Health: Cancer
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Baroness Gardner of Parkes
To ask Her Majesty’s Government whether they have proposals to use photodynamic therapy (PDT) for the treatment of cancer, particularly oral cancer.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, it is for clinicians to decide on the suitability of treating a patient with photodynamic therapy—PDT. It is then for primary care trusts to consider whether to fund that treatment, taking into account the available evidence. The National Institute for Health and Clinical Excellence has issued interventional procedure guidance on photodynamic therapy for nine cancer indications, including oral cancer.
Baroness Gardner of Parkes
I thank the Minister for that reply. Does he agree with me that the most important thing, whatever the type of cancer, is early detection? Will he encourage the research that I hear is being done and which we read about in all the newspapers, which entails a very simple blood test that detects cancer at the earliest stage?
Earl Howe
My noble friend is absolutely correct. It is now generally agreed that the most important reasons for the lower survival rates in England compared with other European countries are: low public awareness of the signs and symptoms of cancer, delays in people presenting to their doctors, and patients having more advanced disease at the time of diagnosis. We are looking very carefully at how best to achieve earlier diagnosis. There are some key messages on the NHS Choices website and the national awareness and early diagnosis initiative has been under way since 2008. As for my noble friend’s second question, on the blood test, the newspaper reports in recent days have been extremely exciting in terms of the potential. However, it is clear that researchers will have to demonstrate improved clinical outcomes for patients before any large-scale rollout can be applied.
Baroness Gould of Potternewton
My Lords, given the Minister’s reply, does he agree that targeted screening remains the best way to prevent growth of oral cancer? Given the success of the previous Government in cutting the overall rates of cancer deaths, is he prepared to guarantee that the current investment and screening programme will continue?
Earl Howe
The noble Baroness is quite right that screening plays a very important part in the detection of cancer. However, it is not universally applicable to every cancer. In terms of oral cancer, which was the particular subject of my noble friend’s Question, there are difficulties. For example, there is considerable uncertainty about how the disease progresses—its natural history—and we cannot predict which lesions will be malignant and which will not. We need clear guidelines—for dentists, for example—and we do not have those. There is also no clear evidence base for the management of malignant lesions when we find them. However, the National Screening Committee will review its position again in about three years’ time and will no doubt take all the current evidence into account.
Lord Alderdice
My Lords, does my noble friend accept that when we are trying to improve treatments for cancer, we are looking for non-invasive approaches and specific and, so far as possible, less expensive approaches? Photodynamic therapy has been very useful not just for oral cancer but for skin cancers of various kinds, particularly squamous cell carcinoma. Does he accept that encouraging not just dermatologists but also general practitioners to move in this direction will mean that we can have specific, non-invasive and generally quite efficient treatment, and that that is to be encouraged by the Government?
Earl Howe
I am very grateful to my noble friend. It may help the House if I briefly explain what PDT is. It is a technique that uses laser or other light sources combined with a light-sensitive drug, which in combination destroy cancer cells. When the light is directed in the area of the cancer, the drug is activated. As my noble friend indicated, although this is an invasive procedure, it is minimally so; and its advantage is that, unlike radiotherapy, no cumulative toxicity is involved, so someone can be treated with PDT repeatedly. However, there are difficulties, one of which is that there is no obvious clinical leadership in this field, and that has to be addressed. There need to be centres of excellence in order for the right lessons to be learnt and the right research to be done.
Baroness Howarth of Breckland
My Lords, there is no doubt that, once patients are at the hospital, they are likely to get the treatment, but can the Minister assure us that GPs will be encouraged to make speedy referrals? In the cases that I know of, the difficulty has been in getting from the GP to the centre of excellence in order to get the treatment.
Earl Howe
The noble Baroness is quite right, which is why in the NHS there is such an emphasis on speed of referral when a GP first suspects that cancer may be present in a patient. This is an area to which we are very alive, and I hope that we will be able to make further announcements about it in due course.
Baroness Thornton
Does the Minister accept that new cancer treatments such as PDT have benefited both from crucial investment by the Government and from partnership with leading cancer research charities? Is he prepared to guarantee that this crucial research will continue to be funded by the Government so that more deaths from cancer can be prevented in the future?
Earl Howe
The noble Baroness is quite right. This is a partnership effort, and she may know that a systematic review of PDT has been undertaken as part of the Health Technology Assessment programme, which is an element of the National Institute for Health Research. The final report on that will be published in August, but the institute has already identified that there are not enough high-quality research studies in this area. We know from experts in the field that there are at least three or four areas where further research should be prioritised.
Baroness Deech
Is the Minister aware that this month is the 50th anniversary of the invention of the laser? At that time its use in medicine could not have been foreseen. Does he therefore accept how important it is to enable universities to continue to do research in this field, in the hope that there will be future inventions, and not to cut them back in this area?
Earl Howe
The noble Baroness makes a crucial point. I am sure she will agree that neither basic research nor translational research should be neglected when we look at the research effort. Indeed, my own department is looking carefully at how the barriers to clinical research can be reduced. Therefore, she is absolutely right to focus our attention on the importance of continuing research.
First Aid
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Lord Harrison
To ask Her Majesty’s Government what is their response to the St John Ambulance campaign, entitled “The Difference”, promoting better public understanding and practice of first aid.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government admire the work undertaken by health organisations such as St John Ambulance and the Red Cross, and warmly welcome the contribution that “The Difference” can make to the treatment of the ill and injured.
Lord Harrison
Given that the St John Ambulance report suggests that some 150,000 lives could be saved if there was a rudimentary understanding of first aid, and given the paucity of understanding in this country—where only seven out of 100 of us have such knowledge, compared to four out of five of our German colleagues—will the Government redouble their efforts and consider including first aid in the PSHE part of the national curriculum? Will the Minister also study the work being done in the north-west, in a crucial project in Greater Manchester, where ambulancemen and paramedics teach primary schoolchildren about the work of providing and administering first aid? That has gone down very well indeed.
Earl Howe
My Lords, the noble Lord asks several questions there. As I have indicated, we are extremely grateful to organisations such as St John Ambulance, the Red Cross and the British Heart Foundation for the extensive and excellent work that they do. As a general approach, we are clear that the NHS locally is best placed to assess and address what is needed in its areas, as indeed in other areas of healthcare. However, we encourage NHS providers to consider the kind of partnerships that work so well.
As regards schools and PSHE, as the noble Lord will know, first aid is included in the PSHE part of the school curriculum. It is not a mandatory module, though it is often included in key stages 3 and 4. What I can do is convey the noble Lord’s concerns to my colleagues in the Department for Education.
Baroness Gardner of Parkes
My Lords, can the Minister assure me that emphasis will still be placed on the continuing need to educate the public about when to call an ambulance? I strongly support making people more aware of first aid, but there are many conditions, such as strokes, which it is too late to treat unless it is done within a certain timeframe. The ambulance service, as I learnt when I had a fall recently, is very good when you call at sorting out exactly what your symptoms are and whether you need an ambulance. Will the Government ensure that the public remain aware of that situation?
Earl Howe
My Lords, my noble friend is absolutely right. The kind of basic first aid provided by community first responders, as they are called, is extremely important, not least in terms of operating defibrillators. However, that sort of service should be seen as complementary to and supportive of ambulance responses to emergencies. It is not a substitute for emergency ambulance response, and it is right that my noble friend should raise that distinction.
Baroness Emerton
I declare an interest as a former chief commander of St John. I am in touch with the recent campaign. It is interesting to note that there were 250,000 responses to an advertisement from people showing an interest in first aid, of which 70,000 indicated a desire to learn more about it. As part of this campaign, St John has decided that it needs to concentrate—the noble Lord, Lord Harrison, has already mentioned this—on young people and the workplace. An interesting statistic is that 45 per cent of incidents where resuscitation is required occur in offices rather than on building sites. Will the Minister assist St John and the many other agencies by supporting their call to improve workplace facilities for first aid to take place?
Earl Howe
My Lords, the noble Baroness makes an important point. We all know that St John is active in major emergencies and road accidents and was active in the London bombings of five years ago. She is absolutely right that accidents in the workplace are a significant feature of the kinds of injuries that hospitals see. The ambulance service extends training in the workplace in a number of areas. However, I shall go back to the department and inquire about the extent to which St John in particular is doing this work. We may be able to feed in some important messages.
Baroness Massey of Darwen
Given the original Question, and the fact that we are in a workplace, has the noble Earl thought of enabling short first aid courses to be held in your Lordships’ House—I do not mean in the Chamber—so that we could respond in an emergency?
The Lord Bishop of Chester
My Lords, the noble Baroness has asked my question. However, I wonder whether mouth-to-mouth resuscitation might be excluded from such a course?
Baroness Masham of Ilton
My Lords, is the Minister aware that the St John’s guide on first aid and the five basics is free and can be carried round in somebody’s pocket? Should not all restaurants have it because people can choke very easily?
Earl Howe
My Lords, I was aware that the St John guide is free. I take this opportunity to congratulate it on the way in which it distributes so much free material in this area. The noble Baroness raises a concern about the incidence of choking in restaurants. I am not aware of the extent to which restaurants as a whole are equipped to deal with that, but I will find out.
Carers
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Baroness Pitkeathley
My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as vice-president of Carers UK.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we understand the urgency of reforming both the NHS and the social care system to provide more control to individuals and their carers. The coalition agreement makes it clear that we will,
“extend … personal budgets to give people and their carers more control … We will use direct payments to carers and better community-based provision to improve access to respite care”,
and we will,
“extend the right to request flexible working to all employees”,
including carers.
Baroness Pitkeathley
My Lords, I thank the Minister for that helpful reply. In national Carers Week, I am sure that millions of carers will be glad to hear of the Government’s commitment to support all that carers do. In their national carers strategy published in 2007, the previous Government pledged that no carer would be in financial hardship by 2018. Are the coalition Government planning to honour that pledge?
Earl Howe
My Lords, I pay tribute to the noble Baroness for all that she has done over the years to highlight the work of carers and their needs—indeed, the Government are very pleased to support Carers Week. We are entirely supportive of the ambitions set out in the previous Government’s strategy. We naturally need to focus on delivering the things that will have the greatest impact on improving carers’ lives. I think that there will be three strands to that. The first is to make sure that carers are able to stay in work if they wish to. The second is to help carers who wish to get back into work to return to employment—Jobcentre Plus has in train a number of initiatives in that regard. The third is the safety net of benefits and we will review the benefits system in a way that encourages, among other things, fairness.
