Health: Healthcare Assistants
Earl Howe Excerpts(13 years, 8 months ago)
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Baroness Wall of New Barnet
To ask Her Majesty’s Government whether they have any plans to regulate healthcare assistants by establishing minimum standards and a code of conduct to ensure the protection of patients.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, there are provisions in the Health and Social Care Bill to enable the Council for Healthcare Regulatory Excellence to establish a process for accrediting voluntary registers for healthcare workers. Assured voluntary registration for healthcare assistants would build on existing safeguards such as the Care Quality Commission’s registration requirements and the vetting and barring scheme, and would include setting national standards for training, conduct and competence for those on the register.
Baroness Wall of New Barnet
I thank the noble Earl for his response, but is he aware of the worry and concern he has caused in his comments in the Times this morning? At my hospital, the director of nursing is very concerned that there are many reasons why nurses are reported to the statutory body and some of that can just be that they are not caring properly. The noble Earl’s remarks do not take that into account. Will he also accept, in a positive way, that many healthcare assistants would like to be regulated so that they can assure their patients and themselves that the skills they have and the service they are providing are of the very best?
Earl Howe
I agree with the latter part of the noble Baroness’s question in so far as I am quite sure that many healthcare assistants would like to be recognised for their skills. The question is whether statutory regulation or voluntary registration is the best and most proportionate route to achieve that. As regards the first part of her question, I regret the slant that the Times took on my remarks, because if a nurse has been struck off because they are considered to pose a risk to patients, then they must be referred to the Independent Safeguarding Authority, which would have the power to bar them. On the other hand, if a nurse is struck off for, say, misprescribing drugs to patients but is still capable of performing care tasks such as washing and bathing, they could still work as a healthcare assistant under appropriate supervision—depending on the circumstances. So there is no blanket prescription in this area; one has to look at the competencies of the individual and whether they are safe to work with adults.
Baroness Gardner of Parkes
My Lords, the same article in the Times referred to people without any experience whatever being appointed as healthcare assistants. While that might be splendid in terms of more people helping in the hospital, is it not important to develop training standards of some level to replace the lost SENs—state-enrolled nurses—and to be sure that these care assistants are reasonably competent in what they are being asked to do?
Earl Howe
I agree with my noble friend and it is why we are proposing a system of assured voluntary registration that would provide those training standards. We need to bear it in mind that the health and social care sectors are already subject to numerous tiers of regulation, including the important requirement on employers who are providing regulated activities to use only people who are appropriately trained and qualified. That means taking up references, having proper induction processes and so on. No national set of arrangements absolves employers of their responsibility to ensure that the people they are employing are suitable for the roles that they are fulfilling.
Lord Low of Dalston
My Lords, does not the problem lie with nursing having been made a wholly graduate profession, whereby nurses are taught nothing but theory and not how to nurse people at all? Indeed, I recently heard a nurse on the radio complaining that being asked to minister to the needs of patients was very inconvenient because it got in the way of completing their paperwork. Should it not be the case that nurses are taught the traditional skills of nursing that are directed at meeting patients’ needs, and that if nurses are to be helped by healthcare assistants it is important that the job of nurses is not simply delegated to the kind of untrained people that the noble Baroness, Lady Gardner of Parkes, was talking about?
Earl Howe
I can agree in part with what the noble Lord says. I do not agree that the training of nurses is skewed against what one might call the traditional caring activities that we associate with nursing, because my understanding is that the division is around 50:50 between the academic and practical elements of the training. We recognise the important contribution of nurses, not just in the new roles that they have taken on but in the fundamental aspects of care. They have the reach and relationships to improve outcomes and experiences for patients. We are doing our best to support them by various means.
Baroness Thornton
My Lords, I often take my lead from the noble Baroness, Lady Masham. In an article in the Times today she said that a voluntary register was no cure. This, taken with the confusion created by, I am afraid, the noble Earl’s remarks about struck-off nurses, underlines the point at issue. I ask the Minister: is it really satisfactory that there is a chance that no one would know that a nurse was a struck-off nurse? Is it satisfactory that thousands of nursing care assistants are taking blood and carrying out procedures, but patients cannot know whether they are on a register and properly regulated? That is the problem. The noble Earl needs to think about the kind of juggernaut that is heading towards him on this one.
Earl Howe
No, it is not satisfactory that people should not know that a nurse has been struck off and is on the barred list. That is why it is incumbent on employers to make exactly those inquiries when taking on a new employee. As regards patients, the presence or absence of statutory regulation will not change one jot the responsibilities of employers or the responsibility of nurses to delegate appropriately on a ward or in a care home. Unsupervised, unregistered healthcare assistants should not be working without the proper authority and supervision.
Health: Obesity
Earl Howe Excerpts(13 years, 8 months ago)
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Lord McColl of Dulwich
To ask Her Majesty’s Government what action they are taking to address rising levels of obesity.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government are committed to tackling obesity, which has serious consequences for individuals, the NHS and the wider economy. The Government recently published A call to action on obesity in England, which sets out how obesity will be tackled in the new public health and NHS systems and the role of key partners.
Lord McColl of Dulwich
I thank my noble friend for that reply. Would he kindly consider launching a campaign comparable to that launched by my noble friend Lord Fowler in the 1980s, which was so striking and so very effective?
Earl Howe
I agree with my noble friend about the campaign launched by our noble friend Lord Fowler, which was extremely effective. We recognise that excess weight is a really serious problem. That is why we have set out what we believe is an ambitious approach to dealing with it. We are radically overhauling the public health system. We are working with business to go further and faster on making it easier for people to make healthy choices for themselves and their families. We are also continuing to invest in programmes such as Change4Life. The Government cannot solve the problem on their own but we can encourage and support a wide range of partners to play their part. The call to action sets out how we are going to do that.
Lord Brooke of Alverthorpe
My Lords, will the noble Earl please explain how people can be expected to take personal responsibility for sorting out their health problems when so much information about the food and drink they consume is kept from them? Can he please also explain why the Government are failing to press the drinks industry to show the number of calories in alcoholic drinks on the labels, and declining to meet the industry and press it accordingly?
Earl Howe
I am not aware that we have declined to meet the drinks industry; the noble Lord may know something that I do not. We talk regularly to the drinks industry. As he will be aware from a Question tabled in this House the other day, the result of the European nutrition labelling regulation is that we now have the flexibility in this country to construct rules that suit us. That includes encouraging the drinks industry—and I believe that it is willing to do it—to place energy information on its labels.
Baroness Trumpington
My Lords, does the Minister realise that some of us eat like sparrows but end up like turkeys? Does the publication which he spoke of cover the situation of those of us whom I have just spoken of?
Earl Howe
My Lords, my noble friend makes what is in fact a very complex point. Many of us believe that there is a genetic element to this, and indeed the 2007 Foresight report underlined the complexity around the causes of obesity. Genetic, psychological, cultural and behavioural factors all have a part to play in it. I do not have specific advice to give my noble friend—far be it from me to do so—but there is obviously a balance to be struck between calories in and calories out.
