care programme? Can he think of anything worse than dying of thirst?
Tobacco: Control
Earl Howe Excerpts(13 years ago)
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Lord Naseby
To ask Her Majesty’s Government whether they will meet representatives of non-governmental organisations, the tobacco industry and retailers to discuss tobacco control issues, publishing the minutes of such meetings, in line with both the requirements of Article 5.3 of the World Health Organisation Framework Convention on Tobacco Control and the practice of the European Commission and other member states.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, Health Ministers consider all meeting requests carefully. Article 5.3 of the Framework Convention on Tobacco Control requires the Government to protect the development of public health policies from the vested and commercial interests of the tobacco industry. The tobacco industry is welcome to share its views on tobacco control issues with us in writing at any time.
Lord Naseby
My Lords, that is a depressing Answer. How is it possible that in a country that believes in freedom of speech, a highly regulated and legitimate industry employing thousands of people and providing millions of pounds of revenue for Her Majesty's Government can be treated quite so shabbily when the Government are developing new regulations affecting plain packaging, which affects intellectual property, and are involved in consumer safety? I ask my noble friend to think again and to receive representations. The Government may not want to agree with those representations, but surely it is the legitimate right of every elector and every employer in this country to make their representations in person to Her Majesty’s Government.
Earl Howe
My Lords, we welcome the views of tobacco companies, retailers and all those with an interest in tobacco-related policy. Ministers in other departments may have legitimate reasons to meet the tobacco industry—I understand that, from time to time, they do—but Health Ministers and Department of Health officials would have a good reason to meet tobacco companies only if a specific matter, as opposed to general issues to do with tobacco control, demanded that. We would have to think carefully whether there was a good reason.
Lord Hunt of Kings Heath
My Lords, I refer the House to my health interests in the register, in particular as president of the Royal Society for Public Health. I ask the noble Earl to continue his efforts to keep those companies at some distance from him and the Department of Health. Will he confirm that it is the view of the Government, as it was of the previous Government, that the tobacco industry promotes a product that has been described by the WHO as being proven scientifically to be addictive and to cause disease and death, and that we should have very little to do with those companies?
Earl Howe
My Lords, I can only agree with the noble Lord, Lord Hunt, that tobacco is extremely damaging to public health. There is no safe level of smoking, and as a party to the Framework Convention on Tobacco Control, the UK has an obligation to take its undertakings very seriously—which means to develop public health policy free from influence from the vested commercial interests of a very powerful industry. However, that does not mean that we close our ears to what the tobacco industry may have to say: we are very happy to hear from it in writing. That promotes transparency, which I think assists everybody in a freedom of information context.
Lord Stoddart of Swindon
But is it not hypocritical of a Government—not only this one but previous Governments—to refuse to meet the tobacco industry, which is their tax-gatherer to the extent of £10.5 billion a year? If they had any honour and really believed that tobacco is such a bad commodity they would ban it. If they believe that, why do they not?
Earl Howe
My Lords, across government we recognise the need for Ministers or officials from other government departments to meet the tobacco industry within the parameters set under the framework convention. There may be legitimate operational reasons why such meetings might be necessary—for example, Her Majesty’s Revenue and Customs sometimes meets the tobacco industry to discuss measures to reduce the illicit trade in tobacco. So it is not as if all government departments have closed their doors, but there is a very specific issue to do with Health Ministers and health officials.
Lord Rennard
My Lords, I declare my interest as an unpaid director of Action on Smoking and Health. Does the Minister recognise that any dealings he has with the tobacco industry will be with an industry that is responsible for the deaths of around 300 of its own consumers every day in this country alone, and that any claims that that industry makes must be treated with very great scepticism given its knowledge over many years of the connection between smoking and lung cancer and the addictive properties of nicotine—facts which it well knew but denied for many decades?
Earl Howe
My Lords, my noble friend makes some very powerful points and he is right. Smoking is the biggest preventable cause of death in England. It causes more than 80,000 premature deaths every year. Tobacco use is a significant cause of health inequalities in the UK. One in two long-term smokers will die as a result of smoking. That demands that we take this issue very seriously indeed.
Lord Faulkner of Worcester
My Lords, is the Minister aware that his answers this afternoon will give a great deal of satisfaction to those of us who care about public health and the pernicious effect of the tobacco industry in its attempt to subvert it? As other questioners have said, this is a unique product: it is the only legal product that kills if it is used as the manufacturers intend. Does he share the views of his Secretary of State, who told the Times last month that he wanted the tobacco companies to have “no business” in the United Kingdom? If he does, he can be assured that he will certainly have the support of many Members of this House.
Earl Howe
My Lords, if we are successful in our strategy to reduce smoking rates significantly, an inevitable consequence will be that, over time, less and less tobacco will be sold. It is smoking that we aim to reduce, which will have consequences for the sale of tobacco products. For the good of public health we are trying to arrive at a point where there is no smoking in this country, and that would mean no retail sales of smoking tobacco. Hence I fully support the remarks of my right honourable friend the Secretary of State.
Lord Ribeiro
My Lords, I am grateful to my noble friend for acknowledging the harm and damage that smoking does. Can he assure the House that the Government are equally determined to ensure that smoking will not have an adverse effect on children and children’s health in the future?