Baroness Gardner of Parkes
My Lords, my noble friend said that respite care is seen as important. Will he assure us that the huge contribution made by so many families who unstintingly give their time, love and care is fully appreciated and that he recognises how essential respite is for them?
Earl Howe
My Lords, my noble friend makes a critical point. She would like to know, I am sure, that there is already money in the baselines for primary care trusts to ensure that carers can get breaks. The continuation of the area-based grant, of which the carers grant forms a part, will need to be considered in the wider context of future spending reviews but, at the moment, £256 million is allocated in the budget for the current year.
Baroness Howe of Idlicote
My Lords, will the Minister give special consideration to child carers, who may need extra support, both from the social services and from the voluntary sector? I know that some is already given, but there really is extra need for it.
Earl Howe
My Lords, the noble Baroness draws our attention to an extremely important area. Supporting vulnerable children is a priority for the Government. I would say that many young people are happy to help to care for a family member; it helps them to develop a sense of responsibility. However, inappropriate and excessive levels of caring by young people can put their education, training and health at risk and prevent them from enjoying their childhood. We are therefore very mindful of this area of need.
Baroness Massey of Darwen
My Lords, young carers are often overlooked. Is the Minister prepared to meet young carers and organisations that represent them to discuss their needs? We have done this in the past and, while some of the issues have been resolved, some have not.
Baroness Greengross
My Lords, will the Government collect information to help the growing numbers of young, usually working-class grandparents who need to work and who increasingly care nearly full-time for their grandchildren, as well as, frequently, for their ageing parents at the same time?
Earl Howe
My Lords, the noble Baroness raises another important area. One thing that we propose to introduce is greater scope for flexible working, as I said in my original Answer, to enable all employees to avail themselves of that. It will allow greater scope for grandparents in particular but it will also allow neighbours and friends to engage in caring on a much wider scale than they can at the moment.
Lord Mackay of Clashfern
My Lords, I declare an interest as a vice-president of the Princess Royal Trust for Carers. Can the noble Lord say whether it is appropriate that carers for those who are disabled on account of substance abuse should be subject to the same disability, as it were, as the person for whom they care?
Earl Howe
My Lords, this is a complex question and one that my noble and learned friend will, I hope, know that we are bearing closely in mind. Those often young people who look after disabled parents are in special need, as I have said, but we recognise, too, the huge responsibility placed on parents who care for a disabled child and who often bear particular burdens. On that score, while noble Lords will be aware that the child trust fund has been abolished, the changes that we introduced in so doing include provision for more than £20 million a year, starting next year, to be spent on providing additional respite breaks for carers of severely disabled children. In passing, I pay tribute to the work of the Princess Royal Trust for Carers.
Lord Tebbit
My Lords, is my noble friend aware that the cost of providing day care alone for a severely disabled person is something like £40,000 a year? Is he further aware that, while a woman who has chosen to have a child can set the costs of care against tax to get back to work, the spouse of a disabled person cannot do so?
Health: Isle of Man
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Lord Smith of Clifton
To ask Her Majesty’s Government when they will decide whether to continue or cancel their reciprocal healthcare agreement with the Isle of Man.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the current reciprocal healthcare agreement between the United Kingdom and the Isle of Man is due to end on 30 September 2010. My right honourable friend the Secretary of State will consider this matter, in consultation with other relevant parties, in good time to reach a decision by September.
Lord Smith of Clifton
My Lords, I thank the Minister for that reply. At the British-Irish Parliamentary Assembly plenary last March, it was unanimously resolved that the Government should continue with the reciprocal healthcare agreement. It would be very ageist if that agreement were rescinded, because people such as me—I declare an interest—could not get the personal health insurance that would be needed to go to the Crown Dependencies. Is this not a form of discrimination which is totally unacceptable?
Earl Howe
My Lords, it might be helpful if I were to clarify the current position. If the noble Lord were to go the Isle of Man, the agreement in place at the moment would enable him to receive emergency healthcare there—that is, healthcare that is immediately necessary—free of charge should he need it. The only reason for requiring travel insurance in addition would be to cover the cost of, let us say, an air ambulance back to the mainland or any extra costs that were non-medical arising out of the emergency. In that sense, the Isle of Man is no different as a travel destination than, let us say, the United States.
Lord Alderdice
My Lords, the previous Government rightly trumpeted one of the important advances of the Good Friday agreement: the establishment of the British-Irish Council, bringing together government representatives and Ministers from England, Scotland, Wales, Northern Ireland, the Republic of Ireland, the Channel Islands and the Isle of Man. Did the previous Administration raise this question at the British-Irish Council, which would seem the appropriate place to explore it? If they did, what was the response?
Earl Howe
My Lords, I am afraid that I cannot help my noble friend as I have not had access to the papers relating to the previous Administration. However, I can tell him that very cordial discussions and negotiations are proceeding at the moment, and the devolved Administrations will be consulted.
Lord Dubs
My Lords, the Minister in an earlier answer referred to the United States as being a parallel, but does he not agree that what we are after is that British tourists who go on holiday to the Isle of Man feel that they are covered at least as well as if they had gone on holiday to France? Does he agree that that is not the case and, unless insurance arrangements change, our people will suffer, as will Isle of Man people? Surely the right thing to do is to keep these reciprocal arrangements going.
Earl Howe
My Lords, if a UK resident were to travel to the Isle of Man, as I have said, and were to fall ill and need emergency care, they would receive that care free of charge. That is what the agreement currently covers. It was extended by the previous Government in March and will last until the end of September. We are using that window of opportunity to negotiate with the Isle of Man Government and, as I have said, these discussions at official level are proceeding very cordially.
Baroness Gardner of Parkes
My Lords, following the question from the noble Lord, Lord Dubs, about reciprocal arrangements in Europe, as I understand it we have to have a card, which we present if asked to do so, if we go for treatment in Europe. What is the position here? Are people coming from mainland Europe asked to present an equivalent card here? We hear so much about NHS tourism that it rather concerns me.
Earl Howe
My Lords, the rules are quite complicated. In the case of EEA countries, including the European Union, the UK has an obligation under EU law to pay what it is liable for in healthcare costs. Therefore, visitors from EEA member states are provided with NHS healthcare when visiting the UK and, indeed, vice versa. However, under the same regulations, the UK is entitled to claim the cost of treatment provided to citizens from EEA member states whom it has treated. Similarly, other member states can charge the UK for the cost of treating our citizens.
Health: Government Spending
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Baroness Thornton
To ask Her Majesty’s Government which health agencies and arm’s-length bodies will be affected by cuts in government spending.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government are committed to reducing bureaucracy and improving efficiency. By streamlining and simplifying the infrastructure, we can ensure that clinicians focus on what really matters: delivering the best possible health outcomes for patients. All non-front-line organisations will be expected to operate efficiently and contribute to the Government’s commitment to reduce central administration spending by one third. That is why we are reviewing how best to organise the national infrastructure. The review will report in due course.
Baroness Thornton
I thank the Minister for that Answer. Notwithstanding the Government’s proposed intention to create the biggest quango of all in the NHS board, what can the Human Tissue Authority and the Human Fertilisation and Embryology Authority expect from the bonfire of the quangos? Will it be a third of their work, for example? I choose those two because the Minister and many noble Lords in this House were closely involved in considering the legislation that led to the creation of those two important bodies.
Earl Howe
My Lords, the focus of the exercise that is going on at the moment is, on the one hand, to look at value for money and, on the other, to look at how best we can deliver quality. Therefore, the review will consider which functions should be carried out at a national or arm’s-length level, which could be stopped with no detriment to the delivery of front-line services and which could be undertaken elsewhere in the system or, indeed, left to the market. So there is no target as regards getting rid of a certain number of bodies. The point of view from which we come is that of functions.
The Earl of Onslow
My Lords, can my noble friend help me? He implied that savings were to be made, which is excellent. If we are going to make savings in the National Health Service budget, why is the rest of the budget ring-fenced? If you can save £20 here, why not cut the budget by £15 and keep £5 for something else? Why undertake to spend all the savings rather than make them contribute to help after the ghastly state of affairs that was left to the Government?
Earl Howe
My Lords, the simple answer is that we have a duty to ensure that every pound that we spend is spent efficiently, wisely and with value for money at the end of it. As my noble friend will know, the cost of healthcare in this country has traditionally risen at a faster rate than inflation, so even if we are advantaged in the sense of being a protected department, we still have to find savings in order to continue to ensure that we can deliver quality care at an acceptable price.
Baroness Greengross
My Lords, I declare an interest as a member of the Equality and Human Rights Commission. Can the Minister assure the House that public authorities will be able to meet their mandatory equality duties, including carrying out equality impact assessments for all relevant policies and decisions, in spite of the difficult financial constraints?
Lord Faulkner of Worcester
My Lords, given the huge success of the tobacco-control legislation passed in the previous Parliament, which has already produced so many benefits including, as we have seen from recent statistics, a dramatic reduction in the number of heart-attack victims admitted to hospital, will the Minister give an assurance that the excellent smoking-cessation programmes run by his department will be exempted from any programme of cuts?
Lord Alderdice
My Lords, in respect of a number of agencies within the health and social care field, it is clear to practitioners that some of them have been inadequate in their regulatory and monitoring function and others have gold-plated way over the top in a quite counterproductive way. In his search for which agencies could be brought together and their experience shared or which could be changed in other ways, what are the principles that the Minister intends to use to produce a better and more appropriate regulatory monitoring framework within health and social care?
Earl Howe
My Lords, there are several principles. A reduction in the number of arm’s-length bodies is only one of the possible outcomes. As I have said, we are not looking necessarily for a large-scale reduction in numbers, but we want to see both efficiency and the delivery of quality. With those two ends in view, the bodies that we end up with have to make sense in terms of what matters in our wider system reform, which is, as I have said, to deliver quality.
Lord Warner
My Lords, the Minister has said that he will be looking at functions in the review of bodies and that he will be looking to save one-third of running costs. In carrying out this review, will PCTs be examined carefully in terms of divesting themselves of their provider-arm functions so that they can concentrate on their commissioning functions?
