Penrose Inquiry

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 26th March 2015 Lords Chamber

[Earl Howe]

My Lords, if my noble friend will forgive me, I do not want to be drawn too closely on Lord Penrose’s comments, as we should reflect on them carefully. However, it is clear that, as knowledge of these viruses began to emerge in the 1970s and early 1980s, no tests were available to screen blood donations and no means existed to inactivate the virus in blood or blood products. By 1985, a screening test for HIV was available, and heat-treated plasma products that inactivated the virus had been developed. It was not until 1990 that an effective screening test for hepatitis C was available. It is important to put that into context, because Lord Penrose found that clinicians acted in accordance with the technical facilities that they had available to them and in accordance with the ethical frameworks that were in place during the 1970s and 1980s. The ethical frameworks in which clinicians operate today are of course very different from those that were in place then.

[Baroness Masham of Ilton (CB)]

My Lords, looking ahead to the future with the new Government, would the noble Earl agree with me that there are new drugs coming along for hepatitis C? For those poor, unfortunate patients who had haemophilia and who got HIV and hepatitis C, it really was a disaster. Would he consider, if he is still a Minister, that the very best treatment with these new hepatitis C drugs will be given to these patients? That would prevent liver disease, which is a huge problem.

[Earl Howe]

The noble Baroness makes a very important point. NICE guidance on the first of the new hepatitis C drugs is expected in June this year. Pending that, in April last year NHS England introduced an early access scheme for the new hepatitis C therapies. Over 700 patients have now been treated as a result of that policy, including some of those who were infected by blood or blood products in the 1970s and 1980s. NHS England is considering a further early access policy to include patients with cirrhosis, which it is aiming to have in place in the first half of this year. I think that should be of comfort to many patients.

Barts Health NHS Trust

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 19th March 2015 Lords Chamber

[Earl Howe]

My Lords, I cannot disagree with the philosophy expounded by the noble Baroness. It is very important that not just the trade unions but members of staff generally feel involved and have a sense of ownership of the organisation for which they work. I hope it is of some reassurance to the noble Baroness that staff and health partners will be fully involved in the development and implementation of the improvement programme and that a staff representative will be a member of a new improvement board at Whipps Cross.

[Baroness Masham of Ilton (CB)]

My Lords, it was stated in the press that there had been bullying at Whipps Cross and that people had been denied food and fluid for far too long. What is being done about those people who bullied patients?

[Earl Howe]

The noble Baroness is right. The CQC found that there was a culture of bullying at Whipps Cross. They had concerns about whether enough was being done to encourage a culture of openness and transparency—something on which, as she knows, we place great emphasis in the light of the report on Mid Staffordshire NHS Foundation Trust. I can only say to the noble Baroness that this is one of the issues that will be top of the list for the new improvement director at Whipps Cross.

Maternity Services in Morecambe Bay

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 3rd March 2015 Lords Chamber

[Earl Howe]

My Lords, anyone who reads this report will not fail to alight on the phrase that Dr Kirkup uses—that what we had at this hospital was a “lethal mix”, comprising, among other things, substandard clinical competence, poor working relationships in the maternity unit, a move among the midwives to pursue normal childbirth at any cost, shooing obstetricians away at various points, and failures of risk assessment and care planning that led to unsafe care. All these things should pull us up short and, indeed, do so. They are shocking. We certainly expect the relevant professional regulatory bodies, including the GMC and the NMC, to review the findings of this investigation report and act on the recommendations. Those organisations should review the findings of the report concerning the professional conduct of registrants involved in the care of patients at the trust to ensure that appropriate action is taken against anyone who has broken their professional code, but building on those lessons to see whether there are wider matters around safety to be considered.

On mandatory reporting, I can only add to the remarks that I made to the noble Lord, Lord Hunt, by saying that we remain totally committed to the principle of the reforms. Further progress will be informed by reconsideration of the detail of the new system in the light of other positive developments on patient safety since 2010 and by a subsequent public consultation exercise. We are working with the health departments in the devolved Administrations, NHS England and the professional bodies to consider how standardised reviews for all perinatal losses might be introduced.

[Baroness Masham of Ilton (CB)]

My Lords, what will happen if the 18 recommendations are not put into practice? Will they apply to all hospitals across the country? The maternity service at the Friarage Hospital, Northallerton, which is my local hospital, has recently been downgraded to midwives only, to the anxiety of the local people who live in a very rural area. I hope that the noble Earl can give some assurances on safety as there are so many worried people and there will be more after this report.

[Earl Howe]

My Lords, as regards Northallerton, our approach as Ministers and in the department is that service reconfiguration has to be a matter for local decision-making. We do not, as a rule, interfere with those decisions unless there is a referral from an overview and scrutiny committee in the statutory manner. I hope the noble Baroness will therefore understand that I am rather precluded from commenting on that local situation. Nevertheless, on her first point, we have asked the trust to implement the recommendations that have been assigned to it in the report. We have asked Monitor to ensure that this happens within the designated timescales to give maximum reassurance to the patients and families who are using the hospital that time is not being wasted. At a local level, the trust is in special measures. It has put in place a largely new management team, which is working towards delivering against its agreed improvement plan. Progress against that plan is being closely monitored by the quality surveillance group, thereby ensuring that the trust, CCGs, regulators and others are working together in the best interests of the local population.

Jimmy Savile: NHS Investigations

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 26th February 2015 Lords Chamber

[Earl Howe]

My noble friend makes a series of extremely powerful and pertinent points and I am in agreement with the thrust of them. She is absolutely right that this is a matter of the culture of an organisation. While I think we can say hand on heart that the culture in the NHS has in many respects changed for the better in recent years, we must never be complacent about this. This matter was particularly identified by Sir Robert Francis in his recent report on whistleblowing, and we have accepted his recommendations. For example, we will ask every NHS organisation to identify one member of staff to whom other members of staff can speak if they have particular concerns and are not being listened to. We will also consult on establishing a new independent national whistleblowing guardian as a full-time post within the CQC to fulfil the kind of independent role that my noble friend refers to. In that context we are legislating to protect from discrimination whistleblowers who apply for NHS jobs. Therefore, I think that there are things that we can do with the mechanisms to ensure that the NHS is a more benign place for people who would otherwise feel too frightened to speak up.

Nevertheless, the further consultation on mandatory reporting which I have undertaken we will carry out will, I am sure, bring all this into the frame again. I have no doubt—at least, I hope—that my noble friend will feed into that consultation in the way that she has just indicated.

[Baroness Masham of Ilton (CB)]

My Lords, I declare an interest as I have been a patient at the Stoke Mandeville spinal unit since 1958, when I broke my back. I knew Jimmy Savile to some extent over the years. He was very autocratic and very clever, but I never saw his dark side. Many of the people working at Stoke Mandeville did not see that side of him because he was so clever.

There is a problem with hospitals. They do not like bad publicity and there can be cover-ups. We need openness and honesty. I should like to ask the Minister about the present procedure for patients, who need an easy and quick way of raising their concerns. That is very important because many patients are at risk of having bad things done to them. Sometimes those bad things may be done by people on the ward, so patients need to bypass the ward but they cannot just be told that they have to go to the health ombudsman. That takes too long. Therefore, I hope that the procedure for patients will be given great consideration in the future.

[Earl Howe]

The noble Baroness has our admiration for the way in which she has coped with her spinal injury over these many years. She is, of course, absolutely right about the way in which Jimmy Savile duped so many people. He was a forceful character as well as somebody with a superficial charm, and he got away with what he did. She is, of course, correct that the protection of patients lies at the centre of all this and we must ensure that we have proper systems in place to make them feel confident that they can come forward.

I take the noble Baroness’s point about patients perhaps not feeling able to complain to the ward staff. The answer to her question is that the patient, or someone on their behalf, can complain to the chairman of the organisation or trust or to a member of the board, and thus bypass the clinical staff. There should always be a member of the board at the hospital whose responsibility is the protection of patients above all. In the end, it is for that organisation to investigate its own supposed failings. If somebody is not satisfied with the result of that investigation, it is then open to them to go to the ombudsman. We believe that complaints should be investigated at a local level, either with the provider of the service or, if that is not thought appropriate for any reason, with the commissioner of the service.

Francis Report: Update and Response

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

My noble friend makes a series of very good points. We are, as he knows, extremely concerned about the rising level of litigation costs in the NHS. My department is consulting on proposals for how the duty of candour can be further incentivised by requiring trusts and foundation trusts to meet a proportion of the cost of negligence claims in cases where they have failed to be candid. We are also committing up to £35 million so that the NHS Litigation Authority can support trusts in implementing their safety improvement plans where those plans show a likely reduction in the number of higher-volume and higher-value claims over the medium to long term.

[Baroness Masham of Ilton (CB)]

My Lords, I congratulate the Government on accepting this second report. The report states that staff working with vulnerable patients should be responsible. How will the Minister make this happen? Patients and carers should be listened to. They can become whistleblowers, but may feel that they will be branded as troublemakers. How can he stop this happening?

[Earl Howe]

Making every employee responsible goes hand in hand with the duty of candour—the feeling for every employee that they have the freedom to speak up and take ownership of a given situation that is within their control, professionally. We hope that this will gradually show its value in the way that the culture of an organisation changes for the better. Ultimately, though, professionalism depends on training as well. On the whistleblowers, may I ask the noble Baroness to repeat the second half of her question?

[Baroness Masham of Ilton]

My second question was that since patients and carers could become whistleblowers but might feel that they would be branded as troublemakers, how can the Minister stop this happening?

[Earl Howe]

I apologise to the noble Baroness. It is very important that that does not happen. This was very much a matter that Sir Robert had in his sights when preparing the report. We have a certain amount of protection for whistleblowers at the moment—the noble Lord, Lord Hunt, referred to this—and the current Government have augmented that protection, not least through the way in which we have improved the NHS constitution. But Sir Robert is clear that we need to go further and, in particular, to ensure that those whistleblowers who find their position untenable in an organisation and are obliged to leave are not thereby blacklisted by the NHS merely for having spoken up. We think that the measures Sir Robert has proposed will achieve this but, more importantly, they will ensure that there is a better form of conflict resolution, able to nip concerns in the bud at an early stage and at a local level.

Medical Innovation Bill [HL]

Debate between Earl Howe and Baroness Masham of Ilton

Friday 23rd January 2015 Lords Chamber

[Earl Howe]

I would not disagree with the noble Lord at all. I was about to say that on Report, my noble friend Lady Jolly suggested that there should be a registry and made a commitment to that effect. I would like to clarify that the Government are committed to exploring what may be useful in the data registry. The key here is to establish what could be workable and beneficial. The Government have heard a range of views on the topic of a data registry from those who argue, as many of your Lordships do, that this is essential to the Bill to others, including eminent clinicians, who argue that informal methods of sharing learning are more effective and that a compulsory registry would be overly burdensome.

With thanks to the contribution of your Lordships, the Government have started this conversation and are committed to continued engagement with relevant bodies. Any method of learning that should develop from the Bill must surely work for doctors to be of benefit to patients and the wider medical community. That is no simple task. It is crucial that any mechanism to encourage learning should be developed with a sufficiently light touch so that clinicians see it as facilitative of good practice, rather than burdensome and bureaucratic. It is also important to consider the costs of a method of learning and how this can be encouraged in the most cost-effective way. While I do not take issue with the end-point which noble Lords want to reach, I really believe that it is wise for us to remain open to all possibilities, rather than committing in legislation to an approach which may discourage doctors from innovating under the Bill and therefore not be of benefit to patients in the longer term.

This is a beguiling amendment and I understand the motivation behind it but I hope that noble Lords will join me in questioning the wisdom of having such an amendment in the Bill and accept instead our preferred approach: to continue to discuss this issue with relevant parties as the Bill progresses and, should the Bill pass, to engage with the medical community as to the best way to ensure that innovation can be translated into learning.

[Baroness Masham of Ilton]

Before the Minister sits down, to do research surely one needs data to see what benefits patients because these are new procedures that we are talking about.

[Earl Howe]

I would just say that the Bill is not to do with research but with innovative treatment, which is rather different. There is no question of the noble Lord, Lord Saatchi, promoting another form of clinical trial so while I accept the principle that the gathering of data is a very good idea, we must be clear that this is not for clinical research.

HIV: Late Diagnosis

Debate between Earl Howe and Baroness Masham of Ilton

Monday 1st December 2014 Lords Chamber

[Earl Howe]

It is far too early for me to say how the new money will be spent. In any case, that has to be a decision for commissioners weighing up the healthcare priorities that face them. But the new money is excellent news for the NHS, and there will be a Statement later today about that.

[Baroness Masham of Ilton (CB)]

My Lords, how many undiagnosed people with HIV does the Minister think there are? Would it not be beneficial to have testing of HIV, TB and hep C all together to save money and to pick up more infections?

[Earl Howe]

I shall have to take advice on the second question posed by the noble Baroness, which I do not know the answer to. But in answer to her first question, an estimated 107,800 people were living with HIV in the UK in 2013, of whom 24% were unaware of their infection, remain at risk of infecting others and are unable to benefit from effective treatment. That is why it is so very important that we target the at-risk communities to urge them to get tested, either in a clinic or through self-testing kits, which are now legal.

NHS: Five Year Forward View

Debate between Earl Howe and Baroness Masham of Ilton

Monday 1st December 2014 Lords Chamber

[Earl Howe]

I do not think one can develop a consensus prior to a government Statement—that is probably wishing for the moon. The charge that the noble Lord levels against the Government is also, if I may say so, misplaced. We have never pretended that all the money being announced today is new money. I do not seek to suggest that, as I have already explained. As regards the timing, I think it is standard practice for key elements of the Autumn Statement to be trailed ahead of the formal announcement. However my right honourable friend the Chancellor will confirm everything we have said today in the Autumn Statement on Wednesday, and that is as it should be.

[Baroness Masham of Ilton (CB)]

My Lords, the Minister has not said anything about specialised units. I declare an interest as president of the Spinal Injuries Association. Spinal units are vitally important when patients need treatment, yet some spinal units have cut the services of physiotherapists and occupational therapists, who are vital for rehabilitation. The answer is always, “It is up to the trusts”. The trusts can be wrong and in this case they are. Can the Minister give an assurance that there will be enough trained doctors, nurses and therapists for the next five years in spinal units?

[Earl Howe]

My Lords, I will have to take advice about that question. What I can say is that we now have in place a system of workforce planning that is better than its predecessor. I do not think there can ever be such a thing as a perfect system of workforce planning. We now have a national body, Health Education England, that is responsible for making sure that we have adequate numbers of professionals with the right skills. However, we also have local education training boards whose members include representatives from the acute trusts. It is up to those boards to make clear what the requirements are for trained staff and feed those requirements up to Health Education England so that planning over the coming years can be done in a rational and sensible way. I would expect that spinal units should make their case in that fashion so that if there is a need for physiotherapists in spinal units, and those physios are—for any reason—not available, then they will come forward in adequate numbers in years to come.

NHS: Health and Social Care Act 2012 Reforms

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 22nd October 2014 Lords Chamber

[Earl Howe]

The noble Lord raises a very important issue, which results from the fact that commissioning decisions are taken not by the Government but by clinical commissioners across the service. We are very concerned by the reports of lower resources being channelled into mental health services. A lot of work is going on, in my department and in NHS England, to make sure that those services—and, crucially, the outcomes from those services—are maintained.