Baroness Thornton
My Lords, if the Royal Society of Paediatricians, other medical organisations, Which? magazine, Jamie Oliver and many others regard the Secretary of State’s most recent obesity announcement, which presumably is based on corporate relations and the nudge theory, as, variously, “worthless”, “patronising” and “inadequate”, does the noble Earl regard this as people not understanding Mr Lansley—again—or could it be that the obesity strategy is actually not adequate and the Government need to go back to the drawing board?
Earl Howe
It is only inadequate if we as Government fail to work with partners as we have the ambition to do. We do have that ambition, and obviously we are disappointed by some of the reactions that have been published. However, we share the concerns expressed by Jamie Oliver and the bodies mentioned by the noble Baroness that urgent action is required to tackle obesity, and we all have a role to play in that.
Lord Lawson of Blaby
My Lords, as someone who has been there and done that, and indeed written a book about it, may I say to the noble Earl that he is absolutely right that this is not something that the Government can do on their own—indeed, may I suggest that it is not something that the Government can do at all? There is a genetic element, which the Government cannot do anything about, and the rest is about eating less and drinking less. If the Government were more concerned about doing something about the economy, where they do have a responsibility, and less about obesity, that might be sensible.
Earl Howe
My Lords, the fact is, as was recognised in our report, that most of us are eating and drinking more than we need to and we are not active enough. Being overweight or obese is a direct consequence of eating more calories than we need. Increasing physical activity is important but reducing the calories we consume is clearly key to weight loss.
Lord Maxton
My Lords, does the Minister agree that exercise is a vital part of tackling the problem of obesity? If the Government insist on local authorities cutting back on their expenditure, will not those same local authorities close gymnasiums, leisure centres and swimming pools, and sell off their playing fields? How does that help us to tackle obesity?
Baroness Hussein-Ece
My Lords, unlike the noble Lord, Lord Lawson, I have not really been there and done it, but I am full of admiration for him that he has. However, is it not shocking that 25 per cent of children aged between two and 15 are now classified as obese? Does the Minister share my concern that this serious public health problem is not simply a question of celebrity chefs or of parents being lectured about lunch boxes, it is about educating children and families on how to prepare fresh, healthy food? Is there any evidence that this is being done consistently?
Baroness Howarth of Breckland
My Lords, I know that the Ministry is very keen on co-ordination, and I am sure that one of the reasons why the team from the Food Standards Agency was moved into the Department of Health was to ensure that it could work on these issues. The Minister will remember that this team was outstandingly successful in its work on the salt campaign and was moving on to work on fat and sugar, which would have helped with the obesity problem. I understand that the team is now being disbanded. Is that sensible in the light of the Question of the noble Lord, Lord McColl?
Nursing: Elderly and Vulnerable Patients
Earl Howe Excerpts(13 years, 8 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, it is the responsibility of the Nursing and Midwifery Council, the NMC, to set educational standards that higher education institutes’ educational programmes must abide by. The Nursing and Midwifery Professional Advisory Board, the PAB, brings together all relevant stakeholders, including representatives from the service, professions, NMC, Royal College of Nursing, Unison and the higher education institutes, and is well placed to advise the department on workforce education and training matters.
Baroness Gardner of Parkes
I thank the noble Earl for that reply. Does he agree that while we are all pleased to see graduate nurses achieving new heights, there is considerable concern, following the abolition of SENs, about the loss of those caring, practical nurses who did not require university entrance levels? Has he seen Sheila Try’s report, Why is Nursing Failing? A Student Centred Action Plan, and, if not, will he ask his department to look at that?
Earl Howe
My Lords, we do value the contributions that SENs provide, those who are still in practice. It is certainly the case that the NMC no longer approves programmes for nurses on part 2 of the register and there are no plans to reintroduce educational programmes to part 2 of the register. What we have done is to develop guidance on widening the entry gate to preregistration programmes for those individuals who show the necessary values and behaviours but who otherwise do not possess the traditional academic qualifications. I am aware of the report that my noble friend mentioned. Sheila Try has written to me and I have asked the department to consider the recommendations that she has made.
Lord Rooker
Does the Minister agree that it is a very valuable report? If I may remind him, on 31 March in this House when we had a debate on nursing care I asked him if he would meet Sheila Try. Following the question asked by the noble Baroness, I respectfully ask him to study the latest report by this trained nurse, who makes very valid points about what has gone wrong with the training of nurses in the last 25 years.
Baroness Masham of Ilton
My Lords, does the noble Earl agree that district nurses do a very important job in keeping vulnerable, elderly and disabled people in the community? Is he aware that there is a shortage and that their training needs to be different because they go into other people’s homes?
Earl Howe
The noble Baroness, as ever, makes a very important point. It is one of the reasons we have a very ambitious programme of expanding the number of health visitors. She is right about tailoring the training to suit the environment. That is why there are local curricula as well as the core nursing curriculum that have approved standards from the NMC but are sensitive to local needs in individual areas.
Lord Elton
My Lords, when Florence Nightingale initiated the growth of modern hospitals, the most important thing she did was to insist that nurses should deliver what she called “tender, loving care”, which later became known as TLC, and remained so when I was in hospital in my middle age. Is it not time that the National Health Service assessed the personality of people seeking to embark on nursing careers to see whether it contained enough compassion?
Earl Howe
My noble friend is quite right and there is now a renewed emphasis on that very point, with initiatives to help the nursing workforce practise to the highest clinical standards. These include Essence of Care, which outlines quality provision of the fundamentals of care, and Confidence in Caring, which improves nurse interaction with patients. While national initiatives such as those can stimulate thinking and offer guidance on best practice, it is really the local nurse leaders, team leaders, ward sisters and matrons who are key to setting and maintaining standards for quality and safety in their own clinical areas.
Baroness Emerton
My Lords, state enrolled nurses’ training was discontinued on the mere fact that those nurses were being abused and misused, because they were being asked to do tasks that were above the level of their competence. We are in the same situation now with these healthcare support workers, who are not trained to a level where they can accept the tasks being delegated to them. I ask the Government to look at this, because we cannot continue to misuse those support workers in the way in which we are—by their being given tasks which they are not suited to.
Earl Howe
The noble Baroness, with her expertise, makes a powerful point. We fully agree that there is an issue over unregistered healthcare assistants; I think the debate is around what we should do about it. We believe that the case for statutory regulation has not been made, although we would not close our minds to it. The point that the noble Baroness makes relates much more to nursing supervision, appropriate levels of delegation on a ward or in a care home, and appropriate supervision and training. That is a matter not for regulation but for nurse leaders in hospitals and care homes.
Baroness Thornton
My Lords, this is yet another report to add to others highlighting these issues. I think that the Minister has gone some way to explaining what change is needed, so that elderly people get treated in hospitals with the respect and dignity they deserve. However, how does he suggest that the nursing community should resist dangerous cost-cutting exercises by trusts, which are placing patient safety at risk by replacing experienced clinical staff with more junior nurses and healthcare assistants?
