Special Adviser Appointments

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 2nd October 2019 Lords Chamber

[Earl Howe]

My Lords, the 2010 Act, to which I referred, says that all appointments of special advisers must be approved by the Prime Minister and that the Prime Minister may terminate the contract by withdrawing his consent at any time. That is also made clear in the Ministerial Code.

[Lord Campbell-Savours (Lab)]

My Lords, paragraph 11 of the Code of Conduct for Special Advisers states:

“Any special adviser found to be disseminating inappropriate material will be subject to a disciplinary process”.


Can I ask the Minister about the process? What is the process that should have been applied, or that should be applied in these cases more generally?

[Earl Howe]

My Lords, the terms of employment for any special adviser, as I have said, are set in their model contract. They are bound by the Code of Conduct. The process will depend on the terms of that contract. Dominic Cummings is ultimately accountable to the Prime Minister for his conduct, as is the case for all special advisers.

Hong Kong Protests

Debate between Earl Howe and Lord Campbell-Savours

Tuesday 1st October 2019 Lords Chamber

[Earl Howe]

The noble Lord makes an extremely good point. We have been clear all along that we condemn utterly any violence at all. It is essential that any protests that occur are conducted peacefully and within the law, and that the response of the authorities is proportionate.

[Lord Campbell-Savours (Lab)]

Does the Minister not accept that any foreign interference will only make matters worse?

[Earl Howe]

There is a distinct risk of that, yes, my Lords.

Counter-Terrorism and Border Security Bill

Debate between Earl Howe and Lord Campbell-Savours

Committee: 3rd sitting (Hansard): House of Lords
Monday 12th November 2018 Lords Chamber

[Earl Howe]

Once again, I thank my noble friend for the amendment. As he will recall, in 2010 the Conservative-Liberal Democrat coalition decided to end the identity card scheme and the associated national identity register because it was expensive and represented a substantial erosion of civil liberties—and I have to tell him that this Government have no plans to revisit that decision. There are good reasons for that. We have not seen any evidence that a national identity number or database would offer greater protection against terrorism or greater control at the border. There is no evidence that it would have prevented the 2017 terrorist attacks in the UK, and it has not prevented the attacks in France and Belgium, where national identity registers are in place. If my noble friend’s concern relates to people entering this country from abroad, I simply say that the UK is not in the Schengen area: we retain full control of our border and can carry out the necessary checks on those entering the UK.

UK citizens’ biometric data that is already held is stored in different government databases for specific purposes, with strict rules on how they can be used and retained. We cannot foresee any benefits that would justify the expense of introducing a national identity number for everyone in the country linked to a centrally held database which, if it were biometric, would presumably hold the biometric data of all of us indefinitely—an idea which, as I mentioned earlier, Parliament has expressly rejected. Protecting the public and keeping citizens safe is a priority for the Government. We are making big investments to those ends. We believe that the investment that we are making in better security, better use of intelligence and cybersecurity is a more effective use of our resources.

[Lord Campbell-Savours]

The Minister referred to some terror attacks early on in his contribution. Would he accept that, if the United States Government had held DNA material at the time of 9/11, it would have been flagged up when those criminals embarked on the planes, which led to the disaster? If it had been flagged up, they would have been stopped from getting on the plane.

Defence Estate

Debate between Earl Howe and Lord Campbell-Savours

Monday 7th November 2016 Lords Chamber

[Earl Howe]

I am very grateful to the noble and learned Lord. Fort George is a site of historical importance to the Army; there is no question about that. It is home to the Black Watch, but it has many minus points. It is an isolated site; it is not good for retention for the Army; it is a long way from the training estate; and it costs £1.6 million a year to run. It is therefore on our disposals list, but we are clear that 3 Scots will relocate to an alternative location in Scotland. After all, the origins of 42 Regiment Foot, which is how Black Watch originated, were from the Tay. Although I cannot say that it will move back to the Tay, the fact that it is in Fort George is perhaps a product of history more than anything else. We will engage with the Scottish Government and the local authority to identify the most appropriate combination of development types to maximise the opportunity that Fort George presents. We now have time to engage with local authorities generally about how this is to be managed.

[Lord Campbell-Savours (Lab)]

My Lords, will Crichel Down issues apply in the case of selling off of much of the land? Also, in the case of sites contaminated by former MoD activity, will proper evaluation be made of the cost of decontamination to ensure that when they are ultimately sold, they are not sold at deflated prices? Are MoD officials—civil servants—well aware that the National Audit Office will pore over the sales at some stage in future?

[Earl Howe]

As to the last point, yes, we are all too well aware of that. We are anxious at all times to achieve best value for the taxpayer. Crichel Down considerations can and do arise where former owners come forward to claim title. Of course, due process is followed. It is being followed in the case of Southwick Park, for example, which I think was announced as one of our intended disposals in September.

Decontamination is also a live issue on many of the sites. There is no question of disguising contamination where it occurs: environmental assessments always have to be made and are done openly and transparently with potential purchasers.

Counter-Daesh: Quarterly Update

Debate between Earl Howe and Lord Campbell-Savours

Tuesday 24th May 2016 Lords Chamber

[Earl Howe]

The noble Lord makes a series of very good points. Only this morning, I was down in Shrivenham, at the international military religious leaders’ conference, where from 19 nations we have 40 representatives of mainly Muslim denominations, all of them Army, RAF or Navy officers, coming together to share experiences in this area. I attended a lecture on the very subject that the noble Lord mentions. I have personally visited mosques and spoken to imams, and there is no doubt that around the country the Government are engaging with Islamic religious leaders to ensure exactly the point that he makes: that where the Koran is preached, it is preached correctly and no fog of meaning surrounds the words that are bandied about.

[Lord Campbell-Savours (Lab)]

My Lords, following up that question, have Ministers had time to consider the reports in the press last weekend of concerns expressed by Sir Michael Wilshaw about illegal schools, often Islamic schools, operating here in the United Kingdom teaching in a way that promotes extremism? What action are the Government taking to sort out this problem, because these schools are often recruiting areas for people who end up with Daesh?

[Earl Howe]

The noble Lord makes a very good point. It is slightly outside my brief, as that is a Home Office matter, as he will appreciate. But I am aware that there is considerable concern across government about schools of the kind he mentioned, particularly unregistered schools, where a false ideology is being promoted. Again, I shall consult Home Office colleagues and, if I can give the noble Lord up-to-date information, I shall be happy to write to him.

Mental Health Services: Serving Military Personnel

Debate between Earl Howe and Lord Campbell-Savours

Thursday 14th January 2016 Lords Chamber

[Earl Howe]

The noble and gallant Lord raises a very important issue. I do not believe that there is any shortage of information available. Personnel are given briefings and advice on whom to contact if they think they need help. These are reinforced by publicity material such as posters and leaflets in all unit primary care centres. Information is also available online on the MoD’s area of the GOV.UK website. Similar guidance can be found on the NHS Choices pages. I believe that there has been a significant improvement in the provision of this kind of information in recent years.

[Lord Campbell-Savours (Lab)]

My Lords—

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[Lord Campbell-Savours]

My Lords, when many of our young men, who are little more than teenagers, are being hounded by public interest lawyers, the Iraq Historic Allegations Team and the Iraq fatalities investigation unit, is it fully appreciated that they may have been under intense pressure in combat—even in a state of panic and mental stress—when they have been involved in individual incidents? Is this not what happens when we send young men and women to war?

[Earl Howe]

My Lords, as someone who has returned to being a Defence Minister after a break of 20 years, there is no doubt in my mind that the Armed Forces have come a very long way in that time. They take the mental health of their personnel extremely seriously. As one would expect, the model adopted is one of best practice, prevention, early detection and the ready availability of evidence-based treatments. This applies not just during a deployment but pre-deployment and post-deployment as well.

Barts Health NHS Trust

Debate between Earl Howe and Lord Campbell-Savours

Thursday 19th March 2015 Lords Chamber

[Earl Howe]

It is precisely because we have wanted to confront the issue across the NHS that so much has been done following the report of Sir Robert Francis into Mid Staffordshire NHS Foundation Trust. All the recommendations flowing from that report should resonate with every part of the NHS. The recent work done by Sir Robert on whistleblowing can be put into the same category. There are lessons and messages for the NHS as a whole, and I believe that progress is being made, as it needs to be in particular quarters.

[Lord Campbell-Savours (Lab)]

My Lords, I declare an interest as a financial sponsor of research into cancer at St Bartholomew’s Hospital in central London. Can we be given an assurance that the work done at St Bartholomew’s is in no way under criticism in the Statement made by the Minister?

[Earl Howe]

The Statement related to Whipps Cross specifically, but the Trust Development Authority took the decision to place the entire trust into special measures. That was a slightly unusual step to take but I think that it reflected the concern that it felt about the management of the trust generally. However, the TDA also singled out some areas at Barts for particular praise. It is important to stress that patients will receive the good care that they have known about at Barts in the future.

Adult Social Care Contracts

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

My Lords, I make it clear that the personal details of would-be service users should not be put in the public domain. The purpose of this system is to develop a tailored care plan that best meets the person’s needs and does not undermine their well-being. Where this has been done well, it has resulted in good-quality care while also, as I said, providing value for money for the taxpayer. We would not wish to make provision for spot checks of local authorities by the CQC but, where there is clear evidence that a local authority’s commissioning practices are leading to poor-quality care—which they should not be—the Secretary of State can order the Care Quality Commission to carry out a special review.

[Lord Campbell-Savours (Lab)]

My Lords, the Minister will know that self-funders have been subsidising local authority places for decades. Have the Government measured what the impact of the increased cost on self-funders would be in the event that we were to go down the route suggested?

[Earl Howe]

My Lords, whatever system is chosen for commissioning care in a local authority, there has to be a fair system for setting fees. We expect local authorities to comply with their legal duties to sustain a high-quality market of providers in their area, and that involves paying fair fees. That is a matter for local determination. It has to be because, in seeking an open market, as we do, we are also aware that local market conditions have to be taken into account.

--- Later in debate ---

[Earl Howe]

I think that that would be premature. As I have said, we are developing statutory guidance for local authorities, as well as commissioning standards. We have no evidence to date that the process to which the noble Lord, Lord Laming, has drawn attention is leading to perverse results. If there is such evidence, we would be interested to hear about it. But until we are aware that there is a problem, I think that the noble Baroness’s suggestion is not timely.

[Lord Campbell-Savours]

My Lords, I go back to my original question. Will self-funders be further subsidising local authority auctioned places?

[Earl Howe]

My Lords, it is impossible to give generalisations. As I indicated, it will depend on what happens in a given local area. We know that it happens at the moment but, again, it is impossible for me to make a general statement about how much or how little it is happening across the country.

National Health Service: Hospital Beds

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 11th June 2014 Lords Chamber

[Earl Howe]

My noble friend makes the case very eloquently that it is very difficult to compare different health systems. We should pay credit to the NHS for performing very efficiently and effectively in the face of rising demand over recent years.

[Lord Campbell-Savours (Lab)]

My Lords, is there any linkage between hospital-acquired infections and the reduction in the number of beds?

[Earl Howe]

My Lords, no. By comparing the OECD bed-provision data and the 2011 joint prevalence survey, the available European data indicate that bed provision and healthcare-associated infection rates across countries are not correlated. Indeed, as I have said, we have seen a dramatic fall in the number of healthcare-associated infections in hospitals, combined with a rising level of demand for in-patient beds.

Abortion

Debate between Earl Howe and Lord Campbell-Savours

Thursday 3rd April 2014 Grand Committee

[Earl Howe]

That is not the case but, if my noble friend will forgive me, I will respond to that point in a letter. I can assure him that things have been done. It is not a case of these issues not being followed up.

[Lord Campbell-Savours]

Could we all see a copy of that letter?

[Earl Howe]

I shall copy all letters to all Peers who have spoken in the debate. My time is now running out but I know that concerns have been expressed, not least by the noble Lord, Lord Alton, about the way that foetal remains are sometimes disposed of. A recent investigation by the Channel 4 “Dispatches” programme examined this issue. The type of situations highlighted in the programme, where foetal remains were incinerated rather than buried or cremated in line with what the woman would have wanted, are totally unacceptable. Any such practices should cease immediately. A letter has gone to all trusts to make that point emphatically clear.

My noble friend Lady Bakewell asked about hospitals revealing the sex of the foetus at routine ultrasound scans. Disclosing the sex of a foetus is a local decision and should be based on clinical judgment about the certainty of the assessment and the individual circumstances of each case. It is not something that the Government can mandate from the centre.

My noble friend Lady Knight asked about the NHS not employing midwives who would not be willing to perform abortions. The Act allows professionals, including midwives, to opt out of participation in any treatment to which he or she has a conscientious objection. That conscientious objection should not be detrimental to the careers of health professionals. I think I am over my time.

NHS: NICE-appraised Medicines

Debate between Earl Howe and Lord Campbell-Savours

Thursday 27th February 2014 Lords Chamber

[Earl Howe]

The noble Lord asks a very important question. It is slightly wide of the Question on the Order Paper, which relates to a particular set of statistics. However, I can tell him that I am broadly satisfied with the level of funding for AHSNs, and NHS England has given its commitment to maintain its support for them going forward.

[Lord Campbell-Savours (Lab)]

If the appeal is to NHS England or the commissioning groups, does that mean that they have the right to overrule the decision that has been taken by NICE?

[Earl Howe]

My Lords, patients have a right under the NHS constitution to access clinically appropriate drugs and treatments recommended by NICE technology appraisals. That is a legal right. If a prescriber has failed to adhere to that, a clinical commissioning group is bound to find in the patient’s favour. However, there are clearly individual circumstances for each case that need to be looked at. The key is that the patient is entitled to expect a transparent and fair process where the reasons for a decision are published.