[Baroness Masham of Ilton (CB)]

My Lords, how much was paid out in redundancy to health service staff who lost their jobs and were then taken on again? Is the Minister aware that emergency medicine and accident and emergency departments are really overstretched?

[Earl Howe]

The noble Baroness asks two questions. We had to abide by the terms of the contracts of employment which were put in place by the previous Administration. In some cases, people were made redundant and were then re-employed by the health service at a later date. No one can take satisfaction from that, which is why we are completely revisiting the terms of those contracts. As regards accident and emergency departments, we know that the NHS is under pressure, but there are now more accident and emergency doctors than there were in 2010. The work being done by Sir Bruce Keogh to look at the system across the piece will, we trust, address a number of the pressures that the NHS is now experiencing.

Health: Secondary Care

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 26th June 2014 Lords Chamber

[Baroness Masham of Ilton]

To ask Her Majesty’s Government what steps they will take to help to remove barriers to access to secondary care for symptomatic patients so they are identified and can start treatment earlier.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, GPs act as the gateway to and co-ordinator of patient care. GPs hold patients’ medical records and understand their health history. The GP will be able to work with patients and their carers to make an informed decision about whether a specialist referral is necessary, and to recommend appropriate hospitals or clinics. Early diagnosis can improve outcomes and treatment. We are therefore raising awareness of key symptoms and supporting GPs to assess patients more effectively.

[Baroness Masham of Ilton (CB)]

My Lords, I thank the Minister for his reply. Is he aware that some GPs are being penalised by CCGs for sending patients on for diagnosis? Is that not totally wrong and does it not cause late diagnosis, which is always more expensive in every way?

[Earl Howe]

My Lords, I agree with the noble Baroness that early diagnosis is vital for just about every condition one can think of, particularly cancer. I am not aware that GPs are being penalised. I am very concerned to hear that, and if I may I will take the point she has made back with me and write to her about it. I would be very concerned if that practice was taking place. Particularly on cancer, we are keen to see GPs referring more. Indeed, that is what they have been doing, quite markedly, over the past four years: there was a 51% increase in cancer referrals over that period.

National Health Service: Nursing Staff

Debate between Earl Howe and Baroness Masham of Ilton

Monday 16th June 2014 Lords Chamber

[Earl Howe]

The noble Lord is right. The Government recognise the very important contribution that community nurses make in providing high-quality care to people within community settings. I think we have seen a reaction, as I have said, to the Francis report. Lots of hospitals say that they are going to employ more nurses on the wards. We now need to ensure that staffing levels are safe across the NHS and the community, and the Chief Nursing Officer has set up a working group which is looking specifically at what we can do to increase the number of community nurses, which we certainly need to do.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that specialist nurses are not being replaced when they retire and that there is great concern about this as they do such valuable work for many specialties?

[Earl Howe]

I acknowledge the valuable role played by specialist nurses in a number of disciplines but, once again, it is up to employers to exercise their responsibility to manage turnover, retention, recruitment and skill mix to ensure that they have sufficient workforce supply to meet the levels of staffing that the hospital or organisation needs. Here again, patient safety is paramount.

Healthcare Professions: Regulation

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 10th June 2014 Lords Chamber

[Earl Howe]

I recognise the importance of the issue that the noble Lord has raised. Some of those issues are extremely troubling. However, I do not have an up-to-date position on the policy position that the Government are taking but I will write to the noble Lord about that.

[Baroness Masham of Ilton (CB)]

My Lords, is the Minister aware that clinical physiologists desperately need full registration? They have had voluntary registration for some years and they say it does not work.

[Earl Howe]

Yes, my Lords, I am aware of the request by the physiologists, and I will write to the noble Baroness on the up-to-date position.

NHS: Bed Capacity

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 20th March 2014 Lords Chamber

[Earl Howe]

My noble friend is quite right. As she knows, there are far too many frail elderly people who end up in hospital in the first place. We must get better at the discharge arrangements for them and not keep them in hospital too long. This is the focus of much of the work going on in the department and NHS England at present concerning vulnerable older people. We will announce a comprehensive plan around this later in the year.

[Baroness Masham of Ilton (CB)]

My Lords, apart from distressing patients, is not moving them around bad for infection control, particularly if the beds are not properly cleaned?

[Earl Howe]

Yes, my Lords. As ever, the noble Baroness makes an extremely good point. It is heartening that infection rates have come dramatically down in hospitals over the past few years, but we can never be complacent and it is important that when a patient is moved the infection question is always considered.

Health: Local Healthwatch Funding

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 19th March 2014 Lords Chamber

[Earl Howe]

I simply say to the noble Baroness that it is too soon to say whether local Healthwatch has been starved of cash. What matters most to local communities is the difference that their local Healthwatch is making, such as rooting out poor practice, ensuring that the views of local communities are heard in inspections and helping to improve local services. It is only after a period of time that we can make the relevant judgments. I can tell the noble Baroness that Healthwatch England is playing the role that it was designed to do: overseeing and supporting local Healthwatch where necessary.

[Baroness Masham of Ilton (CB)]

My Lords, does not the Minister agree that this is an example of where money should be ring-fenced? The people who work for Healthwatch are volunteers. They should not be out of pocket and they need their expenses for travel.

[Earl Howe]

I agree with the noble Baroness that, in the normal course of events, expenses should be reimbursed, but I say again that it is not the role of Ministers to second-guess the judgments of local authorities. We believe in local autonomy. There are plenty of other ways in which many local authorities are supporting voluntary groups in their areas apart from Healthwatch, and making a difference in that way.

NHS: NICE-appraised Medicines

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 27th February 2014 Lords Chamber

[Earl Howe]

My Lords, drugs which have not yet been assessed or approved by NICE are eligible for use under the Cancer Drugs Fund. I am pleased to say that the Government have made a total of £1 billion available under that fund and 44,000 patients have been treated under it. I appreciate the noble Lord bringing that particular drug to my attention and I undertake to look at it.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister realise the frustration that some clinicians have when there is a drug that gives a better quality of life to patients but they cannot give it to them?

[Earl Howe]

My Lords, if a drug is licensed in this country, it is open to a clinician to prescribe it as long as their clinical commissioning group will fund it. There are local funding policies for drugs. I understand the noble Baroness’s point, but when a drug is assessed by NICE, it can be assessed for quality-of-life properties—that element will have been included in the assessment. Indeed, that is the reason why we have the process that NICE goes through.

Health: Meningitis B Vaccine

Debate between Earl Howe and Baroness Masham of Ilton

Monday 24th February 2014 Lords Chamber

[Earl Howe]

The noble Lord makes a series of very important points. I know he will understand that it would be wrong for me to be drawn into going into too much detail on the clinical and cost-effectiveness of this vaccine because that is the job we have given to the JCVI.

[Baroness Masham of Ilton (CB)]

My Lords, how do we compare with other European countries in giving children this vaccine?

[Earl Howe]

Our childhood immunisation programme generally bears comparison with any country in the world and is very extensive and very successful. However, the incidence and prevalence of meningitis B is higher than in many other countries, which is why there is such concern about it.

NHS: Cancer Treatment

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 29th January 2014 Lords Chamber

[Earl Howe]

My Lords, the Government invested £23 million aimed at increasing the capacity of radiotherapy centres in England to deliver intensity-modulated radiotherapy. The latest analysis shows that the median average of IMRT activity in England is at 29%, with the vast majority of centres delivering at 24% or above. That 24% was the magic figure recommended a few years ago by the national radiotherapy implementation group. We continue to monitor progress and local action plans closely.

[Baroness Masham of Ilton (CB)]

My Lords, I declare an interest as vice-chair of the all-party cancer group. Does the Minister agree that many older people develop cancer and, therefore, to stop treatment would ensure that many Members of your Lordships’ House would not get treatment? Will he therefore take this really very seriously?

[Earl Howe]

My Lords, I am with the noble Baroness all the way in wishing to see your Lordships live a healthy and long life but, as regards the population generally, I hope that I have made clear the Government’s determination to see that all citizens of this country receive treatment according to their ability to benefit from it.

Children and Families Bill

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 29th January 2014 Lords Chamber

[Earl Howe]

I have noted the way the noble Lord’s amendment has been drafted. However, we need to be very careful before accepting it, for the reasons that I am explaining now. One of the points made about enforcement was that we could make a useful comparison with seat-belt legislation. I understand why that comparison has been made but it needs to be borne in mind that we are not comparing like with like. Seat-belt legislation is a road safety measure which is properly enforced by the police; smoking in cars is a public health matter and the police have no public health role or functions. That is part of the reason that the issue is so complex. Before launching into the kind of amendment that the noble Lord, Lord Hunt, invites us to accept, we need to take stock of these questions. There is no point in putting something on the statute book if it is impractical to implement.

[Baroness Masham of Ilton]

Can I just ask the noble Earl whether the police have a duty in respect of alcohol abuse and violence in the streets?

[Earl Howe]

My Lords, the police obviously have public order responsibilities, which they can enforce—but not public health responsibilities, which is rather a different issue.

NHS: Walk-in Centres

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 10th December 2013 Lords Chamber

[Earl Howe]

The noble Baroness makes an extremely good point. One of the findings of the Monitor review was that, when responsibility for walk-in centres was handed down to local commissioners in 2007, many of them were decommissioned because they were duplicating services locally and GPs felt that they were paying twice for the same thing. I am sure that the ideas the noble Baroness has put forward will have a resonance in many areas.

[Baroness Masham of Ilton (CB)]

My Lords, is it true that doctors are being paid not to send patients to hospital? Does the Minister agree that when patients are ill they have no alternative but to go to A&E departments?

[Earl Howe]

I agree with the noble Baroness that A&E often presents the easiest and most convenient route into the NHS. That is why Sir Bruce Keogh is currently conducting his system-wide review and looking at pressures on the system. I am not aware of any doctors who are being paid not to refer patients to hospital. Indeed, as the noble Baroness may be aware, the BMA has been steadfast in its opposition to any such scheme.

NHS: Clinical Commissioning Groups

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 27th November 2013 Lords Chamber

[Earl Howe]

My Lords, age is and has always been, in the formula, the primary driver of an individual’s need for health services. The very young and elderly, whose populations are not evenly distributed throughout the country, tend to make more use of health services than the rest of the population. Having said that, the formula contains elements relating to unavoidable differences in the costs of providing services due to location alone—that is, the market forces factor—and a number of other measures of adjustment. As I say, we are assured by NHS England that deprivation will feature in the formula that is published for next year.

[Baroness Masham of Ilton (CB)]

My Lords, is the noble Earl aware that in Yorkshire, many of the hospitals which are PFI are very seriously in debt? Is there not a rumour that the poorer north will have its money taken to the richer south?

Health: Tuberculosis

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 21st November 2013 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and declare an interest as a member of the All-Party Group on Tuberculosis.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

Public Health England has made TB one of its main priorities, and is leading a coalition of key stakeholders to inform its development of a strategy for tuberculosis. This aims to bring together best practice in clinical care, social support and public health to strengthen TB control, leading to a year on year decrease in incidence and a reduction in health inequalities associated with TB. The strategy will be published by March 2014.

[Baroness Masham of Ilton]

My Lords, I thank the noble Earl for his Answer, but is he aware that London is now known as the TB capital of Europe? It has some good facilities for prevention and treatment, but are those the same throughout the country? That is why the strategy is so important. There is plenty of tuberculosis—and drug-resistant tuberculosis, which is the big concern—in Birmingham, Bradford, Leicester and many other cities. Will he ensure that the strategy is pushed out as soon as possible? That is vital.

[Earl Howe]

The noble Baroness is absolutely right about the seriousness of the position, especially in some of our big cities. I can tell her that a TB control board has been set up in London, where about 40% of TB cases occur in the UK. The board is developing a dedicated London TB plan to strengthen measures to prevent, diagnose and treat TB in London. There are similar initiatives in Manchester and Birmingham. However, she is also right to say that we need to focus on the rest of the country, not least some rural areas, and the strategy there will be different to identify cases, diagnose them quickly and intervene early. Work is going on to roll out the plans for that.

NHS: Mid Staffordshire NHS Foundation Trust

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 19th November 2013 Lords Chamber

[Earl Howe]

My Lords, the trust board at Mid Staffs was ultimately responsible, and individuals on it have been replaced. That was the first step in holding the system to account. We are introducing strengthened accountability for the future, including a fit and proper persons test for directors, as well as a single-failure regime triggered by failures in care. We have also appointed a Chief Inspector of Hospitals with power to ensure that the system acts quickly to tackle unacceptable care. In a range of ways I hope that we have addressed the central point in my noble friend’s question, which is very well placed.

[Baroness Masham of Ilton (CB)]

My Lords, I am pleased to hear about the transparency and the duty of candour, but will the noble Earl give the House an assurance that patients will be listened to? I am thinking about the young man who implored staff for a drink, and even telephoned the police on his mobile, but was ignored by staff. This was not Mid Staffordshire but a London teaching hospital. Further, will staff be protected when they blow the whistle? Will the noble Earl give an assurance that they will not lose their jobs?

[Earl Howe]

My Lords, I completely agree with the noble Baroness that the voice of the patient is an essential part of maintaining a culture of safety in the NHS. Improving the way in which the NHS manages and responds to complaints will be critical in shaping a culture that listens to patients and learns from them and ending a culture of defensiveness or, at worst, a culture of denial about poor care. That is why we welcome and accept the spirit of the review of the NHS hospital complaints system by Ann Clwyd MP and Professor Tricia Hart and the principles behind their recommendations.

On whistleblowers, the amendments to the NHS constitution have enhanced the protection for whistleblowers, but we are not complacent and we are already considering whether there is a need for more developments both to protect whistleblowers and to ensure that action is taken, where necessary, in response to concerns. We are looking, with the national regulators, at how whistleblowing concerns are dealt with at the moment and, where appropriate, we will introduce improvements to systems in the future.

NHS: Clinical Commissioning Groups’ Funding of Treatment

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 12th November 2013 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, if patients are turned down by CCGs, can they appeal to NHS England?

[Earl Howe]

They can appeal to the clinical commissioning group itself in the first instance under what is known as an individual funding request. That request has to be considered rationally and transparently. If the request is turned down, the reasons must be published.

Female Genital Mutilation

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 7th November 2013 Lords Chamber

[Earl Howe]

I completely agree with the noble Lord. It is clear that we need to make a step change in the landscape here. We have continued to prioritise FGM, both at home and overseas. The intercollegiate report, however, published this week, adds a very welcome dimension to the work we are doing. It was written by health professionals and FGM experts for health professionals, and the Government will naturally study the report very carefully and consider the recommendations as part of the cross-government programme of work to tackle and eradicate this awful practice.

[Baroness Masham of Ilton (CB)]

My Lords, is the noble Earl aware that I took through your Lordships’ House the Prohibition of Female Circumcision Act 1985? Is he aware that I, too, am most frustrated by the lack of prosecutions? Why has France convicted people with this horrific condition and not us?

[Earl Howe]

My Lords, I am aware of that. I was a new Member of the House when that Act went through, and I commend the noble Baroness for the work she did on that issue. She mentioned France. One of the features of the French system is the physical examination of all girls under the age of five. We will not be following that path. We do not think it would be right to do so. We think it raises ethical and human rights concerns. However, all children are routinely seen by healthcare staff in the universal healthy child programme that covers England, and prevention and safeguarding absolutely underpin that programme. It is an important channel for conversations to be held with parents and children, so that they can be provided with relevant support and advice.