Earl Howe
The need to reduce and, we hope, eliminate the uptake of smoking by young people is one of our top priorities. I would like to thank my noble friend for his Private Member’s Bill, which will certainly enable this issue to benefit from a wide airing. We would all like to see smoking in cars with children eradicated—the health of people can be harmed by second-hand smoke. The key question for us at the moment is what is the most appropriate and workable way of protecting children from second-hand smoking. No doubt we will debate that matter when we come to my noble friend’s Bill.
Lord Foster of Bishop Auckland
Does the noble Earl ever speak to one of the best Ministers of Health that his party ever had—and, indeed, probably the best leader that they were never intelligent enough to elect—namely Kenneth Clarke, who they tell me used to get £150,000 a year from British American Tobacco? Perhaps I may just add that Rothmans was one of the best employers that I ever encountered. It was good with the employees, good with the trade unions and good with the community. It was just that its product happened to kill people—like arms dealers’.
Older People: Health and Social Care
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Baroness Finlay of Llandaff
To ask Her Majesty’s Government how they plan to implement the recommendations in the report Delivering Dignity.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government welcome the report from the dignity in care commission and will consider carefully all the recommendations addressed to government. We will respond to the commission in detail in due course. Many of the solutions to the issues in the report lie with the local NHS, social care providers and other key stakeholders. The Government will encourage the sharing of best practice by bringing people together and putting in place the right system incentives to enable providers to increase the quality of their services to older people.
Baroness Finlay of Llandaff
Following the report, Delivering Dignity, which was published today, will the Government instruct Monitor and the Care Quality Commission to require all authorised providers to seek, monitor and act on feedback from patients and their families, and will the Nursing and Care Quality Forum be widened to look at all aspects of care home staffing, root out poor care and ensure that action is taken so that respect of the individual is an “always” event in the delivery of care?
Earl Howe
My Lords, the NHS outcomes framework contains two domains that are highly relevant to this area. The NHS Commissioning Board will be in prime position to monitor those areas of the domains that relate to the patient experience. However, I have no doubt that the CQC will continue to do its work in maintaining essential standards of quality and safety. The Nursing and Care Quality Forum is an independent group and it is therefore for the forum itself to consider how to take forward the issues raised in the recommendation, but I understand that its chair, Sally Brearley, was already planning to consider care homes as part of the next phase of the forum’s work. She has already approached a number of individuals to strengthen the forum’s membership and add further expertise in that area.
Baroness Cumberlege
My Lords, one of the most important levers for change in the Health and Social Care Act is the mandate that has been agreed between the Secretary of State and the NHS Commissioning Board. Does my noble friend consider that one could include some of the principles that are established in this very good report within that mandate?
Earl Howe
My Lords, decisions about the content of the mandate will be made on the basis of a full public consultation, which will take place in the summer. More details on that score will follow in due course so there is a limit to what I can say at the moment. However, as I indicated during the passage of the Health and Social Care Act, the mandate is likely to include expectations for improving healthcare outcomes for patients, based on the NHS outcomes framework. That framework reflects the Government’s ambition for an NHS that provides high quality, safe and effective care, treating patients with compassion, dignity and respect.
Baroness Jolly
What measures will be taken by the national Commissioning Board to ensure that clinical commissioning groups always pay proper attention to dignity when commissioning services for older people?
Earl Howe
I come back to the point that I made to the noble Baroness, Lady Finlay. Domain 4 of the NHS outcomes framework is about ensuring that people have a positive experience of care and reflects the importance of providing that positive experience, including treating patients with dignity and respect. Domain 5, which is about treating and caring for people in a safe environment and protecting them from avoidable harm, also relates to that area. These areas will be centre stage in the way that the NHS CCGs in particular are monitored by the board.
Baroness Wheeler
My Lords, the recommendations of the Delivering Dignity report focus on tackling the underlying causes of poor care in hospitals and residential care. As the Minister knows, there is widespread concern among key stakeholders, including voluntary organisations, care professionals and care providers, about the serious impact that the growing crisis in social care funding is having on providing good-quality care in residential homes. Does this not make it even more vital for the Government to stand by the Prime Minister’s pledge to deal with social care funding and with the recommendations of the Dilnot commission in this Parliament?
The Lord Bishop of Exeter
Given that Delivering Dignity recommends that,
“All hospital staff must take personal responsibility for putting the person receiving care first”,
and that staff “should be urged” to challenge practices that they believe are not in the best interests of residents, what measures have Her Majesty’s Government taken to support staff who whistleblow in this respect?
Earl Howe
My Lords, the right reverend Prelate draws attention to an area that we have focused on quite hard in recent months, and the NHS constitution has been changed to strengthen the areas around whistleblowing. In the care home context, often the care home is looking after someone who is not publicly funded and the arrangements there are often ones that the care home itself has put in place. We believe that the CQC needs to focus carefully on the arrangements in the care homes that it inspects to ensure that staff feel free to speak up if they are aware of any problems of maltreatment or anything of that kind.
Baroness Greengross
My Lords, does the Minister agree with the final recommendation in the report that we need a major cultural shift if we are to get this right? A very simple and straightforward way of ensuring that would be if every person receiving care was protected under human rights legislation. That would simplify this and make it work straightaway.