Earl Howe
We believe that patient safety is paramount and that it is a matter not just for staff on a ward but for the board of an organisation as well, to assure itself that the highest standards are being maintained. That means having proper staff ratios—ratios of staff to patients, that is—and ratios of trained and untrained staff within a ward. These are messages that we are consistently putting out.
Medicines Act 1968 (Pharmacy) Order 2011
Earl Howe Excerpts(13 years, 8 months ago)
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EU: Food Labelling
Earl Howe Excerpts(13 years, 8 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we welcome the new regulation. The UK has led the way in Europe in improving nutritional information for consumers. Access to nutritional information supports consumers in choosing a balanced diet and can help in controlling calorie intake. The regulation meets our main negotiating objectives and will give the UK freedom to maintain and build on existing practice.
Baroness Oppenheim-Barnes
My Lords, I am a little astonished by that response. Is my noble friend aware that I have campaigned for many years in your Lordships’ House for clear, uniform food labelling on pre-packaged goods for easy comparison? The FSA produced such labelling, which I understand was approved by all five Select Committees but was rejected by the EU, which has now produced something futile, pathetic and unenforceable, to put it mildly. Does my noble friend agree that it is time for the proverbial worm to turn and to tell the EU that we do not want its version—we prefer our own?
Earl Howe
My Lords, I am not sure that I would accept the epithets that my noble friend has applied to this regulation. We have led the way in these negotiations. It is true that it has taken some time but we have come away with most, if not all, of our key objectives met. Nutritional information will now be displayed in a consistent manner on the back of all pre-packed foods, which is a major plus. A voluntary approach has been secured for front-of-pack nutrition labelling and for non-pre-packed foods, including those sold by caterers. It will also be made easier for alcohol companies to include energy information on their products on a voluntary basis. This will give people the information they need to make informed choices about what they eat and drink, which is the whole idea.
Baroness Howarth of Breckland
My Lords, is that truly the view of the Foods Standards Agency? I understand that we have different policies being developed in England, Scotland and Wales, but without differences being truly ironed out. I also understand that we have three departments—Defra, the Foods Standards Agency and the Department of Health—working at this in England alone. Does the noble Earl not think that there is room for confusion and a lack of cohesion when we do not have better co-operation?
Earl Howe
I take the noble Baroness’s point. Obviously, the Government would like to see greater consistency in front-of-pack labelling. We know that, if we can achieve it, that is likely to increase consumer understanding and indeed the way that consumers use the information. Now that the regulation is finalised, we have the opportunity to discuss with all stakeholders the way to achieve that. It is advantageous that there is the flexibility available for us to do that.
Baroness Parminter
My Lords, this country has one of the highest rates of obesity in Europe. France is taxing sugary carbonated drinks and Denmark is taxing fatty foods. Regulation is one thing, but can the Minister confirm that the Government are looking seriously at the potential of such fiscal measures to address this ballooning health problem?
Baroness Thornton
My Lords, I congratulate the noble Baroness, Lady Oppenheim-Barnes, on her Question but I have to say that I think her target should not be the EU but actually her own Government. If you put “food labelling” into a search engine, you will get hundreds of different versions of how food can be labelled. It feels like we are going backwards because of the flexibility that the Government have sought through the EU regulations. What part have the Government’s relationships with the corporate sector played in this matter, and, indeed, if food labelling is going to become more confusing, will that not count against the drive to have good and well balanced diets?
Earl Howe
My Lords, as the noble Baroness will know, there are various points of view from various sectors of industry about what constitutes the best and most helpful form of food labelling. As a matter of fact, that has lain at the heart of the difficulty in reaching agreement in Europe, because there are so many divergent views around this. It is quite true that we do have very strongly held views—not least by the Food Standards Agency—about the value of traffic lights. We have equally strong views, held by certain sectors of industry, on the GDA model. As I said earlier in answer to the noble Baroness, Lady Howarth, it would be desirable to have consistency, but we are not there yet. We will continue to work at that objective.
Baroness O'Cathain
My Lords, first, has any research been done on the proportion of the population that actually reads these labels; secondly, are people able to read them; thirdly, do they understand them if they do read them; and, fourthly, what about magnifying glasses?
Earl Howe
One advantageous feature of the regulation, my noble friend will be pleased to hear, is provision on the legibility and font size of labels, which I am sure we all welcome. In 2009, the Food Standards Agency commissioned some research to examine which front-of-pack labelling system performed best, and the main finding was that the strongest performing front-of-pack label is one which combines the use of the words “high”, “medium” and “low”, traffic light colours and the percentage of guideline daily amount, in addition to levels of nutrients. That was the same across all socioeconomic groups.
Health and Social Care Bill
Earl Howe Excerpts(13 years, 8 months ago)
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Earl Howe
That it be an instruction to the Committee of the Whole House to which the Health and Social Care Bill has been committed that they consider the bill in the following order:
Clauses 1 to 6, Schedule 1, Clauses 7 to 22, Schedule 2, Clauses 23 to 48, Schedule 3, Clauses 49 to 52, Schedules 4 to 6, Clause 53, Schedule 7, Clauses 54 to 58, Schedule 8, Clauses 59 to 73, Schedule 9, Clauses 74 to 99, Schedule 10 , Clauses 100 to 105, Schedule 11, Clauses 106 to 118, Schedule 12, Clauses 119 to 147, Schedule 13, Clauses 148 to 176, Schedule 14, Clauses 177 to 179, Schedule 15, Clauses 180 to 228, Schedule 16, Clause 229, Schedule 17, Clauses 230 to 246, Schedule 18, Clauses 247 to 249, Schedule 19, Clauses 250 to 271, Schedule 20, Clauses 272 to 274, Schedule 21, Clauses 275 to 291, Schedule 22, Clauses 292 to 294, Schedules 23 and 24, Clauses 295 to 303.
Medicines Act 1968 (Pharmacy) Order 2011
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Medicines Act 1968 (Pharmacy) Order, being debated today, will remove the restriction placed upon pharmacists registered in Britain by virtue of a pharmacy qualification awarded by a relevant European state that prevents them being in charge of a newly established pharmacy. This refers to any pharmacy that has been registered for less than three years and is commonly known as “the three-year rule”.
The relevant European states referred to are Iceland, Norway, Liechtenstein, Switzerland and the European Union (EU) member states. It is not relevant to pharmacists who qualified in the United Kingdom.
I should first give the Grand Committee some background. All pharmacists practising in Britain must be registered by the General Pharmaceutical Council, as must all pharmacy premises. Some pharmacists are registered to practise in Britain under arrangements for the mutual recognition of pharmacist qualifications awarded by EU member states or other relevant European states.