Earl Howe
My Lords, strictly speaking, primary care trusts are not considered to be arm’s-length bodies, but the coalition agreement, which I am sure the noble Lord has read from cover to cover, indicates the new role and the functions envisaged for PCTs. Further details of our plans will be announced very soon.
The Countess of Mar
My Lords, will the Minister be prepared to consider joining together animal and human medicines and health? With global warming, with so many of our illnesses now zoonoses—in other words, caused by animals—and with so many antibiotics and other drugs used in common, would it not be a good idea?
Lord Rea
My Lords, if the Food Standards Agency is to be wound down, which would be regrettable since it would mean the loss of an important, independent voice, will its science-based public health work on nutrition continue to be funded at least at the present level, if not augmented, which it needs to be?
Earl Howe
My Lords, the Government fully recognise the important role that the Food Standards Agency plays in food standards, nutrition and food safety. Public health is a priority, and I reassure the noble Lord that the function that the FSA currently fulfils—to advise the Government and the public on nutrition—is one that we believe is equally important.
Lord Skelmersdale
My Lords, can the Minister give us the assurance that it is functions that matter at the expense of individual bodies, which may of course overlap?
Lord Harris of Haringey
My Lords, the noble Earl has frequently argued in this House in favour of there being arm’s-length bodies to protect the patient’s interest in the NHS. Will extra resources be found to enable this aspiration of his—and I am sure, of the coalition’s—to be fully funded?
Earl Howe
My Lords, the budgetary implications of our plans are being worked through at the moment but we are clear that we need to have a more powerful patient voice within the system than at present. I believe that that goes hand-in-hand with our agenda for patient choice, greater quality standards and more information being made available to patients to enable them to make choices.
Mid Staffordshire NHS Foundation Trust
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, with the leave of the House, I shall now repeat a Statement made earlier in another place by my right honourable friend the Secretary of State for Health.
“With permission, Mr Speaker, I wish to make a Statement on Mid Staffordshire NHS Foundation Trust. In March last year, the Healthcare Commission’s report into Mid Staffordshire and the appalling failures in patient care that were laid bare within it shocked us all. Three reports later and I am announcing today what should have been announced then—a full public inquiry into how these events went undetected and unchallenged for so long. This inquiry will be heard in public, including the evidence, from the oral hearings to the final report. We can only combat a culture of secrecy and restore public confidence by ensuring the fullest openness and transparency in any investigation.
So, why another inquiry? We know only too well what happened at Mid Staffordshire, in all its harrowing detail, and the failings of the trust itself, but we are still little closer to understanding how it was allowed to happen by the wider system. The families of those patients who suffered so dreadfully deserve to know, and so does every NHS patient in this country. This was a failure of the trust first and foremost, but it was also a national failure of the regulatory and supervisory system which should have secured the quality and safety of patient care.
Why was it that it took a determined group of families to expose these failings and campaign tirelessly for answers? I pay tribute, again, to the work of Julie Bailey and Cure the NHS, rightly supported by honourable Members in this House. Why did the primary care trust and strategic health authority not see what was happening and intervene earlier? How was the trust able to gain foundation status while clinical standards were so poor? Why did the regulatory bodies not act sooner to investigate a trust whose mortality rates had been significantly higher than the average since 2003 and whose record in dealing with serious complaints was so poor? The public deserve answers.
The previous reports are clear that a culture of fear existed in which staff did not feel able to report concerns; a culture of secrecy existed in which the trust board shut itself off from what was happening in its hospital and ignored its patients; and a culture of bullying existed which prevented people doing their jobs properly. Yet how these conditions developed has not been satisfactorily addressed. The 800-page report by Robert Francis QC, published in February, gave us a forensic account of the local failures in that hospital and the consequences for patients, but, like its predecessors, his report was limited by its narrow terms of reference.
I am pleased to say that Robert Francis has agreed to chair this new inquiry, and he will have the full statutory force of the Inquiries Act 2005 to compel witnesses to attend and speak under oath. Clearly these are complex issues and Robert Francis has already said he wants to establish an expert panel that can help support him through this process. However, it is important for everyone that this inquiry is conducted thoroughly and swiftly, with the aim of providing its final report and conclusions by March 2011. I want to assure the House we will not wait to take earlier action where necessary.
So I can announce today that we are going to give teeth to the current safeguards for whistleblowers in the Public Interest Disclosure Act by reinforcing the NHS constitution to make clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing; seeking through negotiations with NHS trade unions, to amend terms and conditions of service for NHS staff to include a contractual right to raise concerns in the public interest; issuing unequivocal guidance to NHS organisations that all their contracts of employment should cover staff whistleblowing rights; issuing new guidance to the NHS on supporting and taking action on concerns raised by staff in the public interest; and exploring with NHS staff further measures which could provide a safe and independent authority to which they can turn when their own organisation is not listening or acting on concerns.
In the coming weeks we will be introducing further far-reaching reforms of the NHS, which go to the very heart of the failures at Mid Staffs. This is not about changes in processes or structures. It is about a wider shift in culture—putting patients at the heart of the NHS and focusing on the things that matter most to them. That includes putting the focus on safety. At Mid Staffs safety was not the priority; it was undermined by politically motivated process targets. The first Francis inquiry was crystal clear on this point. As the report says:
“This evidence satisfies me that there was an atmosphere in which front line staff and managers were led to believe that if the targets were not met they would be in danger of losing their jobs. There was an atmosphere which led to decisions being made under pressure about patients, decisions that had nothing to do with patient welfare. As will be seen, the pressure to meet the waiting target was sometimes detrimental to good care in A&E”.
We will scrap such process targets and replace them with a new focus on patients’ outcomes—the only outcomes that matter. We will empower patients with access to information, giving patients the ability to hold their own records, make informed choices and to interact more readily with clinicians. We will put power in patients’ hands because ultimately, if patients had been informed and empowered, if people had listened to them rather than obsessing about centrally mandated processes and targets, these scandalous failings could not have gone unchallenged for so long.
In closing, I want to say a word about the trust itself. It is so important that this hospital, which has been under such an intense spotlight, is able to continue to improve services for the patients it serves and continue to rebuild the trust and fractured confidence of that community. Staffing has increased, with more than 140 more nurses recruited since March 2009; processes are more open and transparent, with monthly board meetings now being held in public; results are improving; the hospital standardised mortality ratio is significantly lower; and the rate of healthcare-associated infections has also improved. The Care Quality Commission will, in the coming weeks, provide its considered view on progress when it publishes the findings of its “12 month on” review.
We cannot and should not underestimate the task still ahead and the attention of the trust must not be unduly diverted. That is why I am clear that this further inquiry should not go over ground already covered in the first Francis inquiry and should, as far as is possible, ensure that it supports all those staff who are working so hard to bring about the changes that are necessary. When this inquiry has completed its work and I return to this House to present its report, I am confident that we will, for the first time in this sorry saga, be able to discuss conclusions rather than questions. We will be able to show that we have finally faced up to the uncomfortable truths of this terrible episode, and we will be able to show that we are taking every step to ensure that it is never allowed to happen again. This is a basic duty of any Government. For the people of Staffordshire, many of whose relatives suffered unbearably in the closing stages of their lives, and for the nation as a whole, this is the very least they are entitled to. I commend this Statement to the House”.
My Lords, that concludes the Statement.
Earl Howe
My Lords, I am grateful to the noble Baroness for the general welcome that she gave to the Statement and to the decision to announce a public inquiry, which indeed the previous Secretary of State signalled his intention of doing before the general election. I agree with a great deal of what she said—particularly the need to support the staff of the hospital. Indeed, my right honourable friend the Secretary of State is to visit the Mid Staffordshire hospital tomorrow and will make a point of seeing the staff and expressing his support, not just for the work that they are doing but for the progress that they have made since these matters came to light, and will assure them that nothing should distract them from that work as this new inquiry proceeds.
The noble Baroness asked how much account will be taken by Robert Francis of the previous reports. The answer to that is full account. We have made it clear to Mr Francis—and he has not been slow to agree—that there is no point in going over the same ground again. Mr Francis has many fine qualities, but one of the great advantages of his agreeing to do this is that he will, so to speak, hit the ground running. He is on familiar territory. We hope that he will have completed his report by March of next year. We recognise that that is a tight timescale within the context of the Inquiries Act, but he believes that it is eminently possible and we wish him well. The manner in which he will conduct his inquiry is the subject of a separate announcement that he has made this afternoon, and I understand that it is now on the departmental website, so the process will be clear from that.
The noble Baroness asked me about the terms of reference and the difference between this inquiry and the previous one. To encapsulate that difference, the previous inquiry concentrated on what happened at the trust while this one focuses on the lessons for the wider system. The other difference is that the first inquiry was carried out under the NHS Act and this inquiry will be conducted under the Inquiries Act, which is a much more powerful statutory basis on which to proceed. It means that there is a presumption that hearings will be held in public and that records of evidence and information given to the inquiry must be made available to the public. There is a power of compelling witnesses to attend and give evidence, a power to take evidence on oath and a power to make recommendations if Mr Francis so wishes, not just about the NHS but about bodies other than the NHS. He can make recommendations to the GMC, for example, which the previous inquiry could not do. These are important added factors.
The noble Baroness asked me about targets. I am well aware that she and I do not entirely see eye to eye on this, but I would like to think that we are perhaps closer together than she supposes. It is not that we regard all targets as bad and wrong, but we think that there should be an analysis of the clinical relevance of the targets that are now in place. How much clinical underpinning do they really have? Some of them have considerable underpinning clinically. One thinks, for example of the hospital-acquired infections target, which is clinically very important. But there are others that we will have to look at very carefully. They have less relevance but of course we are taking advice from the medical community. On the four-hour A&E target that the noble Baroness mentioned specifically, of course I recognise that time limits in A&E are very important to patients, but the precise nature of the current target may be wrong—we think that it is distorting priorities within many trusts. We will not take a doctrinaire approach and say that all targets have to go but we want to look at them carefully to make sure that they are useful.