NHS: Clinical Commissioning Groups

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 27th November 2013 Lords Chamber

[Earl Howe]

My Lords, at present primary care is commissioned by NHS England and has three broad ingredients: primary medical care, primary pharmaceutical services and primary dental services. However, we are looking at ways of making the whole process of primary care commissioning more creative. That could well involve a joint process by NHS England and clinical commissioning groups.

[Lord Campbell-Savours (Lab)]

In light of what the Minister said before, are we being assured therefore that age and gender will not be given priority over gross health inequalities and needs in areas of social deprivation, such as in the north of England? If that is not the case, surely the principles on which the National Health Service was created are being undermined.

[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.

Health: Local Healthwatch Organisations

Debate between Earl Howe and Lord Campbell-Savours

Tuesday 5th November 2013 Lords Chamber

[Earl Howe]

That is potentially within their power, although it is for local Healthwatches which find themselves in that position to consult their commissioning local authority to make sure that the local authority is happy with whatever the proposals are.

[Lord Campbell-Savours (Lab)]

If they are to have a role with regard to complaints following the recommendations in the Clwyd report, will additional resources be provided?

[Earl Howe]

My Lords, we will be responding to the recommendations from the Clwyd/Hart review in the context of our response to the Francis inquiry, so there is a limit to what I can say today. In answer to the noble Lord, I think that the local Healthwatch has an important role to play as patient champion and it is right that individual local Healthwatch organisations have access to information about complaints so that they can spot the themes and trends that emerge from them.

Care Bill [HL]

Debate between Earl Howe and Lord Campbell-Savours

Monday 22nd July 2013 Lords Chamber

[Lord Campbell-Savours]

My Lords, I intervene briefly to ask the Minister a rather pedantic question. Subsections in Clause 35 all use the word “may”. There is no actual requirement for the Government to introduce regulations and therefore for local authorities to be placed in a position whereby they can charge. Why has it been left open, rather than using the word “shall”? If we could take the wording as meaning “shall”, can we assume that each further instance of the word “may”—that is to say:

“The regulations may specify costs … The regulations may require or permit adequate security…The authority may not charge interest under regulations…The regulations may make other provisions”—

is part of a whole package? Or, if “may” does mean “may”, might only individual parts of this clause be introduced, as opposed to the whole clause? For example, subsection (2) states that:

“The regulations may specify costs which are, or which are not, to be regarded as administrative costs for the purposes of subsection (1)(b)”.

If that particular part of the clause were not implemented, it would leave local authorities open to decide for themselves what the administrative costs could be. Whatever internal reasons they may have—and my noble friend Lord Lipsey referred earlier to the reluctance of local authorities—should local authorities have that ability to be flexible? I am seeking to establish whether, if this is all going to happen and we should read “shall” for “may”, all the subsections of Clause 35 will be implemented and that isolated subsections will not be introduced in the regulations. That might create difficulties that we are not foreseeing during the passage of the Bill.

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

I am grateful to the noble Lord, Lord Lipsey, for his amendments. He has a unique perspective, having first put forward the idea of deferred payments—as he reminded us—when a member of the 1999 royal commission. The Government share his disappointment that deferred payments are patchy and inconsistent across the country. Many people going into care face difficult decisions as a result, and authorities lose money when they offer a deferred payment because they cannot charge interest.

We also share the noble Lord’s commitment to ensuring that deferred payments work better in the future. We agree with the Dilnot commission that deferred payments should become a full and universal offer across the country for people who have to sell their homes to pay for residential care. We intend the scheme to be cost neutral to local authorities, as the commission also recommended.

We are proud to introduce this universal scheme from April 2015. It will provide much needed peace of mind to the 40,000 people who sell their homes each year to pay for care. As well as offering time to make decisions and choices over what happens to their home —a point well made by the noble Lord, Lord Lipsey—it will open up new options, such as renting it out.

In his amendments, the noble Lord raises important questions about implementation. These concern the interest rate, the use of a deferred payment to purchase insurance, support for authorities to implement deferred payments and the timetable. Before turning directly to those amendments, it may be helpful if I briefly outline our plans.

Clauses 34 and 35 contain the necessary powers for us to introduce deferred payments. All authorities will offer deferred payments and it is our intention that people at risk of selling their home to pay for residential care will qualify. They will be able to defer reasonable residential care and accommodation fees, in the care home of their choice, for the whole of their lifetime. We are currently consulting on more detailed proposals on who will qualify and what fees they can defer, and are gathering more evidence on the costs and practical issues involved with offering deferred payments.

One practical issue that we are exploring in our consultation is the possibility of situations in which the authority cannot secure its debt through a legal charge on the property. This is why the Bill provides for other forms of security, including third-party guarantees. The noble Lord, Lord Lipsey, expressed doubts about this provision and wondered whether the proposals in the Bill may put people off taking out a deferred payment plan. Our guiding principle here is that we want as many people as possible to benefit from deferred payments, but it is equally important that local authorities are able to secure their debt.

Traditionally, deferred payments have been secured by registering with the Land Registry a legal charge on the person’s land, but this might not always be possible or offer sufficient security to allow the authority to recover its costs. Examples of this might include when a charge cannot be secured by registration with the Land Registry or where there is reasonable doubt about the person’s ability to afford the care home of their choice over the longer term, but we are consulting on whether there are situations in which offering a deferred payment is particularly challenging and, if so, on what a constructive way forward might be. That might include use of a different form of guarantee such as a solicitor’s agreement or the involvement of a third party. It is important that the Bill contains this flexibility so that when we design deferred payments to accommodate all situations that might arise, individuals’ preferences about the type of security that they wish to offer can be built in. I hope that this will persuade the noble Lord to withdraw his amendment, at least for the time being.

These issues will, in turn, inform how we set the interest rate, which has to strike an important balance. The rate must be enough to help authorities cover their lending costs but be affordable to people going into residential care who are at risk of selling their home. I understand the intention of Amendment 92ZZW to fix the interest rate at a predictable level but, as the noble Lord, Lord Lipsey, might have sensed—the noble Lord, Lord Warner, may have alerted him to this—I am concerned that setting the rate in the Bill before we have finalised other aspects of the scheme is premature. We will announce the proposed interest rate following the consultation and decisions on the wider design of the scheme. This will be set out in the regulations that we will consult upon in 2014. It will be a nationally set, maximum interest rate and local authorities will not therefore be able to charge excessive rates.

I have tabled government Amendment 92ZZAA, which would introduce a new clause allowing authorities to make alternative arrangements for people who would not wish to have a deferred payment because of their religious objection to paying interest. I am grateful to the Islamic Bank of Britain for its help on this amendment. We will work with the bank over the summer to produce detailed proposals, and ensure deferred payments are available to such people.

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[Earl Howe]

We fully expect a range of views about how to implement the proposals that we have set out in the consultation document. However, what we do not anticipate is wholesale objections to the very idea of the proposals, because by and large they are widely accepted as being the right ones. We need to ensure that they are capable of being implemented in a practical way.

[Lord Campbell-Savours]

I am sorry to press the Minister, but the point is that some local authorities—let us say Westminster, Maidenhead and Windsor or Wandsworth—may want to raise the charges for administrative costs while other authorities might be more sensible and reasonable about what those costs are. There has to be national uniformity in that area, and we should be given assurances today that there will not be flexibility, which would invite differential administrative costs between local authorities and trouble for many people.

[Earl Howe]

I can reassure the noble Lord that we are aiming to have uniformity. Merely because one local authority may present us with some rather maverick objections, I do not think that I could possibly envisage us capitulating to that kind of pressure. We want to see a system where people, wherever they live in the country, can rely on some clearly set-out rules and can thereby have peace of mind if they take out a deferred payment scheme. I hope and sincerely believe that the noble Lord’s fears will prove groundless, but I am happy to clarify as much of that as I can, given that we have only just gone out to consultation, in the letter.

Care Bill [HL]

Debate between Earl Howe and Lord Campbell-Savours

Tuesday 16th July 2013 Lords Chamber

[Lord Campbell-Savours]

If someone is below the £70,000 figure and funding their own care, why would they bring in the local authority? What business is it of the local authority?

[Earl Howe]

My Lords, potentially, everyone in need of care and support may benefit from these reforms. We want to make it as widely known and as apparent as possible that planning is an important matter, whatever a person’s means. If I have misunderstood the noble Lord’s question, I will review that answer and write to him, but that is the main point.

I come back to the point I made earlier: this is just the beginning and it is why we will shortly be consulting on all these implementation issues. With those comments, I hope that my noble friend will feel able to withdraw his amendment and that other noble Lords will not press theirs.

Medical Litigation: Impact on Medical Innovation

Debate between Earl Howe and Lord Campbell-Savours

Monday 15th July 2013 Lords Chamber

[Earl Howe]

My Lords, naturally I share my noble friend’s concern about the level of litigation in the NHS. Having said that, I have seen no evidence that a particularly large or indeed significant element of that bill relates to medical innovation. We need to reflect that all treatments in routine use in the NHS today began as innovative treatments. We continue to support the introduction of new and innovative treatments in the NHS. I think that, if anything, doctors have more concerns about being reported to the General Medical Council than they do about being sued.

[Lord Campbell-Savours]

My Lords, is there not a danger that the requirement to publish the patient mortality rates of individual surgeons will act as a disincentive for surgeons to innovate and take risks in circumstances where patients themselves might want those surgeons to take a risk?

[Earl Howe]

There is indeed a danger that if the information that is published has not been carefully scrutinised to make sure that it is balanced and reflects faithfully the performance of the individual surgeon or the surgical team. I share the noble Lord’s concern that we should not just release information that has not been carefully examined in that sense, but there is a value, I suggest, to patients and clinicians themselves to have benchmarking metrics against which to judge performance.

Care Bill [HL]

Debate between Earl Howe and Lord Campbell-Savours

Tuesday 9th July 2013 Lords Chamber

[Lord Campbell-Savours]

Does that mean that a self-funder in a home would therefore know what the local authority rate was going to be? That is what I understand the noble Lord to have just said. The information would flow through, would it not?

[Earl Howe]

The point is that what the local authority pays will be transparent. Individuals can therefore make their own decisions in a much more informed way than they can, maybe, at present.

[Lord Campbell-Savours]

I am sorry to press the noble Earl. As I understand it, in many homes, self-funders are completely unaware of what the local authorities pay.

[Earl Howe]

Under the cap arrangement, there will be for all to see a notional rate that the local authority will pay for care. That is the rate at which the progress against the cap will be measured for a particular individual in a particular area. We are moving to a different system.

[Earl Howe]

Local authorities and individuals can pay different prices for care. That can be because individuals have consciously chosen premium facilities or because the local authority has negotiated a lower price in exchange for buying care for a larger number of people, which can often happen as well. As is the case now, local authorities and providers will continue to negotiate arrangements and fees for providing care and support. This process should ensure that contracts reflect the market price for providing care. Local authorities that fail to negotiate properly with providers and do not have regard to the actual cost risk legal challenges to the care fees that they set. However, in response to the noble Lord, Lord Campbell-Savours, I would say that in future the independent personal budget will set out the cost to the local authority. That is the transparency point that I was trying to get at earlier.

[Lord Campbell-Savours]

I am very sorry but the point is being missed and I think that my noble friend on the Front Bench tried to qualify it. Up to £75,000, the self-funder is paying the full whack. As I understand it, what is being said is that in the same home the local authority rate either will be or will not be available to the self-funder who is paying that full rate. All I want to know is: if they are paying under the £75,000 cap, will they know what the local authority rate is? That is what I am trying to find out.

[Earl Howe]

Yes, my Lords, they will know that.

Care Bill [HL]

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 3rd July 2013 Lords Chamber

[Lord Campbell-Savours]

On the question of the surveillance system that the Minister just referred to, what about the proposal that keeps coming up all the time of two unannounced visits per year for every care home within the United Kingdom? Why can that at least not be set down by the Government as a requirement, irrespective of all the other recommendations and decisions that the CQC comes to over its new so-called surveillance system?

[Earl Howe]

My Lords, it really is for the CQC to determine the frequency of its own inspections.

[Lord Campbell-Savours]

It will not work.

[Earl Howe]

It is not for Ministers to do that. I say that with great respect to the noble Lord. In saying that, however, I also highlight the ability of the CQC to flex its inspection frequency in accordance with information received. The noble Lord will know that organisations such as local Healthwatch, and indeed local authorities themselves, are able to alert the necessary authorities through Healthwatch England, which, as noble Lords know, is an integral part of the CQC, to any problems that may be flagged up. The CQC will be consulting in future on its proposals for care home inspections, and I do not doubt that a difference of view will emerge about the frequency of those inspections. I am the first to say how important it is that the inspections take place, and I totally take the point that those assessments should not be allowed to drift in any way. However, for better or worse we have an independent body known as the CQC, which should be allowed to act accordingly. The noble Lord, Lord Campbell-Savours, took us back to the 2008 Act. I would say to him that, in agreeing with the noble Baroness, Lady Howarth, Robert Francis was clear in his report that the system should not be significantly reorganised.

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[Earl Howe]

My Lords, I do agree with the spirit of this amendment. It is critical that care and support generally, and these reforms in particular, are fully funded. Without adequate funding, they will not deliver the benefits we all want to see. However, let me reassure noble Lords that we already have full procedures in place to ensure that there is proper funding for social care.

The first and very basic point is that the Government set spending plans for all areas of public expenditure at once during a spending review. This ensures that decisions can be taken about the future funding requirements of government as a whole, rather than assessing each part piecemeal. The noble Lord, Lord Sutherland, spoke about the review of priorities being a task of government. I agree, and that is exactly what spending rounds are designed to do.