EU Directive 85/433—now 2005/36/EC—includes provision for member states to place restrictions on the recognition of the qualifications of such pharmacists in the case of pharmacy premises registered for a period of less than three years. In Britain, the restriction applies to the pharmacist in charge of such pharmacies, known as the “responsible pharmacist”. In other words, while all pharmacists registered in Britain under the mutual recognition arrangements may work in any British pharmacy, however long it has been registered, such pharmacists cannot hold the position of responsible pharmacist in a pharmacy that has been registered for less than three years. The current restrictions on visiting pharmacists owning pharmacy businesses or acting as superintendents are not affected by this order.
The derogation in the directive was originally put in place in the mid-1980s for economic reasons, following concerns by UK MEPs. They believed that, given the UK’s comparatively open arrangements in relation to pharmacy ownership, there was a risk that the mutual recognition arrangements would put existing UK pharmacies at a disadvantage. Since then, however, much has changed both in terms of pharmacy arrangements in other EU member states and the evolution of domestic policy in Britain.
We have conducted a full public consultation on removing the restriction, both for established pharmacists—those fully registered with the General Pharmaceutical Council in part 1 of the register—and for visiting pharmacists—those temporarily practising in the UK and registered in part 4 of the register. However, the restriction has not affected any visiting pharmacists as, to date, none has been registered.
The response to the public consultation has been very much in favour of removing the restriction. The proposal has support from the General Pharmaceutical Council, the pharmacy regulator, the Royal Pharmaceutical Society, the professional body for pharmacists, as well as all the main pharmacy representative organisations, including the Pharmaceutical Services Negotiating Committee, Community Pharmacy Scotland, the Company Chemists Association and the devolved Administrations.
The proposal will encourage flexibility, efficiency and continuity of care within pharmacy. It will end the situation where a responsible pharmacist, registered here by virtue of the mutual recognition arrangements, can no longer continue in that role if their pharmacy relocates, even if it only moves next door, and therefore becomes a newly registered pharmacy. Removing this restriction will mean that patients can enjoy greater continuity of care in such circumstances; that all registered pharmacists will be placed on a level footing in terms of their employment prospects; and that employers will have a deeper pool of potential employees to draw upon and less bureaucracy to deal with when filling vacancies.
I should now explain the revision of the draft Explanatory Memorandum laid before your Lordships today and the change required to the final version of the Explanatory Note on the order. In undertaking preparatory work for this debate on the draft order, officials in the Department of Health realised that, contrary to previous understanding, “visiting pharmacists”, a sub-category of registrants from relevant European states who do not go through the full registration procedure, are covered by the removal of restrictions that the draft order would achieve. It will not, therefore, require a separate legal instrument to remove the restriction upon their acting as “responsible pharmacist” at new pharmacies. Up to this point, it had been thought that a separate legislative instrument would be required to achieve this. The confusion appears to have arisen in the understanding of the differences between the restrictions applying to those who either may own, or carry on, a pharmacy business or act as superintendent, on the one hand, and the provisions relating to the responsible pharmacist on the other. A superintendent manages a pharmacy on behalf of a company. A responsible pharmacist is in charge of a pharmacy at a given time, and takes on responsibility for the effective management of pharmacy law and practice within a single branch at a particular time. If the draft order is approved, it will still not be possible for a visiting pharmacist to carry on—that is, to own a new pharmacy—or act as a superintendent in relation to a new pharmacy.
However, a visiting pharmacist, and any other pharmacist registered by virtue of the mutual recognition arrangements, would, upon the coming into force of the order, be entitled to be the responsible pharmacist in charge of a newly registered pharmacy in Britain. It is the similarity between the different concepts of control that appears to have led to the confusion. The intention has always been to remove the restriction on responsible pharmacists for all those registered to practise in Great Britain under the EU mutual recognition arrangements, whether visiting or not. The consultation reflected this and the order as currently drafted would achieve this.
Because of the misunderstanding, the earlier version of the accompanying draft Explanatory Memorandum, and the Explanatory Note on the order itself, suggested that the order did not remove the restriction in relation to visiting pharmacists. In fact, the substantive provisions of the order achieve the intention and a further instrument is not, therefore, required. However, the text in the Explanatory Note that refers to the register was incorrect, and the reference to part 1 of the register will not appear in the final version. I apologise for any confusion caused by this late change. I commend this order to the Committee.
Lord Collins of Highbury
As the noble Earl stated, a lot has changed since the derogation in the directive was put in place. Much has changed in pharmacy arrangements in other EU member states and in the evolution of domestic policy. The reasons, as the Minister stated, were commercial.
In England, for example, there has been a welcome change over the past few years making it easier for people to get to a chemist, given that there are new pharmacies with longer opening hours. Clearly, such market restrictions are not appropriate today, and their removal will assist by increasing the pool of available pharmacists and ensure improved continuity of service delivery. I note that the change has also been welcomed by the key representative bodies of pharmacies.
I of course recognise that the restriction affects a relatively small number of pharmacies—just over 10 per cent, and just over 5 per cent of all pharmacists registered to practise in Great Britain. I also understand and accept the reasons for the change in the Explanatory Memorandum. However, these changes in the legislation raise broader issues relating to the competencies of the pharmacist and the person’s ability to manage a pharmacy. For example, the report on the consultation noted that concerns were expressed by respondents on competency in English. The Department of Health in its response stated that in the UK a check on the language knowledge of a pharmacist from outside the UK who is seeking work within the NHS is applied by the prospective employer, but that there is no check made at the point of registration.
This leads to three specific questions to the Minister. First, are there plans to introduce a standardised competency test to ensure that any pharmacists from the countries mentioned in the order who are in charge of a new pharmacy have all the required skills and competences? Secondly, are there plans to ensure that those in charge of a pharmacy will have a sufficiently high standard of English to avoid all risk of a patient misunderstanding any advice given? Thirdly, how can an employer determine whether the pharmacist in question is qualified in their own country and has no pending fitness-to-practise cases to answer?
Lord Clement-Jones
My Lords, I declare an interest as chairman of the council of the School of Pharmacy of the University of London. I thank the noble Earl, Lord Howe, for a crystal clear explanation. I suppose, perforce, it had to be crystal clear to clear up some confusion arising from the Explanatory Memorandum. This is precisely the kind of uncontroversial deregulation that is important in the context. From both professional and consumer perspectives one could say that it is a perfectly formed small regulation. It affects a limited number of people who could not be responsible pharmacists in certain circumstances, but will now be able to be so where there are no significant safety implications from deregulating in the way that this order does.
I want to raise the issue of reciprocity. The noble Earl mentioned that the reason for deregulation is that circumstances have changed. The noble Lord, Lord Collins, also referred to that. I am sure that in broad terms that is the case, but I should be extremely grateful to hear what the noble Earl believes the level of that deregulation would be. I remember doing a study of several EU countries, looking into what was permissible in pharmacy ownership and the level of regulation. That was about five years ago, when the level of regulation was extremely high—not just pharmacy regulation but the kind of licensing required to run a retail outlet, and so on. We have some extremely well run chains in this country, which would like to expand their offer in the EU more broadly. They have been largely frustrated from doing so by some of the regulation that applies. Therefore, reciprocity in these circumstances is extremely important. I am interested to hear just what the Minister believes to be the level of significant deregulation that has taken place.
