Health: Hospital-acquired Infection
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Lord Sheldon
To ask Her Majesty’s Government how many hospital patients acquired an infection following their admission during 2010.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, information on all healthcare-associated infections is not collected centrally. The best available information is from the mandatory surveillance system, managed by the Health Protection Agency. During 2010, 1,630 MRSA bloodstream infections and 23,208 Clostridium difficile infections were reported in England. Of these, an estimated 818 and 11,547 cases respectively were acquired after admission to an acute National Health Service trust. Data on other infections subject to mandatory surveillance are not yet available for this period.
Lord Sheldon
My Lords, according to the British Medical Journal, about 7 per cent of patients in hospital in Europe develop healthcare-associated infections. In the past there was a shortage of beds in hospitals, but what is the position now? Is there still a shortage of beds, and how many hospital patients acquired an infection in 2010?
Earl Howe
My Lords, we expect all provider trusts to have sufficient isolation units for those patients in whom an infection is identified. I am not quite sure whether this is what lay behind the noble Lord’s question, but there is no evidence to support a link between higher bed occupancy rates and higher rates of healthcare-associated infections. The number of beds occupied in a trust, in other words, should not have a bearing on the infection rate in that hospital.
Lord Roberts of Conwy
My Lords, could the Minister confirm that the best hospitals actually test patients in advance of admission for MRSA, for example—as I personally was tested but yesterday at the Royal Liverpool and Broadgreen University Hospital?
Baroness Howarth of Breckland
Does the Minister agree that the length of stay that a patient has increases the risk, particularly among elderly patients? Can he tell me how many elderly patients are now staying in hospital for greater lengths of time because they are not being discharged into appropriate local authority provision?
Earl Howe
The noble Baroness is quite right that delayed discharge poses a risk, not only in terms of infection but in terms of mobility and other issues that affect the elderly. We are clear that if this problem is to be eased, further funding is required at local authority level, which is why we have made available up to £1 billion over the period of the spending review to ensure that the issue is addressed.
Baroness Pitkeathley
I declare an interest as a recoverer from MRSA. Is the Minister making any assessment of the effectiveness of preventive measures, such as hand sanitisers and making sure that doctors do not wear ties, which droop in wounds, and so on?
Earl Howe
My Lords, the noble Baroness will know that a code of practice was issued some time ago, which the CQC uses to ensure that the registration requirements of a provider have been complied with. It is clear that the decline in numbers of hospital-acquired infections has coincided with the issue of that guidance. We believe that it has made a material difference. I am not aware that there has yet been systematic evidence-gathering of whether the guidance has had an effect, but it appears that it has.
Baroness Masham of Ilton
Does the Minister not think it is about time that the figures for infections were kept nationally? Is he aware that some hospitals have got better and some have got worse, and the outcomes across the country are very patchy?
Earl Howe
The noble Baroness is absolutely right. The headline figures disguise considerable variations between the best and worst performers. Our approach has been to adopt a zero tolerance policy to all avoidable healthcare-associated infections. To support that we have introduced a number of specific actions, including establishing clear objectives under the NHS operating framework, which are requirements for all trusts to meet, and for primary care organisations, and extending to health and social care settings the regulations on infection prevention and control. We have also increased the requirements on publishing data trust by trust.
Baroness Thornton
My Lords, I welcome very much the fact that the Government have continued to bear down on this issue, which of course my Government made great strides on when we were in office. Can the Minister assure the House that the funding to continue bearing down on it will be ensured from a national level?
Earl Howe
My Lords, as the noble Baroness knows, we expect trusts and primary care organisations to utilise funds from within their global budgets to meet the requirements that I have just outlined, such as those in the NHS operating framework. These requirements are mandatory, and it appears that over the past few years, trusts and primary care organisations have really got to grips with this problem.
Lord Patel
My Lords, the Government are to be commended on insisting that all hospitals publish their infection rates for Clostridium difficile and MRSA on a weekly basis, which we can monitor on the website. It is interesting to note that one or two hospitals stand out by consistently having higher numbers while the rest make dramatic reductions. What is important, however, is that there has been no reduction in central venous line or other central line infections. I hope that the Government have a strategy similar to the one on MRSA and C. difficile to insist that hospitals reduce their rates of central line infections.
Earl Howe
My Lords, the noble Lord makes an important point. We have consciously limited the extent to which it is a requirement to publish data to the most prevalent infections that need to be addressed. That is not to say that other types of infection are less important; they are extremely important. However, we would expect a ward-to-board policy to operate within each trust so that the boards of trusts bear down on these infections as hard as on others.
Care Homes
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Baroness Bakewell
To ask Her Majesty’s Government what steps they are taking to protect the interests of residents of care homes, such as those operated by Southern Cross.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government will take whatever action is necessary to protect the welfare of care home residents. Southern Cross has plans in place to restructure its business and is keeping the Government updated on progress. We will continue to keep in close touch with the situation and will work with local authorities, the Care Quality Commission and others to ensure that there is an effective response, which delivers protection to everyone affected.
Baroness Bakewell
I thank the noble Earl for that information. Given the latest revelations that Southern Cross traded the care of older people for short-term profit and that the Care Quality Commission so woefully failed to come to the help of suffering people in a home in Bristol, can I urge him to take the most urgent steps as soon as possible to relieve the suffering of people who are old, frail and dependent, and who are suffering much neglect?
Earl Howe
My Lords, I am sure the noble Baroness’s concerns will be echoed throughout the House. We have seen distressing reports in recent days of the treatment of certain patients in private hospitals, but the worry over Southern Cross relates much more to its financial situation and the future of its residents. I can assure the noble Baroness that we are taking this situation very seriously. We are in touch, as I have said, with all the relevant parties—and have been for the last several months. We are making sure that everybody is aware of their responsibilities in this area, not least towards the residents concerned. As regards Southern Cross, we are now in a critical period when restructuring is being explored, and we wish those efforts well.
Lord Low of Dalston
My Lords, does the Minister agree that the problems besetting Southern Cross are an object lesson in the dangers of market failure attending the privatisation of public services?
Earl Howe
My Lords, I do not agree with that. For many years, successive Governments have relied upon private care providers in social care. In general, this has been entirely satisfactory. It has given people wide choice in the care available and Governments have encouraged that. Financial issues for one provider—albeit a major one, I concede—do not undermine the entire principle of independent care provision.
Baroness Knight of Collingtree
Will my noble friend the Minister confirm that the original principle, stated to be the main aim of all these reforms, is unchanged in spite of the very necessary talks he is having with several different bodies? Is it still to be the case that nothing is more important than the care, treatment and curing of the patient, and the patient’s dignity and comfort, including being fed in hospital?
Earl Howe
I am grateful to my noble friend. That is entirely the aim of the modernisation programme for the NHS that we have laid out. It must be a much more patient-centred and user-centred service. As regards Southern Cross, we have said that there will be effective protection for the residents involved; no one will lose out. We are clear that we are putting the interests of residents first.