Secondly, we have the new burdens doctrine in place, which requires that,

“all new burdens on local authorities must be properly assessed and fully funded”.

That ensures that all new funding pressures, including those that result from this Bill, are fully funded. I can tell the noble Lord, Lord Best, that our commitments are in line with the new burdens doctrine, the costs have been identified in the impact assessment, and the funding in the spending round will support local authorities to deliver on current and future commitments through to 2015-16. To answer the noble Lord, Lord Campbell-Savours, yes, the work has been done.

It is only right that the Government take spending decisions for all areas of public expenditure at once. This ensures that future spending plans are drawn up which are coherent and consistent across all public services. This is exactly the purpose of a spending round, the latest of which concluded last week, as noble Lords know, and set spending plans for 2015-16. Fundamentally, this settlement delivers the funding required to ensure that service levels in the care and support system can be protected and are able to deliver on all the commitments in this Bill.

However, with additional pressure on the system, we must ensure that the Government, the NHS, local government and care and support services are all working together to offer the best possible services for patients while also addressing the growing demand on the system that the noble Lord, Lord Best, rightly referred to. That is why we have announced in this year’s settlement a £3.8 billion pooled health and care budget to ensure that everyone gets a properly joined-up service, so that they get the care and support they need from whoever is best placed to deliver it, whether that is the NHS or the local authority.

In 2014-15, the NHS will transfer £1.1 billion to support social care with a health benefit. The pooled fund will include £2 billion more through the NHS in 2015-16. But this money will be given only on the basis that services are commissioned jointly and seamlessly between the local NHS and local councils. I hope that that helps to answer the question posed by the noble Lord, Lord Beecham.

[Lord Campbell-Savours]

Before the noble Earl moves on, perhaps he can answer this question. Is he saying that the statistics that were used in the report by the Committee on Public Service and Demographic Change were known to the department and were all taken into account, and that the calculations the department made were based on those statistics, which were well sourced, when the budget for these areas was decided upon by the Government?

[Earl Howe]

The statistics that the Government relied upon were official statistics and, I think, were exactly the same as the statistics used by the report to which the noble Lord referred. Of course, that report takes us forward 10 and 20 years. I am not pretending that the spending round has done that—it never does and I think it is safe to say that it never will. But we did look forward in a rigorous way to the pressures on the system in 2015-16 and based our assessment on the statistics that are officially issued.

As all plans will be jointly agreed by the NHS and local authorities in the pooling arrangements that I referred to, that in itself will provide a strong guarantee that the money is spent in a way that delivers on the priorities of health as well as of care and support. Not only will this fund help to deliver joined-up services, it provides the necessary funding for all the commitments and duties set out in this Bill, and the growth in demand from an ageing population and growing number of disabled people—I say in particular to the noble Lord, Lord Rix, and the noble Baroness, Lady Campbell. In particular, funding worth £335 million has been set aside for the introduction of the cap on care costs and the extension of deferred payment agreements.

Care Quality Commission: Morecambe Bay Hospitals

Debate between Earl Howe and Lord Campbell-Savours

Thursday 20th June 2013 Lords Chamber

[Earl Howe]

My noble friend raises a key issue, which successive Governments have wrestled with. We all know how life works. Whistleblowers are treated badly because their message is often very uncomfortable. That is why local Healthwatch could potentially be a very important part of the puzzle here, by ensuring that people have a place to go to that they can trust and that can raise concerns without necessarily naming the person who has initiated those concerns.

More and more, we need to encourage providers of care to take ownership of their performance. They have to be candid with themselves and accept criticism where it is laid. Boards of directors have to look systematically and regularly at the complaints made against them—whether rightly or wrongly—to make sure that they are as open as possible with themselves. Only by instilling a culture of that kind can we move forward.

[Lord Campbell-Savours]

My Lords—

NHS: Accident and Emergency Units

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 19th June 2013 Lords Chamber

[Lord Campbell-Savours]

To ask Her Majesty’s Government what assessment they have made of the impact of closures of Accident and Emergency units in Buckinghamshire on neighbouring hospitals; and how that compares with the impact of closures of Accident and Emergency units elsewhere in the country.

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

My Lords, we know that there have been increasing pressures in A&E across the country. In October 2012, a GP-led 24/7 minor injuries unit was introduced in Wycombe to deal with cuts, bruises, sprains and other minor injuries and illnesses. A modest increase in the number of patients going to neighbouring A&E units was expected as a result of local changes. Commissioners provided £4 million to these hospitals to address that increase.

[Lord Campbell-Savours]

My Lords, the minutes of the Heatherwood and Wexham Park National Health Service Trust disclose that the downgrading of A&E and medical emergency departments in neighbouring hospitals led to a fivefold increase in the number of people having to wait more than four hours—the national target—in Wexham Park A&E and a dramatic increase in the number of cancelled operations. Indeed, I am told that that number doubled. What is the point of making this national policy of closing these A&E departments when all it is doing is upsetting people all over the country and making them extremely angry?

[Earl Howe]

My Lords, I have to emphasise to the noble Lord that, although I understand his concerns in relation to Wexham Park and other hospitals, there is no government policy about the closure of A&E departments. The whole thrust of government policy since we were elected to office has been that there should be no top-down direction of this type of decision. Rather, we are clear that any changes to healthcare services should be locally led, clinically driven and involve the local population in a consultation. All patients have the right to high-quality urgent care at whatever time they use the health service. The key for local commissioners and decision-makers is to ensure that that happens. I am aware that the situation at Wexham Park has improved and money is being invested to ensure that there are enough beds for the future.

Autism

Debate between Earl Howe and Lord Campbell-Savours

Monday 17th June 2013 Lords Chamber

[Earl Howe]

I agree with the noble Baroness that the needs of those with autism in older age should not be forgotten. We will meet the National Autistic Society, following the publication next month of its report on autism and ageing, to see how we can support the taking forward of this work, which builds on that done by the autism and ageing commission in this House. We are also looking at the whole issue of the training of health professionals, in particular the core curricula for doctors, nurses and other clinicians.

[Lord Campbell-Savours]

Is there a connection between the MMR jab and autism?

[Earl Howe]

My Lords, no.

Care Bill [HL]

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 12th June 2013 Lords Chamber

[Lord Campbell-Savours]

My Lords, I will intervene only briefly, unlike yesterday when I went on at length on a couple of the amendments. My noble friend Lord Warner referred to the absence of a new force in town. I suspect that in some ways he is referring in part to the confusion referred to by my noble friend Lord Hunt. I will deal with paragraphs 60 and 61 of the Francis report, where two recommendations are made. Will the Minister, in his response to this debate, just tell us why the Government are refusing to implement those recommendations? I will not read those paragraphs in their entirety, but just the key points. The report states:

“The Secretary of State should consider transferring the functions of regulating governance of healthcare providers and the fitness of persons to be directors, governors or equivalent persons from Monitor to the Care Quality Commission. A merger of system regulatory functions between Monitor and the Care Quality Commission should be undertaken incrementally and after thorough planning”.

I would have thought that the Bill was the opportunity to do that. If that is the case, will the Minister tell us precisely what the objection is, and why we are not taking up that particular recommendation from the Francis report?

[Earl Howe]

My Lords, in addressing this complex and very important topic, I begin by thanking all noble Lords who have spoken in this debate, not least those who have introduced the amendments they have tabled. I welcome the opportunity to debate these clauses as they form a key part of our response to the issues raised by Robert Francis QC. They deal with difficult issues and I recognise the critical importance of getting this right. I particularly welcome the support of the noble Lord, Lord Hunt, for the principles, which I can assure him have governed the Government’s work in this area.

The intention of the changes we are making is to deliver a strong but flexible process for tackling quality failures to ensure that all NHS trusts adopt a rigorous approach to maintaining high quality care. I hope that noble Lords have had an opportunity to familiarise themselves with the document my department published, in collaboration with CQC, Monitor, the Trust Development Authority and NHS England, copies of which can be found in the Library. In my response to the amendments, it may help if I summarise the key elements of our proposals and why we feel that the approach we have taken is appropriate.

The Francis report made a strong case that the regulation of NHS trusts and foundation trusts needed to change so that greater emphasis is placed on addressing failures of quality. We agree. In future, roles within the regulatory system will be simpler and clearer. The Care Quality Commission will focus on assessing and reporting on quality, and Monitor and the NHS Trust Development Authority—the TDA—will be responsible for using their enforcement powers to address quality problems. To free up time to care, the overall regulatory burden on providers will be radically reduced. I remember that that concern was raised from the Benches opposite when I made a Statement to your Lordships on the Francis report. However, where there are failings in the quality of care, there will be a stronger response.

The CQC, through its new Chief Inspector of Hospitals, will become the authoritative voice on the quality of care provided. It will take the lead in developing a methodology for assessing the overall performance of organisations in meeting the needs of patients and the public. In doing so, the CQC will consult a range of bodies, including Monitor, the TDA and NHS England, to ensure that national organisations are working to a common definition of quality. The idea here is to arrive at, if I can put it this way, a single version of the truth: a single, national definition of quality that brings together information and intelligence from commissioners, regulators and local Healthwatch, as well as from the other bodies I mentioned. This new approach to assessment and inspection will form the basis of a new system of ratings to provide a fair, balanced and easy to understand assessment of how each provider is performing relative to its peers. It will also provide the basis for identifying where improvements are needed. We will, of course, debate the provisions on ratings later on.

The noble Lord, Lord Hunt, has tabled a number of amendments—Amendments 64A, 66ZB, 66ZD and 66ZF—relating to the consistency of CQC’s judgment. I understand the concern to ensure that there is transparency and consistency over how decisions to intervene are reached, but I am not sure that it can be defined through legislation. In part, it will be for the CQC, Monitor and the TDA to agree and set out in guidance—something, incidentally, they have all committed to doing. However, ultimately they must be matters of judgment rather than the tick-box mentality that allowed the failures uncovered in Mid Staffordshire to go unnoticed for so long.

Care Bill [HL]

Debate between Earl Howe and Lord Campbell-Savours

Monday 10th June 2013 Lords Chamber

[Lord Campbell-Savours]

Has anyone in the department ever sat down to work out the annual cost to the health service of paying for litigation defence and compensation to people who have made complaints successfully? What proportion of those complaints stem from failures on wards arising simply from a lack of training? Would that not be a useful exercise for the department? Although I know it is difficult to introduce this principle of candour, it might well be that if someone were to look at this and some honest assessments were made in hospitals, we might find out that a lot of it has to do with people simply not being trained properly.

[Earl Howe]

I agree with the noble Lord. It would be an interesting exercise. If I can glean relevant facts from the National Health Service Litigation Authority, which is the holder of the corpus of information in this area, I would be glad to share it with noble Lords. We do not dispute that skills are an issue. They clearly are. That is why we have instigated the Cavendish review, but it is important that we set about this in the right way.

The Secretary of State has clearly stated in his mandate to Health Education England that it should work with employers to improve the capability of healthcare assistants. That will include the standards of training that they receive. In developing a strategy and implementation plan to achieve this, Health Education England will build on the Cavendish review, when it is before us, and the work of Skills for Health and Skills for Care on minimum training standards for health and care support workers.

The Government accept that the arrangements for induction, training and performance management of this workforce vary between providers. We do not duck the importance of training and I want to stress that. The Cavendish review has been tasked with reviewing how the training and support of healthcare and care assistants can be strengthened so that they provide safe and compassionate care to all people using health and social care services. The noble Lord, Lord Patel, is right that Amendment 23A and whatever recommendations emerge from the Cavendish review may not necessarily be mutually exclusive. At the same time, it surely makes sense for the Government to look at all these issues in the round before pronouncing one way or the other on prescribing specific arrangements around certification, new criminal offences or whatever the case may be.

I hope the noble Baroness will agree that the Government should be afforded the time to consider any recommendations from the Cavendish review and the respective roles of employers, commissioners, regulators and other bodies before taking further steps. At the same time, I hope that she will feel reassured by what I have said today and that Health Education England and the Government have taken sufficient steps in committing to the training and development of this workforce, and that she will feel able to withdraw her amendment.

Care Bill [HL]

Debate between Earl Howe and Lord Campbell-Savours

Monday 10th June 2013 Lords Chamber

[Lord Campbell-Savours]

As a layman among all these very professional people, I raise a very simple point. Returning to the private care home paying workers something like £7 an hour, I presume that that care home, if it so wished, could use the LETB.

[Earl Howe]

No, that is not the case, because the LETB is only responsible for healthcare staff, not adult social care staff.

[Lord Campbell-Savours]

Perhaps that answers the question, but from the way in which the Bill is written I understood that it went wider than that and included care home staff. What about nursing homes? Nursing home workers are healthcare workers, are they not? I suppose that they are covered by both areas.

[Earl Howe]

My Lords, in so far as nursing homes are staffed by healthcare staff, those staff are certainly eligible to benefit from the education and training budget. Indeed, I should have clarified that in privately run care homes you might well find a nurse who is healthcare trained, and therefore is in a position to receive the benefit of the healthcare budget if they are an employee funded by the NHS.

[Lord Campbell-Savours]

Then let us take it to the next statement. What about the healthcare assistant working in a nursing home—in other words, in this particular sector, where I presume the LETB applies? Would that worker also be trainable under the system established under the Bill, or does that nursing home healthcare assistant also have access to other training facilities outside the provision being made here? In other words, does the employer have the option?