Earl Howe
The noble Baroness is right. This is about a culture shift and nothing unfortunately can happen overnight. To extend the Human Rights Act to apply to private providers in purely private arrangements in which there is no involvement by a public body would be a radical extension of the Act. The Ministry of Justice leads on humans rights but we will be discussing this recommendation with it and will consider whether further action is needed. However, we need to remember that everyone in a care setting is already protected by the law. I have mentioned to the right reverend Prelate the Care Quality Commission’s registration requirements which set essential levels of safety and quality in the provision of services. Those cover, in a nutshell, the care and welfare of service users, safeguarding service users from abuse and respecting and involving service users. The CQC has extensive enforcement powers to ensure that those standards are met.
Health Research Authority (Amendment) Regulations 2012
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Lord Patel
My Lords, my apologies to the Minister. I was not quick enough to get up. First, I welcome this order, which establishes the Health Research Authority. Like the noble Lords who have already spoken, I ask when we will have further legislation defining all the roles of the Health Research Authority. Can the noble Earl also confirm that this new authority will be required to give ethical approval to all research, no matter how it was funded? I am particularly keen to find out whether research that might be funded by individual trusts or, for that matter, by the department will also come under the ethical scrutiny of the Health Research Authority. Will the authority at this point be promoting research from the NHS, as the new NHS Act requires the foundation trusts and the commissioners to do?
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I start by thanking the noble Lord, Lord Hunt of Kings Heath, for setting out so helpfully the intended roles for the Health Research Authority, which, I think by common consent, is a very positive move forward. It has got off to a solid start. I am grateful to him as well for giving us the opportunity to debate these instruments. They are the second of three steps in the establishment of the Health Research Authority. They amend instruments, laid last year, that established the Health Research Authority in December 2011 as a special health authority with an executive board. That was the first step in fulfilling the Government’s commitment in the March 2011 Plan for Growth to create a new body to streamline the approvals for health research, following an independent review of health research regulation and governance by the Academy of Medical Sciences.
The Health Research Authority was initially constituted with an executive-only board to allow it to begin work quickly on its important agenda. We were able to make suitable interim ex officio appointments from among the initial staff who transferred in.
The instruments that we are debating today provide for the Health Research Authority to have a chair and non-officer members as well, so that it has greater independence and credibility to perform its functions for the purpose of protecting and promoting the interests of patients and the public in health research. That is the second step.
Baroness Emerton
My Lords, the conversation today has been limited to medical and health research. During the passage of the Bill, we had long debates about multiprofessional involvement being included in the research. I am very concerned that the conversation has been very much geared towards medical and health research and has not mentioned the fact that there are healthcare professionals other than those involved with medicine.
Earl Howe
The noble Baroness is right to draw attention to that omission in my coverage of these instruments. Of course, she is right that there are many different kinds of research that will involve the HRA in one form or another. I have emphasised only the medical and pharmaceutical elements of the HRA’s remit, because these matters were high up on the agenda of the Academy of Medical Sciences when it produced its report in the context of UK plc.
However, the noble Baroness should bear in mind my remarks about joining up health research and social care research. The HRA will co-operate with various bodies for the purposes of creating a unified approval process, not just for health research but to promote a consistent national system for research governance generally. Where this includes a social care or nursing element, the HRA will work closely with the relevant bodies to promote processes and standards that are consistent with the NHS and social care elements.
Lord Hunt of Kings Heath
My Lords, I thank the Minister for his positive response. I also thank the noble Baroness, Lady Emerton, the noble Lord, Lord Patel, and my noble friend Lord Turnberg for taking part in this interesting debate. I believe that the appointment and development of the HRA is a positive move forward, and of course we support the appointment of a majority of non-execs. The Minister mentioned the appointment of a chair. I do not know whether that is yet in the public domain or whether he has the name to hand, but it would be helpful to know.
I welcome the publication of draft clauses on the establishment of the HRA as a non-departmental public body in due course.
Earl Howe
My Lords, I am happy to inform the Committee, for noble Lords who were unaware of it, that Professor Jonathan Montgomery was appointed chair of the HRA on 11 June, that interviews for non-exec directors will be held on Friday, that interviews for the substantive chief executive were held on 11 June, and that the other executive members will be appointed by the rest of the new board as soon as possible.
Lord Hunt of Kings Heath
My Lords, that is very helpful. On the question of the reduction of the regulatory burden and the Minister’s reference to improving the cost-effectiveness of the whole process of approvals, that of course is welcome so long as patient consent and confidentiality are maintained and research is ethical. There is common agreement on that. I welcome his commitment to streamlining the approach in general for health research. I also welcome the decision by the devolved Administrations to encompass some of the work within the HRA, particularly the work of research ethics committees, which I assume will mean that cross-UK multi-centre trials will be subject to the streamlined process that the Minister has referred to.