Lord Campbell-Savours
My Lords, does the Minister recall that, on the wind-up of CSCI—which he will recall because he was involved in the debate—we were given absolute assurances that the new successor body, the CQC, would target with random and unannounced visits all those care institutions in the United Kingdom where it was thought that people might be at risk? In so far as Southern Cross had a very bad track record and the CQC has failed to fulfil that promise, should not people at the top of the new body—the CQC—now consider their positions and, indeed, resign?
Earl Howe
My Lords, that is a rather harsh suggestion regarding Southern Cross. The noble Lord will know that care providers must demonstrate to the CQC that they have the financial resources needed to continue to provide services of the required quality. Clearly, there are lessons to be learnt from this episode with Southern Cross, which we all hope will resolve itself successfully. I am sure the CQC will take on board the lessons. From the briefing that I have had on the financial model that Southern Cross adopted, it is extraordinarily complex even for an expert to understand. We need to get that right. I know that my right honourable and honourable colleagues in the Department for Business, Innovation and Skills will be looking in general at business ownership and the issues surrounding that to see whether there are actions that we can take to prevent this kind of thing happening again.
Baroness Hollins
My Lords, with respect to Winterbourne View, could the Minister comment on why so much public money is being spent on placing people with learning disabilities in private hospitals, when government policy is to support such people in the community?
Earl Howe
My Lords, that falls a little way outside the Question on care homes and Southern Cross. I am sure the noble Baroness knows that Winterbourne View is a private hospital with completely different commissioning arrangements. However, I should be happy to write to her. A Written Ministerial Statement that sets out the full position on Winterbourne View is being put down in Hansard today.
Baroness Barker
My Lords, do the Government know how many of Southern Cross’s 31,000 residents are self-funders and therefore entitled only to information and advice? How many of them receive state care and are therefore entitled to alternative provision? Given the uneven geographical distribution of Southern Cross’s homes, do the Government know whether there will be any local authorities with no residential care provision should Southern Cross fail?
Earl Howe
On my noble friend’s last point, there is a national surplus of care home beds—the figure I have here is some 50,000. Therefore, there is, to my knowledge, in no area a shortage of beds. We are dealing here with a series of local markets. The point that I emphasised earlier remains important. Should it come to the closure of a care home—an event of which we should have reasonable notice if it happens—we will ensure that those in that care home are properly looked after.
Baroness Thornton
My Lords, does the Minister actually think that a Written Ministerial Statement is sufficient to deal with the gravity of the treatment of the learning disabled in Winterbourne View care home, as shown on the “Panorama” programme, although I realise that that is not the subject of this Question? I agree with him that it is absurd to suggest that there is no role for private, voluntary, mutual and social enterprise providers in social care. How will the Minister ensure, therefore, that in the private sector—none of these things can happen in any of the other sectors—regulation is extended to cover the financial stability, including asset stripping, of organisations which provide these vital services for thousands of elderly people? I invite him to agree with me that it is very distasteful indeed that older people’s care should be regarded as a commodity to be traded.
Earl Howe
My Lords, I cannot help but agree with the noble Baroness’s last comment. I am sure she will know that we have embarked on a wide-ranging programme of reform of social care. We are considering the Law Commission’s recommendations for modernising social care law, and the report of the Commission on Funding of Care and Support is imminent. As I have said, many lessons have to be learnt from the events of recent weeks. We will want to reflect on them as part of our wider reform agenda. The business model that underpins many of these issues is a legitimate area for the Department for Business, Innovation and Skills to be looking at, although it will do so in a general rather than specific sense in relation to Southern Cross.
NHS: Reform
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Lord Kennedy of Southwark
To ask Her Majesty’s Government how they will ensure that their proposals for the reform of the National Health Service do not lead to a break up of the service.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government are currently pausing to consider possible improvements to the Health and Social Care Bill. However, our proposals will reinforce the NHS as an integrated system, joining up working between the NHS, public health and social care locally. A new NHS commissioning board will set national commissioning guidelines promoting greater consistency. All NHS bodies and providers of NHS services will remain bound by the NHS constitution, and the Secretary of State will remain accountable overall.
Lord Kennedy of Southwark
My Lords, I thank the Minister for his reply. Does he understand the issue of low morale within the NHS that is being caused by these proposals, as well as the concern and worry among patients? Let us be clear that the record of the Conservative Party on the NHS, now supported by the Liberal Democrats, is a great worry to citizens and to anyone who values and cherishes this House.
Earl Howe
My Lords, I accept that a number of aspects of the Government’s proposals have caused concern in many quarters, and that is why we have chosen to pause in order to listen and reflect on those concerns. As I have said, we will be bringing forward proposals shortly to improve the Bill. I hope that those proposals will meet with widespread acceptance. I think that it is fair to say that it is not the main principles which the Government have laid out that have been the subject of controversy but rather the detail and the implementation, which we are looking at most closely.
Lord Patel
My Lords, does the noble Earl agree that if we are going to make the proposed savings in the health service of £20 billion, some form of reconfiguration of how health services are delivered is inevitable? If that is so, which would he prefer: a market-driven reconfiguration, or a planned one that will contain costs in the future?
Earl Howe
My Lords, the way we have set out the Health and Social Care Bill means that, wherever possible, decisions on service reconfiguration will be taken at the local level. That will mean that all stakeholders locally, not only the NHS but local authorities, social services and patient groups, will buy in to and contribute to whatever decisions are taken. So my answer to the noble Lord is this: it should be a considered process of decision-making taken locally.
Baroness Hussein-Ece
My Lords, as we know, the NHS is the most valued public service in this country. It is one that we all rely on from the cradle to the grave. What are my noble friend’s views about the fact that it is still the most unaccountable public body delivering services that we have? It is still unaccountable to its users. What discussions have been taking place to ensure that the NHS becomes far more responsive and accountable to users?
Earl Howe
My noble friend has made a key point. As she will know, patient and public accountability is one of the themes of the listening exercise that we have been conducting. I anticipate that Professor Steve Field and his NHS Future Forum will come forward with some substantive recommendations on how we can improve the arrangements for accountability in the service. I agree with her that it is in practice less than accountable at the moment, and our view is that it should be accountable primarily to patients in the local area but also, crucially, to Parliament as well.
Lord Taylor of Blackburn
My Lords, ought not the Government to pause and think before they introduce policies and not cause disharmony within the service?
Earl Howe
My Lords, if the noble Lord remembers, we consulted extensively last year when we published our White Paper. However, as the Bill progressed though Parliament, it became apparent that concerns on the detail of the Bill gave rise to matters of implementation which could have legislative implications. That is why we have taken a second chance to look at that detail.
Lord Skelmersdale
My Lords, would my noble friend care to cast any light on the fact that I have received criticisms of the Bill from virtually every health professional body but not one from a patient?
Lord Sutherland of Houndwood
My Lords, the NHS makes a considerable contribution to the health of patients through its participation in major research projects, working with drugs companies and those concerned to improve the quality of care in hospitals and outside. What protection is there for this continuing?