[Earl Howe]

My Lords, training can be delivered in a variety of ways. It can be delivered onsite and on the job within the healthcare or care setting. It can be delivered outside as part of a higher education course. Who funds that will depend on the status of the worker. If he or she is a healthcare worker, it is possible, as I said, that they are funded by the NHS. It is also possible that he or she is privately employed by the organisation concerned, and that organisation will therefore fund the course of education. So it depends. I suggest that in a care home it is more likely that the person would be designated as a care worker rather than a healthcare worker if they do not have a recognised qualification to their name. I do not think that there is any generic answer to the noble Lord’s question. I hope that I have been helpful in explaining the various situations that can arise.

--- Later in debate ---

[Lord Campbell-Savours]

I have one final question. How can a person placing a relative in a care home know that the standard of care provided in that home by presumably trained healthcare assistants will be of a similar standard to that available under the arrangements proposed in the Bill for those who work directly in the healthcare sector of the National Health Service?

[Earl Howe]

The answer is twofold. First, the Care Quality Commission inspects every care home to a uniform standard. One of its duties is to ensure that the staff in a care home are sufficiently capable and trained to deliver care in the right way to the patients and service users who live there, taking into account the acuity of need of those people. Secondly, as the noble Lord may be aware, the Government have proposed that a system of star ratings should be reintroduced for both healthcare settings and adult social care settings. In that way the general public may have a much closer and more detailed sense of the quality of care provided in the care home, as assessed by the Care Quality Commission. Again, this is work in progress. The Care Quality Commission is working out its methodologies for delivering those star ratings, but if we get this right, I believe it will take us several steps forward in transparency of quality and the ability of members of the public to choose, in a much more meaningful way, the setting that they wish to see either themselves or their families benefiting from.

--- Later in debate ---

[Earl Howe]

My Lords, I say straight away that I sympathise with the intention behind the noble Lords’ amendments. These two amendments seek to make an explicit statement about the Health Research Authority’s role in encouraging transparency in health and social care research findings and clinical trial results.

We are all keenly aware of how topical the issue of transparency in health research is. The House of Commons Science and Technology Select Committee is currently undertaking an inquiry into clinical trials. Last week I gave evidence to that committee along with my right honourable friend the Minister of State for Universities and Science. I look forward with interest to the committee’s report. As the noble Lord, Lord Turnberg, and the noble Baroness, Lady Wheeler, rightly pointed out, maintaining trust in research is crucial to its success, and the way in which we respond to the mounting calls for greater transparency has consequences for how the integrity of research conducted in this country is perceived not just on a national level but on the international stage.

However, in reaching answers to these pressing questions, we must be careful not to create perverse incentives that simply result in people choosing not to carry out research in the UK and invest elsewhere. Promoting transparency in research is a core part of facilitating the conduct of safe, ethical research. People enrol in trials because they want to contribute to medical knowledge and advances. In considering the ethics of research proposals, ethics committees have to be assured that any anticipated risks, burdens or intrusions will be minimised for the people taking part in research and will be justified by the expected benefits for participants, or for science and society. Knowing what research has already been undertaken or is under way and the results of that research is therefore essential in order to minimise risks and burdens by not repeating research that has already been conducted.

Here, I come to the answer to the question asked by the noble Lord, Lord Hunt, in debate on the previous group of amendments. Promoting transparency in research is inextricably part of facilitating the conduct of safe and ethical research, which is the Health Research Authority’s main objective in Clause 97(2)(b). As Dr Wisely, the Health Research Authority chief executive, said in evidence to the Joint Committee which scrutinised the draft Bill, promoting transparency is absolutely fundamental to protecting patients and the public in health research. As a special health authority, the Health Research Authority is already doing a number of things with regard to transparency in research. First, research ethics committees already consider an applicant’s proposals for the registration and publication of research, for dissemination of its findings, including to those who took part, and for making available any data or tissue collected as part of the research.

Secondly, since April 2013, the Health Research Authority has been undertaking checks of research ethics committee applicants’ end-of-study reports to see whether they registered and published research as they declared they would to the ethics committee. Thirdly, as noble Lords may be aware, the Health Research Authority recently published a position statement setting out its plans for promoting transparency in research. This statement has received widespread support from stakeholders, including the AllTrials campaign, the James Lind initiative, the Association of the British Pharmaceutical Industry and INVOLVE.

I turn specifically to Amendment 63, which would specify that one way in which the Health Research Authority, the bodies listed in Clause 98(1)—for example, the Human Tissue Authority—and the devolved Administrations would be able to fulfil their respective duties to co-operate would be through encouraging transparency in the reporting of clinical trials results. The intention behind these duties of co-operation is to encourage co-ordination and standardisation of practice so as to streamline regulation and remove duplication. The aim is that through these duties the people and bodies listed will work collaboratively with the Health Research Authority to create a unified approval process for research applications and to put in place consistent and proportionate standards for compliance and inspection. Streamlining the approval process for research will make initiating research faster for researchers, funders and sponsors, and ultimately enable people who use health and care services to benefit from research more quickly.

Noble Lords will be aware that clinical trials in this country are governed by EU law. The EU Commission’s current proposals for a new clinical trials regulation look likely to enshrine the principle of transparency in the rules governing clinical trials at every stage, including, as the current proposals set out, mandatory publication of clinical trials summaries, not only in their technical form but in a form that ordinary members of the public will understand. We believe that that is the right direction of travel.

Given the focus of these duties on streamlining the regulatory system that the HRA has, I hope that noble Lords understand why it is not necessary to make encouraging transparency in reporting clinical trials a fundamental part of co-ordinating and standardising the regulatory practices of the persons and bodies listed and the devolved authorities. I hope that noble Lords are reassured by the fact that promoting transparency is a core part of the Health Research Authority’s main objective in facilitating safe and ethical research.

The noble Baroness, Lady Wheeler, asked about discussions with the national advisory council on health improvement drugs. Perhaps I may write to her on that topic. I hope she will forgive me for not answering now.

The noble Lord, Lord Campbell-Savours, asked about the patient information leaflet that is now mandatory within packs of medicines. The risks that are set out typically on the patient information leaflets can be derived in several ways: first, from the original clinical trials data—the noble Lord is quite right about that—but also from any data that may have subsequently arisen from the reporting system that exists. Pharmacovigilance legislation, which came into force last year, now enables the Medicines and Health products Regulatory Authority to require pharmaceutical manufacturers to report safety and efficacy data where either concerns arise or where the evidence for a medicine was perhaps less than it might have been in the first instance. So transparency can be promoted in that sense as well. The noble Lord may already be aware that the MHRA regards its pharmacovigilance responsibilities extremely seriously.

[Lord Campbell-Savours]

Is the Minister therefore saying that, in the event that adverse effects arose during the course of the clinical trial, there is now a requirement that the risk factors, as set out in the leaflet to which he referred, will reflect those adverse effects?

[Earl Howe]

There is a requirement that the patient information leaflet should contain warnings about the possible adverse side-effects of the medicine. The noble Lord is quite right that data may well have arisen from the clinical trials, but also from the yellow card reporting system, as it is called, and any other data that emerge from across the world. The point is to ensure that the patient is properly informed. No medicine is risk-free. All medicines carry some kind of risk of a side-effect and one has to recognise that that is part and parcel of the benefit that we get from medicines. The benefit-risk equation has of course to be positive, but these things need to be kept under scrutiny.

[Lord Campbell-Savours]

The noble Earl said that it “may well reflect”, which is different from “shall reflect”.

[Earl Howe]

The MHRA, in granting a marketing authorisation to any medicine will have access to all the clinical trial data that the company has at its disposal. That is mandatory. Therefore, if the MHRA decides to issue a licence for a medicine, it will require that the full range of adverse effects is reflected in the patient information leaflet. The answer to the noble Lord’s question is yes, but he will not necessarily see a whole lot of technical data in the patient information leaflet. It will be translated into language that the ordinary patient can understand.

I believe that the Bill as drafted already gives the HRA a clear objective which requires it to take an active role in promoting transparency in research. I hope that I have given enough reassurance on these issues to all noble Lords to enable the proposers of Amendments 58 and 63 not to press them.

Care Bill [HL]

Debate between Earl Howe and Lord Campbell-Savours

Monday 10th June 2013 Lords Chamber

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

My Lords, integration between health and social care is a strong theme of the Bill, and the Government take it very seriously. I very much agreed with a great deal of what the noble Lord, Lord Warner, and others said on that topic.

First, to deliver integrated care, it is important that local planning is aligned and is mutually reinforcing. That applies also to the planning of education and training. As Members of the Committee are well aware, the future needs of the NHS and the public health and social care system will require a greater emphasis on community, primary and integrated health and social care than in the past. An understanding is required of working in cross-disciplinary teams and working to break down barriers between primary and secondary care.

The mandate the Government published a couple of weeks ago gave Health Education England a clear remit to ensure that it trains and develops a workforce with skills that are transferable between these different care settings. The amendment of the noble Lord, Lord Warner, seeks to amend Clause 85 to require HEE to have,

“regard to the promotion of integration with care and support provision”,

when it performs its duty under that clause of ensuring that there are sufficient skilled healthcare workers for the purposes of the health service. As the noble Lord is well aware, Clause 88, which lists the matters that Health Education England must have regard to in exercising its functions in Clauses 85 and 87, already includes a requirement at subsection (1)(h) that Health Education England must support,

“integration of health provision with health-related provision and care and support provision”.

Subsection (1)(i) requires Health Education England to support staff to be able to work across different settings. These provisions were added to the Bill at the recommendation of the Joint Committee following pre-legislative scrutiny. Although Health Education England does not have a direct remit for the social care workforce, it will be expected to work closely with the social care sector at local and national level to ensure that workforce plans align with the training and development of the healthcare and public health workforce.

To support the development of this integrated approach, Health Education England needs to work with partners across health and care to develop common standards and portable qualifications. This must make it easier for staff to work and move between settings and should build on existing work, such as skills passports and national minimum training standards. Health Education England will work closely with the sector skills councils, Skills for Health and Skills for Care, nationally and through the local education and training boards, to ensure that workforce development is co-ordinated and integrated.

[Lord Campbell-Savours]

Let us consider a private home in the social care sector that is owned by an individual who, let us say, has 10 healthcare assistants in that home. How will this new authority be able to ensure that those people are properly trained? My noble friend’s amendment at least tries to insert into the Bill wording that would in part have covered that. How will this new body be able to ensure that those assistants are getting the necessary training?

[Earl Howe]

The noble Lord’s question relates specifically to private sector organisations, such as care homes, and the broad answer to it is exactly as I have tried to outline. Health Education England will make it its business to ensure, by working with the sector skills councils in social care, that the training that healthcare assistants and care assistants receive is fully aligned and consistent, and that it can more and more ensure that people can transfer from one sector to another. The issue of continuing professional development for somebody who is already working in such a setting is, of course, a separate issue, and we will come on to debate continuing professional development. However, that is the broad answer. As the noble Lord rightly said in his earlier contribution, all this will be increasingly important as more health training shifts into the community and into social care settings. We will see delivery of this training in a variety of settings, not just in the public sector.

To answer a question posed by the noble Baroness, Lady Pitkeathley, about what HEE will be doing to support the needs of carers, Clause 89(2)(c) means that HEE must ensure that it obtains,

“advice on the exercise of its functions from … carers”.

I hope that that gives her reassurance that the role of carers will be every bit as much in the sights of HEE as its other duties.

There is a further plank to this structure, and it is one which was mentioned by the noble Baroness, Lady Wheeler, whose contribution I listened to with great respect and agreement. The Bill places a clear duty on local education and training boards to consult health and well-being boards on their education and training plans. As the vehicle for strengthened partnership working across health and the local government and public health sectors, health and well-being boards will be well placed to reflect local priorities that need to be supported through workforce education, training and development.

The importance of multidisciplinary training was highlighted in the Government’s mandate to Health Education England. Although it will always be necessary to deliver discrete training programmes for many professions, there will be an increasing need to deliver healthcare in multidisciplinary teams, and the delivery of training should reflect this. Where appropriate it should incorporate working in multiskilled teams reflecting care pathways, rather than exclusively professional or staff groupings.

I hope that, with those remarks, the noble Lord, Lord Warner, is reassured that the Government fully support the spirit of his amendment. I hope that he has also gained a sense that, more than simply the spirit, we are pursuing the letter of what everybody wants to see: a much greater degree of integration of training and education in these sectors.

--- Later in debate ---

[Earl Howe]

As a result of the Francis report, we are indeed looking at the whole question of the liability of employers in the NHS as much as anywhere else. No doubt we shall be debating those issues when we reach Part 2 of the Bill. However, I can reassure the noble Lord on that point. We have here a vital segment of our health and social care workforce. I hope that the noble Baroness, Lady Greengross—

[Lord Campbell-Savours]

I am sure the Minister will be very frank with the Committee. Is he aware of concerns being expressed about the operation of the vetting and barring scheme? Is he aware of any complaints?

[Earl Howe]

I am not aware of those concerns, and I apologise to the noble Lord as I meant to pick that up. I was slightly taken aback by his comment. Of course, I shall take advice on that point and I would be very happy to talk to the noble Lord outside the Committee on this matter. I have certainly not been made aware that that service is deficient in any material way, but that it operates effectively to protect patients and the public.

Does the noble Baroness, Lady Emerton, wish to intervene?

Medicine: Experimental Drugs

Debate between Earl Howe and Lord Campbell-Savours

Monday 10th June 2013 Lords Chamber

[Earl Howe]

I do agree. There are two reasons to press on with it: the first is the benefit to patients, as my noble friend rightly emphasises; and the other is the benefit to UK plc if we can get more investment in research in this country.