Lord Alderdice
My Lords, the immediate response of my honourable friend Norman Lamb in the other place to the 2009 Healthcare Commission report was to call for a public inquiry. My noble colleague the Minister can be absolutely confident of the warm welcome on these Benches to the decision to have a public inquiry, a request that was refused by the previous Government. One has to suspect that it was refused because of the likelihood of exposing the inadequacies not just of a particular hospital and trust board but of the regulatory system that had been put in place and the culture of target and finance-driven managerialism that the previous Government championed.
I am sure that the noble Earl expects that this will be exposed in the public inquiry, but is it not important that we should not only protect whistleblowers—he has announced important developments in that regard—but address the whole culture that regarded professionals and commissions raising questions and concerns as troublesome and disloyal rather than as wanting to improve the standards and quality of the service? What is needed is a change in the culture, so that the views of clinicians of all professions are valued, welcomed and encouraged. The priority of managers is not to dominate the service and to impose politically driven targets but to provide it with high levels of patient care.
Earl Howe
My Lords, I agree wholeheartedly with my noble friend that in many parts of the NHS we need a culture change—a culture that puts patients first. We need an NHS that listens to patients and responds to their concerns and needs. We must prioritise the people whom the NHS serves and we must listen to the doctors and nurses who work in it. The measures that we are taking today on whistleblowing are important. Last week, we began to publish more transparent data about the NHS so that people can hold their local services to account in a more meaningful way. We are looking also at reducing the number of hospital readmissions, as I am sure my noble friend is aware.
The culture change that is needed will not happen in a hurry and I would not want to give the impression that it is required everywhere in the NHS. Mid Staffordshire was an unusual event, but unless we get to the bottom of why it happened there must be a fear that it may happen again. As we move forward and propose to Parliament changes in the way in which the NHS is regulated and care is commissioned, we must not lay ourselves open to unintended traps. I therefore concur with all that my noble friend said. I think that he will find, as we bring forward our proposals, that the emphasis on transparency, openness and the patient’s voice will do much to address the concerns raised.
Baroness Finlay of Llandaff
My Lords, the Minister has spoken about listening to professionals and to patients. Will he give an undertaking that, long before whistleblowing is necessary, there really will be measures in place to support staff who want to raise concerns that changes proposed by management might adversely affect patient outcomes? That requires an empowering of clinicians at the coal face.
Furthermore, as the Government consider changes in the NHS generally, will they not be fooled into thinking that this was a completely isolated event? I fear that there are a lot of other pockets in the NHS that are not right. What emerged from the inquiry were the voices of the patients’ relatives. When they gave evidence, those voices shouted out loud and clear that things were wrong, but they were not adequately heard. I commend—I declare an interest here—the Dying Well Matters programme as part of the Wales 1000 Lives Campaign, which I have been involved in instigating. It routinely seeks stories from relatives and patients before trouble occurs to try to detect those subtle but extremely distressing instances of poor and inadequate care in parts of the service that otherwise might go unnoticed.
Earl Howe
My Lords, as ever, the House will listen to the noble Baroness with great attention and respect, knowing that she works in the midst of an important and active part of the NHS. I hope that she is wrong and that the seriousness of the malpractice at Mid Staffordshire is rare, but we have to be vigilant. There could be another instance of a failing trust out there. The House may want to know that the Care Quality Commission has announced the registration status of 378 NHS trusts to provide healthcare services from 1 April. Only 22 of those are registered with conditions, but the CQC has said that those trusts are safe to provide services to patients. No trusts were refused registration, which is an important point.
On the question of openness within trusts, the noble Baroness is right: a culture of openness and willingness to learn from mistakes is essential to a health service that wishes to improve. There is a requirement on hospitals to inform regulators about serious errors, but that requirement does not extend to informing patients, so we are looking at how that can be addressed.
Earl Howe
I am grateful to my noble friend for her kind comments. The House will know what a champion she is of patient care and compassion in the health service. On her last point, it is of course for Robert Francis, who is in charge of the inquiry, to decide whom he calls as witnesses, but he has a completely free hand and I am sure that he will take note of my noble friend’s suggestion.
Lord Warner
My Lords, before I ask my question, I suggest that we register that the usual channels might discuss the sequencing of speakers from the government Benches and these Benches, because I am not sure that there is a correct interpretation.
I have no objections whatsoever to this wider inquiry. I hope that it will look carefully at the extent to which doctors, nurses and managers failed in their professional responsibilities. What the regulators and other bodies did might also be usefully looked at. However, does the Minister accept that it is easy in such circumstances to reach for something that cannot answer back, such as a target, to explain away what is essentially appalling clinical and managerial behaviour? That is clear from many other inquiries into what happened in Mid Staffordshire.
If the Minister wants seriously to consider targets, he might read some of the speeches made by previous Ministers, who made it crystal clear to the NHS that its overriding responsibility was to the care and safety of patients, not obsessively to implement targets. I know that there are conventions about looking at papers from previous Administrations, but I would certainly be prepared to waive that consideration. Will he also look at the extent to which John Reid, when he was Health Secretary, amended the way in which the four-hour target was implemented in response to concerns expressed by doctors? He might like to see the minutes of a meeting that I had with the College of Emergency Medicine. Members of the college came to see me as a Health Minister to ask me—beg me, almost—not to amend the four-hour target because of the improvements that it had produced for its members, for patients and for the way in which hospitals were run. Will he also look at the Nuffield Trust’s independent inquiry into targets, which also shows the benefits that they have brought to patients in terms of better access and shorter waiting times and which compares the experience in England, where there were targets, very favourably with that in the Celtic fringes, which did not have them?
Earl Howe
My Lords, we are not targeting the targets with this inquiry. They are not the main point at issue. The noble Lord is right that the main point at issue is the failure of care, but that is also, as we hope this inquiry will show, a systemic failure. That is the point of the inquiry. I do not doubt anything that he said about the commitment of previous Ministers to putting care above any rigid adherence to targets; I fully accept the good faith of Ministers in the previous Administration in that regard. However, the noble Lord will know that what Ministers say is very often not interpreted in the same way on the ground in the NHS. When people in the NHS hear things coming out of Whitehall, they are inclined to adhere rigidly to what they are told to do. That is part of the problem, but it is not the problem that I want to emphasise in this context. We need to understand how the wider performance management and regulatory system failed to spot the problems earlier and deal with them and why so few professionals felt that they could challenge what they saw. Understanding the lessons from that and the culture in which the events at Mid Staffs were allowed to happen will be key to informing and shaping our plans for the future.
Lord Patel
I declare an interest as chairman of the National Patient Safety Agency. I concur with what the Minister just said: the regulatory authorities that scrutinise the performance of trusts failed Mid Staffordshire. I was criticised for publishing reports of all trusts linked to two parameters of quality of patient safety: trusts’ reporting of incidents and mortality ratios. On both those criteria, Mid Staffordshire would have failed, as other trusts fail now. We need an inquiry that identifies parameters of quality and safety that could be embedded across the whole of the NHS so that we can identify failing hospitals early on and remedy them. I support the inquiry.
Earl Howe
I pay tribute to the noble Lord for his work, in particular for his work with the National Patient Safety Agency. As he will know, hospital standardised mortality ratios are something of a vexed topic. Professor Sir Bruce Keogh, the NHS medical director, has established a working group that will review how those ratios are derived and recommend what method should be used consistently for the NHS in future. The aim is to provide simple, practical guidance on how the ratios should be interpreted and used with other sources of information. Once the technical basis for this work has been developed, it is planned that patients and patient groups will be invited to become closely involved.
Lord Low of Dalston
My Lords, the Minister referred to seeing to it that, following the experience of Mid Staffs, more information will be given to patients. He will no doubt recall from debates in this House during the passage of the Equality Bill that research carried out by Dr Foster for RNIB, of which I am a vice-president, showed that as many as 72 per cent of patients were given information by their GP that they could not read. Even higher figures were uncovered in relation to the rest of the NHS. Will the noble Lord give a commitment that the Government will take steps to ensure that information is given in accessible formats to patients who have difficulty in reading information in ordinary print? To assist in doing this, the Government will have at their disposal the strengthened rights of access to information in accessible formats included in the Equality Bill before it passed into law.
Earl Howe
I am grateful to the noble Lord for his question, which is spot on target—if I dare use that word. The need to create more accessible information for patients is central to the Government’s agenda for creating choice. Choice is meaningless unless it is informed choice, which means rolling out choice to every patient, including those who are visually disabled. We are determined to make more information about care and safety standards and performance available to the public and staff. That should be published online and in formats accessible to all patients. I assure the noble Lord that we will bear these points closely in mind as we develop our plans.
Lord Burnett
My noble friend is right that a widespread culture of secrecy and fear pervades the NHS. I welcome wholeheartedly the establishment of this inquiry and the proposals to buttress the rights of whistleblowers. Will the Government consider making concerted efforts to recruit managers, especially at senior levels, from outside the NHS? I am aware that some high-calibre people are non-executive directors, but we need and should recruit high-calibre non-executive directors in the NHS who are independent, intelligent and fearless.
Earl Howe
I fully agree with my noble friend. We have asked the Appointments Commission to set out proposals for a revised person specification for chairs and non-executive directors to ensure that it is aligned with the current priorities and principles of the NHS. We want to continue to deliver high-calibre non-executives, in particular, who are needed to meet the challenges ahead. The general point raised by my noble friend is well made and we shall certainly take it forward.
Baroness Pitkeathley
My Lords, I declare an interest as chair of the Council for Healthcare Regulatory Excellence. Will the Minister confirm what I think was the thrust of the Statement, which was that regulation and regulatory activities should always be about patient safety and not about maintenance or promotion of professionals? As the strong and welcome implication of the Statement is about putting patients at the centre, does he expect the inquiry to give any indication as to how patients should be supported in bringing forward their concerns?
Earl Howe
On the last point, we are doing quite a lot of work in the department to ensure that patients are supported in an appropriate fashion in their dealings with the health service. Our plans for what we hope to call “health watch” will flesh out that point. I agree that safety lies at the heart of the quality agenda, which was commenced in earnest by the noble Lord, Lord Darzi, when he was a Minister. I have the privilege of being responsible for that agenda, which is being continued with urgency. We are committed to developing the role of the Care Quality Commission to make it a more effective regulator of health services in England. We will bring forward proposals that will focus on the outcomes of the care experienced by patients. The Care Quality Commission will be intimately involved in that.