On the role of the National Health Service in encouraging research, I take the noble Lord’s point about the NHS Commissioning Board’s statement of intent. I have no doubt that at that level Sir David and his colleagues will wish to support research. I am more concerned about the individual organisations in the NHS. I do not think that all NHS bodies quite realise the importance of research not only to patients but to UK plc. Anything that can be done to encourage the NHS to recognise that importance is vital. Sometimes that might mean the practicalities of recognising that their clinicians need time to take part in research activities. At a time when the NHS is having to find large efficiency savings, that may not always be welcome to chief execs of NHS organisations or to clinical commissioning groups. None the less, it would be disastrous if practising clinicians in particular were dissuaded or prevented from taking part in research activities. Again, messages on that matter from Ministers and the NHS Commissioning Board are vital.
Academic health science networks, particularly those outside London, are an important development. They will, I am sure, enhance research efforts. Again, the more support that can be given to them, the better. However, it is important that those networks focus on research—there has been some indication that almost everything about their intent is being put into the bath. One needs to come back to the fact that they are about enhancing our research capacity in the interests of the quality of patient services.
I agree with the Minister that the CPRD is a major step forward. We are uniquely attractive, but can we translate that into research money coming to the UK for what undoubtedly can be offered?
The Minister knows that I have always been sceptical about value-based pricing. He said that there was much to do. I urge him and his department to take their time on this matter. The PPRS allows industry flexibility to set the price within a profits cap. Although the UK is not a great purchaser of branded pharmaceuticals globally, the fact that it is able to set a price has an influence on price throughout Europe. My concern is that taking that away might have an impact on industry’s willingness to invest in R&D in this country, given that we so are slow to take up innovative new medicines. We developed NICE to encourage the health service to do that, and it is still a struggle because unfortunately the default position of the NHS and of clinicians is to be slow to invest in and agree to innovation.
If value-based pricing can encourage the NHS towards innovation in the way that the Minister suggests, that is of course to be welcomed. However, looking more generally at the impact of research, we do not seem yet to have a philosophy that goes hard on innovation where it can definitely improve the quality and outcome of patient care. That is to do partly with the conservative nature of clinicians in the UK and partly, probably, with the mindset of finance directors in the NHS. I know that the noble Earl is the Minister for Innovation and that he is wrestling with those issues. It is very important when we look at both research and value-based pricing that we encourage the NHS as both commissioner and provider to do everything that it can to take advantage of the huge amount of innovation that takes place in this country on the back of a fantastic resource in life sciences, in our universities and in the medical devices industry. Overall, we have had a very good debate and I am glad to support these statutory instruments.
NHS: Public Information and Advice
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Lord Sharkey
To ask Her Majesty’s Government whether they plan to review, after an appropriate interval, the comparative performances of public health information and advice campaigns under (1) the new, and (2) the former, NHS architectures; and, if so, when and whether the findings of that review will be made public.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the department continuously reviews the performance of its public health information and advice campaigns. Our investment in campaigns reflects evidence of their effectiveness. Summaries of campaign research are published online as part of our freedom of information publication scheme. Publication typically occurs six months to a year after receipt of the final research report. As evaluation is ongoing, we have no plans to review the impact of campaigns against specific changes to NHS architecture.
Lord Sharkey
I thank the Minister for that Answer. He will be aware that the country faces an epidemic of obesity, with predictions that nearly a half of all adults could be obese by 2030. He will also know that changing childhood eating habits is the key to addressing this problem. What long-term plans do the Government have for information and advice campaigns aimed at influencing childhood eating habits?
Earl Howe
My Lords, my noble friend is absolutely correct to highlight the importance of preventing obesity, particularly obesity in the young. He will be reassured to know that the Change4Life Campaign, which we have continued from the previous Government, will include this as a major focus into the future.
Baroness Gould of Potternewton
My Lords, in light of the fact that the Minister talked about having a review, have the Government given any reconsideration to the need for a specific national prevention campaign designed to reduce the number of HIV infections? Does he accept that there is a necessity to reduce the increasing level of transmission, not only because it is spreading into non-high-risk groups but also because of the cost of treatment, which is extremely costly indeed? It seems to me that there is no question that the long-term savings would be substantial compared to the cost of a national campaign. Can the Minister also clarify the future of the two current targeted HIV campaigns?
Earl Howe
My Lords, I share the noble Baroness’s concern. She has highlighted a major area on which Public Health England and local authorities will wish to focus going forward. This is the great advantage of the architecture that we have put in place, with health and well-being boards responsible for determining local needs and the way in which to address them. Public health awareness campaigns have their place but they are not the total answer. The noble Baroness has drawn attention to the importance of having sufficient treatment facilities, and access to them, available. So, with the support of Public Health England at a national level, local authorities should be addressing sexual health as one of their key areas.
Baroness Gardner of Parkes
My Lords, as the Minister has said, the situation is constantly being evaluated. Has he looked into the recent problems of patients who cannot see displayed the costs for National Health Service dentistry procedures? Would it not be a good idea to set up an online application so that patients can see the information for themselves, with a simple form to fill in that lets them know what they should be paying before they go? That would remove all the arguments about whether or not there is a notice in the waiting room.
Earl Howe
My noble friend is right. Many dentists are good at conforming to the terms of their contract, which means making it clear to patients what it will cost them to have a particular course of NHS treatment. Other dentists, I am afraid to say, are less scrupulous. It is part of the contractual arrangement that dentists should be open on that score and it is an area to which we are currently devoting a good deal of attention.