[Lord Campbell-Savours]

The Question refers to waiving the right to sue pharmaceutical companies. What is the Minister’s response to that?

[Earl Howe]

My Lords, there is no need to think in those terms. There are many routes by which patients can access medicines lawfully and maintain their legal rights. We want to make sure that ethics and patient protection continue to be at the forefront of drug development. It would be wrong to give an indication to drug companies that they can throw caution to the winds in that sense.

Health: Cancer

Debate between Earl Howe and Lord Campbell-Savours

Monday 20th May 2013 Lords Chamber

[Earl Howe]

My Lords, I agree that it is important to have more information on the effect of cancer treatments on mortality. New data collections which will provide more detail in this area are under way. The systemic anti-cancer therapy dataset will enable better information to be collected about deaths after the delivery of chemotherapy, and the cancer outcomes and services data set will provide information in respect of death after surgical treatment. However, it is important to make one point here: it can be hard to identify the precise cause or sequence of progression of factors resulting in death, particularly for those with end-stage cancer or who are particularly frail and are experiencing physical deterioration. I do not think that it can ever be a precise science.

[Lord Campbell-Savours]

My Lords, what about the circumstances where a person awaiting treatment in a congested cancer clinic is surrounded by patients who are coughing and spluttering? There will be consequential effects on immunity for those being treated. It may well be the drop in immunity that kills the patient, not necessarily the original cancer.

NHS: Private Companies

Debate between Earl Howe and Lord Campbell-Savours

Monday 11th February 2013 Lords Chamber

[Earl Howe]

My Lords, regional pay is already allowed for under Agenda for Change, and has been for a number of years. The Government do not intend to change that.

[Lord Campbell-Savours]

What about the living wage?

[Earl Howe]

I am not sure what the noble Lord’s question about the living wage implies. I answered a question about the minimum wage, which is what the law entails. It is of course up to employers to ensure that they pay their employees in a way that is not derisory and that reflects the value of the work that they do.

Social Care: Funding

Debate between Earl Howe and Lord Campbell-Savours

Monday 21st January 2013 Lords Chamber

[Earl Howe]

My Lords, as my noble friend is aware, the universal deferred payments scheme will be part of the Care and Support Bill. No doubt, we will debate those provisions when the Bill comes before us. I cannot tell her when that will be, but, clearly, they will be the subject of close scrutiny by the Joint Committee.

[Lord Campbell-Savours]

My Lords, is not one of the unfortunate effects of the Dilnot proposals that they protect inherited wealth at a time when the NHS needs money?

[Earl Howe]

My Lords, the main benefit of the Dilnot proposals is to protect people from unpredictable and catastrophic costs of long-term care. While the noble Lord could interpret the raising of the means test as a way of protecting the rich, I see the combination of the cap and the threshold as a way of giving greater certainty and predictability for all concerned, because none of us, whether we are rich or less rich, can know whether we will be subject to catastrophic care costs at a later stage in our lives. That is the inherent unfairness which Dilnot and the rest of the commission attempted to address.

NHS: Hospital Services

Debate between Earl Howe and Lord Campbell-Savours

Thursday 6th December 2012 Lords Chamber

[Earl Howe]

I agree with my noble friend and that is why work is currently being done under the leadership of Sir Bruce Keogh in the Department of Health to examine the scope for greater 24/7 working. She is right that this is important, not just for the benefit of patients but also to make the NHS more efficient and effective in deploying its staff and assets.

[Lord Campbell-Savours]

If services are carried forward as the noble Earl suggested, how does that influence estimates?

[Earl Howe]

We have reverted to the previous Question, if I am not mistaken. The departmental expenditure limit is set by the Treasury. My own department is in the fortunate position of knowing that it has real-terms increases every year of this Parliament; however, if the department has an underspend that cannot be carried forward, yes, some money has to be returned to the Treasury.

Care Homes

Debate between Earl Howe and Lord Campbell-Savours

Monday 28th May 2012 Lords Chamber

[Earl Howe]

My noble friend makes an excellent point. I expect he knows that in the selection process for nurse training, greater emphasis is now placed on the applicant’s suitability as a person to undertake caring duties. As regards healthcare assistants who may not be qualified, it is of course up to the employing organisation to make checks of that kind. We believe that to be a variable practice. We need to focus on that issue more than ever.

[Lord Campbell-Savours]

My Lords, why does the Minister not reply directly to the question of my noble friend Lady Bakewell? What, in principle, is wrong with a “fit and proper person” test to apply in these cases?

[Earl Howe]

My Lords, as I made clear earlier, there is already a test for those people who are in charge of a care home. The CQC has procedures to verify the acceptable status of such people. Furthermore, there are very strict rules under the Financial Services Authority regulations, which require company directors to pass a “fit and proper person” test. We are not sure what added value might be conveyed by a further test, as the tests are already there.

Health Transition Risk Register

Debate between Earl Howe and Lord Campbell-Savours

Thursday 10th May 2012 Lords Chamber

[Earl Howe]

If you talk to any Permanent Secretary in any department I guarantee that they would take issue with the noble and right reverend Lord on his final point. It is firmly the view of departments across government that if civil servants believe that what they say will reach the public domain immediately, they will not wish to embarrass either themselves or their Ministers by expressing their concerns in graphic language. I understand the noble and right reverend Lord’s point, but I disagree with it for that reason.

He made a distinction between certain parts of the risk register—between the nature of the risks described, their ratings and so on. He was perfectly right to make that distinction. We reviewed the content of the transition risk register following the tribunal’s decision and decided that it would be possible to publish material taken from the register to inform both Houses, and members of the public, about as much of the content of the register as we could. That is why the document that we published on Tuesday, which I commend to the noble and right reverend Lord, included key information relating to the risk areas in the register, an explanation of why we considered that to be a material factor, and the actions taken to mitigate those risk areas. We were as candid as we could be, given the decision of principle that I outlined.

[Lord Campbell-Savours]

My Lords, perhaps I may take a stage further the point of the noble and right reverend Lord, Lord Harries. Is there not a converse argument that where civil servants feel strongly, one way or another, about whether there is a risk inherent in a policy initiative, there should be a mechanism whereby that view can enter the public domain so that the public should be informed of strong divisions of opinion, even between civil servants? Is not the risk register on this Bill precisely one of those areas where strong views may have prevailed?

[Earl Howe]

The noble Lord may correct me, but he seems to be advocating a world where all disagreements in private between civil servants become public property. With respect, I disagree with that point of view, which would be the consequence of his position. Section 35 of the Freedom of Information Act explicitly allows for those disagreements to be kept private. There is no doubt about that. Both the Information Commissioner and the tribunal agreed that Section 35 was engaged in this instance, and was there for a reason.

There are several other reasons why we felt that there was a need to withhold information. The need for candour was one. I referred to the risk that publication of the content of the risk register would distort rather than enhance public debate. Another reason was that disclosure could in some instances—including in this case—increase the likelihood of some of the risks happening. Some risks in the register were theoretical rather than real. If people had thought that the risk was real, they might have taken action that would have made the risk a self-fulfilling prophecy. Nobody wanted that.

Health and Social Care Act 2012

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 25th April 2012 Lords Chamber

[Earl Howe]

My Lords, the plan is to conduct the post-legislative scrutiny three years from Royal Assent, so it will no doubt fall immediately prior to what one assumes will be the date of the next general election.

[Lord Campbell-Savours]

By whom is this post-legislative scrutiny on a five-year basis being conducted?

[Earl Howe]

My Lords, it will be conducted by the Health Select Committee of another place. The process is that the Department of Health will submit a memorandum to the Health Select Committee and that memorandum will include a preliminary assessment of how the Act has worked out in practice relative to the objectives and benchmarks identified during the passage of the Bill.

Health and Social Care Bill

Debate between Earl Howe and Lord Campbell-Savours

Monday 12th March 2012 Lords Chamber

[Earl Howe]

I am grateful to my noble friend because I do not believe that there were any. The Opposition sometimes point to the risk register relating to the third runway at Heathrow, but the key difference with that was that it was to do with policy implementation rather than policy formulation. Once you know what you want to do, there are risks associated with rolling a policy out. It is a very different matter when civil servants wish to have safe space to think the unthinkable and then advise Ministers.

[Lord Campbell-Savours]

Does the Minister intend to delay the Third Reading of the Bill?

[Earl Howe]

We have a Motion before us in the name of the noble Lord, Lord Owen. That question will be addressed then.

Health and Social Care Bill

Debate between Earl Howe and Lord Campbell-Savours

Thursday 8th March 2012 Lords Chamber

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

My Lords, this has been a good and constructive debate on NHS foundation trusts. It is right that we should focus on the removal of the private patient income cap, as I am acutely aware that that is where the majority of noble Lords’ concerns lie.

We need to focus on one core point at the outset. Fears have been expressed that removal of the cap could see foundation trusts increasing private income at the expense of NHS patients—in other words, that it could create a two-tier NHS, with those who can afford to pay going to the front of the queue. That is wrong and, I believe, alarmist. There are robust safeguards in place to prevent that kind of outcome.

Allowing a foundation trust to generate more private income does not release it from its prime duty to its NHS patients. Foundation trusts will still have to meet their legally binding contractual obligations on waiting times and provide the highest standards of care for NHS patients. Foundation trusts themselves are very clear about that. Removing the private patient income cap would allow them to bring extra investment in infrastructure and leading-edge technology to benefit NHS patients. Today, foundation trusts can be prevented by the cap from treating private patients who wish to be treated at the trust even when the income that the trust would earn would support its NHS services. The point made by the noble Baroness, Lady Finlay, was absolutely spot on. The cap leads to the ridiculous situation where NHS consultants are forced to get into their cars to drive to independent providers to perform private patient work in their non-contracted hours. Removing the cap would improve clinical safety for all patients in NHS hospitals, because doctors would be more likely to remain on site for longer.

It may well be, as the noble Baroness, Lady Murphy, pointed out, that most foundation trusts will not be affected at all by the removal of the cap. Many of them are earning below their caps at the moment. It is worth noting that NHS trusts, as distinct from NHS foundation trusts, which are not subject to a cap at all, are not earning proportionately more than corresponding foundation trusts. The point is that removing the cap gives the most innovative organisations the opportunity to boost income for NHS services.

I can also assure the House that we have put in place substantial safeguards to protect NHS patients. NHS foundation trusts will remain first and foremost NHS providers. Their principal legal purpose, to treat NHS patients, has been in legislation since 2003. I tabled an amendment in Committee to clarify its legal meaning. A foundation trust’s principal purpose requires it to earn the majority of its income from the NHS. That is very different from saying that 49 per cent of the work of foundation trusts will be with private patients, as some have misinterpreted it. The Bill does not mention 49 per cent, as I hope the noble Baroness is aware. Amendment 220A would remove the clause. That would be most unfortunate, because its effect would be to leave governors and local communities unclear that foundation trusts must remain predominately NHS providers.

There have been worries that the internal governance of foundation trusts will not be strong enough to exercise the requisite control in that area. I hope that I can provide reassurance on that point. As the local community's representatives, it is the responsibility of the governors to hold the board to account for its management of the trust. The governors should also consider whether the level of private activity is in the best interests of their organisation. The Bill will ensure that governors are better able to do that. It strengthens their arm by giving them new powers to hold directors to account and, if necessary, to remove the chair and non-executives of the board of directors. It would be entirely appropriate for the governors to use these powers if they felt that non-NHS activity was not operating in the interests of NHS patients.

At this stage, I should like to thank my noble friend Lord Clement-Jones for setting out a very persuasive case for adding to governors’ powers to oversee a foundation trust’s private income. I have tabled an amendment, which I hope will address his concerns, requiring directors to detail in the trust’s annual plan—that is, the forward look—any proposals to earn private income and the income that they expect to receive. By law, directors already have to take into account governors’ views in preparing this plan, but this amendment would place an explicit duty on governors to consider the plan and be satisfied that any proposals to increase private income would not significantly interfere with their foundation trust’s principal legal purpose to treat NHS patients.

With regard to the point raised by the noble Lord, Lord Campbell-Savours, a plan to increase private income substantially—that is, to increase by 5 percentage points or more the proportion of total income earned from non-NHS activity—must secure agreement by a majority of governors in a vote. For example, governors would be required to vote where a foundation trust planned an increase in non-NHS income from 2 per cent to 7 per cent or more of its total income, or from 3 per cent to 8 per cent or more. To make it quite clear, the vote would be triggered by plans for large increases in non-NHS income. Other matters, such as significant transactions, are for foundation trusts to decide. These proposals would complement the amendment that we introduced in Committee to require directors to explain in a foundation trust’s annual report how private income had benefited NHS patients.

[Lord Campbell-Savours]

We all know of cases where in the real world GPs have said to their patients, “Go private and go early. Effectively, jump the queue”. That is going on all over the country and in certain parts it is happening on a great scale. If that is the case, what is to stop GPs working with governors and consultants to try to move patient activity more towards the development of private operations within National Health Service facilities? Will the impetus not come from GPs working in conjunction with consultants and governors who might be sympathetic to the cause?

[Earl Howe]

With respect to the noble Lord, perhaps I may point to a later group of amendments in the name of my noble friend Lord Phillips, which gets to the heart of that question. I do not think that the noble Lord’s question is directly related to the private patient income cap but, if I may, I should like to cover the answer to it when we reach the later group.

Health and Social Care Bill

Debate between Earl Howe and Lord Campbell-Savours

Tuesday 28th February 2012 Lords Chamber

[Earl Howe]

My Lords, I completely agree with my noble friend. I feel that the debate and discussions that we have had in your Lordships’ House have made this a better Bill, as I said a moment ago. Again, a prime example of that is the clauses relating to ministerial accountability. With regard to the Royal Colleges, we have made all sorts of improvements, such as those in response to concerns about the integration of services, education and training, research, health inequalities, ensuring that competition is never an end in itself and a number of other important issues. I am glad that these changes were all welcomed by a wide range of Royal Colleges.