Earl Howe
The Bill states that the prospective NHS commissioning board will have a duty to promote research and continuous improvement in the quality of care. As the noble Lord will know, that duty will be underpinned by the role of NICE, which will be tasked with producing quality standards that are informed by the latest innovations coming through from the research agenda.
Lord Walton of Detchant
My Lords, I am sure that all of us await with considerable interest the outcome of the review that was recently undertaken and its proposals relating to the changes proposed in the Health and Social Care Bill. May I take it that, in addition to the bodies which the noble Earl listed, the universities which train doctors and other healthcare professionals and provide facilities for research will be fully consulted because of the importance of the training of those professionals in the NHS?
Earl Howe
The noble Lord is quite right. The vital importance of education and training is one of the four main themes of the listening exercise. We have received some very interesting and significant proposals from the academic sector which Professor Field will no doubt reflect in his conclusions.
Baroness Thornton
According to information provided in response to a recent freedom of information request, in Hull GPs have 17 per cent of the budget whereas in the East Riding they have 69 per cent; in Derbyshire there are 12 finance officers supporting GPs, whereas in Bristol there are none; and in London there are 10 executive directors, of which three are public health directors, but nobody knows to which of the 32 boroughs they belong. How will the Government ensure patient safety in what I hope the Government might recognise is possible impending chaos resulting from the de facto implementation of key parts of the Bill, the dismantling of the SHAs and PCTs, the patchwork of growth of new organisation and the leaching away of experienced staff?
Earl Howe
My Lords, we are putting patient safety at the centre of the NHS by moving it to the NHS commissioning board. In that way, patient safety will be embedded into the health service through GP commissioning and their contracts with providers. We are strengthening the Care Quality Commission so that patients know whether providers are meeting minimum standards of safety. We are also developing outcome measures for patient safety so that everyone can see how organisations are performing and can be held to account by the people that they serve.
Health: Brittle Bone Society
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Lord McAvoy
To ask Her Majesty’s Government how they are supporting the Brittle Bone Society.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we welcome the important work of the Brittle Bone Society in raising awareness of this distressing condition and in providing advice and help to patients. We would be pleased to consider any request from the society for support.
Lord McAvoy
I am grateful to the Minister for that reply. As he is aware, the society works in the field of osteogenesis imperfecta, which is not to be confused with osteoporosis. I know the Minister is also aware that a particular problem in this field is the transition from childhood to adulthood and that there is definitely a doubt about the level of services. Will the Minister consider a request from me to receive a delegation, led by me and accompanied by the chief executive of the Brittle Bone Society, Mrs Patricia Osborne—who used to work for me in a former life—trustee John Phillips and Professor Nick Bishop, in order that the society can have an input into the development and allocation of services for that period from childhood to adulthood for those who suffer from this condition?
Earl Howe
My Lords, I should be more than happy to see the noble Lord and representatives of the Brittle Bone Society to discuss those matters. I am well aware of the issue he raises. I understand that when an application was made to designate specialised services for children with brittle bone disease as a national specialised service, no similar case was made for adult services. However, if the society or leading clinicians in this field now feel that an application should be made, we would be pleased to refer it to the Advisory Group for National Specialised Services against the normal criteria.
Lord Alderdice
My Lords, given that osteogenesis imperfecta is a genetic disorder and that real progress in proactive treatment for sufferers will require progress in genetic medicine, is my noble friend reassured that we retain in this country sufficient researchers, funding and facilities to ensure that sufferers from osteogenesis imperfecta and their families can look to research from this country to see progress in proactive treatment rather than simply to elsewhere, particularly the United States of America?
Earl Howe
My noble friend is absolutely right. As he knows, the UK is one of the pioneers of genetic research; it takes a lead role in the international human genome project and its application to medicine. The human genome project has sequenced the 25,000 or so genes that make us human and research is now looking at how groups of genes interact not only with each other but with environmental factors to cause disease. We remain absolutely committed to genetics research and aim to make the UK the best place in the world for that research to continue. If there are proposals relating to this specific condition, my department will be very pleased to receive them.
Lord Colwyn
My Lords, would my noble friend also pass his invitation to researchers in dentinogenesis imperfecta?
Lord Willis of Knaresborough
My Lords, does my noble friend the Minister accept that the charitable sector is absolutely fundamental to medical research in this country, putting over £1.4 billion a year into research? The Brittle Bone Society is one of the charities that does exactly that. However, many of these charitable research organisations fear that the resources that go in through the charitable support fund may be lost at the end of this comprehensive spending period. Will my noble friend give an assurance that that fund will continue at current levels into the future so that the charitable sector in funding research can have the security of knowing that it will not have to find money simply to underpin the research facilities in our universities?
Earl Howe
My Lords, the voluntary sector investment programme has a confirmed budget of £25 million for 2011-12. That is the same as the budget allocated last year. I hope that that sends a strong message to commissioners about the role that the voluntary sector plays in health and care. We are sending a message to local authorities and PCTs that the voluntary sector should not shoulder a disproportionate share of any funding cuts that they may have to implement.
Mental Health: Children in Local Authority Care
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The Earl of Listowel
To ask Her Majesty’s Government how they are meeting the mental health needs of children in the care of local authorities.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, supporting and promoting the mental health needs and well-being of looked-after children is of the utmost importance. It is not the job of any one person or organisation. Strong and effective multi-agency working across local authority and health partners is essential. No Health without Mental Health provides a co-ordinated, cross-government focus to improving mental health outcomes for people of all ages, including those in vulnerable groups such as children in the care of local authorities.
The Earl of Listowel
My Lords, I thank the noble Earl for his reply. Will he urgently consider working with local authorities to ensure that, in the early assessment of children when they are taken into care, a clinical psychologist with appropriate training or a child psychiatrist is involved so that mental health needs are recognised and can be acted on? Furthermore, will he say what the state of specialist looked-after children’s mental health services is? These are multidisciplinary teams developed in some local authorities and are particularly vulnerable to closure at this time of funding shortage.
Earl Howe
My Lords, with his experience in this area, the noble Earl hits upon some extremely important points. As he will be aware, support for the mental health needs of looked-after children is at its most effective when child and adolescent mental health services, CAMHS, provide dedicated resources to work with looked-after children and their carers with trained and experienced staff. It is up to local authorities to decide the level at which staff should be appropriately deployed. Targeted CAMHS for looked-after children should work closely alongside the child’s social worker, carers and other professionals such as nurses and paediatricians. It is reassuring that data collected over past years for the CAMHS mapping survey by Durham University show an increase from 2003 to 2009 in the number of social services teams and teams with a focus on looked-after children, although those data carry a slight health warning in that participation in the survey, I understand, was voluntary.
Baroness Hollins
My Lords, how much research are the Government funding into the mental health and social outcomes for looked-after children and for adults who were looked after as children?