Health: Local Healthwatch Organisations

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 5th November 2013 Lords Chamber

[Earl Howe]

I am grateful to the noble Baroness. She is certainly right that some local Healthwatches have got off to more of a flying start than others. I am aware of many that are working closely with their local clinical commissioning groups and indeed with provider trusts. However, others need encouragement and support, and we have created Healthwatch England to provide exactly that kind of support. That is the route for the Healthwatches which find themselves in some uncertainty about their role.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that Healthwatch members working in rural counties have extra travelling expenses and will these be considered? Healthwatch members should not be out of pocket.

[Earl Howe]

I am very much in sympathy with that thought. However, it is up to the local Healthwatch organisation to organise its funding as it sees fit and in the most cost-effective way possible. I would not want to dictate to them what they should do but, clearly, for a Healthwatch to work effectively, one has to have volunteers who are ready and willing to do the work, which might involve the need to reimburse them for some expenses.

NHS: London

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 30th October 2013 Lords Chamber

[Earl Howe]

I can certainly find out the answer to that last question. As regards the appeal, we have only just received the judgment, as the noble Lord will know. But that is only the outline judgment. We have not received the full text. It is important that we read that and inwardly digest it before we finally decide on the way forward. The lessons of Lewisham are very clear. I confirm that we shall not be legislating around Lewisham and the recent provisions in the Care Bill were not retrospective, as the noble Lord is aware. I have not personally visited Lewisham, which is clearly an omission that I should at some point rectify, but it is important for me to put on the record that the concerns expressed by the people of Lewisham are, and have always been, entirely understandable. Ministers greatly respect the wish of local residents to see their hospital thriving, as it always has in the past. Nevertheless, as I said earlier, Lewisham and Greenwich now have a challenge. There is a financial issue that needs to be addressed and I hope that commissioners and providers, acting together, can do that successfully over the months ahead.

[Baroness Masham of Ilton (CB)]

My Lords, can the Minister say whether, if A&E departments are shut, hospitals will be downgraded? Will the resources of the ambulance service be increased to transport ill patients around, as the ones with A&E departments may not have enough capacity to treat them?

[Earl Howe]

I do not think that it is appropriate to talk about downgrading in this case. However, it is appropriate to talk about changing the way in which services are delivered to the local population. In the case of two hospitals, we are seeing fully fledged A&E departments becoming 24/7 urgent care centres. That means that the most serious A&E cases, such as trauma and cardiovascular emergencies, will be taken to centres of excellence where patients will have a much higher chance of survival. That is a pattern that we are seeing throughout the NHS and one that has been proved to be successful and in the interests of patients. On ambulances services, we are already seeing in London, for example with stroke care, ambulances taking patients to centres of excellence for stroke care. Eight of these centres now exist compared to 32 some years ago. That means longer journeys in an ambulance but also much higher survival rates for the patients. I do not think that we should look on the kind of reconfiguration that I have described in a negative way. On the contrary, the whole thrust of these proposals is to improve the quality of care for patients.

Care Bill [HL]

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 29th October 2013 Lords Chamber

[Earl Howe]

My Lords, I will begin by making absolutely clear that we agree that all prisons and approved premises should have arrangements for safeguarding the adults in their care. They should have a comprehensive policy that is understood by all staff and which ensures that vulnerable adults are identified and given appropriate support. I hope that we also agree that we cannot relieve prisons and probation providers of their duty of care by imposing a duty on a local authority to make safeguarding inquiries into suspected abuse or neglect in a prison or approved premises.

We need clear guidance for prisons, probation providers and local authorities to ensure that the procedures within prisons and approved premises are informed by best practice and local expertise. My officials will work with the Ministry of Justice and the National Offender Management Service, together with the Association of Directors of Adult Social Services and other stakeholders, such as the Prison Reform Trust, to develop instructions and guidance for prisons, probation providers and their local authorities. Those instructions and guidance will be in place by the time the Bill is implemented and will give improved clarity about the Prison Service and probation providers’ roles and responsibilities in safeguarding adults in their care, including the need to have a whole-institution approach to safeguarding, and cover their relationship with the local safeguarding adults board.

The Ministry of Justice encourages prison and probation staff to be involved with local safeguarding adults boards. The guidance on how safeguarding should be carried out in conjunction with local authority partners can draw attention to the duty in Clause 6 that local authorities and their partners must co-operate in the exercise of their respective functions relating to adults with needs for care and support. The guidance will be consistent with the broader advice and guidance on safeguarding adults in the community to ensure that good practice on safeguarding policies and inquiries is routinely shared.

In addition, the guidance will set out clearly the need for locally agreed relationships with local safeguarding boards, including clear local protocols around the circumstances for involvement of local SABs. The guidance will also make clear how prison and probation staff can benefit from the expertise of social services and local authority safeguarding teams.

For approved premises, the probation provider has a clear responsibility in relation to safeguarding but there is nothing to prevent it seeking advice from either the safeguarding adults board or the local authority safeguarding team. This already happens in many areas. Since a local authority’s duties in relation to safeguarding would not extend to safeguarding adults who are at risk of abuse or neglect by reason of their detention or their offence, a joint approach would be much more effective where there is a particularly difficult safeguarding challenge in an approved premises.

Her Majesty’s Inspectorates of Prisons and Probation and the Prisons and Probation Ombudsman will take account of the guidance and local agreements and make recommendations for improved practice, if relevant, when inspecting services and investigating complaints within the prison and probation services.

I wish to be clear in answering the noble Lord, Lord Patel of Bradford, who said that the document No Secrets said that local authorities have responsibility for safeguarding in approved premises. Local authorities do not have a statutory duty at the moment. It is the duty to conduct inquiries that will not apply—not that local authorities cannot conduct an inquiry if invited to by the probation trust or provider. Guidance and probation instructions will provide further detail on how local authorities and probation trusts, as they currently are, can work together at a local level. The guidance will go to all probation providers who run approved premises. Probation services will be contracted out in due course, so these will be approved premises provided by the probation service and by voluntary or private providers. The guidance will make it clear that the provider running the accommodation has a duty of care and a safeguarding responsibility.

I hope that, with those assurances and clarifications, the noble Lord will feel able to withdraw his amendment.

[Baroness Masham of Ilton (CB)]

My Lords, how will the Government ensure that the guidance is carried out? Would a report not be useful?

[Earl Howe]

My Lords, the Ministry of Justice will want to ensure that the guidance is adhered to and the department will have oversight of the way that this works in practice, as the noble Baroness might expect. As I say, there is best practice already out there; we want to build on what we know works, with joint working across the prison and probation services and local authorities.

Care Bill [HL]

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 16th October 2013 Lords Chamber

[Baroness Masham of Ilton]

My Lords, what will happen to the protection of the public from those who have schizophrenia?

[Earl Howe]

My Lords, the protection of the public is of great importance, as I need hardly say; but we are dealing here with quite a narrow point of definition about who should be entitled to free mental health aftercare. To expand the scope of that definition to include others would not be fair on many people, which is why I have argued that I believe we have positioned the definition in the right way. The noble Baroness’s question is a very relevant one in the broader context of how we look after those with mental illness, but I would like to think that this amendment should not affect her concern one way or another.

Care Bill [HL]

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 16th October 2013 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I hope that the Minister will take note of the very serious points which the noble Lord, Lord Patel of Bradford, has made to your Lordships tonight.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, these two amendments deal with changes to Clause 72 to impose a duty on local authorities to make safeguarding inquiries in prisons and approved premises. I thank the noble Lord, Lord Patel, for tabling these amendments. We strongly agree that a person with care and support needs should be protected against abuse or neglect wherever they live.

Prison governors and directors, and the probation trust in the case of approved premises, are responsible for safeguarding prisoners and for protecting them from abuse and neglect. They have in place procedures to follow in response to allegations of abuse or neglect, and they must provide assurance on this to the National Offender Management Service. The UK operates a comprehensive level of monitoring and scrutiny within prisons to ensure that prisoners are kept safe and secure and that governors and directors are accountable for taking steps to improve matters if necessary.

We have in place a fully independent prison inspectorate that carries out a rigorous programme of scrutiny; more than 1,700 volunteers on prison independent monitoring boards who monitor the treatment of adult prisoners; and a Prisons and Probation Ombudsman who investigates both the complaints of those in prison and all deaths that occur among prisoners. Her Majesty’s Chief Inspector of Prisons and the Prison and Probation Ombudsman require assurance that safeguarding procedures are in place and their implementation provides equivalent protection to that available in the community. Investigations by the Ombudsman will provide learning to improve effectiveness. The important thing is not to impose a duty on another body to conduct inquiries in prisons and approved premises, but to ensure that the procedures within the prisons and approved premises are informed by best practice and local expertise.

The Ministry of Justice and the National Offender Management Service have acknowledged that there is a need for improved directions on safeguarding to the Prison Service and probation trusts. They will be working with officials from my department and stakeholders to develop instructions and guidance that will give improved clarity about the roles and responsibilities of the Prison Service and probation trusts in safeguarding adults in their care. The Ministry of Justice encourages prison staff to be involved with local safeguarding adults boards, but the nature of that involvement is best determined at local level.

The Ministry of Justice and the National Offender Management Service will be producing guidance for prison staff on safeguarding in conjunction with their partners. This will be consistent with the broader advice and guidance on safeguarding adults in the community and will ensure that the importance of active engagements with SABs is routinely reiterated to prison staff. Any particular safeguarding considerations for older prisoners and those with dementia will be part of this operational policy. The guidance will set out clear instructions on the need for structured relationships with local safeguarding boards; for example, the model being employed by Surrey, where a memorandum of understanding sets out how prison staff will benefit from the expertise of social services and local authority safeguarding teams. It will also set out how and in what instances referrals to SABs will be made.

I hope that I have reassured the noble Lord, Lord Patel of Bradford, that the existing position makes clear the responsibility and accountability for the safeguarding and protection of prisoners, and that further guidance to prisons and approved premises will bring about the improvement and joint working that we all want to see. The proposed amendments to Clause 72 are therefore not necessary and I would respectfully ask him to withdraw this amendment.

--- Later in debate ---

[Earl Howe]

My Lords, this amendment concerns the new statutory duty of candour. This will place a requirement on registered providers of health and adult social care to be open with patients and service users about failings in care. The Francis report made a clear recommendation that there should be a statutory obligation to observe a duty of candour on providers of healthcare who believe that treatment or care provided by them to a patient has caused death or serious injury. This would require the provider to inform the patient of that fact. This amendment is a major step towards implementing that key recommendation of the Francis report.

The Government’s approach is to introduce this duty as a requirement for registration with the CQC. In Committee, noble Lords tabled amendments that sought to place the duty of candour in the Bill. The amendment that I am presenting today seeks to strike a balance; I make no apology for that, since it allows us to have the best of both worlds. The amendment tabled in my name makes it clear that the Government must introduce such a regulation. It does not present the Government with a choice; rather, it imposes a crystal clear obligation on the Government to put such a regulation in place. I hope that it will be welcome to noble Lords for those reasons. I beg to move.

[Baroness Masham of Ilton (CB)]

My Lords, the duty of candour means honesty and straightforwardness. We desperately need an open, honest, transparent and compassionate health service, and I hope that Amendments 140 and 152 will help to achieve that.

Something has gone desperately wrong with the care in some hospitals and care homes. We now live in a litigious society, and I feel that that has been increased by cover-ups when something has gone wrong and gagging people who try to speak out. People will go to any lengths to find out what happened to their loved ones if they are not told and given an apology. Good medical personnel will explain and apologise if something adverse happens. So often, that is all that is needed.

Patients know that there are risks, if they are explained when they sign a consent form. When they go wrong, lessons should be learnt so that they do not happen again. That is one of the reasons why openness is so important. Have lessons been learnt after the horrific situation of the Mid Staffordshire hospital? Recently I heard of a former police superintendent who had had a brain injury due to an accident, and was a patient in a well known central London hospital. When his wife and young son went to visit him, they smelt him before they saw him. They found him facing the wall in bed, unable to move and lying in soiled sheets and wearing a filthy gown. His wife was so upset that she told a nurse, who just said that they were overworked. The next time the wife visited she found him sitting alone, facing a curtain, looking miserable and wearing a pad that had not been changed. She said to her children, “We are taking Daddy home”, and smuggled him out of the hospital.

Care Bill [HL]

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 9th October 2013 Lords Chamber

[Earl Howe]

I apologise to my noble friend. I cannot give her a precise answer, but I shall endeavour to do so as soon as possible. I do not think that the guidance will be available before the Bill leaves this House.

[Baroness Masham of Ilton]

Would Amendment 28 be more acceptable if “may consider” were replaced by “shall consider”? There is a big difference between “may” and “shall.”

[Earl Howe]

My Lords, Amendment 28 is in my name and therefore I consider it to be well shaped and well drafted. I am not about to suggest improvements on the hoof, but I shall take the noble Baroness’s suggestion away with me.

Care Bill [HL]

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 9th October 2013 Lords Chamber

[Earl Howe]

At least we have given them more notice this year than they have had in previous years. Quite often, winter pressure money has been released into the system only around Christmas. We have consciously tried to do it several months earlier. While I acknowledge the truth of what the noble Lord said in certain areas of the country, I hope and believe that by the time the pressure becomes significant, those crucial decisions will have been made.

[Baroness Masham of Ilton]

As the Minister has brought this matter up, I shall ask about the hospitals that got the money. York and Leeds got extra money, but Hull did not. Hull is one of the most deprived and difficult areas in the country. Will he look into it and let me know?

[Earl Howe]

I will happily look into it, because I do not have with me the complete list of trusts and the factors that lay behind the decision that was taken by NHS England. I will certainly write to the noble Baroness about that.

Delivering joined-up, person-centred and co-ordinated care in a way that stops patients falling through the gaps in the system is of key importance to improving their outcomes and experiences. I believe it is incontrovertible that local authorities and relevant partners must co-operate in order to ensure safe and timely transfers of care. Indeed, the Bill already requires that. Clause 6 requires that local authorities and relevant partners co-operate with one another where this is relevant to care and support. Subsection (5) of the clause sets out some key examples of when this duty should be used. There can be no question that this duty would apply also to ensuring safe and timely discharges, and we do not see the need to add further detail to such broadly worded provisions. New guidance on discharge planning and on how local authorities should perform co-operation duties under Clauses 6 and 7 will be issued following the passage of the Bill.

Further, Schedule 3 to the Bill sets out a process around ensuring the safe and timely discharge of acute hospital patients. This not only requires the local authority, following notification from the responsible NHS body, to assess a patient who it appears may have a need for care and support before they are discharged but requires the authority to have the necessary care and support package in place before discharge takes place. The duties to co-operate apply to that process as well. In fact, to come back to the point that the noble Lord, Lord Warner, raised about guidance, the current discharge guidance, Ready to Go, makes it clear that discharge planning should start before or on a patient’s admission to hospital. We know that that does not always happen, but it is best practice, and has been best practice for some considerable time.

Amendment 125 would allow the Government to specify what the authority and its partners must have regard to when performing that assessment. Surely this is right. I reassure the noble Baroness that, as the assessment required to be carried out by this schedule is the same as the one in Clause 9, we already have this power in Clause 12(1)(b) of the Bill, which allows for regulations to,

“specify other matters to which the local authority must have regard in carrying out the assessment”,

and in Clause 12(6) which allows for an assessment to be carried out jointly.