[Lord Campbell-Savours]

My Lords, in the light of what the Minister has just said, if I came to him over the next couple of days and handed him a document about the problems that it is felt will be experienced in specialist services, would he then deal with it before the completion of Report and let me have an answer?

[Earl Howe]

I would be happy to talk to the noble Lord about specialised services, and I speak as the Minister in charge of that policy area. If he would like to contact my office, I would be very glad to see him.

NHS: Management Consultants

Debate between Earl Howe and Lord Campbell-Savours

Monday 13th February 2012 Lords Chamber

[Lord Campbell-Savours]

Have civil servants been sharing information during the course of meetings with McKinsey people which McKinsey has been giving to its corporate clients? In other words, has McKinsey been discussing what has been going on in the formation of the Bill and the potential business benefits which arise from the Bill with its corporate clients? Have civil servants at any stage received any sponsorship for their travel or entertainment from McKinsey during the development of the Bill? Is it true that some meetings with civil servants and McKinsey have taken place at McKinsey headquarters in Jermyn Street in London? Does not that whole area of activity by McKinsey suggest that there is a conflict of interest which the public should know about at this stage in the development of the Bill?

[Earl Howe]

The noble Lord is, I think, insinuating some impropriety on the part of McKinsey and, perhaps, on the part of civil servants. I know of no such impropriety. Indeed, as I said earlier, there are clear and strict rules about transparency and openness. Declaring hospitality received is something that all civil servants and Ministers have to do. The results are published regularly. I will of course ask the question of McKinsey, which I have not yet had time to do. If I discover that there is any substance to the questions that the noble Lord has asked, I shall of course write to him and place a copy in the Library, but I very much doubt that I shall find any substance to them.

Health and Social Care Bill

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 7th December 2011 Lords Chamber

[Earl Howe]

Having anticipated that question before this debate, I made a point of asking but I am afraid that I do not have a definite answer to give the noble Baroness at this stage. As soon as I am able, I would be delighted to do so.

Our appeal is based on the belief that the commissioner has not given sufficient weight in his judgment to the considerations embodied in the relevant provisions of the relevant FOI Act. As the noble Lord, Lord Butler, made clear on 28 November, the ruling has serious implications across government in the precedent it sets for all risk registers.

[Lord Campbell-Savours]

The noble Earl said that he could not give us an idea of the timetable, but he does have something under his control: he has control of the timing of Report. He could say, “We will defer Report stage until the appeal result”. Why does he not just do that?

[Earl Howe]

The noble Lord knows that that is a matter for the House and the usual channels and not for me. However, I have no doubt that his suggestion will be registered in the appropriate places and will be considered. He must understand that it is not solely in my gift to order the business of this House.

I am of course acutely aware of the concerns of noble Lords on this issue. However, I would just ask those noble Lords who may at first blush be inclined to side with the noble Baroness in her amendment to recognise that there is room for an honestly held difference of view on this matter, that the principle involved is very important for the workings of government and that the Government have acted both properly and reasonably in asking the Information Tribunal to reconsider the merits of the case.

Health and Social Care Bill

Debate between Earl Howe and Lord Campbell-Savours

Monday 28th November 2011 Lords Chamber

[Baroness Thornton]

I thank the Minister for that statement, of which I did not have more than two minutes’ notice. It is very disappointing indeed. Basically, the noble Earl is saying that the Government are choosing what they do and do not disclose to the Committee on this matter. It is an issue of trust—whether or not we can trust that we will know what we need to know to make judgments about whether this Bill will work.

I thank the noble Earl for the issues that he has decided that the Government can let us know about, but of course I am therefore concerned about what the issues are that the Government have decided that we should not know about. What are the risks that we cannot know about? That is a matter of grave concern to the Committee.

I shall be looking in detail at the Minister’s statement to the House and I reserve the right to return to this matter if I feel that we need to. For example, during the last two days in Committee I put two direct questions to the Minister about whether certain matters—one concerning children—were on the risk register and what the register said about them. I have not received answers to either of those questions. I shall continue to put my questions in that context and I suggest that other noble Lords do the same.

I am very grateful for the Statement as far as it goes but I do not think that this is an end to the matter. I can see why the Government might think that there is a cross-government issue here. However, no other department is in the position in which we find ourselves here—that of discussing a Bill that is going through the House right now. We need full information on this matter in order to be able to make proper decisions but I believe that we still do not have that. Therefore, I thank the noble Earl so far as this goes but I reserve the right to return to the issue in due course.

[Lord Campbell-Savours]

Perhaps I may ask the Minister a question. He gave us a list of all the areas which he thought it was not possible for Parliament to scrutinise in some detail. Did the Information Commissioner have access to all the document headings to which the Minister has referred, and did he have the opportunity to read all the documentation under those headings? If the Information Commissioner did have access to information on, for example, the handling of the legislation as it goes through Parliament, why did he, throughout the whole report, repeatedly say that these matters should be placed in the public domain? Again, is it not clear that the Government are trying to hide something from Parliament? The Minister’s first reference was to the handling of the legislation by Parliament. Why should not Parliament see what considerations took place within the department concerning how legislation should be handled as it goes through this House?

[Earl Howe]

My Lords, my clear understanding is that the Information Commissioner had full access to the risk register so that he would be able to see for himself what it contained. I do not believe that anything material was withheld from him. The whole purpose of risk registers of this type is to record all risks, even the unthinkable and the highly unlikely actual risks, as well as potential risks—in other words, risks that may not arise in the future but which could be mitigated with action today. Such risk registers record mitigating actions so that the risks identified do not become a reality. In our clear view, exposing that kind of information could cause needless concern, set hares running and seriously undermine confidence in the programme of work. No Government of any persuasion have routinely made risk registers of this type public for the very reason that to do so would undermine open and frank discussion among policy-makers for fear that the policy would be made public before it was fully developed.

The department has published and discussed its proposals for reform at every stage of this process. It has debated them at length in both Houses. It has even released some detail about the associated risks and what it is doing to address these in impact assessments. Therefore, I firmly believe that the Committee has all the information that it needs to discuss the proposals in detail.

--- Later in debate ---

[Lord Campbell-Savours]

My Lords, I understand there is a precedent—a Department of Transport one. Therefore, there is a discretion and the Government are in a position on this occasion and not on a further one. I do not really see that that case is relevant.

[Earl Howe]

My Lords, I am very grateful to the noble Lord, Lord Butler, whose understanding of these matters is one that noble Lords will respect greatly. He is absolutely right—this is not an issue that solely affects the Department of Health: it affects all government departments. That is why the stance taken by the BMA to this Bill was not material in our decision. We regret that stance but it did not come into our thinking in any way.

On the question of precedent, I am aware that during the course of the last Government three separate recent requests were made to the Department of Health to release risk registers. All three requests were declined. I have the letter here that was sent when the right honourable Andy Burnham was Secretary of State, citing exactly the same kinds of reasons I have given.

I was asked how long the appeal would take. I do not know but my understanding is that the process should come to a conclusion reasonably early in the new year. I cannot be more definite than that because it is not up to us—it will be up to the tribunal to order its business as it sees fit. Will the Government accept the result? Clearly, we will have to take a view whatever the result; I cannot pre-empt the decision today. My noble friend Lady Williams asked whether we had considered releasing a redacted version—the decision before us was whether to comply with the Information Commissioner’s decision in full, or not to and appeal. We did not have the option of redaction but I am grateful to my noble friend for her suggestion, which I will take away and consider.

Health and Social Care Bill

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 16th November 2011 Lords Chamber

[Lord Campbell-Savours]

My Lords, I read the report the other day and it seems to me that the Government are refusing to publish because they have got something to hide. We want to read this document. The Information Commissioner’s report is a fascinating document which repeatedly, under a number of paragraph headings, states that the Government should publish this document and act in a transparent way in the public interest. That phrase is repeatedly referred to in the course of the document. It is quite incomprehensible that the Government should have taken this very silly decision—a sort of ostrich in the sand approach to these matters.

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

My Lords, I fully appreciate the strength of feeling that noble Lords have on this matter and I hope that the House will accept my assurance that I have no wish to be, or to appear, unnecessarily obstructive over the release of data which your Lordships may feel should be in the public domain.

However, I should bring the House up to date. The ruling of the Information Commissioner carries with it very significant implications, not only for my department but for every department across government. The risk register is a basic tool for the management of policy implementation. It is a working document which informs advice to Ministers. Publication of departmental risk registers, were this to become routine under the Freedom of Information Act, would fundamentally affect the day-to-day working of government. In this context we are of course looking carefully at the issue of precedent, and I am grateful to the noble Baroness for having raised this.

The Government, as a whole, must therefore consider whether or not to appeal the Information Commissioner’s ruling. Officially, we are allowed 28 days from the date of the ruling in which to do this. Consequently, I regret that I cannot make any specific commitment on these matters today. I emphasise that the Government’s wish to take some further time to consider the way forward is in no way an attempt to string this matter out in a needless or obstructive manner. We intend to act with maximum speed. If a decision is taken not to appeal the Information Commissioner’s ruling, we will proceed to comply with it immediately.

I hope, however, that noble Lords will understand the Government’s view that it is reasonable to allow time in which to take a decision on a matter that is both complex and important. Meanwhile, I am very willing to consider the noble Baroness’s constructive suggestion that I should examine whether there are any risks covered in the Department of Health risk register which have not already been placed in the public domain and which could be provided without further ado. I shall give a progress report to the House on these issues at the earliest opportunity.

Health and Social Care Bill

Debate between Earl Howe and Lord Campbell-Savours

Monday 7th November 2011 Lords Chamber

[Earl Howe]

I will come on to talk about GPs and primary care providers in a moment, if the noble Baroness will bear with me. I listened with great care—

[Lord Campbell-Savours]

Will this cover private contractors where they provide a service to the National Health Service? What would happen in a dual provision facility whereby, let us say, half the clients were private and the other half were from the National Health Service? Would this provision apply only to those who were in effect being funded by the National Health Service?

[Earl Howe]

Clearly, our concern is for NHS patients. We cannot legislate for private patients who may have completely different terms in the contract. However, the point is that if an independent provider comes forward as an accredited provider for the health service, we should subject that provider to exactly the same kinds of duties that apply to an NHS provider.

I was about to say that I listened with great care to the noble Lord, Lord Winston, and my noble friend Lord Lucas, who I thought spoke wise words in their respective speeches. We have made it clear that we think that services should be commissioned by those who are closest to patients and who best understand the needs of their patients—the clinicians. Therefore, we think it is right that the duty of candour is set out in the contracts that clinical commissioning groups will enter into with service providers. CCGs will be responsible for holding providers to account and therefore will in any case need to consider patient safety events in doing so. In future, the Secretary of State will ensure that this contractual duty is introduced consistently, as the Bill already contains powers for the Secretary of State to set standard contractual requirements where necessary using “standing rules” regulations under new Section 6E of the National Health Service Act, inserted by Clause 17.

The noble Baroness, Lady Masham, suggested that there was nothing in the Bill about patients. I confess that I am disappointed that she has come to that conclusion, as the Bill is all about creating a patient-centred health service—for example, through placing clinicians at the forefront of commissioning, strengthening patient involvement and ensuring that quality is at the heart of all that the NHS does. She suggested that if a duty of candour were in the contracts, perhaps all CQC standards should also be in the contracts. I disagree. A duty of candour is best suited to the contract because, first, the CQC has specifically stated that it is unable routinely to enforce such a duty, unlike the contents of its core standards. Secondly, the issue is very difficult to monitor effectively. Placing the duty closer to patients and clinicians maximises the chances of it working, and placing it in contracts does exactly that.

I would not want the noble Baroness to think that we have chosen the contracting route as in some way a lesser option, showing that this issue is not of importance to the Government. That is absolutely not the case. We propose a contractual duty of candour because we feel strongly that it has the best chance of working. If I may say so, I believe that the noble Baroness has been rather too quick to dismiss the Government’s proposals, which, I say again, represent a considerable advance on the current position.

It has been pointed out that the contractual duty will apply only to providers with an NHS contract and that GPs, for example, without a standard contract will not be covered. We have explicitly acknowledged that primary care contractors will not be covered under the current proposals for a requirement in the NHS standard contract, and we have asked for views on this as part of the ongoing consultation. We recognise that we should aim for an holistic system that applies to every provider of NHS-funded services, but we still need to consider what legislative and contractual changes will work best within primary care.

It should also be remembered more widely that the policy of openness still applies to all NHS services, regardless of the existence of any contractual requirement. For example, primary medical services contractors must have regard to the NHS constitution, the professional codes of conduct and any guidance issued by PCTs or the Secretary of State. Once they are registered with the CQC, a failure to be open with patients will contravene clear expectations set out in CQC guidance. Therefore, not including a requirement in primary care contracts now does not provide a reason for primary care contractors to avoid telling their patients about things going wrong with their healthcare.

--- Later in debate ---

[Earl Howe]

That is exactly why I referred to the need for a culture of openness rather than encouraging a situation in which we simply try to catch people out when they are not open. The amendment tabled by the noble Baroness looks to me like yet another way for people to get into trouble, rather than a way in which an organisation can take ownership of things that go wrong, encourage openness and look in-house to put things right. That is my fear about the amendment.