The Lord Bishop of Blackburn
My Lords, one of the most startling ways that deprivation is measured is by health inequalities. We are all aware that, under the Act, the responsibility for public health passes to local authorities. As I understand it, local authorities do not have a duty under the Act to prioritise the reduction of health inequalities. How will the Government use the non-legislative processes open to them to reduce inequalities, especially with regard to local authorities?
Earl Howe
The answer to the right reverend Prelate, who makes a good point, is that clinical commissioning groups do have and will have a duty to bear down upon health inequalities and to ensure that they look after not only the patients on GP lists but the unregistered patients in their catchment areas as well. What we expect to see emerging from the joint health and well-being strategies coming out of the health and well-being boards is account being taken of those hard-to-reach groups in society who may not be on the immediate radar of GPs, but whose needs are nevertheless extremely acute and will have to be factored into commissioning plans.
Lord Hunt of Kings Heath
My Lords, first, I declare my health interests which are set out in the register. Perhaps I may take the noble Earl back to the decision of his department to reduce the number of national campaigns in relation to public health. A survey by the Association of Directors of Public Health published at the weekend shows that, in the transfer to local authorities, there has been a loss both of capacity and of funding. Given that, how can he justify the emphasis on local campaigns at the expense of national focus programmes?
Earl Howe
My Lords, there will be national focus programmes led primarily by Public Health England, but we see those as complementary to the work going on at the local level. By no means are we abandoning national campaigns. Indeed, we have seen considerable successes. In 2010-11 we invested almost £11 million to support 59 cancer awareness campaigns around the country. In 2011-12 we provided £8.5 million to support a range of cancer awareness campaigns, and this year we hope to spend even more on cancer awareness than we have in previous years.
Baroness Oppenheim-Barnes
My Lords, what is the reaction of the NHS to the explosive headlines appearing daily in newspapers about new cures, magic pills and other things of that nature? Surely these are being trialled for the NHS, which must be creating new demands every day as a result. Does the service have a plan to deal with this?
Earl Howe
The key is to make available to the public accredited sources of information because there is an awful lot of unaccredited information available. Through mechanisms such as NHS Choices and NHS Evidence, people can now see online not only what best practice looks like, but what clinical trials are available for the latest drugs and treatments. My noble friend is right; we have to direct people to the right sources of information.
Social Care: Legislation
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Baroness Wheeler
To ask Her Majesty’s Government what is the timetable for the draft Bill to modernise adult care and support in England announced in the Queen’s Speech and to what extent the proposals in the Bill follow the recommendations of the Dilnot commission.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government have committed to publishing a draft Bill for pre-legislative scrutiny this Session, and will outline plans for transforming care and support in the forthcoming White Paper. The Dilnot commission’s recommendations are hugely valuable. However, implementing them would have significant costs, which must be considered in light of the growing demand for social care, and of other priorities. We will set out the way forward in the progress report alongside the White Paper.
Baroness Wheeler
I thank the Minister for his response. However, with local authorities having to cut £1 billion from current social care budgets, does he not agree that there must be a package of reforms that will embrace current and long-term funding solutions, as well as the legal framework proposals expected in the White Paper and Bill? Will he reassure the House that the progress report accompanying the White Paper will contain a clear timetable for consultation on funding issues? Will he also reassure us that the Government intend to honour the Prime Minister’s pledge to deal with social care funding in this Parliament?
Earl Howe
My Lords, this is the first reform of social care law in more than 60 years. It is a unique opportunity to get the legal framework right. That is why we have deliberately taken time to engage fully with those who have experience and expertise in care and support. Many people in the sector have called explicitly for scrutiny on a draft Bill, so publishing a Bill in this way demonstrates our commitment to working in partnership. We remain absolutely committed to introducing legislation at the earliest opportunity in this Parliament to establish a sustainable legal framework for adult social care. The draft Bill will be the critical next step in delivering the reform agenda.
Baroness Finlay of Llandaff
Will the Government reassure us that in considering adult social care they will also take into account the transitional needs of children with very complex needs as they grow older and transition to adult care, because many of them are in the last phase of their illness and will die in early adulthood?
Baroness Barker
My Lords, the Government will be aware of the report, Reforming Social Care: Options for Funding, published by the Nuffield Foundation in May. What is their response to the proposal that some universal benefits that currently go to wealthy pensioners should be restricted to enable the implementation of the Dilnot report?
Baroness Pitkeathley
My Lords, the Minister will know that many older people are concerned not only about how they will fund residential care, should they need it, but also about its quality. How will the White Paper ensure adequate and indeed satisfactory quality for the delivery of residential care, and also the competence of those who deliver it?
Earl Howe
As the noble Baroness will know, one of the main reasons that we wanted to engage widely in recent months with the sector was the very issue that she raised. The quality of social care, the training of those in the workforce and the supply of carers, both paid and unpaid, are concerns going into the future. As the noble Baroness will find out, this will be a major focus of the White Paper.