Genomic Medicine: S&T Committee Report
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I join other noble Lords in thanking the noble Lord, Lord Patel, for his excellent introduction to this debate, which was of particularly high quality and which was crowned by the coruscating contribution that we have just heard from the noble Lord, Lord Winston. It provides the new Government with the chance to hear, first hand, your Lordships’ views on this important area of science—one that offers so much potential to improve the health of our nation, as we have heard.
The United Kingdom has a well deserved worldwide reputation for its work in the field of genetics—the study of individual genes—and now genomics, which is the study of the interaction between genes: if genomics is like a garden, genetics is like a single plant. It is now more than half a century since Watson and Crick published their research on the double helix, while this year marks the 10th anniversary of the human genome project. The sequencing of the human genome has not only revolutionised the way in which we view ourselves as human beings, but it has led to many practical benefits, including new medicines and diagnostic tools. Throughout, British scientists have been at the forefront of this groundbreaking technology. It is a technology that increasingly brings economic benefits, as well as important improvements in healthcare.
The inquiry by your Lordships’ committee was thorough in its investigation and forthright in its conclusion, which was that this reputation, and the benefits that the science could bring, would be at risk if action were not taken to ensure that we remained at the forefront of genetic technology. The benefits are real—for patients, business and society. That is why the government response was a joint one from the Department of Health and the Department for Business, Innovation and Skills. That collaboration continues, ensuring that the UK is a place where technology and enterprise can flourish within a transparent, facilitating regulatory environment that encourages, not stifles, innovation. This includes eliminating obsolete and inefficient regulation. We want regulation to complement, not complicate, the way in which people work—not, incidentally, just in the UK but also at a European level. We will work with the EU to improve current guidelines and ensure that initiatives on research and regulation meet UK objectives.
As your Lordships’ committee rightly said, the 2003 genetics White Paper recognised the potential impact of genetics and the genome project, as well as the importance of preparing the NHS to take advantage of these developments. These were laudable aspirations, and some advances were made in the diagnosis and treatment of rare single gene disorders, yet the accompanying strategy has proved incapable of keeping pace with the speed of change in this field—a point well made by a number of noble Lords. This inability to respond to a rapidly changing landscape means, as the committee rightly concluded, that doctors, nurses and other healthcare specialists are unable fully to exploit these developments for the benefit of their patients. Clearly, this Government want NHS patients to be able to access the best medical advances that genomics will bring.
As many noble Lords mentioned, the Human Genomics Strategy Group has already been established under the chairmanship of Professor Sir John Bell. Its remit is to develop strategic options for genomics in the NHS—that is, to work with the objective of ensuring enhanced patient services through the better use of advances in research and technology. We are fully supportive of the work of that group. The noble Lord, Lord Sutherland, made various proposals for the group’s remit and I shall see that that remit and the development plan for the group are shared with the Science and Technology Committee. I will invite him to share his thoughts on both documents with the chair, Sir John Bell. He may like to know that the group had its inaugural meeting on 25 May.
The noble Lord, Lord Taverne, asked about the funding of the group and I think that the noble Lord, Lord Warner, expressed a few fears on that front. I agree that we need to ensure that the group is properly supported. That is why we provided this support through the Department of Health, which I trust will continue.
As the noble Lord, Lord Patel, and many other noble Lords pointed out, we are already seeing some important developments in relation to patients with diseases such as cancer and diabetes. Scientists are finding new genetic mutations that can help to define alternative treatments. We can identify patients who respond better or who suffer more severe side effects from a particular drug, helping to ensure that it is appropriately prescribed. The development of these stratified medicines has the potential to improve patient outcomes without increasing the cost to the NHS.
In laboratories, the new DNA sequencing machines have increased capacity so that a single laboratory can sequence more data in one day than was achieved during the entire human genome project. Utilising this capacity effectively across all branches of medicine will save the NHS millions. We are linking DNA sequencing with advanced IT to diagnose children born with severe congenital problems and to help guide their treatment and care. All these achievements are opening up a new world of healthcare that can be tailored more effectively and efficiently towards individual patients.
The Government are determined to develop a patient-led NHS that delivers better health outcomes. It is clear that genetics and genomics have an important role to play in achieving this aim. However, before moving forward, we must ensure that we are getting the most from the investment already made. Services should be commissioned by those best placed to make the decisions—doctors in consultation with patients who are free to make confident choices about their own healthcare, and better manage it as well. To make that happen we need a commissioning system that is consistent and provides appropriate services to NHS patients and their families. The UK genetic testing network is already working with specialised commissioners to determine how these services can be improved.
While we need to ensure that the NHS benefits from advances in genomic medicine we must also make sure that existing services are fit for purpose and are accessible. As the report rightly pointed out, ensuring that NHS staff have the necessary skills to use genetic testing effectively is a vital component of providing better services. We want to see that addressed as soon as possible so that the roughly 400 types of genetic tests already available are better used by NHS staff. That is why we support the work of the GMC’s Tomorrow’s Doctors programme, which sets out the requirements for the knowledge, skill and behaviours that undergraduate medical students should learn. It includes a requirement on medical schools to cover genetics in their curricula and provides flexibility on how best to cover its application and its place in diagnosis.
Reducing the budget deficit is the main priority of the Government but even if that were not the case the public still have the right to expect NHS services to be provided in the most cost-effective way possible. We have a duty to identify any practice that is not providing value for money and to take action to remedy the situation. That is why the Department of Health is pushing ahead with the recommendations of the Carter review on modernising pathology services, as mentioned by the noble Lord, Lord Warner. They deliver the highest volume of genetic testing services by far. This will see the services rationalised and reconfigured to increase the quality, productivity, efficiency and effectiveness of pathology services. I say to the noble Lord, Lord Warner, that the size and importance of these services mean that we have a duty to ensure that they are as effective and efficient as possible. The Carter review estimated that the reconfiguration of services could improve quality and realise £250 million to £500 million efficiency savings annually. It is our challenge to realise that potential.
The public have a right to hold us accountable for the way in which we invest in the NHS and to be confident that its primary focus is to improve outcomes. The Government will ensure that these principles are applied across all genetics testing services available to the NHS. The noble Lord, Lord Patel, spoke about clinical trials. Currently, the Department of Health, the MHRA and the MRC are considering what the obstacles are to the initiation and conduct of clinical trials in the UK and how these might be addressed. The MHRA is also working with European colleagues to identify any issues at a European level. The Government consult all interested parties when considering changes to legislation.
The noble Lord also raised the issue of inconsistencies in access to the provision of genetic services. Clearly articulated commissioning competences will ensure that commissioners can incorporate new scientific developments into their commissioning decisions and deal with unacceptable variations in access to care and treatment. As the noble Lord, Lord Kakkar, rightly pointed out, one of the keys to this is education. That function is currently provided by the National Genetics Education and Development Centre based at Birmingham Women’s NHS Foundation Trust. We have agreed a work programme for 2010-11 with the trust. It is agreed to target key professional groups for the programme. Future provision will be further considered through the work of the strategy group and in consultation with the trust and the centre.
The National Genetics Education and Development Centre has already made good progress in raising the need for genetics to be part of the curricular and CIPD programmes across the medical professions, but we recognise that this conversation must be had with the royal colleges and the GMC, which are best placed to advise on curricular content for the professions that they represent.
My noble friend Lord Selborne, whose speech on bioinformatics I listened to with close attention, asked a number of questions. It is still very unclear what type of bioinformatics will be needed for genetic testing, and what their true role will be in supporting genetic services. Work is already under way at Manchester National Genetics Reference Laboratory, and the NHS chair on pharmacogenetics based at the University of Liverpool is carrying out further research into how this new technology can best be utilised.
The noble Lord, Lord Patel, and my noble friend Lord Selborne asked whether the Government intend to establish an institute for bioinformatics. The Government’s main priority is to reduce the budget deficit and so I cannot give a commitment now on this matter. However, the Human Genomics Strategy Group will lead on giving this issue further consideration as it looks at how best we might take forward issues such as the proposed institute.
The right reverend Prelate the Bishop of Newcastle and my noble friend Lord Colwyn referred to predictive genetic testing. My noble friend rightly said that there is a moratorium on predictive genetic test results until 2014—certainly by insurance companies. We are due to review the concordat and moratorium in 2011 and we believe that that is the right time to review the Select Committee’s recommendation. We will specifically examine the question about whether a long-term agreement about the use of genetic testing for insurance purposes is appropriate.
The noble Baroness, Lady Finlay, asked whether the Department of Health had commissioned NICE to develop and manage a single evaluation pathway specifically for diagnostic technologies. Good progress has been made. NICE’s evaluation pathway programme for medical technologies and diagnostic assessment programme are already helping the NHS to adopt effective and cost-effective medical devices and diagnostics more rapidly and consistently. She asked about the role of value-based pricing and perhaps I may write to her on that. It is a matter slightly for the medium term, but I will write to her on that even though our thoughts are not yet fully worked out.
The noble Baroness also raised the issue of BIS working with the Department of Health to ensure that the intellectual property system supports diagnostic test development. Intellectual property issues will be considered as part of the innovation sub-group of the Human Genomics Strategy Group and BIS is fully engaged with the department in taking that matter forward. She also spoke about single-gene testing for sudden cardiac death. As she knows, the taking of human tissue for any scientific or medical purposes is governed by the Human Tissue Act, which is essentially based on consent. However, I would like to provide the noble Baroness with a fuller answer and so I will take this issue away and ask my officials to supply more detailed information.
My noble friend Lord Colwyn spoke about genetic testing kits sold to the general public and expressed his worry about that. Often, the answer proposed is that there should be some form of regulation. We have thought about that carefully, but we cannot see that compulsory regulation would be effective, given the cross-border nature of the market delivered by the internet. The Human Genetics Commission’s common framework of principles provides what we see as a proportionate and effective response, given the support that it has received from the international industry and other interested parties.
The noble Lord, Lord Warner, asked whether NICE was evaluating genomic tests for common diseases. Good progress has been made. NICE’s new medical technology advisory committee has been appointed and NICE’s evaluation pathway programme for medical technologies and diagnostics assessment is already helping the NHS to adopt effective and cost-effective medical devices more rapidly. The noble Lord referred to the excellent and interesting report by the PHG Foundation, a copy of which I have. We have noted that report with considerable interest. The Human Genomics Strategy Group has been asked to note the recommendations in that report as part of its work to develop a strategic vision.