Earl Howe
My Lords, the noble Baroness may know that NICE and the Social Care Institute for Excellence prepared guidance recently on promoting the quality of life of looked-after children and young people. In doing so, they considered evidence including research reviews, a practice survey, a consultation with young people who have been in care, field work with practitioners and the testimony of expert witnesses. The evidence demonstrated that the health and well-being of looked-after children and young people are affected by nearly all aspects of their lives and care. The noble Baroness may like to know that a detailed list of that evidence is contained in appendix C to the guidance.
The Lord Bishop of Blackburn
My Lords, some local authorities are experiencing a very large number of looked-after children moving from other local authorities. I believe that in Medway there has been an increase of some 21 per cent. What action are Her Majesty's Government taking to ensure that local authorities that accept children from other local authorities are able to provide the specialist care that this vulnerable group needs in the field of mental health?
Earl Howe
The right reverend Prelate is quite right that the numbers of children going into care have been rising and some local authorities have been under particular pressure. But local authorities generally should be in no doubt that they have legal obligations in this area that they cannot obviate. The Department for Education has produced revised regulations and statutory guidance on care planning for looked-after children and care leavers, which came into force on 1 April. I have already mentioned the NICE and Social Care Institute for Excellence guidance, which should be followed alongside those regulations.
All local authorities in England must provide information on the emotional and behavioural health of children in their care and there are established screening tools to enable them to do that effectively. A recent study published by the Local Government Association found that more than 60 per cent of councils are seeking to protect children’s social care from any cuts.
Baroness Hussein-Ece
Does my noble friend share my concerns that significant numbers of black and minority-ethnic children in the care system suffer from mental health problems, but do not receive the appropriate intervention and support until it is far too late and they have already become involved in the criminal justice system? Will my noble friend tell me what is being done to ensure early intervention, treatment and support for these young people and children?
Earl Howe
My noble friend is absolutely right. She will know that minority-ethnic groups appear to be overrepresented in the looked-after population. Around 3 per cent of the child population of Great Britain is from black, black British or mixed groups, but 8 per cent of looked-after children are black and 7 per cent are from mixed groups. She is right that there is a problem. She is also right that early intervention is key. There is a strong emphasis on public mental health in the mental health strategy. The good foundations are down to early intervention, as I mentioned, and we are clear that this is a priority for the Government.
Baroness Armstrong of Hill Top
The Minister will be aware from recent research that an integrated budget actually makes sure that looked-after children and other vulnerable groups are more effectively responded to. Is he confident that the current confusion in the health service about the future and what the priorities should be is not preventing good work being developed in this area, because practitioners do not know what they should be doing?
Earl Howe
My Lords, I see the Government's proposals for local health and well-being boards as absolutely key to the effective integration of services and working across boundaries. The noble Baroness will know that the NICE and SCIE guidance that I mentioned is all about how better agencies and services should work together to produce the best results. We have a big opportunity in the Government's reform proposals to do the very thing that she is seeking.
Health: Cancer
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Lord Davies of Coity
To ask Her Majesty’s Government what steps they are taking to improve outcomes for kidney cancer patients.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, our cancer strategy sets out a range of actions to improve outcomes for all cancer patients. It shows how we intend to tackle preventable cancer incidence, improve the quality and efficiency of cancer services and deliver improved outcomes. We are providing £450 million to achieve earlier diagnosis of cancer, and we are working with a number of rarer cancer charities to discuss current barriers to early diagnosis of rarer cancers and possible solutions.
Lord Davies of Coity
My Lords, I thank the Minister for that Answer. Is he aware that each year more than 8,000 people in the United Kingdom learn that they have kidney cancer? That is approximately 22 people a day. Is he aware, too, that some of the treatment options contained in the UK guidelines for the systemic treatment of renal cell carcinoma have not been approved by NICE? Finally, will the Minister meet the James Whale Fund for Kidney Cancer and leading clinicians to explore methods and systems to improve the diagnosis of kidney cancer at the early stage?
Earl Howe
My Lords, I pay tribute, first of all, to the James Whale Fund for Kidney Cancer, which is an organisation that I know quite well, as the noble Lord is aware. It is doing tremendous work, not least in the field of specialist cancer nursing but also as regards its care line, on which I congratulate it. The noble Lord asked whether I would agree to meet the fund. For my own part I would be very happy to do so, but it may be more appropriate for my colleague in the department, who deals with cancer services, to do so as well. We recognise that more needs to be done to raise awareness of the signs and symptoms of rarer cancers such as kidney cancer. Our strategy for cancer sets out our commitment to work with a number of cancer-focused charities. Officials have already met such charities and more meetings are planned over the summer.
Lord Alderdice
My Lords, the noble Lord, Lord Davies, raised the question of National Institute for Health and Clinical Excellence approval of chemotherapeutic drugs. After a nephrectomy, not much else is available, because radiotherapy is generally not terribly helpful in renal cell carcinoma and other cancers of the kidney. The National Institute for Health and Clinical Excellence has to look, with these often quite expensive drugs, at how much benefit is being achieved for the cost of the drug. It is not an easy decision, which is why the noble Lord, Lord Davies, raised the question of some non-approved drugs. Is the Minister satisfied about the judgments being made by NICE about the benefit as against the cost? They are difficult judgments, but is he satisfied with the judgments being made?
Earl Howe
I am grateful to my noble friend. He is absolutely right; these are very difficult decisions to make. NICE issues final guidance on the use of a drug only after very careful consideration of the evidence and wide consultation with stakeholders. The noble Lord, Lord Davies, and, I am sure, my noble friend will be aware that one particular drug has been refused or not recommended by NICE. However, we have established the cancer drugs fund, which will enable individual clinicians on a patient-by-patient basis to apply to access drugs even though they have not been recommended by NICE.
Baroness Masham of Ilton
My Lords, will the Minister look at the problem of neuroblastoma, which is an aggressive type of child cancer? I have to declare an interest as I had a small cousin who had his kidney removed at five with a tumour. He had to go to America for treatment. Will the Minister ensure that the UK, which does not have a good survival rate for these children, looks with America at the research needed for them? There are only about 100 a year in the UK who have neuroblastoma.
Earl Howe
The noble Baroness raises an important issue, because these conditions are devastating even though they affect only a comparatively small number. There is a good deal of research going on into cancer, some of it funded by my department. I do not have details of whether that condition is the focus of any such programme but I will take away her concern and write to her if I have further information.
Baroness Thornton
My Lords, today the Cancer Campaigning Group, which represents dozens of cancer organisations including Kidney Cancer UK, has launched a survey of GPs in which 71 per cent agree or strongly agree that they will require specialist advice effectively to commission cancer services. Given that the cancer networks’ funding is not guaranteed beyond 2011-12, how will that commissioning support be provided? On an individual basis, how will support be provided to GPs when they have to tell a kidney cancer patient that they will not be able to afford to offer Afinitor? That is the drug the Minister referred to, which is not approved by NICE and which costs £200,000 per course of treatment.