The noble Baroness, Lady Hollins, asked whether the consultation that we are undertaking covers whistleblowing. No, the consultation is focused on the duty of candour; whistleblowing is a separate, but linked, issue. Since coming to office, we have, as she may know, taken a number of important steps to promote it in NHS settings.

The noble Baroness, Lady Morgan, asked about the timing of the consultation response. She is right to say that the consultation finishes on 2 January. The government response will follow in due time after that. Unfortunately, I cannot be more specific. I shall be happy to write all noble Lords upon publication of the government response and I encourage noble Lords to take part in the consultation before it closes.

My noble friends Lord Mawhinney and Lady Williams referred to mediation. I take their point. They will know that mediation can mean a number of different things. As part of the proposed contractual requirement, we suggest that providers will have to offer an apology and an explanation and provide further information as appropriate, all in person with the patient, their representative, the relevant clinicians and other hospital or trust representatives as appropriate. That might well involve a mediator. I am all for mediation if legal fees and all the expense and heartache that goes with them can be avoided.

[Lord Campbell-Savours]

Following up on what the noble Lord, Lord Walton, said in his intervention about professional bodies, why can we not build into consumer law a requirement on private providers to provide a contractual obligation to their private customers?

[Earl Howe]

My Lords, unfortunately, I am not an expert in consumer law. My noble friend Lord Marks might be able to enlighten us on this, but there are, of course, consumer protection laws, which every organisation has to abide by, as provided for in the Consumer Protection Act. I think there are probably consumer protection aspects to contracts relating to healthcare services, but we have to tailor the contracts to ensure that we cover the issues that healthcare gives rise to.

The noble Lord, Lord Warner, asked me about the NHS Redress Act and whether the provisions of that Act were capable of taking forward some of the issues raised in the debate. I understand why he has asked that question, but there is a difference between redress for negligence and openness and it is important to distinguish between the two. As such, some of the issues raised this afternoon fall into the remit of redress and associated legislation rather than being specifically linked to a duty of candour. However, I note that, notwithstanding the long hours that we spent debating the NHS Redress Bill some years ago, the previous Government chose never to bring it into force; it is potentially on the statute book, but it is not in operation.

I shall reflect carefully on the points made in this debate. I hope that I have in some way reassured the noble Baroness, Lady Masham, that we are putting systems in place to introduce the duty of candour. To answer my noble friend Lord Mawhinney, we have a strategy. There are good reasons for the contractual route that we have chosen as well as a real potential downside if we were to go down the statutory route proposed here. So against that background, I hope that the noble Baroness will feel able to withdraw her amendment.

Hospitals and Care Homes: Hydration

Debate between Earl Howe and Lord Campbell-Savours

Monday 7th November 2011 Lords Chamber

[Earl Howe]

I think that my noble friend asked about the period of time after an inspection. The CQC has flexibility depending on what it finds. As my noble friend will know, there is a whole succession of increasingly strong measures that it can take, depending on the concern. It can mandate immediate action to be taken, and in those circumstances it will return, typically, for a further inspection within a fairly short space of time to ascertain whether the action has been carried out.

[Lord Campbell-Savours]

Is not this hands-off attitude to dealing with this matter costing the health service a fortune on urinary tract infections?

[Earl Howe]

My Lords, the noble Lord is right to express concern about urinary tract infections. There is a programme of work designed to bear down on that, as there is for hospital-acquired infections generally. He is absolutely right to raise that concern, which has a direct bearing on the Question on the Order Paper and the need for proper hydration at all times.

Southern Cross Care Homes

Debate between Earl Howe and Lord Campbell-Savours

Tuesday 12th July 2011 Lords Chamber

[Earl Howe]

My clear understanding is that many homes will continue in operation with the same staff, and that the residents of those homes will therefore not be required to move. We hope most earnestly that no resident of any Southern Cross care home will be required to move. I am not aware of the precise situation in the north-east of England, but my noble friend’s comments suggest to me that there is no undue cause for concern in that part of the country. The plan certainly would be, as far as possible, to maintain the residents in their current homes, and they should notice no difference in the quality of care that they are receiving.

To the extent that residents are required to move—and as I have said, we hope that that will not be necessary—yes, of course there will have to be a process of monitoring the welfare of those people in those circumstances. The duty to do that falls primarily on local authorities, where they are the commissioner of the care, but I have absolutely no doubt that the CQC will wish to add to that oversight. I believe that it is too soon to speculate—because we are not sufficiently far down the restructuring process—on the extent to which residents will be disrupted, but the number of homes that do not in the end prove viable as businesses will emerge in due course.

[Lord Campbell-Savours]

My Lords, first, I noticed that the noble Earl did not respond to the question asked by my noble friend on the publication of the names of the property companies that stand behind many of these homes. Will a special regime be introduced by the CQC of random unannounced visits for homes managed by property companies? It is important that we get an assurance that it will carry out random unannounced visits as against other forms of visits which are possible. Secondly, given that Regulation 13 of the CQC registration regulations 2009 requires a service provider to,

“take all reasonable steps to carry on the regulated activity in such a manner as to ensure the financial viability”,

of the operation, who then is going to monitor compliance with Regulation 13? Should we not now have—set and enshrined in some regulatory arrangement —some authority given the power to seek to secure compliance, or are we simply going to leave it to an offence, as the noble Earl has referred to in an Answer he has given to me, whereby no one is actually monitoring these matters?

[Earl Howe]

First of all, the CQC is an independent body; it is not under the jurisdiction of Ministers, and it must be free to organise itself as it sees fit. I cannot undertake on its behalf that it will perform random unannounced visits. It does, however, do that as a matter of course, and it generally does so on a risk-based basis so it would surprise me if, where the CQC saw that there was an enhanced risk to residents, it did not make it its business to perform inspections. Looking ahead into the medium term, should the Health and Social Care Bill pass through Parliament, as the Government propose, local HealthWatch will be in a position to enter and view care homes, as LINks are at the moment, but I believe that HealthWatch will be, in most areas at least, in a better position to undertake such inspections on a random basis.

The financial liability will of course not be the province of HealthWatch, but any concerns about the welfare of residents would be subject to the powers of HealthWatch to refer up to HealthWatch England, and in so doing, through HealthWatch England to the CQC. The financial viability of care homes is of course a live issue. I have commented on this in the past, and we are certainly considering whether Clause 57 of the Health and Social Care Bill could be used to extend the regulatory regime that we are proposing for the NHS to care homes. That is something that we will need to discuss because it would amount to a regulatory burden on care homes. Nevertheless, I do not belittle the issue. My ministerial colleagues in the Department for Business, Innovation and Skills are looking at the issue of private bodies that provide publicly funded services and whether there are implications in the sense that the noble Lord has indicated.

--- Later in debate ---

[Earl Howe]

My Lords, we are reverting to the question asked by the noble Lord, Lord Campbell-Savours. The CQC already has some duties to ensure that the care homes it registers are able financially to sustain their business, as well as simply providing a quality service. But this is clearly an issue that needs to be looked at. As I have mentioned, we are taking powers in the Health and Social Care Bill which potentially could see the care-home sector subject to the kind of financial regulation that we are applying to the NHS. This is a work in progress.

[Lord Campbell-Savours]

My Lords—

Abattoirs

Debate between Earl Howe and Lord Campbell-Savours

Monday 11th July 2011 Lords Chamber

[Earl Howe]

My Lords, smaller abattoirs are extremely important to the rural economy, as the noble Countess rightly says. They are more likely to be rural. The support to be provided to those abattoirs processing up to 5,000 cattle—a higher threshold than was previously proposed—is intended to help preserve the provision of local services to the livestock industry. That will helpfully reduce the impact on small livestock producers, the rural economy, animal welfare and indeed consumer choice. As regards mobile abattoirs, I am not aware what initiatives are being undertaken, although I believe that there are a few around, so it will be necessary for me to seek further advice on that point.

[Lord Campbell-Savours]

My Lords, was not this so-called risk-based approach used in the monitoring of care homes? Has that not been a disaster?

[Earl Howe]

No, my Lords, it has not been a disaster. It is sensible to look at accreditation and such devices to ensure that regulation is directed where it is most needed.

Southern Cross

Debate between Earl Howe and Lord Campbell-Savours

Thursday 16th June 2011 Lords Chamber

[Earl Howe]

My noble friend raises an important issue. As she knows, care providers have to be able to demonstrate to the Care Quality Commission that they have the financial resources needed to continue to provide services of the required quality. We have embarked on a wide-ranging programme of reform for social care. We are currently considering the Law Commission’s recommendations for modernising social care law and, as my noble friend mentioned, the report of the Commission on Funding of Care and Support is imminent. There are many lessons that have to be learnt from the events of recent weeks. We want to reflect on them as part of our wider reform agenda for social care.

On private equity finance, I simply make my own observation to my noble friend: I do not think that private equity finance is at the root of the problems that we have been seeing but the business model, which is rather a different issue. It was the choices and decisions made by the management of Southern Cross that made the business fundamentally unsustainable. I do not see that as a reflection directly on private equity providers. We have been clear that we were going to take action to ensure that there was proper oversight of the market in social care. That is why the Health and Social Care Bill specifically allows us to extend to social care, if we chose to do so, the proper financial regulatory regime that we are putting in place for the NHS. However, I suggest that regulation is not the only solution; we need to approach this in a measured way, not least because there are complex negotiations under way. We need to look at social care reform as a whole, which is exactly what we have committed to doing.

[Lord Campbell-Savours]

My Lords, on the question of the business model that the Minister just referred to, does not this whole sorry saga reveal how completely out of touch with the world of reality were the main board and executive directors of Three Delta, who advised the Qatar Investment Authority to spend billions buying property in the healthcare sector on the back of inflated and totally unrealistic rent levels paid by companies such as Southern Cross? Were the Qataris made aware of the huge risk involved? What were the so-called great and the good like Sir Peter Middleton, Nick Land, Sir Christopher Howes and David Mellor—a former government Minister—doing when any estate agent in the commercial property sector could have told them that the commercial care property market was both overgeared and overpriced?

Finally, will Messrs Scott, Murphy, Sizer and Colvin, formerly directors of Southern Cross, be prosecuted for insider dealing in Southern Cross shares when they privately promoted the sale of shares in the months immediately prior to their profits warning and collapse in the share price? Is this whole affair not riddled with greed and stupidity?

[Earl Howe]

My Lords, I fear that I am unable to answer the noble Lord’s questions, for which I apologise, but I understand why he has asked them. If I have some concise answers that I can send him, I will certainly do so by way of a letter.

I think that the noble Lord and I agree that we are looking at a fundamentally unsound business model. As I understand it, it is a unique business model in the care home sector, where a deliberate decision was taken for the company not to own its own care homes but rather to pay the rent on them. The market clearly moved against it in more than one sense. The company’s problems are partly attributable to the occupancy levels of some of their care homes. Southern Cross occupancy levels have gone down, I understand, more than those of other care homes. It is not about fee levels; other providers of residential care are not in the same position as Southern Cross. I believe that Southern Cross’s problems relate to the rental agreements—the leases—that they entered into. It is those things that the restructuring aims to fix.

--- Later in debate ---

[Earl Howe]

I am grateful to the noble Baroness, and I am also clear about the position of the noble Lord, Lord Beecham. She is of course right. Our first concern should be for the safety and welfare of residents. That is why, as I said earlier, some time ago we asked the Care Quality Commission to engage in close discussion with Southern Cross when the news of the impending redundancies was made public. We did that precisely to ensure that standards would not be compromised. My understanding is that there are no concerns on that front. Southern Cross has, in that sense, behaved impeccably in ensuring that residents have not suffered, other than from the inevitable uncertainty that the publicity over this matter has generated. Going forward, the principles that the noble Baroness has articulated are absolutely right. However, she would agree with me—as I think she did—that questions need to be asked about the financial models adopted by care homes or, indeed, by any independent business providing public services.

[Lord Campbell-Savours]

Were we not told after Jon Manel of the BBC's exposure of what was going on in care homes in 2008 that lessons would be learnt and that there would be a review; and was not an inquiry set up by the department at the request of the then Minister, the noble Baroness, Lady Thornton? Were we not given assurances that that would not happen again? Is not the reality that these reviews and statements about lessons to be learnt all end up in the long grass, because this area of care is basically out of control?

[Earl Howe]

I do not agree with the noble Lord that this area of care is out of control. The situation that arose at the time to which the noble Lord refers was of quite a different nature from the one we are looking at at the moment. As I recall, it was about the quality of care delivered in particular care homes. We now have the CQC, which is responsible for policing quality of care across the NHS and social care. The previous Government put that arrangement in place. We are content with it. We think that the arrangements are robust. The CQC does very good work.

Of course, with the best will in the world, mistakes occur. One can easily point the finger at the CQC. As I said, in the case of Winterbourne View, that would be an easy but unfair thing to do. All that the CQC can be expected to do is to take a snapshot at any given moment of what it sees and hears. When I say that lessons need to be learnt, I reiterate to the noble Lord, Lord Campbell-Savours, that my counterpart in the Department for Business, Innovation and Skills is considering the lessons to be learnt about the business models that apply not just to the care home sector but generically where public services are provided.

Care Homes

Debate between Earl Howe and Lord Campbell-Savours

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. That is entirely the aim of the modernisation programme for the NHS that we have laid out. It must be a much more patient-centred and user-centred service. As regards Southern Cross, we have said that there will be effective protection for the residents involved; no one will lose out. We are clear that we are putting the interests of residents first.

[Lord Campbell-Savours]

My Lords, does the Minister recall that, on the wind-up of CSCI—which he will recall because he was involved in the debate—we were given absolute assurances that the new successor body, the CQC, would target with random and unannounced visits all those care institutions in the United Kingdom where it was thought that people might be at risk? In so far as Southern Cross had a very bad track record and the CQC has failed to fulfil that promise, should not people at the top of the new body—the CQC—now consider their positions and, indeed, resign?