The noble Lord spoke about the commissioning of genetic testing in the NHS, which was a subject raised by several noble Lords. The UK Genetic Testing Network is part of the national specialised commissioning team in the London NHS. It currently offers more than 400 genetic tests for single gene disorders. Those are available across the NHS. It is held up as an excellent template for the evaluation and commissioning of genetic tests. It is widely admired and copied across the world.
Several noble Lords, not least the noble Lord, Lord Patel, have put the $64,000 question to me about the possibility of a White Paper. I have to disappoint the noble Lord, because we do not believe that there is compelling evidence for a White Paper on genomic medicine at the moment. The point of a White Paper would be to address a perceived lack of strategic direction. I hope that I have shown that that is not an issue, not least because of Sir John Bell’s strategy group. That is particularly true because the White Paper of 2003 was reviewed in 2008; several initiatives were refreshed, including the strengthening of specialised genetic services, building genetics into mainstream services, spreading knowledge across the NHS and generating new applications. That is clearly a matter that we will have to keep under review.
Like your Lordships’ committee, we want a future strategy for these services. That strategy must be clear, patient-led and deliver better health outcomes at a time when the national finances are in a mess. We look to Sir John Bell to provide us with that road map. We need to look at what we have already achieved and ensure that the system is delivering what the NHS needs. If not, we must be committed to making the necessary changes to make it work. Finally, we must be creative in how we deliver to ensure that we not only maintain our reputation for the science in this area but translate that science into services for NHS patients.
It is my hope, as it is the Government’s, that Members of this House, especially the noble Lord, Lord Patel, will continue to provide us with the benefit of their knowledge in this area and that they will remain at the forefront of this debate over the years ahead.
Health: Dementia
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Baroness Greengross
My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as a member of the advisory committee on dementia research.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, dementia is one of the most important issues we face as the population ages. We are fully committed to improving the quality of care for people with dementia and their carers. We will accelerate the pace of improvement through a greater focus on local delivery and accountability, and empower citizens to hold local organisations to account.
Baroness Greengross
I thank the noble Earl for that encouraging reply. How will the Care Quality Commission be strengthened and aligned with the strategy so that it can support the development of better quality social care, particularly for dementia? As I understand it, there are plans to stop the star rating system in favour of a new registration scheme.
Earl Howe
My Lords, the Care Quality Commission is revising its current quality rating system for adult social care and is working closely with the adult social care sector to develop a more user-friendly system that provides people using services with the information they need to make decisions about their care. That is absolutely in tune with the work being done in the department on driving up quality standards in dementia care. Better information for people with dementia and their carers will enable individuals to have a good understanding of their local services, how they compare with other services and the level of quality that they can expect.
Baroness Finlay of Llandaff
My Lords, will the Government maintain the e-learning packages developed in palliative care to enhance end-of-life care for people with dementia across health and social care, and will they respect the agreement that those packages should be rolled out in Wales? I declare an interest as the palliative care lead for Wales.
Baroness Gardner of Parkes
Does the Minister agree that respite care is extremely valuable, but can he say what help there is for people whose dementia has developed into violence? What can be done for those who wish to keep such patients at home, but find themselves in a very frightening position? Can they be given any respite?
Earl Howe
My Lords, my noble friend has raised an important issue, and one which we are giving consideration to. We recognise fully that breaks from caring are one of the top priorities for carers in terms of the sort of help they want. Supporting the physical and mental well-being of carers by giving them breaks obviously enables them to do their job more safely and effectively, and can keep families together. But where violence intrudes, it is often an intractable problem. I hope to be able to give my noble friend more details once we have given this area the thought that it deserves.
Baroness Thornton
My Lords, we are at the beginning of the second year of what is in fact a five-year dementia strategy, which is what the noble Baroness, Lady Greengross, referred to in her Question. Some £150 million was earmarked for the first two years of the strategy. Is that £150 million safe, particularly the £90 million for 2010-11, and do the Government have plans to implement the rest of the five-year strategy?
Earl Howe
My Lords, the answer to the specific question about whether the money is safe this year is yes, but we want to ensure that the strategy is sustainable over the following three years. We will do that principally by driving up quality standards through a tariff for dementia patients, by better regulation of providers and by better commissioning of services, including public health interventions. Alongside that, as I said to the noble Baroness, Lady Greengross, we plan to provide better information to people with dementia so that they have a good understanding of their local services, and local organisations will be expected to publish how they are delivering on those standards.
Lord Alderdice
My Lords, the strategy is set out in an ambitious and sophisticated document that says that it is not just for five years, but that:
“There is no expectation therefore that all areas will necessarily be able to implement the Strategy within five years”.
I wonder if, even at this early stage of the coalition Government, my noble colleague has been able to identify whether all 17 objectives are to be carried forward at the same time or any priority areas that might be moved forward more quickly.
Earl Howe
We are looking at the implementation plan at the moment. I say to my noble friend that there are perhaps four key dementia priorities for us. One is promoting awareness and early diagnosis and referral; the second is the care of people in hospital; the third is the care of those in care homes; and the fourth is a reduction in the use of anti-psychotic medication. That is not to say that the other objectives are trivial—by no means—but we think that these will yield the most tangible results in the shorter term.
Lord Laming
My Lords, does the noble Earl accept that we are all familiar with frequent reports of research into other diseases, but much less so with research reports into dementia? Will he keep in mind the importance of developing more effective research into this growing problem?
Earl Howe
My Lords, we will be giving increased priority to dementia research. The work of the Ministerial Advisory Group on Dementia Research, in which the noble Baroness, Lady Greengross, is playing an important part, is key to that. The group is time-limited but very focused. We anticipate that once it has completed its work the dementia research community will be better positioned to compete successfully for available funding opportunities.
Queen's Speech
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, this has been a wide-ranging and most fascinating debate, marking, as it does, the conclusion of our deliberations on the gracious Speech. Having been given the privilege of responding, I can begin by expressing my appreciation for the congratulations extended to me and to my noble friend Lord Hill from around the House. I also thank all noble Lords who have spoken so well and so eloquently. Chief among those have been our four maiden speakers, who have provided us with truly splendid contributions. The first of those came from my noble friend, who referred in brief to the Government's programme for health.
In health, as in education, our desire is simple. It is to see standards driven up in response to those who are closest to the delivery of the service: the professionals and, in the health service, the patients whom they look after. Those are the people whom we wish to empower. In fulfilling that wish, we shall move away from centrally imposed targets which focus simply on process in favour of quality standards linked to results. Those quality standards will be defined by reference to clinical evidence. We will commission for quality care. We will pay for performance. We will put the patient at the centre of care by giving him information and choice, and we will encourage health and social care providers to be more efficient and effective at delivering quality and good value. I say to the noble Baroness, Lady Wall, that that does not mean that providers will no longer be held to account. Good regulation matters very much, but it has to be meaningful regulation.
That is a far-reaching programme. One of the key steps in setting the NHS free from central diktat will be the creation of the autonomous NHS board. I was grateful to the noble Lord, Lord Patel, for his remarks in that connection. The board will allocate resources; it will provide commissioning guidance; and it will support GPs to commission services on behalf of their patients.
For the first time, the NHS will be led not by politicians but by clinicians, who will be fully accountable for what they do. Despite the huge investment in the NHS in recent years and the improvements that we have seen—which I am the first to acknowledge—the fact is that costs have risen, productivity has fallen, bureaucracy has increased and outcomes have simply not kept pace. In many of the common cancers, our survival rates are the worst in the OECD. We are on the wrong side of the average in western Europe for infant mortality and for premature mortality from lung cancer and heart and respiratory disease. People are more than twice as likely to die from a heart attack in the UK than in France.
We want our health outcomes to be among the best in Europe—indeed, among the best in the world. To achieve that, we have to set doctors, nurses and midwives free to do their job. It is a sobering statistic that the system now demands in the order of 250,000 separate data returns from trusts every year. We have to reduce that burden dramatically and trust the professionals on the ground to judge what is right for their patients.
If we are to match the best health outcomes in the world, we will have to improve our public health services alongside the NHS. That theme was pursued by the noble Baronesses, Lady Greengross and Lady Masham, my noble friend Lord Fowler, the noble Lords, Lord Kakkar and Lord Patel, and others. We will have to invest in prevention—to keep people healthy and prevent them getting ill in the first place. To do that, we shall give local communities greater control over public health budgets, with payments linked to the outcomes that they achieve. We will work more closely with local NHS organisations, local authorities and the voluntary and private sectors, and we will take more targeted action to reduce health inequalities.
That is where our health premium comes in. Like the pupil premium, it will directly tackle disadvantage and reduce inequalities, and it will make for a much fairer approach to public health. In the coming weeks, we will be publishing a White Paper which establishes our long-term strategy for reform of the NHS and we plan to introduce a health Bill in the autumn.
The right reverend Prelate the Bishop of Chichester spoke about the NHS workforce and asked who was included in that term. He was right to give me a prod on that. We will give all NHS doctors, nurses, allied health professions and other health professions back their professional autonomy. They need to be able to use their professional judgment about what is right for patients. He asked me specifically about chaplains. We very much value the work done by NHS chaplains, who play an important part in providing high-quality spiritual care services to patients and staff, and we are committed to ensuring that patients and staff in the NHS have access to the spiritual care that they want, whatever faith they may have.
The noble Baroness, Lady Greengross, asked about Monitor, which was also raised by the noble Baroness, Lady Murphy, who also asked me about the NHS board. In short, by creating an independent NHS board, we will make sure that funding decisions are made on the basis of need, that commissioning decisions are made according to evidence-based quality standards and that resources are allocated appropriately. We propose to develop the role of Monitor to establish an economic regulator with responsibility for ensuring that patients have access to essential services and that the money invested in the NHS achieves maximum value. The noble Lord, Lord Warner, was right in all that he said on that issue.
My noble friend Lord Colwyn, as he customarily does, spoke about his own subject: dentistry. We will introduce a new dentistry contract that will focus on achieving good health and increasing access to NHS dentistry. At this stage, we need to review the details of the system that we have inherited. Once we have done that and have talked to the profession and patient groups, we will announce the details of the reforms that we are proposing.