Baroness Greengross
My Lords, will the Minister reassure some of us who have worked closely with the Dilnot recommendations that the Government will take into account the huge savings to the NHS which, following the initial costs, will result from implementing the proposals? The cost of implementation is very limited compared with the huge annual costs of such care to the NHS. Adequate social care will remove much of that from the NHS.
Earl Howe
I take the noble Baroness’s point. Nevertheless, she will recognise that Ministers in government cannot ignore cost pressures arising from proposals such as those of Dilnot. We have calculated those costs at £2.2 billion. This is not money that can be drummed up easily. Nevertheless, we are looking at ways in which to address that particular issue.
Baroness Gardner of Parkes
My Lords, is the noble Earl telling us that the Bill will be only about funding? Following the point raised by the noble Baroness, Lady Pitkeathley, can he assure us that there will be some sort of new training for those who will be doing a job that is half-way between that of a carer and that of a nurse? By losing the SENs we have lost a very powerful and useful facility that can operate in the middle. Surely there is a need for someone to bridge the gap between health and social care.
Earl Howe
My Lords, my noble friend raises an important issue, and I am sure that there will be an opportunity during the Bill’s passage to debate the subjects to which she referred. The draft Bill will be published after the Government publish their White Paper and the progress report on funding, and the Bill will set out the legislative framework for adult social care in the future. I have no doubt that noble Lords will wish to raise issues pertinent to that.
Baroness Hollis of Heigham
My Lords, the Minister has referred to drumming up finance for long-term care for older people. He will be aware that higher rate tax relief on pensions—as part of the total of £30 billion of tax relief—amounts to £7 billion a year. Were that money ring-fenced and redistributed within the same age group it could pay for Dilnot three times over. Will he consider looking at that as a source of funding for Dilnot?
Lord Skelmersdale
My Lords, recent press reports—in fact, they are not that recent—have concerned the quality of care, not least the care given by care assistants. In their consideration of this matter will my noble friend and his department consider the registration and suitability of care assistants?
Earl Howe
My Lords, as my noble friend will recall, we debated this subject extensively during the passage of the Health and Social Care Act. The Government’s position is that voluntary assured registration is the way forward for the time being. However, we have not closed our minds to statutory regulation in this area.
Health: Local Healthwatch Organisations
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Lord Collins of Highbury
To ask Her Majesty’s Government what progress is being made on establishing local Healthwatch organisations and what steps they will take to ensure that their commissioning and administrative costs are kept to a minimum.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, 75 local Healthwatch pathfinders have generated learning for all local authorities to use. The Local Government Association is working with all local authorities, including holding a series of master classes, and the Government are undertaking targeted engagement on local Healthwatch regulations until mid-June. The Government have made £3.2 million available for start-up costs and information is being made available on commissioning and procurement options.
Lord Collins of Highbury
I thank the Minister for that response. Only one local Healthwatch organisation will be contracted in an individual local authority, but the body itself will be permitted to subcontract most if not all of its activities. What are the department’s estimates for the overall cost of multiple contracts, solicitors’ fees and all the other on-costs of commissioning? Can the Minister also explain how fragmenting local Healthwatch organisations in this way will provide the strong and co-ordinated voice for patients and their carers that we need for real local scrutiny and accountability?
Earl Howe
My Lords, the noble Lord is absolutely right to raise the question of the cost-effective commissioning of Healthwatch and I have no doubt, from the Local Government Association, that both the efficient and effective functioning of Healthwatch is something that is well within its sights. The noble Lord has raised a series of hypotheses which I think are somewhat extreme, of local Healthwatch organisations parcelling out their functions all over the place. Our aim is to have as locally inclusive a body as possible in each local Healthwatch area to enable Healthwatch to perform its functions as much by itself as with the aid of others. Indeed, the pathfinder events to which I have referred have been clear that there is a local appetite to do that.
Lord Kakkar
My Lords, how do Her Majesty’s Government propose to mobilise interest, enthusiasm and participation in local Healthwatch organisations by patients and members of the public?
Earl Howe
We are working with the Local Government Association and the Care Quality Commission to provide support for the implementation of local Healthwatch organisations. As I mentioned, the LGA is running a series of master classes for local authority commissioners. It has published 15 case studies taken from the 75 Healthwatch pathfinders, and a small number of Healthwatch experts will be available to help spread learning. As regards making the public aware, it will be very much for local authorities to decide what is appropriate in their particular areas in order to ensure that patients and the public are engaged in the important work of Healthwatch and understand what the statutory remit of local Healthwatch consists of, because that is the only way in which local Healthwatch will make its voice truly heard.
Baroness Masham of Ilton
My Lords, will local Healthwatch members be able to support members of the public if they go to a tribunal?
Earl Howe
One of the potential functions of local Healthwatch is to act as a support in terms of advocacy for local people and to signpost patients and the public to appropriate services. It is too early to say which local authorities will commission what services from local Healthwatch in an area, but the resources available to local Healthwatch have to be borne in mind in that context.
Baroness Cumberlege
My Lords, does my noble friend agree that in the light of the comparative studies that have been made between different health systems in developing countries, it is very disappointing that the National Health Service comes last out of seven when it comes to patient and public involvement? It does well on other factors but not on this one. Does my noble friend agree that although taxpayers’ money must always be very well spent, really strong patient and public involvement will ensure that healthcare is improved?