I hope that I have reassured the noble Baroness that the Bill already requires local authorities and “relevant partners” to co-operate in the safe and timely discharge of patients and contains sufficient provisions to make such regulations and to issue guidance on this matter. With those reassurances, I hope the noble Baroness will be able to withdraw her amendment.

NHS: Out-of-Hours Services

Debate between Earl Howe and Baroness Masham of Ilton

Monday 29th July 2013 Lords Chamber

[Earl Howe]

I am sure that I speak for all of us in saying how pleased I am that the service worked so well in the noble Lord’s case. The answer to his broader question is that the service is working well in the vast bulk of the country. Unfortunately, in two particular areas we have seen problems, which are being gripped, and I am confident that NHS England has taken these issues forward with the seriousness that they deserve. I am assured that, even in the areas where problems have arisen, the service is good.

[Baroness Masham of Ilton]

Would it not have been simpler to build on NHS Direct, which would have saved confusion?

[Earl Howe]

The difficulty there was that we were more ambitious than simply wanting a revamped advice service. This is a service that puts a patient directly in touch with a doctor if they need one, a nurse if they need a nurse, or an ambulance if they need an ambulance, without the need for call-back. It is also free of charge, which the old NHS Direct was not.

NHS: Accident and Emergency Services

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

That is very much in the focus of Health Education England, which oversees workforce issues in the health service. There has been a shortage of A&E consultants for some time and Health Education England is looking at that area very carefully. A&E is a discipline that has not traditionally proved attractive to trainee doctors for a number of reasons. It is very stressful and the remuneration is perhaps less than in other areas of medicine. That needs to be addressed and is very much an area of scrutiny.

[Baroness Masham of Ilton]

My Lords, following on from that, is the Minister aware that half as many again emergency doctors are needed? What is he going to do about recruiting?

[Earl Howe]

As I have just said to the noble Baroness, there are no instant fixes to this but we want to ensure that recruitment over the medium term is addressed and Health Education England is doing that.

NHS: Children’s Congenital Heart Services

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 23rd July 2013 Lords Chamber

[Earl Howe]

Yes, my Lords. The point that the noble Lord makes is extremely important. I think that there were a number of people who, for whatever reason when the Safe and Sustainable review was going on, felt left out of the picture. NHS England is clear that that should not happen again and that lessons have to be learnt so that this is a genuinely inclusive process.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that adult and children’s services for congenital heart disease should be located on the same site to ensure continuity of care? When young people reach the age of 16, they seem to be thrown out of children’s service provision.

NHS: Keogh Review

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

I can certainly use my best endeavours through the usual channels with regard to my noble friend’s latter question. On his first point, he is absolutely right. That is what led us to believe that aggregate hospital ratings, provided that they are produced in a sophisticated and careful way, will be very informative to the general public and to patients in a local area, and to professional staff within the health service. The Healthcare Commission, of old, used to produce aggregate ratings. They fell into disuse and, I have to say, into some disrepute, because they were so broad brush as to be meaningless. When we asked the Nuffield Trust to look at this area, it told us very clearly that, as long as we adopted a nuanced and sophisticated approach so that what was assessed was not just a hospital trust or an individual hospital within that trust but rather the performance of individual medical teams and units within a hospital, we would provide useful information to the public. However, that information needs to be accessible.

[Baroness Masham of Ilton]

If the chief inspector, when visiting failing hospitals, finds a lack of senior sisters on the wards and a shortage of doctors working in emergency medicine, what is he going to do about it? Does the Minister realise that there is a serious shortage of emergency medicine doctors?

Public Health England Advisory Board Membership

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 4th July 2013 Lords Chamber

[Earl Howe]

My Lords, across the field of health it is difficult for me to give a generic answer, but the NHS Leadership Academy, which is now starting its work, will ensure that women with promise for leadership will be encouraged to come forward in a variety of roles, not just clinical but managerial. I hope that we will see the fruits of that work over the coming months.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that Public Health England is responsible for campaigns for vaccinations, and that as vaccinations deal mostly with children and young people, mothers are involved, so it is essential to have women on the advisory board?

Care Bill [HL]

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 3rd July 2013 Lords Chamber

[Baroness Masham of Ilton]

Before the Minister sits down, I would just like to ask him: does he not really want to get things right? When there were problems at Mid Staffordshire, people were desperately thirsty, drinking out of flower vases, and were lying in their own refuse in their beds. Surely dignity must be written in all over the Bill.

[Earl Howe]

I agree that dignity is a very important concept, which is why we expressly amended the Bill to include that word right at the beginning. Clause 1, which defines the well-being principle, is the foundation for everything that follows. While one could pepper the Bill with references to the word “dignity”, I am not sure that that would add very much in practice.

NHS: Accident and Emergency Units

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 19th June 2013 Lords Chamber

[Earl Howe]

My Lords, Ministers are responsible to Parliament for the provision of the health service so I do not duck that responsibility for a second. Nevertheless, Ministers do not manage the health service day-to-day and have never done so. We are involved day-to-day in the plans to ensure that we have a health service that is properly configured to meet the needs of patients. My right honourable friend the Secretary of State could not be more assiduous in the work that he is doing to make sure that that happens. Responsibilities are not being ducked; nobody is being blamed. The fact is that demand is going up considerably, and has been for a number of years. We need to address that and we need to do it cleverly. It is not always a question of piling more money in; it is looking at how the services are configured and delivering care in the right place.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that drunken and aggressive people are putting great pressure on A&E departments across the country, especially at weekends? Can he do something about it?

[Earl Howe]

The noble Baroness is right. Quite a considerable proportion of people who attend A&E do so at weekends after heavy drinking, and in some areas, that has overloaded the system. I am aware of many hospitals that are working with the local police force and others to keep such people out of hospital if they do not need to go, but to make sure that they do not disrupt the work of an A&E department if they do go.

Health: Midwives

Debate between Earl Howe and Baroness Masham of Ilton

Monday 10th June 2013 Lords Chamber

[Earl Howe]

My Lords, we are working hard on this. Officials from the department have been in discussion with stakeholders, including Independent Midwives UK, on an ongoing basis for at least four years with a view to identifying potential solutions to the issue. Arising in part from these discussions, independent midwives can now obtain affordable indemnity cover for the whole of the maternity care pathway either in the NHS or in the private sector. However, it is acknowledged that this is achievable only if they operate as part of some form of social enterprise or corporate entity. That is the issue that we have to get to grips with between now and October.

[Baroness Masham of Ilton]

My Lords, how independent are these midwives? Are they responsible to themselves?

[Earl Howe]

My Lords, in terms of their practice, they are responsible to themselves and of course to their patients or clients but they are registered with the Nursing and Midwifery Council as professionals.

Abortion

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 6th June 2013 Lords Chamber

[Earl Howe]

I am sure that those issues should be discussed very thoroughly. I agree that young people should be taught about relationships. However, I also believe that access to contraception is very important. Our data show that there has been no decrease in the number of women using contraception, and that more women are turning to extremely effective measures such as long-acting contraception. It is encouraging that the abortion rate for the under-18s is coming down.

[Baroness Masham of Ilton]

My Lords, how many late abortions have there been for babies who may have had a handicap?

[Earl Howe]

The vast majority of abortions are performed at under 13 weeks. The figure was 91% in 2011. There has been a continuing increase in the proportion of abortions that are performed under 10 weeks. Again, that is positive news. I do not have detailed information on the issue which the noble Baroness asked about, but I will write to her.

Care Bill [HL]

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 4th June 2013 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I, too, support having a nurse on the board. It is vital because the nursing workforce is the biggest of all the professions, and training and recruitment is sometimes the problem that has to be faced.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, we begin our Committee proceedings with a series of amendments that take us to the heart of the theme that permeates this Bill. The driving principle of reforming the education and training system is to improve care and outcomes for patients. Excellent health and healthcare require a training system that will deliver a highly skilled workforce, working together with compassion and respect for people.

Noble Lords will remember our debates of last year when, recognising the importance of education and training in the NHS and public health, we inserted into the Health and Social Care Act a clear duty on the Secretary of State to ensure that there is an effective education and training system. This Bill delegates that duty to Health Education England. This means that Health Education England will be clearly accountable to the Secretary of State for ensuring that there is an effective education and training system in place for healthcare workers in England. Health Education England will provide national leadership for workforce planning, the commissioning of education, training and development activity, and the quality assurance of the education and training that is delivered.

The backdrop to all that is the changing face of healthcare provision. The way health services are provided is expected to change significantly over the next few decades, with more care provided in the community and an increased emphasis on public health. This cannot happen unless we equip the workforce with the skills and knowledge to do this. To do it successfully, the local and national infrastructure needs to be in place to plan and commission effectively. That is why the creation of Health Education England and the local education and training boards is so important.

It is vital that the board of Health Education England has the necessary skills and experience to oversee the delivery of its important functions. In recognition of this, the Government have already strengthened the Bill, following pre-legislative scrutiny, to place an explicit requirement, in paragraph 2(1) of Schedule 5, on Health Education England to recruit members with clinical expertise. The specific nature and description of the expertise and specified numbers are to be set out in regulations. That amendment has been well received by stakeholders such as the Royal College of Surgeons. A similar requirement has been placed on local education and training boards to have members with clinical expertise.

The noble Lords, Lord Hunt and Lord Turnberg, have tabled a number of amendments relating to clinical expertise on the board of HEE and the LETBs. I realise that Amendment 1 is a probing amendment. It may be helpful to explain our thinking around the Schedule 5 requirement. This sub-paragraph was added to the Bill following pre-legislative scrutiny to place an explicit requirement on Health Education England to ensure that there is clinical expertise on the Health Education England board. It also responds to responses to the consultation on the Bill, which touched on the importance of Health Education England having access to professional leadership. This will give Parliament and bodies representing the professions the necessary assurance that the Health Education England board has access to the appropriate knowledge and understanding in making decisions that impact on professional education and training. It also provides the basis for a clear duty in the Bill for both the Secretary of State and Health Education England to make appointments of clinical experts, which can be developed subject to regulations. For example, the regulations will specify what we mean by “clinical expertise” and allow greater flexibility to specify any detailed requirements. It will also allow changes to be made to those requirements as Health Education England matures, should circumstances demand it.

Amendments 3 and 4 seek to extend the requirement for members with clinical expertise by expressly requiring Health Education England to include in its board membership a registered nurse and someone with experience in staff groups that are not professionally registered. Similarly, Amendment 2, tabled by the noble Lord, Lord Turnberg, seeks to extend the requirement for members with clinical expertise by expressly requiring Health Education England to include one or more members with expertise in research and one or more members with expertise in medical education and training in the Bill.

It is undoubtedly important for Health Education England to have access to professional expertise, but having said that I need to make clear that the Government do not believe that it is appropriate for the Bill to mandate requirements for certain professions or particular areas of expertise. That is better suited to be set out in secondary legislation, as it may change over time, and Health Education England will need greater flexibility to recruit the expertise it requires and to specify any detailed requirements as circumstances demand.

One of the great strengths of Health Education England over previous arrangements is that it has a remit for all the professions, bringing a strengthened approach to multi-professional education and training. Although medical and nurse training, and an understanding of the importance of research, are extremely important elements of its functions, HEE has a much broader focus. It may be helpful to the Committee to have a sense of how the new organisation intends to do justice to that broad remit.

First, HEE will employ a director of education and quality at board level who is responsible for ensuring a co-ordinated multi-professional approach to education and training. Within the Health Education England special health authority, that post is filled by a doctor, and is supported by a medical director, a director of nursing, and other professional advisers for dentistry, pharmacy, healthcare science and the allied health professions.

Secondly, Health Education England has established professional advisory groups, bringing together employers and national stakeholders, to focus on profession-specific education and training issues covering medicine, dentistry, nursing, pharmacy, healthcare science and the allied health professions. These advisory boards will support HEE and its board in the decisions they make that impact on health professional education and training. It should also be remembered that Health Education England employs many health professionals that support the activities of the LETBs. In these ways it has direct access to a wealth of knowledge and expertise on the planning, commissioning, provision and quality assurance of education and training.

The Government understand the importance of considering the support workforce that is not professionally registered. Health Education England, with the networks of employers working through the LETBs, will provide a wider leadership role in the development of the whole workforce engaged in the delivery of healthcare and public health. This is emphasised in the Government’s mandate for the Health Education England special health authority. In making non-executive appointments to the Health Education England board, the Secretary of State will source the skills and expertise that are required to ensure the Health Education England board can function effectively. The chair and non-executive directors will do likewise in making executive appointments to the board. That approach has worked well for the recruitment of the current HEE special health authority board, which has three members with clinical expertise, including a doctor. I should also mention that two non-executive appointments are still to be completed. In recruiting for those, we are looking for a further clinician with experience of equality and diversity issues, and someone who can bring a strengthened focus on the patient perspective to support the development of education and training.

In the light of what I have said, I hope noble Lords will feel reassured that the Health Education England board is suitably clinically informed, and that they will feel able to withdraw those amendments.

I now turn to Amendment 5. The Bill already requires the consent of the Secretary of State to the appointment of the chief executive of Health Education England. That approach is in line with the appointment of other chief executive officers across the health system and seems proportionate for a body of this size and nature. In addition to approving the appointment of the chief executive, the Secretary of State will appoint the chair and non-executive directors of Health Education England. This approach has worked well for the HEE special health authority, which has a board with a good blend of experience and expertise.

As for the role of Parliament, the Bill makes provision for Health Education England to report to Parliament on an annual basis, with the requirement to publish an annual report setting out its achievements and to publish annual accounts. I am sure the Health Select Committee will rightly continue to take a strong interest in education and training and will have the opportunity to discuss progress with Health Education England whenever necessary. I hope that will reassure the noble Lord on this amendment.

Ensuring that non-departmental public bodies have robust governance and accountability arrangements in place is clearly essential. Schedule 5 to the Bill makes provision for the constitution of Health Education England and deals with the exercise of its functions and its financial and accounting obligations. A number of amendments in this group fall under that broad heading.

Amendment 6, which again I realise is a probing amendment, poses a question about the terms of remuneration of HEE’s employees. In establishing HEE as a non-departmental public body, it is important that it is given the appropriate levels of autonomy and independence to carry out its important education and training functions without day-to-day interference from Ministers or the Department of Health. Yes, it needs to be held accountable for the use of its resources, and the Government are committed to holding it to account in an open and transparent way, but I hope noble Lords would agree that it is important for a body of this nature to have the ability to determine the pay and remuneration rates for the people it recruits and employs, including its executives. That does not mean that it will not be subject to any constraints. I can reassure the Committee that as an arm’s-length body of the Department of Health, HEE will be subject to the rules and controls covering the use of its budget, and to procedures applicable to senior appointments and levels of remuneration. These are the very same rules that apply to other arm’s-length bodies and to all government departments.

The noble Lord, Lord Hunt, asked me whether HEE employees will be engaged on NHS terms and conditions. In fact, HEE employees are currently employed on NHS terms and conditions and there are no plans to change that when HEE becomes an NDPB.

Amendment 7 is another probing amendment. The provision which the noble Lord has questioned is important. It clarifies that Health Education England’s property is not to be regarded as property of, or held on behalf of, the Crown. This is a standard provision that applies to other arm’s-length bodies in the health system. It allows Health Education England to make arrangements for its own property and office needs. It needs to do so to support the staff it employs nationally and across the local education and training boards. It would not be practical for any other body to hold this responsibility. Of course, Health Education England will work with other bodies to look for savings on estates, information technology, human resources and in other areas. It is already doing that as part of the shared services programme which the Department of Health and all its arm’s-length bodies are signed up to.