Earl Howe
My Lords, there are drugs which NICE has recommended for kidney cancer, so Afinitor is not the only drug on the menu. GPs have a crucial role to play if we are to achieve earlier diagnosis of cancer and meet our ambition of cancer outcomes that are among the best in the world. The National Cancer Director, Professor Sir Mike Richards, is working with pathfinder GP consortia to understand how we can support them in commissioning services that deliver the best outcomes. He is clear, as are we, that cancer networks will have a central role in the reformed NHS as a place where clinicians from different sectors come together to improve the quality of care across integrated pathways.
Baroness Knight of Collingtree
My Lords, has my noble friend made any assessment of the difficulties of treating cancer patients, when the trouble is with the kidneys, because of lack of spare parts?
Earl Howe
I think I shall need to clarify with my noble friend what she means by spare parts in this context. I am aware that if we look at treatment options for kidney cancer, neither chemotherapy nor radiotherapy is generally appropriate. Usually, surgery is the preferred course of treatment. If my noble friend will allow, I will speak to her afterwards and investigate as appropriate.
Public Bodies Bill [HL]
Earl Howe Excerpts(14 years, 5 months ago)
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Baroness Thornton
My Lords, I thank the noble Baroness, Lady Deech, my noble friend Lady Warwick and other noble Lords for their determination to have the future work of the HFEA and the HTA clarified during the course of the Bill. I join others in thanking the Minister for his patience and accessibility in discussing the different aspects of the issue.
We have had another excellent debate that has illustrated why it was necessary to bring the issue back to the Floor of the House for further discussion. The House needs to heed the voices raised across the Chamber—as well as the pleas contained in the letters that we have received from some of the parents of Alder Hey children, the letter in the Times this morning signed by a galaxy of medical experts and the briefing from the BMA on behalf of several organisations—as a sign of increasing concern.
Since Report, the Minister has kindly written to me explaining further the Government’s proposals for the HFEA and the HTA and the staged break-up that seems to be the Government’s preferred option at the moment. In brief, the break-up involves HFEA and HTA functions being transferred to the CQC except for research-related functions, which will be transferred to the health research regulatory agency, presumably covering what have been broadly referred to as the ethical issues. To facilitate this, as the noble Baroness, Lady Deech, explained, a special health authority will be created in 2011-12 and there will be primary legislation to establish the agency proper in the second Session of this Parliament. Presumably, the ethical issues will therefore be dealt with by the interim body in that process. Notwithstanding the proposals of the noble Lord, Lord Willis, regarding the Health and Social Care Bill when—indeed, if—it reaches us, it is clear that there will be primary legislation to establish the new research body.
I am further grateful to the Minister for his explanatory letter because it served to strengthen my view that these bodies should never have been in the Bill in the first place. It also illustrated for me the question that I want to put to him: why go through such disruption, risk, lack of stability, potential loss of expertise and expense for the next two years prior to the introduction of primary legislation to establish the new health research agency, which will address all of these issues? Why not agree the amendment that establishes an independent assessment of the work of both bodies? That could feed into the pre-legislative process and consultation, which will include all the questions that need to be asked, leading to primary legislation in about two years’ time. If the Government go down the route that the Minister is proposing, they intend to launch a consultation this summer, as outlined in the Minister’s letter to me, and then presumably will break up the agencies at some point towards the end of this year and the beginning of next. That means that at the beginning of 2012 the agencies would be broken up and then, by the end of 2012, we would start the pre-legislative programme to set up the new research agency.
That is why we on these Benches will be supporting all these amendments. It is not that either the HTA or the HFEA should be preserved for ever; indeed, it is clear that my noble friend Lord Winston and the noble Lord, Lord Patel, have grave problems with the HFEA. I make the point to the noble Lords, which I have also done outside the Chamber, that that is not the point of the Bill. Passing the amendments would actually be more likely to address their concerns than would leaving the situation as it is. In other words, there is no guarantee that their concerns about the HFEA, which I am sure are legitimate, would be addressed if we left the Bill as it is without the reassurances.
The one thing that we know is that there is going to be a health research agency. It is an idea of merit. It is also a proposal that is ideally suited to the expertise and inclination of this House; the Select Committee, the pre-legislative scrutiny, the draft Bill and, if I may say, the skills that the Minister brought to bear when he helped to create both these agencies make this the place where that process should start. I am certain that that would ensure a good outcome.
The amendments are different from the simple deletion amendments that we tabled in Committee and on Report, particularly the third amendment, because it accepts the principle that the Minister may transfer or modify the functions under Clause 5 in respect of these bodies but would require the Minister to have first established the Government’s new regulatory body with a separate ethics committee. It would ensure that there were no gaps between what is happening now with the current bodies and the Government’s intended independent regulatory body in future, a point that many noble Lords have made. However, it would not preclude an examination and independent assessment of the work of both these bodies. It would ensure that the critically important ethical functions performed by these bodies were recognised and catered for, which, in a way, is where we came in at the first stage of the Bill.
Earl Howe
My Lords, I thank noble Lords who have moved or spoken to these amendments. I recognise and understand the sentiments underlying them. I do not in the least wish to argue against or downplay the importance of cost-effectiveness in any legislative changes that we propose, or of ensuring that the right successor arrangements are in place for discharging the relevant functions of the HFEA and HTA. I therefore hope that what I am about to say will satisfy noble Lords that in most key respects I am in the same place as they are regarding the points at issue.
Since our debate on Report I have written to the noble Baroness, Lady Thornton, to set out my reflections on the points that she and others have made. There were common themes: a desire for greater clarity on where the Government intend to transfer the functions of the HFEA and HTA to; concern that the dispersal of functions across a range of bodies would risk fragmenting regulation; and concern over loss of expertise. I have considered these concerns carefully. As I have made clear, we intend to consult in the late summer on the options as to where certain functions would be most appropriately transferred. That remains our aim. However, having taken into account the strength of feeling about keeping functions together, we now intend to proceed on the basis that our preferred option is for all HFEA and HTA functions to be transferred to the Care Quality Commission, except for certain research-related functions that will transfer to the proposed health research regulatory agency. We shall therefore consult on this basis but, at the same time, remain open to receiving views on the way forward from all stakeholders through the consultation process. I hope noble Lords will agree that this preferred option will address concerns about the potential impact of fragmentation.
The noble Baroness, Lady Deech, expressed the fear that the Government’s proposals would lead to a vacuum as regards the ethical focus of these bodies—in the decision-making process for research and treatment involving embryos in particular. Let me explain what we intend. Ethical safeguards—for example, the type of embryo and gamete that can be used in treatment, the need to consider the welfare of the child, and the need for consent in respect of human tissue—are clearly enshrined in legislation in accordance with the wishes of Parliament. These safeguards will remain firmly in place.