The noble Lord, Lord Mitchell, spoke about foetal alcohol syndrome, a subject about which he and I have spoken many times in the past. We want to improve labelling so that people are more aware of the amount of alcohol in drinks as well as of guideline limits. We want to see the necessary improvement in labelling information through a voluntary approach if we can, but we will consider all responses from the consultation that closed very recently—I think on 31 May—before we make any decisions on that matter.
The noble Lord, Lord Sutherland, chided the Government for setting up a royal commission on long-term care. He rightly pointed out that we have had many papers on this subject, not least the royal commission that he chaired in such a distinguished way. I simply say to him that this is an urgent matter. We are not pressing the reset button, as it were, on reform of long-term care. It is a hugely challenging issue, and the independent commission will consider the evidence and information gathered through the public debate over the past few years. We know that we must reform social care on a sustainable and long-term basis. A number of options have been put forward for funding a reformed system, so we just have to build on all this work and keep up the momentum of change. I welcomed what the noble Lord, Lord Warner, said on that subject.
The noble Baroness, Lady Masham, asked about the patient voice. We are going to give the public a strong and independent voice though Health Watch, which will be a statutory body with the power to investigate and support complaints. I hope that this will be music to the ears of my noble friend Lady Knight. Locally, we will strengthen the patient voice by having directly elected members of the public on the boards of PCTs. That will ensure that boards are balanced between locally accountable individuals and technical expertise. We will publish detailed data about the performance of healthcare providers online so that everybody will know who is providing a good service and who is falling behind. We will measure our success on the health results that really matter, such as improving cancer and stroke survival rates and reducing hospital infections.
The noble Lord, Lord Patel, asked me about preventive health measures, including those relating to alcohol, tobacco and nutrition. Lifestyle-linked health problems like those and the spread of infectious diseases are leading to soaring costs for the NHS. We will provide separate public health funding to local communities that will be accountable for and paid according to how successful they are in improving their residents’ health.
The noble Baroness, Lady Thornton, asked me about targets. The service priorities for the NHS have to be based on evidence about their benefits for patients; that is, they should be focused on the outcomes that they achieve, rather than on chasing nationally mandated targets with incomplete clinical justification. We are going to remove the politically motivated process targets. I am looking at the list that we have inherited from the previous Government with a view to ensuring that any targets that work against better patient care are removed at an early opportunity.
The noble Baroness asked me about creating a department of public health. The coalition agreement is not the entire sum of our policy, and we will announce further information in due course. As I have indicated already, we are committed to taking action on public health and encouraging behaviour to change, to help people to live healthier lives.
The noble Baroness, Lady Murphy, asked about foundation trusts. I apologise for being so brief, but can say that we are considering a number of options for all NHS providers to become foundation trusts, taking into account many of the issues that she rightly raised. We want to resolve issues of efficiency, issues of clinical sustainability and an explicit assessment of quality, as those are affecting the flow of trusts becoming foundation trusts, as she well knows. This is not easy, but we are determined to make progress.
The noble Lord, Lord Rea, criticised the purchaser/provider split, particularly in relation to the costs of running a commissioning system. I should say to him simply that before we created the division between purchasers and providers, we did not have an accurate idea of how much anything cost in the NHS. That was a very basic lacuna in budgetary control and service planning, so the split has been a helpful feature of our health system at a time when value for money is more important than ever.
The noble Lord also asked about the workability of patients being able to choose their own GP. We believe that patients should be able to choose their own GP practice and not have an arbitrary set of rules that dictate where they can register. If people want to be able to register near their work or near their home, or with a practice that offers better service, they should be able to do so. We know, incidentally, that these problems persist mainly in our most deprived communities, where patients have historically had less choice, yet these are the areas with the greatest health needs.
My noble friend Lord Addington asked about getting the population involved in sport—a subject on which he is a renowned expert. As part of delivering a health legacy for the 2012 Olympics, the legacy action plan aims to make 2 million more adults in England active by 2012-13 and will be measured by the number of adults aged 16 and over who participate in sport or undertake some form of physical activity.
My noble friend Lord Bridgeman spoke about hospices, which play a very valuable role in end-of-life care, particularly for cancer patients. The coalition’s programme for government included a commitment to introduce a new per-patient funding system for all hospices and providers of palliative care. I am sure he knows that the responsibility for setting standards in palliative care training for nurses sits with the professional regulators, but I shall ensure that his remarks are brought to the attention of the Nursing and Midwifery Council.
My noble friend Lord Fowler spoke about the prevention of HIV and hepatitis B and C. These are priorities for us. The Joint Committee on Vaccination and Immunisation considered the hep B vaccination last year and concluded that a universal programme would not be cost effective in the UK, but I note all that he said.
In view of the number of speakers in this debate, I hope that the House will allow me to take a little longer than I might otherwise take. We have had a curtailed debate on the gracious Speech, and I think that those who have spoken would like to hear what I have to say, although I will inevitably have to be brief.
The noble Baroness, Lady Morgan, made a powerful speech focusing in the main on education funding. She was especially worried about damage to front-line education because of spending cuts. There will have to be savings, but we plan that the savings will be made from reducing waste and cutting the cost of quangos. We have announced that schools, Sure Start and spending on 16 to 19 year-olds will be protected from any in-year spending cuts. Any efficiencies made within schools, Sure Start and 16 to 19 year-olds’ education will be recycled within their respective budgets.
We are not back-tracking on one-to-one tuition. Front-line funding for one-to-one tuition is protected. The first quarter payment for one-to-one tuition for schools has been made this week in line with Standards Fund allocations. That funding will allow schools to provide up to 600,000 tuition places in primary and secondary schools. Although it was part of an overall budget identified for tuition by the previous Administration, it is not part of funding for the front line.
The noble Baroness also asked from where the money would come for new schools and academies. Decisions about the level of funding available to set up and run new schools will be dependent on the outcome of the spending review in the autumn. I cannot be of greater help on that at the moment. I do not agree with the noble Baroness that our policy will entrench unfairness or create a two-tier education policy, as she indicated. That concern was raised in various ways by the noble Lord, Lord Rix, and the noble Baroness, Lady Howe. We are committed to helping all children achieve their potential, which is why we will introduce a pupil premium and will ensure that extra money follows disadvantaged pupils. This will make sure that it is more attractive to establish new schools in areas of disadvantage and that schools with significant deprivations get more money even in less deprived parts of the country. Schools that recruit and retain disadvantaged children will know that they will receive additional funding to help them meet their needs. It will be for head teachers to decide how best to meet those needs, but they might, for example, use the money to attract the best teachers, to reduce class sizes or to provide extra tuition.
The noble Baroness, Lady Howe, asked about the calibre of teachers. The single most important determinant of a good education is for every child to have access to a good teacher. Our aim is to improve the quality of the teaching profession. As an example, I would cite the Teach First initiative. We also want to create Teach Now to build on the Graduate Teacher Programme and to look for other ways to improve the teaching profession, particularly in terms of attracting more science and maths graduates to be teachers.
The noble Baroness, Lady Morris of Yardley, in her thoughtful speech indicated that in her view there was no evidence that structural change led to successful reform or better results. We can see the evidence from academies which have shown a 5 percentage point increase in the proportion of pupils achieving at least five GCSEs at A* to C grades, which is double the average national increase of 2.5 percentage points. As regards non-academies, I have no hesitation in paying tribute to those that are outstanding, and I do not believe that any of my ministerial colleagues would either. The recent announcement allows all schools the opportunity to benefit from the additional freedoms and flexibilities of academy status, with those rated outstanding being fast-tracked through the process.
The noble Baroness made the very good point that teaching and leadership are the most important things. I agree with her on that. A key principle behind the partnership of the coalition Government is trusting professionals, which is why the Government will give them more power and control and will trust them to get on with the job. Many school leaders have already shown a keen interest in gaining academy freedoms.
The noble Baroness, Lady Sharp of Guildford, spoke about reducing bureaucracy in schools. We are committed to freeing all schools from unnecessary bureaucracy so that they can focus on their core purpose of raising standards for all children. We will shortly outline a package of proposals for how we intend to reduce bureaucratic restrictions placed on schools.
The right reverend Prelate the Bishop of Lincoln asked about free schools and how they would drive up standards for everyone. Free schools will be established to meet parental demand. They will be open to meet that demand wherever it exists. The introduction of free schools will make sure that parents get what they want in these schools and will act as a spur to improvement in other schools. I have already mentioned the pupil premium in this context.
My noble friend Lord Baker spoke compellingly about university technical colleges, a subject also referred to by the noble Baroness, Lady Sharp. Technical academies are likely to build on the university technical colleges model which we have been developing with my noble friend and the Baker Dearing Educational Trust. We are working on three pilot projects in Birmingham, Walsall and Greenwich. Those are progressing well, but they are unlikely to open before 2011.
The noble Lord, Lord Griffiths of Burry Port, spoke about school governance and particularly the role of school governors. I would say to him that, from family experience, I recognise all too well how hard school governors work. They give their time and energy to serving on governing bodies. It is true that their duties can be demanding, but a well-organised governing body can spread its workload, as I am sure he knows, by setting up sub-committees. He asked me to comment specifically on the future of Building Schools for the Future commitments, especially in relation to the Central Foundation Girls’ School in Tower Hamlets. The Department of Education has not yet taken any decisions on Building Schools for the Future, and they will be announced in due course.
The right reverend Prelate the Bishop of Bath and Wells asked about the composition of boards of governors in academies. Our current model articles of association say that academies must have one local authority governor and at least one parent governor, but Ministers have not yet made a decision about the composition of future academy governing bodies. The noble Baroness, Lady Howarth, spoke about children’s services, which she does so well. The Government recognise the challenges that local authorities face in delivering really effective children’s services. When Ministers have evidence that a council is not discharging its accountabilities to an acceptable standard, the Government will want firm assurances that the local authority involved has the determination and the capacity to turn its performance around. We do not want to interfere unnecessarily in local authorities’ improvement processes, but in the most severe cases where councils fail to improve, we will not hesitate to consider using our statutory intervention powers.