Part 2 of Schedule 5 imposes a very clear duty on Health Education England to exercise its functions effectively, efficiently and economically. Part 3 of Schedule 5 sets out how the Secretary of State will fund Health Education England and includes restrictions on the use of resources. These are consistent with provisions made for other bodies in the healthcare system such as NHS England.

I make the same point as I did a minute ago—that HEE needs to be held accountable for the use of its resources—but it is right to give it direct responsibility for how it operates and manages its day-to-day business, including the ability to make arrangements for its own property and accommodation. In the light of that, I hope the noble Lord will feel sufficiently reassured to not press his amendment.

NHS: GP Dispensing

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 16th May 2013 Lords Chamber

[Earl Howe]

My noble friend makes a good point. There is a special provision that allows a patient who has serious difficulty in getting to a pharmacy by virtue either of the distance involved or lack of means of communication to receive dispensing services from a doctor. Any patient is eligible to receive these services; they do not have to live in a rural area to do so.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that some pharmacies do not have wheelchair access? Some have steps, including the one in my own village. However, surely it is the easiest place for a disabled person to receive their prescriptions.

[Earl Howe]

My Lords, the rules as they stand do not present a major obstacle for disabled patients. Many pharmacies, for example, offer a free prescription collection and delivery service if a patient encounters difficulty in getting into the pharmacy premises. Under that arrangement, the pharmacy collects the prescription from the surgery on behalf of the patient, dispenses it and delivers it to the patient. Patients can contact their local pharmacies to see whether they offer that service.

Emergency Services: Paramedics

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 15th May 2013 Lords Chamber

[Earl Howe]

The noble Lord is quite right that certain areas of the country have seen unacceptable delays in ambulance response times—I am aware of two trusts in that regard. However, this is not an issue around a lack of trained paramedics. Projections by the Centre for Workforce Intelligence show that there is a secure supply of paramedics until 2016. The College of Paramedics has stated that training posts on courses are always filled and, currently, 900 ambulance technicians are training to become paramedics. We are seeing an increase in paramedic numbers, which is encouraging.

[Baroness Masham of Ilton]

My Lords, does the noble Earl agree that first aid ought to be taught in all schools mandatorily, so that as many people as possible in the community can learn first aid, help when there is an emergency and save lives?

[Earl Howe]

I agree with the general thesis that the noble Baroness has advanced. As many people as possible should know first aid. That is how we will ensure that we can save more lives, particularly among those who suffer heart attacks in public places.

NHS: 111 Telephone Service

Debate between Earl Howe and Baroness Masham of Ilton

Monday 13th May 2013 Lords Chamber

[Earl Howe]

My Lords, I hope the noble Lord will understand that I cannot comment on Lewisham because it is sub judice. I do not accept that the advice that Sir Bruce gave was ill founded.

[Baroness Masham of Ilton]

The Minister said that there had been confusion in the past. There is even more confusion now. Does he not agree that there should be some publicity for the general public so that they know where to go?

[Earl Howe]

I agree. NHS England and clinical commissioning groups are engaged in that publicity. I think it will be a while before the general public are fully aware of what NHS 111 has to offer, but I have in my brief a series of very complimentary testimonials about 111 that show that many members of the public are already enjoying its benefits.

NHS: Leeds General Infirmary

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 23rd April 2013 Lords Chamber

[Earl Howe]

My Lords, if the noble Lord can supply me with some examples, of course I will look into them. I remind him that tomorrow we are debating a set of regulations that bear on this very question and I shall have plenty to say on that occasion, which I hope will assuage his concerns.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that it has been really splendid to witness the Members of Parliament from all over Yorkshire supporting their constituents? Will the Government listen to them?

[Earl Howe]

My Lords, I have made clear that it is not for the Government to take a decision on this question. It is for the NHS to decide what the best configuration of services should be, and I think most noble Lords agree with that.

NHS: ECMO Machines

Debate between Earl Howe and Baroness Masham of Ilton

Monday 22nd April 2013 Lords Chamber

[Earl Howe]

My Lords, the department itself no longer has a role in commissioning highly specialised services. NHS England is implementing a single operating model for the commissioning of 143 specialised services. That replaces the previous arrangement whereby 10 regional organisations were responsible for commissioning specialised services and, to be frank, there were wide variations in the standard of those services. The new operating model represents a significant change to the previous system and should result in better outcomes.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that Glenfield Hospital in Leicester, which has ECMO, saved many lives in the swine flu epidemic last year and does more than just hearts?

[Earl Howe]

I am fully aware of that. Glenfield has been leading the development of ECMO services. It is one of the biggest ECMO centres in Europe. It is currently the largest provider of children’s ECMO in the country, treating about 70 paediatric ECMO patients a year, and now provides an adult service.

Mid Staffordshire Foundation Trust Inquiry

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 26th March 2013 Lords Chamber

[Earl Howe]

My noble friend is right to raise this issue, and I pay tribute to the work that she has so consistently done to improve the lot of those with autism. I undertake to write to her about this, but I can give her the general reassurance that the Department of Health will certainly be involved in the scrutiny of these measures, as will the NHS Commissioning Board. I want to ensure that we learn the right lessons from the actions already taken.

[Baroness Masham of Ilton]

My Lords, does the Minister not think that, with the duty of candour, those who make mistakes should take responsibility and be accountable for them? Otherwise people will not learn from those mistakes and they will continue. I also want to ask about the 10 disciplines. I was very surprised that respiratory conditions are not included as nearly all death certificates have pneumonia on them.

[Earl Howe]

I undertake to look at the latter point made by the noble Baroness. The 10 disciplines were selected as ones that could reasonably and readily be subject to the kind of assessment process that we are looking to achieve. I will come back to her on that.

As regards the duty of candour, individuals should certainly take responsibility for their actions and be encouraged to do so. We fear, however, that criminalising individuals’ behaviour within an NHS organisation could risk doing the opposite of what we all want to see: a much more open culture, one that has made the NPSA and its work so successful; a no-blame culture, where people take responsibility for when things go wrong but do not feel that the heavy hand of authority is going to descend upon them at the merest mistake. However, it is important that people are held to account if they are dishonest or deliberately withhold information, and that is a different set of issues.

Health: Cancer Drugs Fund

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 13th March 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Lord raises a very important point because clinical audit of the drugs in the cancer drugs fund and their use will be extremely important in informing the use of these drugs going forward and, indeed, in determining their price under a value-based pricing scheme. As yet we have not heard from the Oxford Cancer Intelligence Unit although I understand that we will receive a preliminary report quite soon. However, as I mentioned earlier, when the current fund comes to an end we will ensure that those patients who are receiving drugs under it will continue to do so.

[Baroness Masham of Ilton]

My Lords, does the Minister agree with me that the cancer drugs fund has been very helpful? Will he find some way of getting more orphan drugs for the very rare cancers, because that is a problem?

[Earl Howe]

The noble Baroness raises another important point about orphan drugs and indeed ultra-orphan drugs as they are termed—drugs which are efficacious and helpful for patients with very rare conditions. It is likely that we will need to put special arrangements in place for the pricing of those drugs. Overall, however, I agree with the noble Baroness that the cancer drugs fund has been immensely helpful. So far, since October 2010, the funding has helped more than 28,000 patients in England to access the cancer drugs that their clinicians recommended, which they would not have done otherwise.

NHS: West London Hospitals

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 28th February 2013 Lords Chamber

[Earl Howe]

No, I do not accept that at all. A reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, develop services that are closer to home and, most importantly, save lives. It is not about saving money.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that the downgrading of anything is very depressing, worst of all for patients when they want upgrading?

[Earl Howe]

My Lords, I think that often when plans are explained to patients, they realise that the word “downgrading” is inappropriate. For example, in north-west London, there has been a lot of unnecessary worry about urgent care centres as substitutes for A&E units. The majority of people who attend A&E can very well be treated in an urgent care centre on the same site, and patients who dial 999 will be taken by ambulance straight to the appropriate hospital. Therefore, I think there is, in some senses, a false debate going on here.

Health: Healthcare Assistance

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 13th February 2013 Lords Chamber

[Earl Howe]

My Lords, the policy on nursing is clear: there is general acceptance that nursing should be a graduate profession. The problem with giving responsibility to the NMC for healthcare assistance is that that is not currently within its remit, and I think it would say that it has enough on its plate to deal with, without that added dimension as well.

[Baroness Masham of Ilton]

My Lords, what does the Minister think of the care assistant who posed as a nurse for four years, working in four different surgeries, before she was found out? She did several hundred vaccinations and cancer smears on patients.

Health: Sugar Consumption

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

My noble friend makes a good point, but in healthy children exercise is very important as a preventive measure for obesity and diabetes. The central point he makes is absolutely right. We look to healthcare workers, not only health visitors but also midwives, through programmes such as the Healthy Child programme and Start for Life, to get families and children off to the right start, so that they eat properly and live healthy lifestyles.

[Baroness Masham of Ilton]

My Lords, does the Minister think sweeteners are a good substitute for sugar or do they have side effects?

[Earl Howe]

My Lords, we are clear that artificial sweeteners are safe if taken as intended. That is the advice of the European Food Safety Authority and we take that advice. However, encouraging people to take low-diet fizzy drinks, for example, in preference to sugary drinks is problematic because all fizzy drinks have an adverse effect on tooth enamel. We need to be balanced in our messages but we think that artificial sweeteners have a role in a proper calorie-controlled diet.

Health: HIV Strategy for England

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 15th January 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness raises an extremely important issue about violence against women. There is a great deal of activity in my department designed to bear down on that and I should be happy to write to her about it. On the issue that she specifically alluded to at the end of her question, we think that, as most HIV is transmissible sexually, it makes much more sense to build that dimension into a sexual health strategy which embraces not only HIV but all transmissible sexual conditions.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that there are many commissioning bodies for various aspects of HIV, such as CCGs, a commissioning board, local authorities, community nurses and voluntary organisations? Does he therefore agree that it is most important to have some strict guidelines and a strategy so that there is not a muddle?

[Earl Howe]

The noble Baroness makes a very good point. I can tell her that the sexual health policy document, which we will be publishing shortly, will set out our plans for improving sexual health generally, as well as our plans for offering support to women facing unwanted pregnancy. It is an important document. It is crucial that we take the time to get it right and make it clear that, as she points out, all the commissioners in the system need to work together with the benefit of advice not only from the commissioning board but from local health and well-being boards at a local level.

NHS: Research and Development

Debate between Earl Howe and Baroness Masham of Ilton

Monday 17th December 2012 Lords Chamber

[Earl Howe]

I share the concern of my noble friend, although he will be pleased, I am sure, to know that through its integrated academic training programme, the NIHR has taken a lead in reversing the decline that we have seen in recent years in clinical academic careers. Around 250 NIHR academic clinical fellowships and 100 NIHR clinical lectureships are now available annually for medics, which is good news. I also think that intercalated degrees play a very important part in developing the next generation of clinical academics, as does the INSPIRE programme from the Academy of Medical Sciences.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that some exciting research is being done, such as that which treated a paralysed dachshund with stem cells and enabled it to walk?

[Earl Howe]

The noble Baroness is absolutely correct. Some exciting research is going on in the field of regenerative medicine and the NIHR has a funding stream to support that.

NHS: Clinical Networks

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 12th December 2012 Lords Chamber

[Earl Howe]

My Lords, yes. National guidance is being produced by the NHS Commissioning Board, setting out the different areas of focus for academic health science networks, health and well-being boards, local education and training bodies and clinical senates. The defined geographies of the 12 network support teams have been developed precisely to gain close alignment and therefore promote close relationships and co-operation with the other structures in the new system—including academic health science networks.

[Baroness Masham of Ilton]

My Lords, how are clinical network members recruited? Are they advertised?

[Earl Howe]

My Lords, in some cases, yes, but we anticipate that many members of existing networks will be transferred across into the new ones.

Care Services: Winterbourne View

Debate between Earl Howe and Baroness Masham of Ilton

Monday 10th December 2012 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Baroness for what she has said. She is right to point out that the patient pathway is integral to any proper planning process for individuals, and that it should be built around the particular individual’s needs and preferences if possible. This brings us back to the role of an assessment and treatment centre: namely, as its name implies, to assess the needs of a person and to define what their care plan should be over a future period of time. As I mentioned, the care plan is best when it is drawn up with the benefit of advice from the individual, their family and their carers. Therefore, if we want more community care, we need to ensure that there is the capacity in the community to deliver good patient pathways to individuals. We are clear that some areas of the country are ill equipped to do that. Part of the task of the joint improvement programme will be to look at the facilities and resources that are required in local areas to enable commissioners to plan those patient pathways with confidence.

On the issue of the training of care assistants, I take the noble Baroness’s point. I think that it is common ground between us that those who lack a recognised qualification should nevertheless be enabled to upskill themselves and get themselves on a register to prove that they are familiar with and abiding by a code of conduct that has been recognised, with the register itself being duly accredited. Our position is that the system of voluntary registration, almost by definition, will result in an upskilling of the workforce, but it is not the whole story. There is a role for employers to ensure that there is proper supervision of care assistants, and that proper delegation takes place that does not require a person to do more than he or she is skilled to do. There is no single answer here, but I believe that voluntary registration is a good start.

[Baroness Masham of Ilton]

My Lords, following from the question about registration and regulation, is the Minister aware that people such as nurses and care assistants who have been sacked for dishonesty or undertaking dangerous procedures with patients can take a job anywhere as a care assistant? Without regulation, how will he control the matter? It is very dangerous for vulnerable patients because these establishments are so hard-pressed to get staff to work in their centres that they will take almost anyone, without even taking up references.

[Earl Howe]

My Lords, the noble Baroness raises another important point. In this country we have a list that acts as a check on those who have abused or otherwise maltreated adults or children and have been dismissed on that basis, to ensure that the scenario that she has painted in which someone who has committed such an offence is re-employed cannot occur in practice. I am not sure that I recognise the situation that she outlined because the POVA system is designed to ensure that dangerous people are not employed to look after the vulnerable. However, I will gladly drop her a line in writing to set out what we propose in this area.

Health: HIV

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 29th November 2012 Lords Chamber

[Earl Howe]

My noble friend is quite right. As he will know, this is National HIV Testing Week. We support the Terrence Higgins Trust and its partners in this important new initiative. The NHS medical director has written to all medical directors about the week and the importance of healthcare professionals being alert to the need to offer HIV testing. As regards self-testing, we agree that the current regulations are not sustainable, which is why we are reviewing our policy on banning the sale of home HIV testing kits. We support repeal but we are required to do a short consultation setting out our reasons. We plan to do that early next year.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that we have some of the best services in the world for HIV/AIDS? Can he give an assurance that, with the changes in the National Health Service now, there will not be a dilution of these services?

[Earl Howe]

My Lords, yes. We believe that the complex needs of people with HIV will be best served by the work being done by the HIV national clinical reference group of the NHS Commissioning Board. The board will commission these services in the future, and that will drive greater consistency and quality throughout the system.

Health: Cancer

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 7th November 2012 Lords Chamber

[Earl Howe]

We will certainly be monitoring the outcomes in the field of cancer, but I would just like to impress upon the noble Lord that the creation of the clinical support teams—the network support teams—will ensure that the whole service is more efficiently delivered. By having 12 support teams there to underpin all the networks, we will ensure that we have a more cost-effective system.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that our cancer outcomes are not as good as those in some other countries in Europe? What is the reason for that? Does he agree that it would be a very retrograde step if the cancer networks lost expertise which we badly need?