In keeping an integrated approach to HFEA functions, the CQC would be the focal point for ethical considerations of treatment licensing that arise from the Human Fertilisation and Embryology Act. There is no reason whatever to suppose that it is not up to fulfilling that role. I say to my noble friend Lord Newton that my department’s officials have had discussions with the CQC senior managers about the proposed transfer of functions. The CQC is confident that these can be taken on effectively. The health research agency will provide a focal point for the ethical consideration of research using embryos. It will draw on expert advice, as the HFEA does now. The aim is to simplify and rationalise the ethical approvals process for all kinds of research. Far from the ethical focus for each type of activity being lost, it will be actively preserved.
My noble friend Lord Willis suggested that we might use the Health and Social Care Bill, now in another place, as the vehicle for the proposed changes, rather than this Bill. I recognise the force of his proposal. He will know why we have chosen not to go down that road. We do not want to add to what is already a substantial Bill. It is important, too, that the Government retain momentum for their planned changes across the ALB sector. The ALB review process has already garnered significant rationalisation across the health sector and we do not want that rolled back. By keeping the HTA and the HFEA within the Public Bodies Bill, we can deal discretely with complex issues and undertake detailed consultation and impact assessments in a timely and considered way. We also, as I have indicated on several earlier occasions, wish to avoid reopening the Human Tissue Act and the Human Fertilisation and Embryology Act, which command widespread agreement. Our desire to maintain momentum is why we plan to establish a special health authority to continue and strengthen the work of the National Research Ethics Service and to be a starting point for the simplification of research approval processes. That special health authority would be the platform on which we would build the fully fledged research regulator.
Lord Willis of Knaresborough
Does the Minister not understand the incredulity of many of us? This is a Bill that deals with getting rid of quangos, yet the Minister’s solution is to set up a quango to create time in order to set up a bona fide agency. Surely the Minister sees that by simply delaying the whole process until the agency is in place, everything can be transferred either to the CQC or to the new agency, all at once, without an interim body.
Earl Howe
I ask my noble friend to wait a few minutes; I hope I will tell him something that he will welcome.
I turn to the amendments. On Amendments 7 and 8 the issue is not so much the end point that they seek to achieve as the practical implications that they would carry if they were accepted. Let me set out what we plan to do. There will be a full public consultation on our proposals this summer. Alongside that, we will publish an impact assessment, which will include a view about the cost-effectiveness of options for transferring functions. I assure the House that the key comparison for the purposes of the assessment will be between our preferred option and the organisations’ own plans for rationalisation. I hope noble Lords will endorse the idea of a formal impact assessment as the vehicle for doing this. It is a process that, until now, has been accepted by Parliament for general legislative and policy changes. There does not seem to be any obvious reason why that should not be an appropriate way to proceed in this case.
In addition, as I have said previously, there will be a further consultation on the proposed regulations in due course before these are laid. Taken together, these three safeguards should be sufficient to meet the aspirations of noble Lords for achieving a robust evaluation. The approach that we propose on consultation and impact assessment will, I suggest, produce a result that is thorough, transparent, balanced and, therefore, fit for purpose. The amendments, taken literally, would have us go further by suggesting a formal process of independent assessment of cost-effectiveness. This would be neither necessary nor desirable. With the best will in the world, any such assessment would be costly to the public purse, highly subjective—as any assessment of cost-effectiveness is bound to be—and very difficult to measure definitively. Practically, it would get us no further forward than a standard impact assessment. In any issue of this kind, we need to take care that legislation does not set conditions that are impossible to meet. That is why I hope the assurances that I have given will be enough to persuade the noble Baroness not to press these amendments.
In turning to Amendment 9, I will address the question posed by my noble friend Lord Willis. The amendment seeks to ensure that no HFEA or HTA functions would be transferred using the powers in this Bill until the health research regulatory agency has been established. I fully appreciate the reasoning behind this. It very much accords with the Government’s wish to avoid a piecemeal approach to the transfer of functions. In my letter of 27 April to the noble Baroness, Lady Thornton, I said that,
“in principle our preference would be to consult on the draft secondary legislation during 2012 and to commence it after the primary legislation is place that will give the health research regulatory agency the necessary legal basis. In that way, transfer could take place as a single and clear exercise, and in a co-ordinated and least disruptive way”.
In the light of this amendment and the points made today in support of it, I am prepared to go further and give a firm commitment that, subject to the will and views of Parliament, the Government will proceed on the basis of transferring functions from the HFEA and HTA only once the research regulatory agency is established in legislation. I hope that this commitment will satisfy the House. There are problems with including the amendment in the Bill from a legal perspective. It is difficult to envisage how, within this Bill, we could describe with the necessary level of legal certainty the new research body that would need to be established. The detail of what a new regulator will look like and the functions it should hold is a matter for Parliament to debate and determine as and when the relevant legislation comes before it. To make provision for a future body in this Bill risks both describing it in a way that is not accurate, thus making the power to transfer functions redundant, and attempting to limit the discretion of Parliament in relation to future legislation.
The amendment also seeks to provide in this Bill that the research agency,
“must have a separate ethics committee to undertake … ethical consideration functions”
transferred to it from the HFEA and HTA. I fully appreciate the need for assurance that the research regulatory agency will have access to the relevant expertise to deal with the licensing of embryo research and any research-related functions that may transfer to it from the HTA. Therefore, I repeat the assurance that we have consistently given that expertise will follow function, and that we expect that the research agency will have access to expert peer reviewers and others in the relevant fields that are currently available to the HFEA and HTA. However, I suggest that the level of detail on matters such as expert committees is again more appropriate for consideration by Parliament in relation to any legislation that will seek to establish the research regulatory agency rather than attempting to include it prematurely in this Bill.
Although, for the reasons I have given, I cannot accept the amendment, as I indicated at the beginning of my remarks, I would like to believe that noble Lords who have spoken will not now be too far removed from the Government’s own position on these matters. In view of our developed approach to the transfer of functions and our clear intention to consult on our proposals in an open and transparent way, I hope that the noble Baroness will feel able to withdraw the amendment.
NHS: Waiting Times
Earl Howe Excerpts(14 years, 6 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the four-hour A&E waiting time standard was replaced by a set of clinical quality indicators, incorporating measures of timeliness, in April 2011. The proportion of patients waiting for less than four hours during the four weeks up to 24 April 2011 was 96.7 per cent compared to 98.3 per cent in April 2010. The average median referral-to-treatment waiting time for admitted patients was nine weeks in February 2011 and 8.4 weeks in May 2010.
Baroness McDonagh
I thank the noble Earl for that Answer. It would be clearer to the House to explain that waiting times for in-patients are at a three-year, all-time high since the 18-week target was set and that A&E waits are rising sharply. I am sure the Minister accepts the evidence that longer waits for treatment cost more per patient and clinical outcomes are worse. Can he tell the House how much on average it is costing per additional patient for those waiting over the 18-week target, which amounts to tens of thousands of patients each month?