[Earl Howe]

My Lords, that is a rather harsh suggestion regarding Southern Cross. The noble Lord will know that care providers must demonstrate to the CQC that they have the financial resources needed to continue to provide services of the required quality. Clearly, there are lessons to be learnt from this episode with Southern Cross, which we all hope will resolve itself successfully. I am sure the CQC will take on board the lessons. From the briefing that I have had on the financial model that Southern Cross adopted, it is extraordinarily complex even for an expert to understand. We need to get that right. I know that my right honourable and honourable colleagues in the Department for Business, Innovation and Skills will be looking in general at business ownership and the issues surrounding that to see whether there are actions that we can take to prevent this kind of thing happening again.

Health: Obesity

Debate between Earl Howe and Lord Campbell-Savours

Monday 4th April 2011 Grand Committee

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

My Lords, I thank my noble friend for raising this important issue, about which he knows a very great deal. I value the insights that he was able to give us in his most informative introductory speech.

Obesity is one of our biggest public health challenges. In England, three-fifths of all adults and more than a quarter of children aged two to 10 are overweight or obese. The noble Baroness, Lady Thornton, reminded us of some other statistics in that connection.

Already, more teenagers and young adults are being diagnosed with type 2 diabetes. Experts tell us that if obesity stays at anywhere near its current high levels the health of the population will deteriorate dramatically in the years ahead. For instance, the National Heart Forum has predicted that, by 2050, the number of people getting diabetes because of their weight will nearly double and those with heart disease caused by obesity will rise by 44 per cent.

Our first thought has to be the human cost. Just as obesity cuts years from a person’s life, it also takes life from a person’s years. Statistics do not really convey the long-term effects of diabetes. They include limb amputations, long-term disability, chronic pain and heart disease, robbing people of their energy, their independence and their chances of a decent quality of life.

The other consideration is financial cost. Obesity already costs the NHS £4.2 billion. That figure is set to double by 2050. The prognosis is simple: make rapid progress or face a personal and financial catastrophe within a generation. As a country, we need to change our behaviour. The White Paper on public health sets out a new approach to improving people’s health that is locally centred, outcomes-driven and professionally led.

New local health and well-being boards will help to bring together the NHS and local government under a shared local strategy. The outcomes framework for public health will provide consistent measures to judge progress, and this includes two potential indicators covering obesity. Public Health England, a new, dedicated national public health service, will provide the resources, ideas and evidence to support local strategies. A specific obesity document will follow, setting out how the new system will work to reduce obesity levels.

However, as important as systems and structures may be, this is also about changing cultures. It is about encouraging greater personal responsibility. We have found that the state does not have all the answers, and the more the state intervenes, the more individual responsibility shrinks back. Rather than nannying people, we must nudge them, as the noble Lord, Lord Patel, reminded us, giving them the support and encouragement they need to look after their own health.

Although the noble Lord, Lord Patel, raised this subject, he expressed some doubts about its efficacy. I simply say to him that the Government cannot change people’s behaviour; what they can do is help people to change their behaviour themselves by encouraging them, rewarding them, making it easier and making it the norm. We can provide information to individuals to help them to make informed decisions about their health and we can provide encouragement, which we are already doing.

The noble Lord was doubtful whether the voluntary approach would work. I share his wish for an evidence-based evaluation of whatever we do. That is a core component of the responsibility deal and we are investing in it. However, as part of our new approach, we will consider what can be achieved through voluntary approaches before considering regulation. People’s lifestyle choices are affecting their health. The Government cannot address that challenge on their own. We believe that collective voluntary effort can deliver more progress and do so more quickly than regulation. Through the public health responsibility deal, we can tap into the unrealised potential of a wide range of resources that can promote healthier lifestyles and support people in achieving them. We have examples of working with industry, and this approach works. Change4Life is a recent example of how we have successfully worked with industry. We firmly believe that collective voluntary efforts can deliver real progress. The responsibility deal and deliverables arising from it have to deliver real improvements to public health, and we are looking at what independent monitoring or evaluation will be needed to that end.

While obesity often has complex social, psychological and cultural foundations, its basic cause is simple. My noble friend Lord McColl spoke about energy balance in its broadest sense. He is right: people become overweight because they take in more calories than is necessary and they do not burn off the excess calories that they do not need. I do not think that my noble friend was arguing against that proposition. It is a point clearly made in the NICE guidance on obesity and being overweight, and it is central to the Government’s approach. The NICE guidelines on obesity address the prevention, identification and management of obesity. They stress the importance of addressing both diet and energy out. The guidelines were based on the best available evidence that NICE had at its disposal at the time. However, my noble friend will be reassured to hear that NICE’s clinical guidelines are updated as required so that recommendations take into account important new information, and the obesity guideline is no exception to that.

My noble friend referred to the work of Professor Wilkin. The department is familiar with the EarlyBird diabetes study by Professor Wilkin. The study makes some useful points concerning the importance of early-life experiences for future health. It provides some useful messages on the importance of a child’s early years and the impact that this can have on the child’s future health and behaviour. However, this is one study which needs to be seen alongside other research with different findings on physical activity and weight.

My noble friend Lord McColl made very clear his emphasis on diet as the more important ingredient in weight loss. However, I think he would agree that any planned weight management programme should be tailored to the person’s preferences—their initial fitness, their health status in general and their lifestyle. The NICE guideline recognises that relatively high levels of activity may be required by certain individuals wishing to lose weight or maintain weight following weight loss. However, it also emphasises that, while an individual’s ability to be physically active may be hampered by their initial level of fitness or comorbidities, physical activity recommendations can be built up gradually, be focused on everyday activities, such as walking, and be accompanied by a reduction in sedentary behaviour. The guideline includes a raft of recommendations for clinical practice on dietary management.

Therefore, what is to be done? First, we need to give people the information and the opportunities so that people can choose to change their diet and lifestyle. A powerful way of doing this is through the Change4Life brand, which helps people to cut down on fatty and sugary foods and become more active. Another is working with industry to guide people towards healthier choices. The noble Lord, Lord Campbell-Savours, asked why we cannot ask restaurants and so on to place calorific content on menus. Through the responsibility deal, we now have 29 partners who are committed to posting calorific content on their menus in more than 4,000 restaurants. The noble Lord, Lord Patel, mentioned trans-fats, and my noble friend Lord Addington also referred to the fat content of food. They are both quite right. They will be pleased to hear that businesses have already committed themselves to removing artificial trans-fats from foods so that people can keep the tastes they enjoy without suffering such negative consequences. We shall continue to work with industry on other measures to help people to reduce their calorie intake, including reformulation. We will say more in the obesity document when it is published later this year.

A second issue is improving access to healthier food. In some areas, local shops simply do not stock healthier options. We are working with the Association of Convenience Stores to make fresh fruit and vegetables more available. The scheme has expanded incredibly quickly, with participating stores seeing a marked increase in the sale of fruit and vegetables. Of course, even if people have fresh produce, they still need to know what to do with it, so education is vital. There are many great local initiatives—involving the NHS, local authorities and a range of partners—which provide cookery schools and other local healthier eating initiatives.

The noble Baroness, Lady Thornton, spoke very eloquently about school food, and I agree with a lot of what she said. The Government are committed to ensuring that pupils can eat healthy, nutritious school food. We are supporting the School Food Trust in its work to help caterers to become more efficient while continuing to provide healthy meals. The schools budget will increase by £3.6 billion in cash terms by 2014-15—the end of the spending review period. Although the school lunch grant will not remain as a specific grant, it will be one of the grants that make up schools’ baseline funding from 2011-12. It will, however, no longer be ring-fenced; it will be for schools to decide how to spend the money.

We have not changed the current rules for free school meals. Therefore, some 900,000 pupils in the neediest families—those without work—continue to receive free meals. We took the difficult decision not to extend eligibility to low-income working families because the previous Government had underfunded this plan by £295 million. The money saved by not extending eligibility will be used more directly to improve the educational attainment of disadvantaged pupils, which is key to extending opportunities for poorer children. We are continuing to support three pilot projects of extended free school meals. We will look at the evidence from these of the costs and benefits of extending free school meals before making any future decisions on this front.

The noble Baroness, Lady Thornton, also mentioned advertising. As she knows, the television regulator, Ofcom, has placed scheduling restrictions on the broadcast advertising of food high in fat, salt and sugar during children’s programmes and programmes of particular appeal to children up to the age of 16. Since January 2009, these restrictions have applied to all channels. The Ofcom review in 2010 showed a 37 per cent reduction in the exposure of children to television HFSS advertising, with the highest reduction for children aged four to nine years, and a fall of 22 per cent in children—

[Lord Campbell-Savours]

Perhaps I may stop the noble Earl for a moment. In the first few moments of his speech he spelt out the scale of the crisis, yet almost all the measures that he has referred to are voluntary. They are based on an agreement with the industry or with this or that body. If that is not working—and it clearly is not, because the noble Earl himself set out the nature of the crisis—why, at an early stage, cannot we go down a more regulatory route?

[Earl Howe]

I hope that the Committee will allow me a little extra time in view of that intervention. The answer to the noble Lord, Lord Campbell-Savours, is that if voluntary measures do not work, we will indeed consider regulation. I need to make that clear. We have a ladder of intervention at our disposal. However, as I also emphasised to him earlier, we think that we can make progress faster by means of voluntary measures. The food labelling regulations, for example, are governed by EU law, and the noble Lord will know how long it takes to change EU law. If we can make progress more rapidly by voluntary measures in this country, I am sure that he would welcome that as everybody else would.

On the other side of the coin, although equally important, is physical activity—the calories we burn rather than consume. My noble friend Lord McColl made some strong statements on that aspect of the issue but, as my noble friend Lord Addington indicated, physical activity is important in the wider context of people’s health. The public messaging on this clearly has to be balanced. We are currently reviewing the Chief Medical Officer guidelines on recommended levels of physical activity and we hope to publish those in the summer. Incidentally, I am delighted that my noble friend Lord Addington has underlined the importance of diet and exercise because I still believe that the two should be emphasised.

Finally, we need to make sure that those who need it can get the specialist help to reduce and manage their weight effectively. Weight management providers will continue to play a key role in this area. I believe that through the new public health system, with the responsibility deal and Change4Life, we can truly make a difference over the next few years.

Health: Influenza Vaccination

Debate between Earl Howe and Lord Campbell-Savours

Thursday 20th January 2011 Lords Chamber

[Earl Howe]

I can reassure my noble friend that the advice that the JCVI gives is subject to regular review. Clearly, before the next flu season, it will be looking again at the experience of the current flu season.

[Lord Campbell-Savours]

What lessons have Ministers learnt from the management of the vaccine programme over the past six months? Is there anything that they may be prepared to do differently next year?

Health: Prostate Cancer

Debate between Earl Howe and Lord Campbell-Savours

Monday 19th July 2010 Lords Chamber

[Earl Howe]

My Lords, I am not aware that there is thought to be a significant shortage of urological surgeons or expertise around the country, although the coverage varies from region to region, as the noble Lord will know. However, I shall take his concerns back with me and make suitable inquiries. If I can write to him further, I shall certainly do so.

[Lord Campbell-Savours]

My Lords, why cannot we have a national PSA screening programme? Would that not help to avoid late diagnosis?

[Earl Howe]

My Lords, the noble Lord may know that the UK National Screening Committee examined this question recently. The matter is out for consultation, which will last until the end of September, when a conclusion will be reached.

Health: Spending Cuts

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 30th June 2010 Lords Chamber

[Earl Howe]

My Lords, as so often, my noble friend is right. Local authorities will have a major role to play in the prevention agenda, as will third sector organisations. I can tell her that we are having extensive discussions at the moment with many such organisations.

[Lord Campbell-Savours]

My Lords—

[Lord Ashley of Stoke]

I wonder if the Minister will also say that I am often right, like the previous speaker. He always says that the Government intend to improve the health service, but he says in the same breath that they intend to go ahead with cuts. How can this illogical stance be repeated time and again?

NHS: Budget

Debate between Earl Howe and Lord Campbell-Savours

Wednesday 23rd June 2010 Lords Chamber

[Lord Campbell-Savours]

To ask Her Majesty’s Government what assessment they have made of economies available within the National Health Service’s budget.

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

My Lords, the Government have guaranteed that health spending will increase in real terms in each year of the Parliament. However, it is clear that funding growth will be constrained and, in order to meet rapidly rising demands and to realise our ambitions for improved health outcomes, substantial improvements in economy and efficiency will be required across all areas of health spending. Full plans for delivering these improvements will be developed during the spending review.

[Lord Campbell-Savours]

My Lords, recognising the relationship between transparency and the economic use of resources, will the Government consider amending the National Health Service pharmaceutical regulations to require manufacturers of prescribed products and appliances to indicate on the label of the packaging the tariff price of a generic product or the manufacturer’s list price of a branded product? Can he refer this whole matter to the transparency unit that his Government have set up?

--- Later in debate ---

[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.

[Lord Campbell-Savours]

Would it not be quite wrong for the Department of Health to prejudge what the transparency unit might say on the price labelling of prescribed products?

[Earl Howe]

My Lords, I do not think that we have prejudged it because extensive work has already been done in the department. It found that if, for example, a medicine has a high price attached to it, people might be deterred from taking it because of their fear of being a burden on the NHS. Equally, if a medicine has a low price put on it, someone might wrongly perceive that the lower price was linked to lower quality. That is based on research. It is not simply civil servants reacting to an idea; there is a lot of work behind it.