[Earl Howe]

I agree with the noble Baroness, and it is part of the reason why we felt that the recent health service reforms to align clinical decision-making with financial decision-making were so important. The reason why this country lags behind has been clearly set out in a number of documents and, broadly speaking, it is because patients do not present early enough with their symptoms and doctors do not refer early enough to specialist consultants for treatment. There is a lot of work to do there, and I am sure that the noble Baroness will be reassured to know that there will be no let-up in that area.

NHS: Accident and Emergency Services

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 23rd October 2012 Lords Chamber

[Earl Howe]

My Lords, I apologise. The Question on the Order Paper relates to north-west London, so I do not have pan-London figures in front of me. The answer to the question is as I gave it in my initial response: those decisions are subject to local determination. That is right, because it is only local commissioners and providers who can assess the situation on the ground properly. As the noble Baroness will be aware, there is a system for escalating decisions—ultimately to the Secretary of State, if necessary, who takes advice from the Independent Reconfiguration Panel in the most extreme cases—but normally, we hope and expect those decisions to be resolved on the ground in the local area.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that many patients have difficulties accessing their GPs and out-of-hours services? Does he realise that the only resource might be the A and E department? In a case of meningitis, that could be a death sentence if they cannot get that access.

[Earl Howe]

My Lords, I agree with the noble Baroness. That is exactly why the Government are planning to roll out the 111 service, which will run alongside the 999 service for emergency calls. But where the situation falls short of an emergency, the 111 service will instantly direct the patient to exactly the right service, without a call back being necessary. I am pleased to say that that programme is on track and should be rolled out next year.

Care Services: Elderly People

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 17th October 2012 Lords Chamber

[Earl Howe]

Yes, I firmly agree with that. It bears upon the point that I alluded to very briefly, which is that the risk assessment process should not just be a tick-box exercise. It should assess the suitability of the individual and their own characteristics, the environment in which they will be working, the kind of people for whom they will be working and whether they have the right skills and characteristics as the people required to do that job.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that it is not only the elderly who are vulnerable but also some very disabled people, including some with learning disabilities?

[Earl Howe]

Yes, like the CQC, we are very clear that when providers are assessed for the recruitment processes that they undertake in relation to those groups of patients and service users, no corners whatever should be cut in the requirements for vetting those people.

NHS: Walk-in Centres

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

My Lords, the Government’s clear policy is that people should be able to rely on high-quality, 24/7 urgent and emergency care that is right for them, when they need it. That is our starting point.

I say to the noble Lord that since walk-in centres were invented the array of services available to patients has been considerably enhanced. It is not just a case of going to an A and E department as an alternative. There are now many GP health centres, minor injuries units, urgent care centres and, in the extreme case, ambulance services, so I do not necessarily accept the premise of the noble Lord’s question.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that I have a colleague who went to the Victoria walk-in centre and found it closed? She went, in the end, to St Thomas’s. The whole procedure took her four hours. She had a urinary infection. Many of the people who go to these centres are working people who come up to cities and are away from their home environment.

[Earl Howe]

My Lords, I am sorry to hear of the experience of the noble Baroness’s friend. I asked my officials to let me know which walk-in centres were available within striking distance of this building. There are, in fact, five NHS walk-in centres in or very near central London. I am aware of another privately run centre as well. A quick search on NHS choices will bring you to a menu of options.

Health: Diabetes

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 25th July 2012 Lords Chamber

[Earl Howe]

My advice is that type 1 diabetes is not a particular issue in ethnic-minority communities. We are talking about type 2 diabetes, which is five times more common in black and ethnic-minority groups, six times more common in south Asian ethnic groups, and three times more common in areas of social deprivation than in the rest of the population. There are particular clinical risks associated with those from ethnic minority communities who have diabetes. Complications include particularly heart disease—south Asian people are 50% more likely than the general population to die prematurely from coronary heart disease—and the prevalence of stroke is also much higher in African, Caribbean and south Asian men.

[Baroness Masham of Ilton]

My Lords, can genetic problems be a cause? Are not exercise and getting fit an important part of stopping diabetes?

[Earl Howe]

Exercise is recommended under the Change4Life programme and under the advice given by NICE. However, the noble Baroness is absolutely right to mention a possible genetic cause. The cause of diabetes is not fully understood and is multi-factorial. Healthy eating, weight control and exercise can help reduce the risks, but that is not the full picture. It is suspected that there is a genetic component in the case of black and ethnic-minority communities.

NHS: Primary Care Trusts

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 17th July 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, will the noble Earl find out to how many cases the PCT in North Yorkshire has denied treatment in the past year? Is he aware of how distressing it is for very ill patients to have to appeal?

[Earl Howe]

My Lords, I do not have the figures for North Yorkshire in front of me but, as the noble Baroness is aware, there is a process for patients to make an exceptional case application to their primary care trust where the circumstances are deemed to be exceptional. We had a short debate about this matter the other day. However, there will inevitably be variation around the country in the extent to which treatments are seen as a priority for the local population in a given area.

NHS: Definition of Exceptional Case

Debate between Earl Howe and Baroness Masham of Ilton

Monday 2nd July 2012 Lords Chamber

[Baroness Masham of Ilton]

To ask Her Majesty’s Government what is the definition of an exceptional case needing surgical and medical care through the National Health Service, and who makes the decision.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the department has not issued definitive guidance on this difficult issue. Indeed, there is a paradox in the whole concept of defining an exception. However, good practice in the NHS suggests that a patient can be considered for treatment which is not normally provided locally if the patient has exceptional clinical need or is likely to derive exceptional clinical benefit. The decision is made by the local commissioner.

[Baroness Masham of Ilton]

My Lords, I thank the noble Earl for that reply. However, is he aware that there is a young doctor in Northallerton, North Yorkshire, whose PCT has denied her a vital operation for a genetic pancreatic condition? If she does not have this operation, she will remain in excruciating pain all the time, she will not be able to work, and there will be a risk of cancer.

[Earl Howe]

My Lords, I hasten to reassure the noble Baroness that I have every sympathy with the individual in question, and I was aware of this particular case. The chief executive of the NHS will shortly be writing to her clinical tutor to suggest a possible way forward. However, I should put on record my view that the commissioner is acting reasonably in insisting that its decision on exceptionality should depend solely on the clinical need of the patient, and not on any broader social factors. If there is now good clinical evidence to support the use of this particular treatment, commissioners should be considering whether to make it available to all patients with similar clinical needs, and not just to a few individuals.

NHS: Liverpool Care Pathway

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 20th June 2012 Lords Chamber

[Earl Howe]

My Lords, I am pleased to hear that the noble Baroness’s mother was well looked after with the benefit of the Liverpool care pathway. I take the point about the name. Indeed, the noble Baroness, Lady Finlay, can probably give us some instructive examples from Wales, where the word “pathway” has not been adopted and the process has, I believe, been refined.

[Baroness Masham of Ilton]

My Lords, is the noble Earl aware that some relatives and loved ones have to fight to stop their loved ones being on the Liverpool care programme? Can he think of anything worse than dying of thirst?

[Earl Howe]

My Lords, no one should be denied basic care at the end of life. However, that is a different question from whether artificial nutrition and hydration should be withheld. Relatives should always be consulted.

Health: Local Healthwatch Organisations

Debate between Earl Howe and Baroness Masham of Ilton

Monday 11th June 2012 Lords Chamber

[Earl Howe]

We are working with the Local Government Association and the Care Quality Commission to provide support for the implementation of local Healthwatch organisations. As I mentioned, the LGA is running a series of master classes for local authority commissioners. It has published 15 case studies taken from the 75 Healthwatch pathfinders, and a small number of Healthwatch experts will be available to help spread learning. As regards making the public aware, it will be very much for local authorities to decide what is appropriate in their particular areas in order to ensure that patients and the public are engaged in the important work of Healthwatch and understand what the statutory remit of local Healthwatch consists of, because that is the only way in which local Healthwatch will make its voice truly heard.

[Baroness Masham of Ilton]

My Lords, will local Healthwatch members be able to support members of the public if they go to a tribunal?

[Earl Howe]

One of the potential functions of local Healthwatch is to act as a support in terms of advocacy for local people and to signpost patients and the public to appropriate services. It is too early to say which local authorities will commission what services from local Healthwatch in an area, but the resources available to local Healthwatch have to be borne in mind in that context.

Health and Social Care Act 2012

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 25th April 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, does the Minister agree that HealthWatch has been left in limbo? Would he agree to a fast-track legislative scrutiny?

[Earl Howe]

I do not agree that HealthWatch has been left in limbo; in fact, only this morning I was attending a round table of pathfinder local healthwatches and witnessing for myself the tremendous energy and enthusiasm that they were devoting to HealthWatch. So the short answer to the noble Baroness is no, I think the process as regards HealthWatch is very much on track.

Health and Social Care Bill

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 8th March 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, perhaps I may ask a question following the speech of the noble Baroness, Lady Barker. Does healthwatch not cover health and social care? If it does, the noble Baroness, Lady Bakewell, has a strong point.

[Earl Howe]

My Lords, while, for reasons which I shall explain later, I do not feel able to accept this amendment, I say immediately to the noble Baroness that she has raised a very important issue with which the Government are in complete sympathy.

It is important for older people to have a strong voice to champion their interests and to ensure that their needs are addressed in public services. Both I and my honourable friend the Minister of State for Care Services have met the noble Baroness over recent months to discuss this issue and have been struck forcefully by the powerful case that she has made. As she is aware, my honourable friend would like to continue these discussions with her, as we are particularly grateful for the expertise that she brings to this area.

I am sure noble Lords will agree that older people are affected by a wide range of issues—not only health and social care but areas of policy such as housing and pensions. The Government recognise this. The UK Advisory Forum on Ageing, co-chaired by the Minister of State for Care Services and the Minister of State for Pensions, provides advice across government on the additional steps that they and their partners need to take to improve well-being and independence in later life.

In health, a range of functions in relation to older people are already carried out in this country. That should not surprise us because we all know that a very large proportion of the NHS budget is accounted for by healthcare delivered to the elderly. The Department of Health is pursuing a number of initiatives to improve the care of older people in hospitals, care homes and other settings. These initiatives cover all stages of the care pathway—from helping individuals to stay healthy and to stay in the community all the way through to end-of-life care. For example, the department already has a National Clinical Director for Older People, Professor David Oliver, whose remit is to promote the better care of older people across the NHS and social services, and to provide clinical leadership for cross-government work on older people.

My noble friend Lady Barker rightly stressed the key role of social care in relation to older people. Looking across the spectrum of health and social care, each health and well-being board will be required to develop a joint strategic needs assessment, identifying the current and future needs of the local population, and a joint health and well-being strategy to set out how those needs will be met. I can say to the noble Baroness, Lady Bakewell, that it is intended that health and well-being boards will bring together the key local commissioners to enable them, first, to consider the total resource available to improve their population’s health and well-being, and then to come to a joint understanding about how those resources can best be invested. This will undoubtedly help to encourage a more integrated local service which is better able to meet the needs of older people by joining up NHS and social care services. I hope that that offers some reassurance to the noble Baroness that the voice and needs of older people in health is absolutely a priority for this Government.

Amendment 231A proposes that the role of commissioner for older people should fall on a member of HealthWatch England. I am afraid that I cannot agree that that would be an effective approach. The first reason is the one that I mentioned earlier: the role of an old people's champion goes wider than health and social care. Equally importantly, the job of HealthWatch England will be to carry out functions in relation to people. The word “people” is a deliberately broad term and its ordinary meaning would include older people of course, so we do not feel that it would be appropriate to give a member of HealthWatch England a remit for older people, which would give additional weight to one group of people over another. It could also lead to calls for a commissioner for other groups like those with learning disabilities and it would be difficult to see where the list would stop.

Although I completely understand the concern that older people have often lacked a voice within the system, and the need to ensure that they are not overlooked, we do not agree that the singling out of this group over others, within the context of healthwatch, would be the best way to achieve that. We want to address the concerns of the noble Baroness but not in this way. In the light of that and on the basis that she will continue to have discussions with my honourable friend on the issue in a wider sense, I hope that she will feel sufficiently reassured to withdraw her amendment.

Health: Neurological Conditions

Debate between Earl Howe and Baroness Masham of Ilton

Monday 27th February 2012 Lords Chamber

[Earl Howe]

My noble friend is quite right. We know that people with long-term neurological conditions are high users of NHS services and, as the NAO report identifies, they often have high levels of unplanned admissions to hospital. To help to provide personalised care and to support better-planned care, there is quite a deal of evidence—of the generic kind, but nevertheless very useful—out there for neurological patients. It focuses on the individual, on planning, on supported self-care and on how patients themselves can improve their own outcomes. We are building a strategy on that model to set out how local authorities, the voluntary sector and government agencies can work together to prevent the kind of emergency admissions to which my noble friend refers.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that specialised nurses working on these very complicated neurological conditions are very important? Would he see to it that their services are not cut but increased?

[Earl Howe]

The noble Baroness is quite right that specialist nurses provide an important source of support and advice to patients with a range of neurological conditions. They enable patients to manage their own condition effectively, as I mentioned just now. Guidance issued by NICE is clear on the important role that specialist nurses can play in the provision of effective services for those living with a range of neurological conditions.

Health and Social Care Bill

Debate between Earl Howe and Baroness Masham of Ilton

Monday 27th February 2012 Lords Chamber

[Earl Howe]

My Lords, this has been an interesting and worthwhile debate and I appreciate the concern that the noble Baroness, Lady Finlay, and other noble Lords have demonstrated throughout the Bill’s proceedings to ensure that the board and CCGs benefit from as wide a range of advice as possible. The Government have been clear that everyone with a role to play in securing the best possible services for local people should be able to do so. The NHS Future Forum recommended that we strengthen the legislative duties to help achieve this, which is why the duties on the board and CCGs to obtain appropriate advice were strengthened in another place to incorporate the wording used to define the comprehensive health service and to ensure that it was clear that such advice should come from persons who, taken together, have a broad range of professional expertise.

I mentioned clinical senates on the last group of amendments. Of course we envisage a role for clinical senates in the arrangements for how these duties are fulfilled, providing not just clinical but multidisciplinary advice from professionals from public health and social care alongside patient and public representation and other groups as appropriate. The noble Baroness, Lady Masham, asked me specifically about clinical senates. They will be established as strategic advisory bodies, with a clear focus on quality improvement and improving outcomes. They will bring together clinicians with strong clinical credibility, drawn from across the disciplines, as I have mentioned. They will include patients and members of the public as well. They will have a role, too, in advancing public understanding of health and healthcare.

Why do we need clinical senates? Commissioning is at its best when it is a collaboration of professionals, based on a shared drive for continuous quality improvement. Maximum participation will be key here. The Future Forum report showed:

“There was universal agreement that people would be”,

better served if their,

“care were designed around their needs and based on the input of the public, patients and carers, health and social care professionals”,

the voluntary sector, “and specialist societies”. The exact detail of who will be part of the clinical senates, the number that will exist and the roles that they may have are all to be determined through a process of discussion and engagement, but I hope that I have outlined, at least in broad terms, what they will be there to do.

[Baroness Masham of Ilton]

Who will pay for them?

[Earl Howe]

My Lords, they will come under the aegis of the NHS Commissioning Board. They will be part of the board.