Earl Howe
My Lords, first, referral-to-treatment times fluctuate. Having looked at how the figures have moved over the past year or two, my advice is that they are broadly stable. The figures to which the noble Baroness referred were struck at a particularly pressurised time for the NHS. As she knows, there are all kinds of reasons why during the winter referral-to-treatment times tend to lengthen. However, the right in the NHS constitution to be treated within 18 weeks remains. On accident and emergency waiting times, our clear advice from clinicians was that the four-hour target should be adjusted to reflect the clinical case mix and clinical priorities.
Lord Kakkar
My Lords, I am sure the noble Earl is aware of the recent report from the Royal College of Surgeons on emergency surgical standards. Does he share its concerns about the potential detrimental impact of waiting list targets for elective procedures on clinical outcomes for patients requiring emergency operations? In asking the question, I declare an interest as a practising surgeon and professor of surgery.
Earl Howe
My Lords, we are quite clear that timeliness remains an important ingredient in the care of patients. However, we are also clear that it is not the only measure of quality. On emergency surgery, there is no reason to expect that patients will be treated any less urgently in the future than they have been in the past. What matters is clinical priorities being set correctly.
Baroness Sharples
Is my noble friend aware that very recently I was in A&E on a trolley at St Thomas’s for just under five hours waiting for a bed?
Earl Howe
My Lords, that does concern me. I do not think anyone could endorse the practice of patients remaining on trolleys. I hope my noble friend was seen and tended to in a timely manner, but what she describes does not sound to me as though it conforms with good clinical practice. However, I stress to her that the figures I have show that nationally hospitals as a whole are adhering to the new standards that have been set.
Baroness Finlay of Llandaff
My Lords, do the Government recognise that, until the shortfall of 1,280 A&E consultants is met, the quality indicators will not be met because they require consultant sign-off? They must not be interpreted as rigid targets because of the variability of clinical scenarios that present. Indeed, the Primary Care Foundation report showed that this consultant shortfall must be met because only 15 to 25 per cent of attendances could be seen by co-located primary care. That figure is much lower than other people had previously estimated.
Baroness Hussein-Ece
My Lords, attendance at A&E has steadily gone up by more than 1.3 million over the past five years. How much is this the result of the lack of access to GP out-of-hours services? Is it not the case that too many people are presenting at A&E who should be seen at a primary care setting?
Earl Howe
My Lords, I agree with my noble friend completely. That is why we are quite clear that general practitioners have to take much greater direct responsibility for out-of-hours care. At the moment they can, if they choose, divorce themselves from that responsibility and I think that was a retrograde move. Equally, we are clear that we should encourage general practitioners to look at ways of avoiding unplanned emergency admissions to hospital in the first place. That will reduce pressure on A&E.
Lord Reid of Cardowan
My Lords, I declare an interest as the person who introduced the 18-week target and limit. Clinical outcomes and efficiency are important but equally important are the pain and distress of the patients—and often their families—in waiting a long time. The Minister refers to things being no worse than in the past but in the past the waiting time after diagnosis—not counting the first consultation with a consultant or GP—to operation was two years and three years for the whole patient journey. That has now been reduced to 18 weeks and six weeks after diagnosis. Does the Minister accept that it would be a tragedy, inflicting huge pain and distress on many people, if that was now to be abandoned?
Earl Howe
My Lords, I agree with much of what the noble Lord said. There is no doubt that great strides were made under the previous Government to reduce waiting times. That is entirely to the advantage of patients. However, the noble Lord will know that, as I mentioned earlier, the NHS constitution still retains the right for treatment within 18 weeks and the contracts between commissioners and providers still retain the financial penalties if the 18-week target is broken.
Baroness Wall of New Barnet
My Lords, will the Minister reflect on the discussion that he and I have had in the past around how important waiting times are to patients? Despite the new six-week “more quality” input into how the analysis is done and the processes to which my noble friend Lady Finlay has just referred, there is still an issue when people leave hospital. They say they waited longer. We need to rethink what that really means. In the context of waiting lists, if we separate elective and A&E, as my husband is proposing, then we will do away with all of that.
Earl Howe
My Lords, the central point that the noble Baroness makes is absolutely right. We have to look at quality in the round. There is more to quality than simply timeliness, although, as I have said, timeliness of treatment is important. We need to develop indicators that show the full range of the level of care and service that patients receive. We are doing that.
NHS: Chiropody and Podiatry Services
Earl Howe Excerpts(14 years, 6 months ago)
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Baroness Gardner of Parkes
To ask Her Majesty’s Government what plans they have to ensure the continuing provision of training and practice in chiropody and podiatry services under new commissioning consortia and the National Commissioning Board.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, it is the responsibility of local National Health Service organisations to commission services to meet the needs of their community and the education and training necessary to deliver them, including the provision of chiropody and podiatry services. This will continue in the future.
Baroness Gardner of Parkes
I thank the Minister for that reply. Does he share my concern that GP consortia may lack the necessary strategic overview to prioritise longer-term preventive care options and ensure future podiatric care? Can he further clarify whether Health Education England, or some other body, will have full responsibility for seeing that adequate numbers of podiatrists and chiropodists are trained?
Earl Howe
My Lords, let me first make it clear to my noble friend that GP consortia will not be responsible for commissioning training—at a local level that will be the responsibility of the skills networks, made up of healthcare providers. Health Education England will be a new organisation with new executive powers. It will provide national leadership on planning and developing the healthcare workforce and promoting high-quality education and training that is responsive to the changing needs of patients and local communities.
Lord Harrison
Is the noble Earl aware of the recent study by the American Podiatric Medical Association which demonstrates that early recognition of foot ulcers or foot problems in diabetics can prevent hospitalisation, or indeed amputation, if action is taken early and resources are commanded to deal with potential problems?
Earl Howe
My Lords, I am aware of that study. If we apply the lessons learnt to the UK, the noble Lord may already know that approximately 100 people have an amputation due to foot ulceration, as a complication of diabetes, every week. The International Diabetes Federation has estimated that 85 per cent of these amputations could be prevented through early intervention by a diabetic foot team that includes a specialist podiatrist. Indeed, the diabetes foot protection team in Southampton, to take one area, reduced in-patient stays from 50 to 18 bed days and saved £1.2 million in the first three years.
Baroness Trumpington
My Lords, is my noble friend the Minister aware that I consider that any feet over the age of six months are utterly revolting? However, I have a serious question: will wounded servicemen, who are unable to reach their own feet due to injury, be given free chiropody?
Earl Howe
I am grateful to my noble friend. She will know that the injuries sustained by our service men and women in the theatres of conflict form a high priority for the National Health Service and the Defence Medical Services. Indeed, chiropody and foot care will play a large part, I am sure, in ensuring the mobility of those wounded personnel. The key will be to ensure that there are sufficient chiropodists and podiatrists to deliver the services required, and that requires a process of local determination and prioritisation to ensure that workforce numbers meet healthcare needs.
Lord Morris of Manchester
My Lords, I have an interest to declare as president of the Society of Chiropodists and Podiatrists. Can the Minister give the House the Government’s estimate of the number of NHS patients who have suffered preventable amputations due to lack of state-qualified podiatric care?