Earl Howe
My Lords, I am grateful to both noble Lords for their support for the order. The noble Lord, Lord Collins, asked me three questions. The first was about whether there are any plans to introduce a standardised competency test to make sure that pharmacists from the various countries mentioned have all the required skills to do their job. Under directive 2005/36/EC on the recognition of professional qualifications, which I mentioned, a pharmacist who holds a recognised qualification issued by one member state is entitled to recognition of that qualification in another member state, and would therefore be entitled to registration with a competent authority, such as the General Pharmaceutical Council.
However, employers of pharmacists should ensure that anybody they employ has the skills required to undertake the specific post. The General Pharmaceutical Council’s standards of conduct, ethics and performance, among other things, require the pharmacist to recognise the limits of their professional competence and practise in only those areas in which they are competent. Their continued registration is subject to adherence to the council’s requirement for continuing professional development—CPD—and standards of conduct, ethics and performance.
Secondly, the noble Lord asked whether there are plans to make sure that those in charge of a pharmacy have a high enough standard of English. The UK Government’s response to the European Commission’s consultation on the review of the directive on the recognition of professional qualifications clearly sets out the view that in the healthcare professions the ability to communicate with patients and service users is vital.
Multiple Sclerosis
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Lord Walton of Detchant
To ask Her Majesty’s Government what action they are taking to improve the United Kingdom’s international standing in relation to patient access to new treatments for multiple sclerosis.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, a number of treatments for multiple sclerosis are available to UK patients, supported by the multiple sclerosis risk sharing scheme, National Institute for Health and Clinical Excellence guidance and Scottish Medicines Consortium advice. Our priority is to ensure that patients have access to new and effective treatments. NICE’s forthcoming review of its clinical guideline on MS will bring together up-to-date advice on the best treatments for patients, as part of the overall package of care.
Lord Walton of Detchant
My Lords, I thank the noble Earl the Minister for that reply. It is true that the prognosis for many patients with multiple sclerosis has been transformed by the use of these immunosuppressive agents since interferons were introduced. Is he aware that recently a new and effective remedy called fingolimod, which is available by oral administration instead of injection, has been introduced? It has been licensed but has been rejected by NICE for the moment purely on cost grounds. At the moment, evidence suggests that about 60 per cent of patients with this condition in the United States, 30 per cent in most of Europe and only 17 per cent in the UK are receiving this type of medication. Is it therefore not likely that this is the result of restraints on prescribing largely on financial grounds?
Earl Howe
The noble Lord is quite right about fingolimod. Since the publication of NICE’s draft guidance, the manufacturer has proposed a patient access scheme for the drug, and the department has agreed that this can be considered as part of NICE’s appraisal. The noble Lord raises a very interesting point about cost. Professor Mike Richards’s report, which came out last year and looked at the extent and causes of international variations in drug usage, outlined a number of potential explanations for the relatively low uptake of some treatments. In the case of MS, one of the reasons identified was caution among some neurologists about the benefits of particular treatments, but also tighter clinical guidelines on the use of MS treatments in the UK compared with some other countries. It is important to stress that in treating MS, medicines form only part of an overall package of care, which of course can consist of access to neurology services and specialist MS nurses.
Lord Monks
My Lords, referring to what the noble Earl just said about the Richards report, that report ranked the UK 23rd out of 25 EU countries, with only Slovenia and Lithuania more restrictive on access to new treatments than the UK. The NICE guidelines will not be revised until 2014, having last been done in 2003. For sufferers of MS, a horrible disease, that seems a very long time to wait. I hope that in the reviews that are taking place, the Government will do everything possible to accelerate this work and ensure that NICE gets on with it, and that the Government give priority to MS research in future.
Earl Howe
My Lords, I take the noble Lord’s point. NICE is reviewing its clinical guideline. That is not due to be published until 2014. Although we strive to ensure that there is national guidance on the most commonly used medicines and treatments, there will always be instances where decisions have to be made locally. Under the NHS constitution, patients have the right to expect local decisions about the funding of medicines and treatments to be made rationally, following proper consideration of the evidence. We are emphasising to PCTs that they should do just that.
Baroness Gardner of Parkes
My Lords, I declare an interest in that I have a daughter who has had MS for 30 years. Recent research announced in Russia indicated that they believe they are developing an answer to rebuilding the myelin sheath, which would be great progress in multiple sclerosis treatment. Can the Minister assure us that when that research is available we will follow it here and introduce it at the earliest possible time?
Earl Howe
My Lords, new and innovative treatments for MS are being developed in a number of countries. It is quite clear that any new treatment of this kind should be subject to the rigours of the regulatory system before it is made available to NHS patients. Many of them will not have been fully tested to ensure efficacy and safety, but we will of course examine every novel and innovative treatment that has the potential to benefit patients.
Earl Howe
The noble Lord makes a very good point. Commissioning by clinical commissioning groups does not mean that individual groups will have to commission every service. They can commission collaboratively across larger populations if that makes sense for them. Additionally, some services for less common conditions, including some neurological conditions, fall within the scope of specialised commissions and will be commissioned subject to the passage of the Health and Social Care Bill by the NHS Commissioning Board.
I understand that in Europe the neurological commissioning support, which was developed with the support of a number of neurological charities, including the MS Society, has been well received by commissioners and is doing very good work.
Health and Social Care Bill
Earl Howe Excerpts(13 years, 8 months ago)
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Earl Howe
I rise to conclude an excellent and constructive debate. It has been long, and the task that rests with me in summing it up in the space of 20 minutes is clearly an impossible one, if I am to do justice to every speaker. Therefore, I hope that the House will find it acceptable if I aim in my response to capture the main themes of this debate and to write to noble Lords whose specific and detailed questions I do not have time to answer. In addition, I am happy to offer any the noble Lord a meeting with me or with officials from the Department of Health to discuss any of the issues that they have raised.
To begin with what might seem an emotional and emotive point, it was said by more than one speaker, including the noble Lord, Lord Hennessy, this morning, that the NHS is the nearest thing that this country has to institutionalised altruism. That is surely right. It is equally right that the NHS is a part of our national life, of which we can be deeply proud. At its best, which is often, it delivers high-quality excellent care. The investment made by the previous Government has contributed significantly to that.
A number of noble Lords asked why, therefore, the Government’s reforms are needed at all. Part of the answer to that is about the clear imperative around the quality of care, about which the noble Lord, Lord Darzi, and my noble friend Lord Black spoke so powerfully. Indeed, we have excellent care in the NHS, but sadly this is not universal. The variations in quality and outcomes and longevity around the country are too great for us to sit back and do very little. But there is another less visible reason. In a sense, the need for reform is not about how excellent the NHS may be today; it is about our making sure that in five, 10 and 20 years’ time the NHS is still there as a sustainable public service, free at the point of use, delivering the care that we all want it to.