Having said all that, I remain unconvinced that imposing specific duties as to where advice should come from, including specifying particular sources of advice such as in Amendments 57 and 99, is the right way forward. I am afraid that if we were to do that, there would be then justifiable demands to include in the Bill other clinicians and groups of people who commissioners should seek advice from when exercising this duty. My view is that this is horses for courses, and that it is appropriate that the board and CCGs should have the freedom to determine what advice it is appropriate to seek in each instance. That is why the emphasis in the duties as they stand is rightly placed on ensuring that the commissioner obtains “appropriate advice” from people with a broad range of professional expertise. It is that breadth of expertise which is important, not the particular professionals involved.

Amendments 58 and 100 are admirable, if I may say so, in that they seek to require that the advice should come from across the care pathway. I have every sympathy with the noble Baroness’s intentions there. Again, however, I think that this is already provided for in the duty which—in its reference to expertise in the prevention, diagnosis, or treatment of illness, and the need to obtain advice from persons who, taken together, have a broad range of professional expertise—is designed to be of maximum scope, and I am confident that it will be interpreted as such.

We have also just discussed the important role that both patients, and the organisations that represent their interests, can bring to the commissioning process. However, I think that Amendments 59 and 101 are unnecessary. Let us be clear that while these duties refer to obtaining advice from people with expertise in relation to the health service, this is not confined to clinical expertise. There is nothing to prevent the board or CCGs securing advice from patients’ organisations, or those with expertise in the patient experience. The board can also draw on the advice of national and local healthwatch as a conduit for such advice. CCGs, similarly, are able to draw on the advice of local healthwatch.

However, to reiterate the point that I made in Committee, there is a risk in becoming too prescriptive. In reality, we have to trust them to build these relationships themselves and judge them on the outcomes that they achieve. If we commission for good outcomes, we will, as night follows day, secure the appropriate knowledge and advice to enable us to do that.

It will also be an important part of the board’s remit to produce advice and guidance to prevent the recurrence of incidents that jeopardise patient safety, just as the National Patient Safety Agency does now. It is important that the board is able to share relevant information relating to patient safety. The noble Lord, Lord Patel, is absolutely right that information that can inform and enhance patient safety in the NHS should be made available to all those who would benefit from it. The NPSA, as he will know, currently shares this information with a number of bodies with a particular role in relation to patient safety—for example, the MHRA and the CQC—and this will continue to be the case. Indeed, if it did not make important information available to those who it thought could reasonably benefit from it, the board would be in breach of its duty.

In addition to NHS bodies, this information is currently also used to develop products for use by non-NHS organisations, by the devolved Administrations and international organisations, for which the board may determine it appropriate to charge a fee. It is for those reasons that we have framed the duty to share information in broad terms, and we would not want to be more prescriptive in the way that Amendment 65 proposes. Neither would we want to prevent the board charging a fee when appropriate, as would be the effect of Amendment 66. I think that it is reasonable for the board to determine how and in what circumstances it may impose charges for the information it provides. The power is intended to allow the board to seek adequate compensation for the services that it provides to other bodies where there would otherwise be no benefit to the health service. However, there is no scope for the board to charge for the advice and guidance that it would be required to provide for the purpose of maintaining and improving patient safety, and although there is provision for the board to impose charges, Clause 22, which inserts new Section 13Q(4), makes it clear that the board must give, not sell, advice and guidance to appropriate bodies to maintain and improve the safety of the health service. I hope that that is reassuring to noble Lords.

The noble Baroness, Lady Morgan, asked me about the monitoring of advice and what happens if they fail on that duty. CCGs will have an annual performance assessment by the board, which would assess how well they discharge their functions, including this duty to obtain advice. If a CCG fails to perform any of its functions, effectively the board can intervene and can take action. I hope that the clarification I have given is helpful and that I have sufficiently reassured noble Lords to enable them to withdraw their Amendments 57, 58, 59, 65 and 66.

National Institute for Health and Clinical Excellence

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 14th December 2011 Lords Chamber

[Earl Howe]

My Lords, our expectation is that the NHS will continue to use NICE clinical guidelines to inform local improvement activity. These guidelines are tremendously valued and very authoritative. The noble Baroness is quite right: they have the potential to make a big impact on the quality of care and to add value.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that the Statement was very encouraging? Will it keep pharmaceuticals and more research here in the UK? That would be welcome.

[Earl Howe]

My Lords, part of the objective of the growth strategy is to break down some of the barriers that undoubtedly exist to pharmaceutical companies conducting clinical trials in this country. There have been unwelcome delays in the system and we are putting in place several measures to get rid of them, which in turn should encourage pharmaceutical companies to view the UK as the platform of choice for clinical research.

Health: Oral Cancer Detection

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 6th December 2011 Lords Chamber

[Earl Howe]

My noble friend is quite right that the worrying feature of oral cancer is that it is increasingly appearing in the young. The risk factors that have been identified for oral cancer are primarily smoking and consumption of alcohol, but particularly the two combined. It is important that we get to grips with this. A number of public health campaigns are in train, certainly on smoking, and our alcohol strategy is due out very shortly, which will also address drinking among the young.

[Baroness Masham of Ilton]

My Lords, does the Minister think that HPV and HIV can be first detected in the mouth by dentists, and does he not think that dentists should have more training?

[Earl Howe]

My Lords, my understanding is that HIV needs to be fairly far advanced before it manifests itself in the mouth. However, the noble Baroness is absolutely right with regard to HPV—human papilloma virus—because since 2009 there has been further research suggesting a link between HPV and oral cancer. There is now a sufficient evidence base to suggest that infection with HPV is a risk factor, particularly for the soft tissues at the back of the mouth. Her point about dentists picking this up is very well made. My understanding is that dentists are very much on the lookout for these symptoms.

Health and Social Care Bill

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 30th November 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I spoke on Second Reading of the need for safeguards. These are important amendments. They are safeguards which are necessary. Many people are worried about the conflict of interest.

[Earl Howe]

My Lords, I know full well that noble Lords have some concerns about the potential for conflict of interest in a system of clinical commissioning groups. Those are natural concerns, but I hope to show that the approach that we are advocating has some very specific and robust safeguards within it, which meet the intentions of the amendments in this group.

The CCG constitution provides for dealing with conflicts of interest and specifies arrangements for securing transparency about the decisions of the CCG and its governing body. The governing body must in turn ensure that the group has arrangements in place to ensure adherence to relevant principles of good governance. The CCG’s governing body will have responsibility for ensuring that the CCG adheres to relevant principles of good governance. The Secretary of State can also make regulations for CCGs under Clause 71 of the Bill, which are designed to ensure that in commissioning, CCGs adhere to good procurement practice. These regulations may impose requirements relating to,

“the management of conflicts between the interests involved in commissioning services and the interests involved in providing them”.

These regulations can also confer on Monitor powers to investigate suspected non-compliance. These are the safeguards that the Bill puts in place. My view is that it is unnecessary and indeed undesirable to go further.

Requiring CCGs to adhere to examples of good practice in managing conflicts of interest, such as declarations of interest; or maintaining a register of interests; or the monitoring or registration of hospitality received by members is a temptation, but one that should be resisted. We have got to be very careful about encumbering the Bill and CCGs with inflexible prescriptions as to how CCGs should operate within the statutory framework, or procedure about how they specifically manage potential conflicts of interest. This does not mean that these are not reasonable safeguards. Requiring the governing body to discuss in public choices between potential providers, or publish any decisions made in camera, for example, would remove a necessary discretion around ensuring that sensitive issues, either relating to contract values or performance, or staff matters, were given the appropriate level of confidentiality. I would urge in particular that we do not—as proposed in Amendment 175CC—put restrictions on those from whom a CCG can commission services. Given the importance we attach to ensuring that services are delivered in an integrated way, we cannot afford to cut CCGs off from being able to commission services from local GPs with a special interest, for example, who could deliver secondary care services in a community-based setting.

Health and Social Care Bill

Debate between Earl Howe and Baroness Masham of Ilton

Monday 14th November 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords, how could one not accept this amendment?

[Earl Howe]

My Lords, I begin by saying that I completely understand the seriousness of the issues raised by the noble Lords, Lord Patel of Bradford and Lord Noon, and others noble Lords. The noble Lord, Lord Patel of Bradford, suggested that part of his purpose was to ensure that this issue remained on the government agenda. Let me assure him that the issue is very firmly on the Government’s agenda, and I am pleased that we are having this debate today so that I can outline exactly what we are doing.

Before I turn to address the amendment, I think it would be helpful if I briefly laid out the Government’s view of the role of the voluntary sector in the NHS. We firmly believe that voluntary sector organisations have a strong and often crucial role to play, due to the experience, expertise and insights that they can offer to commissioners and the system more widely. I of course acknowledge and pay tribute to the valuable work performed by Sue Ryder and numerous other charities, including most especially hospices. We recognise that they can play a vital role in delivering innovative, high-quality user-focused services in their local communities, along with improved outcomes for patients and increased value for taxpayers. We also acknowledge, as Amendment 46 highlights, that taxation treatment is one potential barrier to voluntary sector organisations’ entry into the provision of NHS services and to their increased involvement in those services. Access to capital is another. We are very keen to explore ways to overcome these challenges. The department is discussing this, as part of a wide range of issues, with voluntary sector providers of NHS-funded services.

When I was preparing for this debate, I asked whether the Treasury was looking at these issues, and the answer is that it is. I understand that Treasury officials are already working with representatives from the voluntary sector to explore the value added tax treatment of charities supplying the NHS, taking into account the legal limitations and the potential complexities around possible solutions. We are keen that they should make speed over this. However, the introduction of an artificial one-year timetable, as this amendment proposes, would limit the scope for a full and thorough discussion and consideration of this issue. I cannot commit to that limitation. However, I emphasise that we are very keen to work at possible solutions as fast as we can. It is a complex issue. My noble friend Lady Barker pointed us towards some of those complexities.

It is worth my repeating a general point here. The Government are committed to fair competition that delivers better outcomes and greater choice for patients and better value for the taxpayer. We want to see providers from all sectors delivering healthcare services. We have not the least wish to favour one type of provider over another. Indeed, as a result, and to ensure that the Secretary of State, Monitor and the Commissioning Board do not confer preferential treatment on any type or sector of provider, the Government have introduced amendments to Clauses 144, 59 and 20, inserting a new section, Section 130, into the National Health Service Act 2006.

We know very well that the voluntary sector plays a strong role in bringing the voices and experience of patients, service users and carers to the work of improving services, often reaching individuals who are excluded or who cannot access mainstream services. The voluntary sector brings advocacy and information to support individuals to exercise choice and control over the services that they access. These are major prizes, and we wish to capitalise on them. Opening up services to greater choice, for example, through “any qualified provider”—as was pointed out by the noble Baroness, Lady Finlay—allows for greater involvement by social enterprises or voluntary sector organisations. To a great extent, this is already happening.

Listening to noble Lords, I felt that there was a great deal of consensus around those points. There is a shared feeling across the House that charities have a key part to play in NHS provision, that the current VAT rules can act as a barrier and that this needs to be looked at very closely and urgently. I completely agree with that, and I would like to reassure the noble Lord, Lord Patel of Bradford, that we will ensure that this taxation issue continues to be considered urgently, as we develop work on a fairer playing field for delivering NHS services. In establishing Monitor’s new functions, the department and Monitor will continue to consider these issues and the priorities to be addressed.

The noble Baroness, Lady Armstrong of Hill Top, asked in particular what comfort there is in this Bill for the voluntary sector. She quite rightly mentioned the Future Forum in highlighting the work of the sector. The noble Baroness will be aware that the forum gave a very strong endorsement to the Bill’s creation of a bespoke provider regulator, Monitor, in order to oversee a level playing field. Such a commitment to a fair market was and remains a comfort to the voluntary sector. Of course, we acknowledge that more needs to be done, and that includes the ongoing work at the Treasury.

With those remarks, although I am sure that I have not completely satisfied the noble Lord, Lord Patel of Bradford, I hope that I have given noble Lords the sense that we are onside with this issue and shall be pursuing it with as much urgency as we can. I therefore hope that I have done enough to persuade the noble Lord to withdraw his amendment.

Health and Social Care Bill

Debate between Earl Howe and Baroness Masham of Ilton

Monday 7th November 2011 Lords Chamber

[Earl Howe]

I shall have to get back to my noble friend on whether it is specifically mentioned in the consultation. I can say that it is absolutely pertinent to the subject matter on which we are consulting. It would be extremely helpful if some of the response to the consultation covered issues such as mediation. We need to factor that in and perhaps my noble friend, with her experience, will feel able to send us her views on the subject.

[Baroness Masham of Ilton]

I thank all noble Lords who have supported, or not supported, the amendment. I say to the noble Lord, Lord Winston, that the last thing one wants is to make a difficult situation more dangerous. One wants to achieve accident prevention. It is vital that patients have trust in the doctors, nurses and other professionals who are treating them. Something has to happen now about the culture. We have to look at what happened at the Mid Staffordshire General Hospital. I sincerely hope that something will be learnt from that. I know that the Government want to improve things. I think that all doctors in the House are trusted by their patients, but there are doctors who have lost their patients’ trust. That is why I feel very strongly that whatever the Government try to do will have to be done by statute. Many doctors just follow the book and do not do what they should do.

I feel very strongly that your Lordships’ House, with all its expertise, as displayed tonight, must find a way. I sincerely hope that that will happen with the blessing of the Minister and the Government. I hope that we can work together and, before Report, get something that is acceptable to everyone, especially to patients. One must remember the patients who have suffered so badly and who are suffering today. Every time I open a newspaper, I see something about the culture of nursing, and something has to be done. It is the Government’s responsibility. We should go for a statutory obligation to protect patients. With that, I beg leave to withdraw the amendment.

Health: Diabetes

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 1st November 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords, does the Minister agree that if people cut down on sugar and alcohol it would help? Would he agree that this is a worldwide problem?

[Earl Howe]

I agree fully with the noble Baroness that sugar and the sugars contained in alcohol are a major feature in the obesity problem and in the incidence of type 2 diabetes.

Health and Social Care Bill

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 25th October 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords, could I ask the Minister about something that I do not understand? Why in my noble friend’s amendment does it not include the training of healthcare assistants?

[Earl Howe]

I have already made clear, my Lords, that the amendment could include healthcare assistants. We have been careful to make it all-embracing so that it includes not only all health professionals, but health support workers who are not health professionals.

[Baroness Masham of Ilton]

That is the Government’s amendment. The Minister said that my noble friend’s amendment did not include them.

[Earl Howe]

As I read it, it is the noble Lord’s amendment and it is for him to speak to it, but it refers to the education and training of “the health care workforce”. That will include a lot of people, but not those who are not healthcare workers.

Health: Cardiology

Debate between Earl Howe and Baroness Masham of Ilton

Monday 24th October 2011 Lords Chamber

[Earl Howe]

As my noble friend knows, the children’s heart surgery unit in Belfast is not part of the Safe and Sustainable review as it is the responsibility of the healthcare systems in the devolved Administration. It is for the Northern Irish health service to take a view on the safety and sustainability of those services and to consider the recommendations that flow out of the review in this country. We will, of course, share the learning from our experience in England, but I emphasise again that this is a matter for the NHS, and not Ministers, to resolve.

[Baroness Masham of Ilton]

My Lords, is the noble Earl aware that the north of England is a special case because of deprivation, long distances and cultural problems around the Bradford area? Does he agree that both Leeds and Newcastle need their children’s heart surgery units, and that deprivation is an important factor as far as travelling is concerned?