Earl Howe
My Lords, it is obviously difficult for me to give the noble Lord a precise figure but his central point is absolutely correct. We know that many people suffer needless amputations who, if they had had early intervention, would be spared that appalling outcome. The role of chiropodists and podiatrists, as he will know more than anyone, is in the field of prevention not least for patients with diabetes but also in the care of the elderly to ensure mobility and proper foot care.
Baroness Jolly
My Lords, in some parts of the UK it is not possible to train as a podiatric surgeon. Consequently, podiatric surgery is not widely available. Will my noble friend tell the House whether in England the Government are planning to encourage more centres for training appropriately qualified podiatrists, thus remedying the situation?
Earl Howe
My Lords, my noble friend makes an important point. She will know that there are universities that specialise in the training of chiropodists and podiatrists, and we place great reliance on them. What will emerge from the new architecture that is foreshadowed by the Health and Social Care Bill is a much greater sense of local prioritisation regarding needs. Flowing from that, with the advice and guidance of Health Education England, which will be the national body supervising workforce requirements, we may well see further centres of excellence in training emerging.
Baroness Thornton
My Lords, I hope that the Minister will forgive me for being slightly personal, but I wonder how often he trims his toenails. I expect that he can actually reach his own toenails unlike many elderly people who cannot reach theirs, do not have anyone to do it for them and cannot afford a podiatrist. Would the Minister be happy to have his toenails trimmed once every three months, which seems to be the standard offer by health centres and GPs at the moment? I am sure that he will share my concern that even that service is under threat from the cuts at PCT level. Will the Minister undertake to ensure that podiatry services for the elderly become a priority for the National Commissioning Board?
Earl Howe
My Lords, I am fortunate in being able to cut my own toenails. However, the noble Baroness makes a serious point about the elderly. It is often the lack of that simple service that prevents elderly people being as mobile as they wish and sometimes confines them to their own homes. This is a serious issue in terms of the way that we can prevent unplanned hospital admissions due to elderly people falling over. The process that I have referred to whereby we will see joint health and well-being strategies emerging from the health and well-being boards at local level should ensure a sufficient supply of the workforce over a period of time.
NHS: Consultation on Reform
Earl Howe Excerpts(14 years, 6 months ago)
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Lord Foulkes of Cumnock
To ask Her Majesty’s Government how they propose to report the outcome of the consultation on NHS reform to Parliament.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we ran a public consultation on NHS reform last year and received some 6,000 responses. As a result, we brought forward important changes to our modernisation proposals. We are now taking advantage of the natural pause in the legislative process to listen and reflect, supported by advice from the new NHS Future Forum. The Government will then respond to the forum’s report and the wider listening exercise, setting out the improvements that we will make to the Bill based on what we have heard.
Lord Foulkes of Cumnock
My Lords, did the Minister see the Statement by the Secretary of State that the reason for the pause was because the Bill was allegedly not understood and he had to explain it better? Will he explain to Mr Lansley that it is precisely because the Bill is well understood that there is such widespread opposition, including an unprecedented vote of no confidence by the Royal College of Nursing? Will he give a guarantee that substantial amendments will be brought before Parliament after the current consultation? Otherwise, it will be seen as a complete sham.
Earl Howe
My Lords, I think there is widespread agreement that the principles on which the Bill is based, such as devolving control of the NHS to local levels, placing patients at the heart of decisions about their own care and improving public accountability are the right principles for us to be guided by, but that there are also, as the noble Lord said, questions and concerns, some quite deep, about what we are doing and the mechanics of putting the principles into practice. As the Prime Minister and Deputy Prime Minister made clear, this is a genuine chance to make a difference. Where there are good suggestions to improve the legislation, those changes will be made.
Baroness Tyler of Enfield
My Lords, what steps are the Government taking to plug the gaps in the membership of the NHS Future Forum? Will the minutes of the forum be made available to the public?
Earl Howe
My Lords, the forum, as I understand it, is now fully composed. The appointments were made over the past 10 days or so. I am not aware of any further appointments. The plan is for the forum to produce a report which will be published at the end of the day. I will, however, write to the noble Baroness as regards the minutes, which are a matter for the chair of the forum, which is independent of the Government, as she will know.
Baroness Wall of New Barnet
My Lords, does the noble Earl agree that the pause and the mechanics that he has talked about have to be dealt with—there are lots of issues around that—but that the pause or gap is causing great concern to people working in the health service? Pause is an incidental word as regards the feelings of people who are going through this process and are caring for patients but are not sure what method they are supposed to be using. Will the noble Earl please tell us when we will know what is happening and how these people can get on with the job that they want to do?
Earl Howe
My Lords, I am aware of that concern. This matter has occupied the minds of Ministers. I say to those who are serving in the NHS day by day and, indeed, to the pathfinder consortia and the early implementer local authorities that they should continue with the work that they are doing because it is from them that we most wish to hear about the practical lessons that our proposals may point to. It is, I am sure, an unsettling time for them but we hope that after this period of reflection we can continue with the passage of the Bill with proper momentum.
Lord Ribeiro
Does the Minister agree with me that the principles referred to earlier underpin the NHS reforms? These principles are supported by the coalition Government and follow on from the same reforms that were introduced by the previous Government. I would like him to acknowledge that these principles should be reaffirmed in any response to the listening exercise.
Earl Howe
My noble friend is quite right: the principles that underpin the Bill and—I emphasise this—the principles that have always underpinned the National Health Service, are not going to change. He is right that the approach that we are adopting is in many senses an evolutionary one, following on from initiatives taken by the previous Government. I am grateful to him for pointing that out and I am sure that this will be a feature of the government response that we shall publish in due course.
Baroness Masham of Ilton
My Lords, does the Minister agree with me that there is some concern about so much of public health going over to local authorities? Will he give an assurance that directors of public health will be well qualified in public health?
Earl Howe
The noble Baroness makes a very important point about local directors of public health, who most certainly do need the right qualifications for that role. As she will know, they will be jointly appointed by local authorities and by the Secretary of State and we need to ensure that they can perform their role properly. The four main themes to the listening exercise are: choice and competition; public accountability and patient involvement; clinical advice and leadership—that may be an area that impacts on her question; and education and training. In some ways it is difficult to separate those issues; they are all of a piece and we do need to look at them very carefully.
Baroness Thornton
My Lords, if the current listening exercise hears the almost universal concerns about the Government’s proposal to introduce a new economic regulator into the heart of the NHS—concerns, I have to say, that were expressed but ignored by the Secretary of State right through the autumn and the spring—will the Government be removing that part of the Health and Social Care Bill?
Earl Howe
My Lords, no, because we are clear that the current system requires independent oversight of competition within the health service. Essentially, we have an unregulated health service at the moment; the Government in which she played a distinguished part as a Minister rolled out the independent sector treatment centre programme but its terms were, in the judgment of many, not fair. We need independent scrutiny and determination of pricing in the health service to ensure that there is a fairer playing field for all those providers of NHS services.