The noble Baroness, Lady O’Neill, said that there was too much assessment and testing. We are committed to external assessment and will review how the KS2 tests operate in the future. Schools, as she well knows, do not have to narrow the curriculum to achieve good test results, although I was very interested in all she had to say on that theme. The noble Baroness, Lady Massey of Darwen, asked about physical and personal education. These are important areas and the evidence available to us from Ofsted and the conclusion of the Macdonald review is that the quality of PSHE teaching is highly variable. The current policy is that all young people should receive a comprehensive programme of sex and relationship education to give them the knowledge and skills to make safe and responsible choices. High quality PSHE is a core theme of the Healthy Schools programme.
The noble Baroness, Lady Walmsley, talked about Sure Start and health visitors. The coalition agreement commits the Government to refocus funding from Sure Start peripatetic outreach services and from the Department of Health budget to pay for 4,200 extra Sure Start health visitors. We believe that our new approach to early years services and the profile of the Sure Start health visitor role will prove very attractive. The noble Baroness also spoke about child poverty, as did the right reverend Prelate the Bishop of Bath and Wells. We are very focused on this issue. The position we have inherited means that we are not on track to meet the 2020 target, and we will need to consider carefully what action is needed to make real progress in this area. The right reverend Prelate also asked about the commitment to end child detention, and I refer him to the Question on the subject answered by my noble friend Lady Neville-Jones this week.
The noble Lord, Lord Hall of Birkenhead, asked about funding for the arts, and he is right that more than half of this funding comes from public sources. The vast majority of government funding for the arts is of course via Arts Council England. The rest comes from private sources, including the earned income of people who attend events and venues. But as a general point, putting the economy back on its feet and restoring the nation’s finances are in the interests of all our sectors, and that is the prime task of this Government.
The right reverend Prelate the Bishop of Guildford, in his excellent speech, addressed the issue of the churches needing repair. The Listed Places of Worship Grant Scheme, which makes grants equivalent to the VAT incurred, is expected to make grants of around £15 million in 2010-11. However, a decision on the scheme’s future beyond the end of this year is pending. As he will know, though, other funding is available from various sources—the Repair Grants for Places of Worship Scheme, the Heritage Lottery Fund and the Churches Conservation Trust.
The noble Baroness, Lady Andrews, spoke very powerfully about heritage protection. I pay tribute to the work of English Heritage in protecting the historic environment and to her as its chair. We are currently considering options for legislating in this area. In doing so we are mindful that extensive consultation on reform of the heritage protection system has taken place over the past decade and that a programme of non-statutory reforms is now nearing completion.
My noble friend Lord Colwyn spoke about live music. There seems to be evidence that the Licensing Act 2003 has not created the growth in live music that was hoped for, and we cannot ignore public opinion out there, especially among musicians. We believe that there was much to commend in the Bill of the noble Lord, Lord Clement-Jones, but we want to consider the options carefully before deciding how best to support live music.
The noble Lord, Lord Elis-Thomas, asked about broadband. The UK has made a start on the deployment of superfast broadband but we want to go further. Steps are now in train to reduce the cost, and that could make a significant contribution to availability and open the market to new players. As regards S4C, there will be a reduction in its budget from DCMS for the current year of £2 million. S4C has said that it will endeavour to ensure that this reduction will not directly affect services to viewers.
The noble Lord, Lord Rea—I apologise, I am a little out of order—asked me about NICE and I forgot to address his question. I assure him that we believe that NICE has an important long-term role in assessing the clinical efficacy and cost-effectiveness of new treatments and safeguarding taxpayers’ money.
Moving very briefly to work and pensions, the noble Lord, Lord McKenzie of Luton, asked whether the Government would continue his party’s reforms to the operation of the work capability assessment. The Government take seriously the importance of correctly assessing fluctuating conditions and ensuring the accuracy of the WCA. We are currently considering the department-led review of the WCA and its recommendations. Do we plan to continue the timescale for reassessing those people on incapacity benefit set out by the previous Government? We will be testing and learning from the small-scale trial which will run from October 2010; full migration will not begin until April next year and is expected to take place over a three-year period.
The future jobs fund has not been abolished. We will continue to fund the bids already approved, which will mean that more than 100,000 people are likely to get jobs, but we will not accept any new bids for funding and we will tighten up the way in which contracts are managed.
My noble friend Lord Elton asked me whether I would talk to him about identity fraud. I shall be very happy to do that.
The noble Baroness, Lady Hollis, in an extremely powerful and compelling speech, spoke about pensions and savings. There are obvious attractions to introducing a single pension which wraps up the existing three elements of the state pension system, as she suggested. However, I think she will agree that significant issues would need to be addressed before such a system could be introduced, including costs and transitional issues such as what happens when a person has been contracted out of the state system. However, as the noble Baroness acknowledged, the Government have already brought forward the restoration of the earnings link to April next year. If I may write to her about the other points she made, that would probably be appropriate in the circumstances.
The noble Lord, Lord Rix, spoke powerfully about employment support for disabled people. I agreed with so much of what he said. The single work programme will offer targeted, personalised help for those who need it most. We want to give people who have been so-called “written off” the opportunity to work and contribute, and the reforms will aim to promote employment and tackle poverty.
It has been impossible in the available time to answer every question posed. I hope that noble Lords will forgive me for that, but I undertake to write to those noble Lords whose questions remain unanswered.
Our programme for health, as for education and welfare, has at its heart the concepts of trust, fairness and empowerment of the citizen. The role of government is to create the conditions which will make those concepts a reality. As we debate these important matters over the weeks and months ahead, my ministerial colleagues and I look forward to garnering the wisdom of this House in exactly the way that has proved so valuable to countless Governments who have preceded us.
Meanwhile, I am able with pleasure and a good deal of pride to commend the gracious Speech to your Lordships.
Health: Contaminated Blood Products
Earl Howe Excerpts(14 years, 5 months ago)
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Lord Morris of Manchester
My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, in doing so, declare a non-pecuniary interest as president of the Haemophilia Society.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we have decided not to seek leave to appeal the judgment, and we shall be writing shortly to let the court know of our decision. We are considering our response to the judgment and will announce our decision in due course. In the mean time, ex-gratia payments will continue to be paid at current levels to those affected.
Lord Morris of Manchester
My Lords, I am grateful to the noble Earl and congratulate him on his well merited ministerial post, which I know he will grace with all his customary integrity. Is he aware that 1,982 haemophilia patients have now died from being infected with HIV and hepatitis C by contaminated NHS blood products in this worst ever treatment disaster? Given the High Court’s landmark judgment, the wide all-party acclaim for the Archer inquiry’s findings and David Cameron’s strongly positive response to the Haemophilia Society’s pre-election call for urgent new help for the afflicted and bereaved, can the Minister confirm that there will be no delay now in ensuring a just settlement for this cruelly stricken and arguably most needful minority in Britain today?
Earl Howe
My Lords, perhaps I may begin by thanking the noble Lord for his kind words. I am sure he knows how seriously I take these matters. I hope he can take as read my wish to see that those whose health is suffering as a result of this tragedy are properly looked after by the NHS. I know that the noble Lord will understand that we are looking at the court judgment. It is early days yet, but we are considering very carefully what the court has said and I cannot be of more help to him at this stage than I already have been in my earlier Answer. I stand ready to talk to him, either inside or outside this Chamber, on these important matters.
Lord Archer of Sandwell
My Lords, I endorse my noble friend’s congratulations to the noble Earl. Do the Government accept that the scale of payments to victims in Ireland was not a response to criticisms from an official inquiry, as the scale had been decided and implemented long before either official inquiry reported? Furthermore, is it now accepted that to argue that there has been no similar criticism from an official inquiry in this country is, to say the least, disingenuous, as successive Governments have failed to appoint one?
Earl Howe
My Lords, obviously, I cannot speak on statements made by Ministers of the former Administration. However, I can confirm to the noble and learned Lord that the compensation scheme in the Republic of Ireland was set up in the light of evidence of mistakes made by the Irish Blood Transfusion Service Board. That has been confirmed to us by officials in the Republic of Ireland’s Department of Health and Children. It is important to understand that the events that gave rise to the people in Ireland becoming infected through contaminated blood transfusions were quite dissimilar to the sequence of events that occurred here. There were specific circumstances in Ireland, and quite different circumstances in the UK.
Baroness Campbell of Surbiton
My Lords, I declare an interest as the widow of a haemophiliac who died from contaminated blood products 16 years ago. Is the Minister aware that many of the widows, widowers and children of people who were infected and died received very little compensation—in fact, many do not receive a penny in support from the state? Does he not agree that it would have been wiser to spend the Department of Health’s money used to fight the High Court case on supporting those bereaved families, many of whom have lost their breadwinner?
Earl Howe
My Lords, I am well aware of the noble Baroness’s personal interest in this matter and feel deeply for her. She is of course correct that the Skipton Fund was not designed to support bereaved relatives. It was designed to alleviate the suffering of those infected with hepatitis C. Sympathetic as I am towards those who have lost their loved ones in this tragedy, that fund does have a specific purpose and it would require a major review to alter that purpose. However, I note her concern on this matter.
Lord Alderdice
My Lords, I share in the congratulations and good wishes to the noble Earl, who has served this House so well on health issues, and offer my congratulations to the noble Lord, Lord Morris of Manchester, and the noble and learned Lord, Lord Archer of Sandwell, on their tenacious pursuit of this issue. Does the noble Earl agree that the High Court judgment shows a confusion of thinking on the part of the Department of Health not only in regard to this matter but on the whole question of dealing with adverse health events? Does he accept, as the Scottish Executive have done, as the Chief Medical Officer did in 2003 and the National Audit Office did in its report in 2004, that much more money would be available in compensation if it were not being spent on legal fees and court cases, and that the introduction of a no-fault compensation scheme could achieve that?
Baroness Thornton
My Lords, I join my noble friend in welcoming the noble Earl to his new position and wish him all the very best. Not so long ago, during the passage of my noble friend’s Bill last November, the noble Lord, Lord Thomas of Gresford, and the noble Baroness, Lady Barker, were very keen on a full compensation package for those affected by contaminated blood products. Has this commitment been translated into the coalition Government’s policy? If so, how and in what timescale?
Earl Howe
My Lords, I thank the noble Baroness for her kind remarks. We are in a coalition Government. Not every pledge in either the Conservative or the Liberal Democrat manifesto can be honoured. That is the nature of coalitions. In fact, the specific Liberal Democrat proposal which she referred to was not included in the programme for government which we published.