[Earl Howe]

My Lords, I agree that deprivation is an important consideration. The population density of the West Midlands conurbation and the very high case load of Birmingham Children’s Hospital suggested that the Birmingham service should be, as it were, a fixed point. However, I am afraid that the same cannot be applied to Leeds because although the Leeds catchment area has a high population it has a much lower case load than that of Birmingham. The analysis of the expert group suggested that there needed to be two centres in the north of England because of the population density; that was either Liverpool and Leeds or Liverpool and Newcastle. It was not possible to have a Leeds and Newcastle combination since Newcastle could not achieve a credible network.

Nursing: Elderly and Vulnerable Patients

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 19th October 2011 Lords Chamber

[Earl Howe]

My Lords, from my reading of the report —and I have looked through it—I think there is much there that we can pick up very usefully, so I agree.

[Baroness Masham of Ilton]

My Lords, does the noble Earl agree that district nurses do a very important job in keeping vulnerable, elderly and disabled people in the community? Is he aware that there is a shortage and that their training needs to be different because they go into other people’s homes?

[Earl Howe]

The noble Baroness, as ever, makes a very important point. It is one of the reasons we have a very ambitious programme of expanding the number of health visitors. She is right about tailoring the training to suit the environment. That is why there are local curricula as well as the core nursing curriculum that have approved standards from the NMC but are sensitive to local needs in individual areas.

Health: HIV/AIDS

Debate between Earl Howe and Baroness Masham of Ilton

Monday 5th September 2011 Lords Chamber

[Earl Howe]

The noble Baroness with her experience makes a central point here. We absolutely agree that increasing the offer and uptake of HIV testing in a variety of healthcare settings is important to reduce undiagnosed HIV. We welcome the BHIVA professional guidelines in this area, which have been extremely helpful. The sooner a person with HIV is diagnosed, the sooner they can benefit from treatment and also make any behavioural changes to prevent transmission. It is those behavioural changes that count most strongly.

The department funded pilots to support the implementation of recommendations from the BHIVA, and those were extremely successful. In the coming days, we will consider carefully the report that is due to be published by the Health Protection Agency to see how we can take forward its findings in this area.

[Baroness Masham of Ilton]

My Lords, as a member of the House of Lords committee that produced the report, I pay tribute to our chairman, the noble Lord, Lord Fowler, for his excellent work. Is the Minister aware that one-quarter of the people with HIV do not know that they have it? That is extremely dangerous; late diagnosis costs a lot and many of those people die early. Will he do more to promote prevention?

[Earl Howe]

The noble Baroness is correct that about one-quarter of those with HIV are unaware of it, which is why testing in a variety of healthcare settings is vital and a targeted preventative approach to the two communities that I mentioned has to continue.

Southern Cross

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 16th June 2011 Lords Chamber

[Earl Howe]

My Lords, I cannot issue a government guarantee on the continuing business health of every single care home provider in the country; that would be extremely rash. Of course, we know that over the years some providers have gone out of business. What we are seeing in the country at the moment is much more of a trend towards looking after people in their own homes rather than in residential settings. At the same time, the market is doing the opposite because there are more and more elderly people requiring care of some kind. This industry is not going to disappear overnight or, indeed, at all. Over the indefinite future we will require a residential care home industry, particularly as the number of elderly continues to increase. The key will be to ensure that the quality of provision is maintained. Competition will undoubtedly remain, but it is a telling indicator of the current state of the market that there is an overprovision at present of about 50,000 care home places nationally. That perhaps is a sign that local authorities are successfully meeting the wishes and needs of their service users in providing care in the settings which most people want; namely, their own homes.

[Baroness Masham of Ilton]

My Lords, what safeguards are being put into place so that this situation does not happen again in other care homes and possibly in hospitals?

[Earl Howe]

My Lords, I think I have already indicated that the Government are proactively engaged with all the key parties involved in this situation, not just Southern Cross but the LGA, ADASS, the CQC and others. The precise situation in which we find ourselves with Southern Cross is unlikely to arise again because my understanding is that the business model adopted by Southern Cross is unique. Nevertheless, every privately operated residential care home business will, no doubt, have its own level of business risk, whatever that may be—either slight or something rather less slight. However, the alternative that the noble Lord, Lord Beecham, seemed to desire was a return to the state provision of care homes. The noble Lord is shaking his head, and I am glad of that, because I think neither his party when in government, nor certainly ours, would wish that on the public. I think that all of us believe in choice for the individual, and this is what the current market provides. Nevertheless, there are risks.

The noble Baroness asked about hospitals. To the extent that NHS care is delivered in independent settings, a business risk is inevitably associated with that. However, we are clear in the Health and Social Care Bill that there needs to be a system whereby essential services are protected for the benefit of patients. When the Bill reaches us, we will no doubt debate those provisions.

Health: Transmissible Spongiform Encephalopathies

Debate between Earl Howe and Baroness Masham of Ilton

Monday 13th June 2011 Lords Chamber

[Earl Howe]

My noble friend asks a very good question. Over 20-odd years, we in this country have invested almost £0.5 billion in research into TSEs. That is a significant amount of money. The total amount is declining, but that is because in the early days it was important to invest in research to ascertain the pathogenesis of this condition in cattle in particular. We are much further forward in understanding how this disease develops in cattle. Nevertheless, as I indicated to the noble Countess, important questions remain unanswered, and I think we will continue to see this research funded well into the future.

[Baroness Masham of Ilton]

My Lords, what is happening about the P-Capt filter for prions? Are we not lagging behind Ireland and China in this research?

[Earl Howe]

My Lords, the noble Baroness will know that the independent Advisory Committee on the Safety of Blood, Tissues and Organs—SaBTO—has advised that there is evidence that a particular filter can reduce potential infectivity in a unit of red blood cells. It has recommended the introduction of filtered blood to those born since 1 January 1996, subject to a satisfactory clinical trial to assess safety. We are undertaking an evaluation of the costs, benefits and impacts to inform a decision on whether to implement that recommendation, and we are awaiting the results of clinical trials, which are expected in early 2012.

Health: Hospital-acquired Infection

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness will know that a code of practice was issued some time ago, which the CQC uses to ensure that the registration requirements of a provider have been complied with. It is clear that the decline in numbers of hospital-acquired infections has coincided with the issue of that guidance. We believe that it has made a material difference. I am not aware that there has yet been systematic evidence-gathering of whether the guidance has had an effect, but it appears that it has.

[Baroness Masham of Ilton]

Does the Minister not think it is about time that the figures for infections were kept nationally? Is he aware that some hospitals have got better and some have got worse, and the outcomes across the country are very patchy?

[Earl Howe]

The noble Baroness is absolutely right. The headline figures disguise considerable variations between the best and worst performers. Our approach has been to adopt a zero tolerance policy to all avoidable healthcare-associated infections. To support that we have introduced a number of specific actions, including establishing clear objectives under the NHS operating framework, which are requirements for all trusts to meet, and for primary care organisations, and extending to health and social care settings the regulations on infection prevention and control. We have also increased the requirements on publishing data trust by trust.

Health: Cancer

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 10th May 2011 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. He is absolutely right; these are very difficult decisions to make. NICE issues final guidance on the use of a drug only after very careful consideration of the evidence and wide consultation with stakeholders. The noble Lord, Lord Davies, and, I am sure, my noble friend will be aware that one particular drug has been refused or not recommended by NICE. However, we have established the cancer drugs fund, which will enable individual clinicians on a patient-by-patient basis to apply to access drugs even though they have not been recommended by NICE.

[Baroness Masham of Ilton]

My Lords, will the Minister look at the problem of neuroblastoma, which is an aggressive type of child cancer? I have to declare an interest as I had a small cousin who had his kidney removed at five with a tumour. He had to go to America for treatment. Will the Minister ensure that the UK, which does not have a good survival rate for these children, looks with America at the research needed for them? There are only about 100 a year in the UK who have neuroblastoma.

[Earl Howe]

The noble Baroness raises an important issue, because these conditions are devastating even though they affect only a comparatively small number. There is a good deal of research going on into cancer, some of it funded by my department. I do not have details of whether that condition is the focus of any such programme but I will take away her concern and write to her if I have further information.

NHS: Consultation on Reform

Debate between Earl Howe and Baroness Masham of Ilton

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

My noble friend is quite right: the principles that underpin the Bill and—I emphasise this—the principles that have always underpinned the National Health Service, are not going to change. He is right that the approach that we are adopting is in many senses an evolutionary one, following on from initiatives taken by the previous Government. I am grateful to him for pointing that out and I am sure that this will be a feature of the government response that we shall publish in due course.

[Baroness Masham of Ilton]

My Lords, does the Minister agree with me that there is some concern about so much of public health going over to local authorities? Will he give an assurance that directors of public health will be well qualified in public health?

[Earl Howe]

The noble Baroness makes a very important point about local directors of public health, who most certainly do need the right qualifications for that role. As she will know, they will be jointly appointed by local authorities and by the Secretary of State and we need to ensure that they can perform their role properly. The four main themes to the listening exercise are: choice and competition; public accountability and patient involvement; clinical advice and leadership—that may be an area that impacts on her question; and education and training. In some ways it is difficult to separate those issues; they are all of a piece and we do need to look at them very carefully.

NHS Reform

Debate between Earl Howe and Baroness Masham of Ilton

Monday 4th April 2011 Lords Chamber

[Earl Howe]

My Lords, those who have been re-engaged by the health service, having taken redundancy or early retirement, will forfeit their redundancy pay because there is a clawback arrangement in force, as I told the House the other day.

The noble Lord asked a number of questions. I want to be very brief because I am aware that the noble Baroness, Lady Masham, wants to get in before the time is up. Monitor was described as a promoter of competition. Expressed in stark terms like that, it sounds as though its job will be to go around drumming up competition where there is none already. That is not a correct reading of its functions; it is there to bear down on anti-competitive conduct and to ensure fair competition. The composition of consortia is a concern that we have heard about, and we will listen to that concern. It is now up to the pathfinder consortium to think about this kind of question. The early implementers of health and well-being boards are starting to think about those powers and how they can be used and we will listen to whatever they have to tell us.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that patients very often cannot get an appointment with the GP of their choice so there is no continuity? If GPs have to undertake administration on the consortia, will this not get worse? Would it not be better if the consortia consisted of a mixture of GPs, specialists, nurses, administrators and patients? Working together would surely be better than working in conflict.

[Earl Howe]

The noble Baroness is absolutely right about working together, and our vision for good, clinically led commissioning is that all clinicians, not just GPs but everyone with a stake in the patient pathway, should join together and determine what good care looks like. However, she is mistaken in her first assumption. We are not asking thousands of GPs to become administrators. It will take only a very few to took after the commissioning of care in consortia, and the administration will be taken care of by management employed by the consortia.

Blood and Blood Products

Debate between Earl Howe and Baroness Masham of Ilton

Monday 10th January 2011 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Lord, who comes to this with considerable knowledge and experience as a former Secretary of State for Health. He is right: it has been a difficult if not an intractable problem for successive Secretaries of State. He is also right to say that the human tragedy has become more obvious as the years have passed. For one thing, it was not so obvious in the early days that there would be so many victims of hepatitis C, because that condition only tends to emerge after a considerable lapse of time. The HIV infection was more immediate and more obvious.

The noble Lord is right that in making this announcement for England, we are creating an immediate disparity with the devolved Administrations. As I indicated, I hope that in our discussions with the devolved Administrations—who are, after all, autonomous—we can arrive at a more equitable package for all victims across the United Kingdom. I am sure, without wishing to appear to interfere in the affairs of the devolved Administrations, that that is something that, as human beings, we would like to see. But I cannot pre-empt the decisions that will be taken in those Administrations.

[Baroness Masham of Ilton]

My Lords, I declare an interest as a vice-president of the Haemophilia Society. I am very pleased that the Government have recognised the plight of so many people and families who have suffered this disaster. But what safeguards are in place to prevent any infections from blood transfusions or blood products happening in the future? Prevention is so important and one never knows what is on the horizon.

[Earl Howe]

My Lords, the noble Baroness is, as always, absolutely on the mark. This has been an important issue not just for the current Government but for the previous one.

The measures in place to ensure the safety and quality of human blood, blood components and the blood products manufactured from them have developed significantly since the mid-1980s. We test for viral markers. Donations contribute to a plasma pool which is also tested for viral markers. In 1985, the introduction of heat treatment in the UK removed the risk of both HIV and hepatitis from blood products. Testing of all donations for HIV was also introduced in 1985. Testing for hepatitis C was introduced in 1991 when tests became available. The European directive is now in force. As of 2002, it sets standards of quality and safety for the collection, testing, processing and storage and distribution of human blood and blood components. We have a Community code for medicinal products which affects blood products such as clotting factors. On completion of manufacture, blood products are tested for compliance with specification by the manufacturer. All batches of blood products undergo independent testing by an EU official medicines control laboratory. We are in a different world entirely now from that of the 1970s and 80s.

NHS: Prebiotics

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 17th November 2010 Lords Chamber

[Baroness Masham of Ilton]

To ask Her Majesty’s Government what consideration they will give to using prebiotics to prevent Clostridium difficile in a clinical setting, with a view to improving patient experience and saving NHS resources.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

There is currently insufficient evidence to show that prebiotics offer benefits in a clinical setting to be able to make a general recommendation in relation to prevention of Clostridium difficile infection. Of course, we will keep this issue under review. However, it is important for all patients, including those who have contracted Clostridium difficile infection, to have a well-balanced diet.

[Baroness Masham of Ilton]

My Lords, I thank the noble Earl for that answer. Is he aware that C. difficile costs the country about £100 million a year and prebiotics are very cheap? Prebiotics are a food supplement that bypasses the stomach and goes into the gut and helps to keep a person fit, so that they may not get C. difficile. Does he agree that anything is worth trying with such a debilitating and dangerous condition?

[Earl Howe]

The noble Baroness is absolutely right, not for the first time, about the devastating incidence of C. difficile infection. More than 25,000 cases of C. difficile infection are reported annually and there remain significant variations in outcomes among organisations.

In principle, prebiotics should be beneficial, but there is in fact little good evidence to show that they work or that food can provide a prebiotic effect. There is likely to be considerable inter-patient variation in the gut flora response to prebiotics, which could be exacerbated by differences in diet. However, as I have already indicated, we will look closely at the issue.

NHS: Budget

Debate between Earl Howe and Baroness Masham of Ilton

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

The noble Baroness is quite right that patients who do not attend their appointments cost the NHS a great deal. How do we deal with the issue—I am sure that the previous Government wrestled with it, too—if we are to avoid charging patients for failing to turn up? I would resist the idea of charging because I do not think that it is a road down which we should be going in secondary or primary care. However, the ways in which we can encourage patients to turn up on time should attract greater focus in our efforts towards achieving efficiency.

[Baroness Masham of Ilton]

My Lords, will the Minister assure us that trained nurses, physiotherapists and occupational therapists will not be replaced by cheaper care assistants?

[Earl Howe]

My Lords, to ensure that the quality of NHS services continues to improve in a climate of constrained growth, we must achieve greater productivity, but that means designing services for better quality and value for money. It does not mean downgrading the quality of the services. It is for local NHS bodies to decide how services can best be delivered most efficiently. I would be very surprised if that kind of dilution of expertise formed a part of any such plans.

First Aid

Debate between Earl Howe and Baroness Masham of Ilton

Thursday 17th June 2010 Lords Chamber

[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.