Earl Howe
My Lords, I firmly believe that, and that is why the NHS outcomes framework specifically includes a domain relating to patient experience. As we go forward, I think patients will come to realise that their voice really counts. It is about a culture change—I do not wish to wriggle out of that. This is not going to happen overnight, but it is very important that commissioners and providers in the health service are fully engaged with patients, and vice versa, to ensure that the patient’s voice—and indeed the patient’s needs—are right at the centre of commissioning and provision.
Lord Brooke of Alverthorpe
My Lords, on the same theme, if patients are to be at the centre of the new arrangements, and the Government are handing this over, at least for the time being, to local authorities to ensure that they are participating in the new structure, is the Minister content that this arrangement will truly ensure full patient involvement right across the whole country? When will there be a review of the arrangements if they are not working?
Earl Howe
My Lords, of course we want to see the system working properly. It will be part of the role of Healthwatch England to provide information and best practice advice to local Healthwatch to make sure that local authorities are commissioning both effectively and efficiently. In that sense, there will be national oversight of what happens. Inherently, with the reports that local Healthwatch organisations will have to produce annually on the way that they fulfil their role, there will be transparency on how effective they are being, not just in delivering services but in involving all sections of the community in what they do.
Care Homes
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Baroness Bakewell
To ask Her Majesty’s Government what plans they have for making sure that care home ownership delivers consistent and long-term care.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Care Quality Commission, as regulator of health and adult social care services in England, is responsible for providing assurance that all care home operators, whether in the public or independent sectors, meet regulations that set essential levels of safety and quality.
Baroness Bakewell
I thank the noble Earl for that Answer, but it does not quite meet the background that has arisen since 30 April, when the private equity firm Terra Firma acquired Four Seasons Health Care, which is the largest elderly care provider in the UK. Given that equity firms often favour a short-term business plan model, and in the light of the collapse of Southern Cross, would the Government consider a “fit and proper person” test for care home ownership?
Earl Howe
My Lords, I am aware that this idea is circulating. Recent events have taught us that intelligence about the market and scrutiny of providers should be better. However, we are not convinced that a “fit person” test is necessarily the right approach. Having said that, we will be setting out our proposals shortly and we will consult on those, so there will be an opportunity for the sector to input its views. We should bear in mind that anyone who registers with the CQC as a provider of care must by law be of good character and have the necessary experience. The provider is also required to notify the CQC of any convictions or cautions against them and of any voluntary insolvency arrangements involving them.
Baroness Howarth of Breckland
My Lords, does the Minister agree that one of the greatest inhibitors of long-term, consistent care is funding for individual placements? I speak and declare an interest as the president of Livability, which delivers long-term care for some elderly and a large number of younger disabled people. The great difficulty is ensuring that local authorities will commit to funding in the long term at an appropriate level.
Lord Elton
My Lords, does my noble friend agree that the delivery of a caring and efficient service is dependent not only on training but on character? Is it not true that throughout the health service, and not merely in this area of welfare, there has been a sad departure from reliance on something which was fundamental to the hospital service when it was invented: tender loving care? When will there be an insistence that the right sort of people are admitted to the profession of caring for the elderly and the sick, as well as on proper training?
Earl Howe
My noble friend makes an excellent point. I expect he knows that in the selection process for nurse training, greater emphasis is now placed on the applicant’s suitability as a person to undertake caring duties. As regards healthcare assistants who may not be qualified, it is of course up to the employing organisation to make checks of that kind. We believe that to be a variable practice. We need to focus on that issue more than ever.
Lord Campbell-Savours
My Lords, why does the Minister not reply directly to the question of my noble friend Lady Bakewell? What, in principle, is wrong with a “fit and proper person” test to apply in these cases?
Earl Howe
My Lords, as I made clear earlier, there is already a test for those people who are in charge of a care home. The CQC has procedures to verify the acceptable status of such people. Furthermore, there are very strict rules under the Financial Services Authority regulations, which require company directors to pass a “fit and proper person” test. We are not sure what added value might be conveyed by a further test, as the tests are already there.
Baroness Tyler of Enfield
My Lords, given the very great anxieties experienced by care home residents and their families on this issue, what steps are the Government taking now to prevent another Southern Cross situation arising, in both intelligence gathering and strengthening the regulation and oversight of the sector?
Earl Howe
My Lords, the Government are working with the Association of Directors of Adult Social Services and the Care Quality Commission. We are gathering greater intelligence on the social care market and its major providers, which will be used to give early warning of impending problems. We will continue to meet regularly with the major care providers to discuss their trading performance, their financial situation generally and how they are addressing any issues which put pressure on their ability to continue trading.
Lord Elystan-Morgan
My Lords, perhaps I may raise a technical point in relation to a situation that exists under the Companies Act where a company is threatened with financial difficulties. The noble Earl will be aware that under the Act, to continue trading is a serious offence if there is a danger—not just a certainty—that the company will not be able to meet its financial obligations. Successive departments in successive Governments have properly intervened in the interests of patients. They were probably committing a serious criminal offence. Will the Minister look at the situation so that the law may be relaxed in the interests of patients and of the community in general?