The financial challenge facing the NHS is acute. We have protected its budget in real terms, but that is not going to be enough to meet demand from an ageing and growing population unless we take some radical steps to simplify and streamline the NHS architecture and to free up the service from central control in a way that will drive innovation and productivity as never before. That is the purpose of these reforms and this Bill. It is not just about today; it is about safeguarding the future. If I had one criticism of some of the contributions from the Benches opposite it was of their failure to acknowledge the scale of the financial and quality challenge that now faces us. Money will no longer grow on trees in the NHS; we have to think out of the box. So we are seizing on the evidence of what works in order to drive quality—namely, empowering commissioners. We are cutting the cost of NHS administration by one third, and we are trusting the men and women of the health service—including, incidentally, our many excellent managers—to deliver what we know they can, which is an even better service for their patients. And make no mistake—there are doctors and nurses and managers out there who are keen to get to grips with this. Yes, of course, there are many who have no appetite for change, and there are many critics and doubters. But I have met so many clinicians that I cannot count them, who believe that what we are doing is right, and who are being inspired by these reforms to lead the way in the local pathfinder groups and in local authorities.
The NHS needs continual renewal. It has never stood still, and it cannot do so now. The noble Lord, Lord Darzi, put it perfectly when he said:
“To believe in the NHS is to believe in its reform”.
Many speakers, most prominently my noble friend Lady Williams and the noble Baroness, Lady Jay, have spoken about accountability in the role of the Secretary of State. For me, the debate on this topic crystallised into two issues. A number of speakers aligned themselves with the Select Committee on the Constitution in questioning why we have removed the Secretary of State’s duty to provide. There has been concern that this means that the Minister’s ultimate accountability for the NHS is in some way diluted. I can reassure the House that this is not so. A change as pointed out by several noble Lords, including the noble Lord, Lord Warner, and my noble friend Lady Bottomley, as well as the noble Baroness, Lady Murphy, is to reflect a fact which has been the case for many years; namely, that the Secretary of State does not directly provide services himself.
Under the Bill, the Secretary of State will continue to have a statutory duty to promote a comprehensive health service, and a duty to use his powers to secure the provision of the service. As has been the case for decades, it does not extend to the Secretary of State directly providing services. So rather than pretend that somehow the Secretary of State is responsible for all clinical decision making in the NHS, the Bill recognises that expertise for such decisions must sit with those health professionals closest to patients. Indeed, my noble friend Lord Marks put it well when he pointed to the means by which Secretaries of State will be able to do this; namely, the mandate to the NHS Commissioning Board, the standing rules, and the failure intervention powers. I may say that the improvements that my noble friend suggested to these powers sounded interesting to me, and I look forward to discussing these with him in greater detail at a later date.
The noble Lord, Lord Owen, asked what would happen in the event of a pandemic. If I could direct the noble Lord to Clause 44 of the Bill, he will read of the extensive powers the Secretary of State has to take control in an emergency—and this even extends to foundation trusts, which is a power not available to Ministers today.
The second issue raised with regard to the Secretary of State turns us to Clause 4, the duty of autonomy, and I am sorry that what I have said on this has been the subject of concern. My noble friends Lady Williams and Lord Marks highlighted this clause as raising the possibility that it will lead to an unacceptably hands-off approach on the part of the Secretary of State. We do not think that that is the case. However, I would like to repeat the commitment made by my honourable friend the Minister for Care Services at Report stage in the other place, about Clause 4, namely that,
“we are willing to listen to and consider the concerns that have been raised and make any necessary amendment to put it beyond doubt that the Secretary of State remains responsible and accountable for a comprehensive health service, which we all want to see.”—[Official Report, 7/9/11; col. 454.]
If there is an amendment which will improve the Bill, we will make it. This offer stands, irrespective of how the House votes on the amendment tabled by the noble Lord, Lord Owen, and I hope that this gives reassurance to those who have been concerned on this point. I also today commit to host a meeting with all interested Peers—including the noble and learned Baroness, Lady Scotland, if she wishes—to discuss any matters around accountability further so that we can all better understand each other’s positions and concerns, but also inform Committee discussions on these vital issues.
The second concern I would like to turn to is that of competition. Many speakers, such as the noble Baronesses, Lady Kennedy and Lady Billingham, fear that the Bill could lead to an American-style market free-for-all, with competition harming patients’ interests. Others, such as the noble Baroness, Lady Murphy, have claimed that we are actually doing too much to shackle the benefits of competition, and that we should look at removing some of the safeguards that we have put in place.
Let me be clear about what the Bill does and does not do. The Bill does not introduce a free market for all. It does not change competition law, or widen the scope of competition law. It does introduce a framework in which competition can be effectively managed as a means to benefit patients. That competition can work in the interests of patients is well backed up by academic research, such as the studies quoted by the noble Lord, Lord Warner, on mortality rates, and by noble friend Lady Cumberlege on inequalities. The Bill does not do anything which might or could lead to the privatisation of the NHS. What it does do is create a level playing field between different providers, putting an end to the subsidies and guarantees given to the private sector under the last Government.
The Bill will not mean that competition will trump integration. The safeguards and duties that it places on Monitor, in particular its core duty towards the interests of patients, will ensure that Monitor supports integration. The balance that we have struck in this Bill, once more returns to the North Star—that graphic metaphor from the noble Lord, Lord Kakkar—namely, patients. We believe that competition has a place, but only as a means to an end, the end being to improve quality and efficiency.
The noble Lord, Lord Darzi, made the case, as usual, very strongly, by talking of competition as a means to spark creativity and light innovation. However, it does require safeguards to ensure that other factors such as integration, service continuity and the prevention of cherry-picking are given due weight—and those safeguards are there.
I turn next to concerns raised that the Bill creates too much complexity, meaning that care will be fragmented, and decision-making harder to achieve, and we heard that concern expressed this morning by the noble Baroness, Lady Pitkeathley. Let me first be clear about the different organisations abolished and created by this Bill. The Bill abolishes the 151 primary care trusts, half of the national arm’s-length bodies, and the 10 strategic health authorities. It establishes clinical commissioning groups which are currently growing out of existing practice-based commissioning groups. Likewise, local HealthWatch will build on existing local involvement networks, and HealthWatch England will be situated within the Care Quality Commission. I can reassure the noble Lords that the Bill contains a number of mechanisms to ensure independence of HealthWatch both locally and nationally. Monitor will be expanded to become a provider regulator, and the NHS Commissioning Board, led by Sir David Nicholson, will be a new body, but it will draw on the best aspects of a range of departing organisations. We envisage that it will host the existing clinical networks and the new advisory clinical senates.
Concerns were raised that the board could have too much power over commissioning groups. I genuinely agree that the Bill contains sufficient safeguards against this, but I do of course look forward to discussing this issue further. Overall, administration costs across the health system will be cut by one-third in real terms by 2014-15—this will save £4.5 billion by the end of the Parliament alone—all to be reinvested in front-line patient care.