Earl Howe
The noble Lord made a very good point. As he will know, there are existing oversight and regulatory frameworks, with the CQC regulating the quality of care and support services and local authorities overseeing local providers. The point made by the noble Lord is a major part of why the Government are engaging with the sector, as I described just now to my noble friend. The main point to stress is that under the existing system no one will be left homeless should a provider fail. In an emergency, local authorities have a duty to provide accommodation to anyone, whether they are publicly funded or self-funded, who has an urgent need for it.
Baroness Wheeler
My Lords, this summer the Care Quality Commission is conducting thematic inspections of dignity and nutrition in 500 care homes with nursing provision. Does the Minister agree that these will be vital in providing evidence and guidance to ensure improved standards of care? Will he assure the House that these inspections will go ahead despite the commission’s increased responsibilities and workload resulting from implementation of the Health and Social Care Act and other government policy initiatives?
Earl Howe
My Lords, the noble Baroness is right; this is very important work. I am led to understand by the CQC that the programme is due to proceed as planned. We will place a great deal of reliance on its findings. In the light of recent distressing and unfortunate stories about the absence of dignity in certain care settings and the shortcomings in care quality, it will be important to learn lessons from the CQC’s programme.
NHS: Health Tourism
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Baroness Gardner of Parkes
To ask Her Majesty’s Government what is the cost to the National Health Service of international health tourism, and whether the Home Office has consulted the Department of Health on appropriate assessments of likely health needs or conditions before issuing visas to visitors to the United Kingdom.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, estimated written-off debt for NHS treatment provided to chargeable overseas visitors in 2010-11 was £14 million. However, this will include debts for visitors requiring unexpected treatment as well as those actively seeking NHS treatment to which they are not entitled. On 21 May, the Home Office announced the introduction of pre-entry screening for tuberculosis for long-term migrants from countries with high TB incidence. The department and the Health Protection Agency worked with the Home Office to review current arrangements.
Baroness Gardner of Parkes
That is a considerable increase. In his Written Answer last year, the noble Earl gave the figure for the previous year as under £7 million, so the amount has doubled. I do not know whether the £14 million includes the previous £7 million, but obviously the amount is growing. In the same Written Answer, he said that the Home Office was now consulting. On screening—for TB, for example—does the visa application ask applicants to declare any pre-existing medical condition, as is the case in many overseas countries?
Earl Howe
My Lords, the Home Office, with our agreement, drew up a list of high-risk countries where TB was prevalent. In those countries, if someone seeks a visa to come to this country for six months or more, they will have to undergo TB testing. Questions on other medical conditions are not relevant in this context. We do not screen for other things. TB is an exceptional case because it is an airborne disease and poses a public health risk.
Lord Kakkar
My Lords, what assessment have Her Majesty’s Government made of potential future health tourism from eurozone countries facing imposed austerity measures and cuts to their own local healthcare provision?
Earl Howe
The best answer I can give the noble Lord is that this entire area of health tourism is one which we in the department are looking at extremely closely. A review has been carried out by officials and Ministers are considering the recommendations flowing from that. It is a complex set of issues but clearly the context to which the noble Lord rightly refers will need to come under the spotlight.
Lord Roberts of Llandudno
My Lords, if this is devolved to Scotland, Northern Ireland and Wales, how are the Government relating this particular problem to the Assemblies and the Parliament?
Baroness Boothroyd
My Lords, when I travel abroad on holiday, which I am happy to say I do quite often these days, I have to carry health insurance and it is quite expensive. Because of my age and various other problems I have to take it out each time I go on holiday. I will not tell you how many times a year that is. What happens in reverse when people come here on holiday? Is it required of them to carry health insurance in case they have any problems here?
Earl Howe
The rules are complex, depending on whether the person is from the European Union, where certain rules apply, or from other parts of the world. There is no mandatory requirement for people to carry health insurance unless there is a transparent medical need when they enter the country. For example, a heavily pregnant woman might be asked to produce proof that she could pay for treatment if giving birth was likely. There are clear rules for NHS trusts where a patient who is chargeable presents. The trust must seek either to secure payment before treatment or to bill the person immediately afterwards.
Lord Foulkes of Cumnock
My Lords, in answer to the question asked by the noble Lord, Lord Roberts of Llandudno, the Minister rightly described the situation as it currently is. Is the Department of Health doing any study into the disaster that would happen in terms of healthcare between Scotland and England if Scotland were to separate from the rest of the United Kingdom? If it is not doing a study, why not?
Earl Howe
My Lords, were that situation to occur, the issues arising from it would be little different from the issues today in that health is already devolved. However, I cannot speculate on whether there would be a different policy on immigration in Scotland compared to south of the border as we are really not in that territory yet.
Lord Swinfen
What checks are actually carried out to ensure that patients are entitled to free National Health Service care?
Earl Howe
My Lords, it is incumbent on NHS trusts when a patient presents directly to them to ensure that the person in front of them is entitled to NHS care, and they have various means of doing that. However, primary care in this country—care delivered by GPs—is not subject to any checks of that order.
Baroness Farrington of Ribbleton
My Lords, would somebody from anywhere in the world who had a British passport be entitled to NHS treatment were they to be in this country at the time of need?