A number of noble Lords have asked who takes the decisions. This Bill represents a significant step forward by directly conferring responsibilities in statute, rather than having them all delegated in an opaque way through the Secretary of State. This clarity extends to how different organisations should work together and the Bill contains significant new provisions regarding collaborative working. In her opening remarks, the noble Baroness, Lady Thornton, expressed her support for health and well-being boards, which will be hosted by local authorities. Other speakers have endorsed the plans for joint strategies to be determined and agreed by all relevant local services. Many speakers have raised service configuration, which we can happily debate. However, I believe that the Bill supports effective, clinically led reconfigurations led locally but with the NHS Commissioning Board playing an important leadership role.
A number of speakers spoke about particular service areas within the NHS and how the reforms would impact on them. Let me start by reassuring noble Lords that those working in general practice will not be commissioning in isolation. Clinical commissioning groups must obtain appropriate advice from a broad range of professionals. This would, for example, include experts in mental health, children’s health, learning disabilities or other areas as appropriate. Given this duty to obtain advice, we do not think that it is necessary to expand the membership of clinical commissioning groups’ governing bodies further than is currently set out in the Bill, which was a suggestion made by a number of speakers, including the right reverend Prelate the Bishop of Bristol. Indeed, if all the additional representatives suggested in this debate alone were to join the governing body it would quickly become unwieldy and unworkable. Clinical advice would also come through other forms, such as clinical networks, which I can confirm to my noble friend Lord Clement-Jones will continue, and new clinical senates. These mechanisms should ensure that specialist advice at all levels of the NHS is there. They are not extra layers of bureaucracy.
Many speakers have stressed the importance of public health and health inequalities and the changes proposed by this Bill. I completely agree that these are fundamental issues. Our plans seek to create a new focused approach for public health, protected by a ring-fenced budget. The noble Baroness, Lady Gould, asked a range of questions about the detail behind our arrangements and I will respond to her in writing. But in terms of inequalities, this Bill, for the first time, puts in place specific duties on key relevant bodies to act with a view to reducing health inequalities. That should surely be seen as welcome.
One or two noble Lords, including the noble Baroness, Lady Royall, raised the removal of a foundation trust private income cap and feared that it could lead to longer waiting lists for NHS patients. I am confident that it would not have this effect. My right honourable friend the Minister for Health said on Report in the other place that,
“we are proposing to explore whether and how to amend the Bill to ensure that FTs explain how their non-NHS income is benefiting NHS patients. We will also ensure that governors of FTs can hold boards to account for how they meet their purpose and use that income”.—[Official Report, Commons, 6/9/11; col. 289.]
I hope that provides some reassurance. I look forward however to further debates on that issue.
The future of both education and training, and research, were raised by a number of speakers. The noble Lord, Lord Walton, and my noble friend Lord Willis spoke passionately about the benefits of research. The noble Baroness, Lady Masham, and my noble friend Lord Ribeiro spoke equally passionately about innovation. As Minister responsible for research and innovation, I fully share this passion and I hope that I can reassure noble Lords that we are taking all necessary steps to ensure that we act quickly on taking forward the report of the Academy of Medical Royal Colleges, including future legislation.
Such legislation will also take forward the future arrangements for education and training but I can confirm to the House that we will table a new duty for the Secretary of State with regard to education and training in time for Committee. In addition, as both issues have attracted so much interest, I will ensure that new fact sheets on both topics are produced by officials in the Department of Health and made available prior to Committee. Again, my door is open to noble Lords to discuss any or all those issues.
Several noble Lords called for healthcare assistance to be given full statutory regulation. While I accept the need for action in this area, I cannot agree that statutory regulation is the best way to proceed. Our view is that employers of such workers have to take responsibility for the quality of services provided, including the use of existing systems. In addition, when tasks are delegated by qualified professionals, this has to be done with appropriate and effective supervision. I am of course more than willing to discuss this issue further as the Bill proceeds.
I turn now to the procedural concerns raised during the debate and to the Motions tabled by the noble Lords, Lord Owen and Lord Rea. First, a number of speakers questioned what they call the democratic mandate for this Bill claiming that the Bill’s proposals were not in manifestos or the coalition agreement. Both these claims are untrue, as any quick read of these documents will show.
What is true, as my noble friend Lord Rodgers pointed out, is that sheaves of documents covering every detail of policy were set out in July last year when we published the White Paper and associated consultation documents. This was followed up by a period of public engagement, a lengthy Government response, the listening exercise in the spring of this year and 40 sittings in Committee in the other place. At all stages, we have been open and transparent about our plans. This approach will of course continue and I welcome the proposal of the noble Lord, Lord Kakkar, in terms of ensuring effective post-legislative scrutiny. I can confirm today that while five years would normally elapse prior to post-legislative scrutiny of a Bill, we will bring that forward for this Bill to three years. As a result, I simply cannot accept the amendment in the name of the noble Lord, Lord Rea. I respectfully suggest to your Lordships that to vote for that amendment would run directly counter to the proper role and functions of this House.
Secondly, concerns have been raised about what has been seen as implementation of the Bill’s proposals prior to Royal Assent. I suggest that this fear is unfounded. Preparatory work is ongoing to implement the Government’s plans, such as the creation of clinical commissioning group pathfinders. This is all within the current legal framework. However, such powers can get the reform only so far; hence the need for this Bill. For example, while early implementers of health and well-being boards are emerging all over the country, until this Bill is passed they lack all the statutory powers that we think are essential for them to operate.
Finally, I turn to the Motion in the name of the noble Lord, Lord Owen. I do not feel that a further Select Committee would add significant value to our normal processes. A Committee of the Whole House with all interested Peers, including constitutional experts in attendance, would in my view be the best forum to ensure effective and thorough scrutiny. Perhaps I may say that this Second Reading debate has amply proved that. My noble friend Lord Rodgers put it well in saying:
“The House is now able to make fully informed decisions … we should not duck … them further”.—[Official Report, 11/10/11; col. 1543.]
Furthermore, I agree with my noble and learned friend Lord Mackay of Clashfern that the early clauses of this Bill, which cover the Secretary of State’s duties and powers overarch the rest of the Bill. It is right for a Committee of the Whole House to consider them at the outset of the deliberations.
I engaged in discussions with the noble Lords, Lord Owen and Lord Hennessy, to see if there was a way to accommodate their proposals for a special Select Committee. The only way, I feel, that such a novel procedure could work would be to put a clear end point on both the Select Committee and the Committee of the Whole House. It is not sufficient to put a time limit solely on the Select Committee. This Session, all pre-legislative scrutiny committees set up in this House have required time extensions.
While the noble Lord, Lord Owen, says in perfectly good faith that the committee will report before Christmas, there is no way in which this House can make that truly binding without an end date on both committees. The key point is that if the Select Committee needed more time or if it recommended amendments affecting parts of the Bill—
Lord Peston
Is the Minister certain that there is no way that the amendment to which he refers can be made to work so that the job gets done in time? That bears no resemblance to my knowledge of how this House works. The House can end things at any time it wants to.
Lord Hunt of Kings Heath
My Lords, in my experience, if this House wants something to happen it finds a way for it to happen. Even at this late stage, I ask the noble Earl to give careful consideration to this. I have already said from this Bench that we are happy to meet through the usual channels to agree a date by which the Committee stage will be finished on the Floor of the House. I am sure that the noble Lord, Lord Owen, as far as he is able, will wish to say that he is happy for the special committee to finish by a certain date. I do not believe that it is impossible for agreement to be reached on this.
Earl Howe
My Lords, I very much welcome that offer, which has come rather late in the day. My understanding is that discussions over the timetabling of the Bill have taken place over the past week. However, we are faced with the amendment that is on the Order Paper and must vote on it as it stands.
Baroness Royall of Blaisdon
I beg your Lordships’ pardon but I have to say that we are and have been entirely open to this suggestion. I was not aware of it until yesterday. I give the House my pledge that the Bill will come out of Committee by mid-January, which is, I think, when the noble Earl was thinking of. We should be delighted to give our firm assurance that the Bill will come out in mid-January.
Earl Howe
My Lords, that is an extremely welcome offer, which we accept. I am grateful to the noble Baroness.
It is right for me to conclude, with your Lordships’ agreement. I bring this extended debate to an end by returning to the point of the Bill, which is to improve the quality of care for patients. For all the generosity of the noble Baroness’s offer, the amendment of the noble Lord, Lord Owen, would not help patients. It would insert additional uncertainty into the parliamentary passage of the Bill. As my noble friend Lord Fowler rightly emphasised, the amendment of the noble Lord, Lord Rea, would leave the NHS in far greater uncertainty. It would also leave it unprotected from both the present and future challenges that it faces.
Baroness Royall of Blaisdon
My Lords, I crave the indulgence of the House to confirm one point that was clarified by the noble Lord. I do not advocate any timetabling Motion: that would not be appropriate for the House. I give the assurance that, were the noble Lord’s amendment to be agreed, my Benches would wish the Bill to be out of Committee by mid-January. However, if the amendment is not accepted, it will be right and proper for the usual channels to discuss the appropriate number of days needed in the light of this excellent Second Reading debate. I cite the excellent speeches made by many noble Lords, including the wise words of the noble Lord, Lord Walton of Detchant, who spoke before me last night and who said that enough time must be given. He is absolutely right. I have no intention of delaying the Bill. My intention is to ensure that there is proper agreement between the usual channels on the appropriate amount of time that the Bill needs in Committee.
Earl Howe
My Lords, I will make three very brief points. The provisions that the noble Lord, Lord Owen, asks us to send to a special Select Committee affect the entire Bill. The twin-track approach that he advocates carries a major risk: the potential disconnect between the special Select Committee and the Committee of the whole House. The Select Committee might recommend amendments to parts of the Bill that have already been debated by the Committee of the whole House. The result could be that, notwithstanding the offer made in good faith by the noble Baroness, Lady Royall, we could see a slippage of the timetable of the Bill that would be most unwelcome.
I repeat my assurance that I am entirely open to considering the concerns that have been raised about the issue and to make any necessary amendment to put it beyond doubt that the Secretary of State will remain responsible and accountable for a comprehensive health service.
Health: Charities
Earl Howe Excerpts(13 years, 8 months ago)
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Lord James of Blackheath
To ask Her Majesty’s Government what consideration they have given to extending the cost-saving work of health charities by providing them with NHS premises free of charge.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, health charities make a significant contribution to the NHS and are valuable partners. We are keen to support initiatives that will help them make cost savings and to support them through this challenging financial period. It is for local NHS organisations to decide to whom, and in what circumstances, they can offer NHS premises at concessionary rates.
Lord James of Blackheath
My Lords, I thank my noble friend for that Answer, which is encouraging in the context of local interests. But does he agree that some charities carry a case for a nationwide intervention due to the huge savings that they can produce, such as the Connect aphasia/stroke charity of which I am myself a rescued case? I was rescued so well that I married my therapist; I understand that that is an option, not an obligation. In this case, will my noble friend consider whether the huge savings that can come by removing aphasia cases from a dependence on welfare handouts and enormously expensive treatment could be alleviated by support being provided from the social care allocations fund on a completely cost-effective basis? The money could be replaced afterwards by giving some nominal recognition back to the fund as a consequence of the huge number of cases that would be saved by the charity.
Earl Howe
My Lords, we greatly value the work that Connect and other charities carry out, working alongside people with aphasia and their families to develop communication and rebuild confidence. I can tell my noble friend that we understand that the current fiscal position is presenting voluntary organisations and charities such as Connect with challenging funding issues. But, in the end, we are looking at local services. Where local services are concerned, it is the responsibility of commissioners—currently primary care trusts and local authorities—to commission services based on their local population needs. They must ensure that the services that they secure for local people provide the best value for money and quality for patients. I am afraid that we cannot get away from the value-for-money question. It is important to emphasise that we are sending the message to local authorities and PCTs that the voluntary sector should not shoulder a disproportionate share of funding cuts.
Baroness Finlay of Llandaff
Will the Minister ensure that healthcare charities that provide clinical services have the same VAT exemption as NHS providers, to establish the level playing field at this time of financial stringency that the Minister spoke about in the preceding debate?
Baroness Thornton
Will the Minister confirm that the Department of Health has a strategy for encouraging and supporting charities, social enterprises and mutuals, both as patient and carer advocates and as providers of healthcare? In addition, would the Minister care to say how that policy might be enacted by the proposed commissioning structures in light of, for example, the failure of Surrey Community Health—a local and qualified social enterprise—to win a very large contract, losing it to Richard Branson’s Virgin Healthcare?
Earl Howe
I agree with the noble Baroness that it is important we do not lose vital local services that achieve high-quality outcomes. We shall be working with PCTs, therefore, in the transition to the new arrangements between the NHS Commissioning Board and clinical commissioning groups as they develop, to ensure that the sector’s contribution to improved public health and social care is fully recognised. In the end, however, she will appreciate from our preceding debate that these matters will continue to be determined at a local rather than a national level—and it is quite right that they should be—because centrally we are not aware of local circumstances in the detail that we should be.
Lord Phillips of Sudbury
My noble friend the Minister will be well aware that there is a chapter in the health Bill on public involvement. Will he accept that there is a general perception that at present there is extraordinarily little attempt made by the health bureaucracies to engage particularly small local charities, which often have more to give in terms of public involvement than the very large ones?
Earl Howe
It varies. I am well aware of some PCTs that are engaging very creditably with voluntary organisations, but I am sure my noble friend can give examples of where that is not happening. I can only say to him that the policy of any qualified provider should mean that local voluntary organisations that can provide services to the quality and terms that the NHS requires should be in with an equal chance of providing services. We will ensure that proper guidance is issued to make sure that happens.