Francis Report: Update and Response

Debate between Earl Howe and Lord Elystan-Morgan

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

My Lords, the role of the guardians will be primarily to provide advice to those who have concerns and feel that they are not being listened to. They will be able to report directly to trust chief executives on not just individual issues but on progress in general in stamping out any bullying that may be occurring, or the intimidation that Sir Robert says is all too common. I do not think that the creation of a freedom-to-speak-up guardian will in itself inhibit the process. Of course, we are open to views. If that concern is widely held, we will have to take it into account.

[Lord Elystan-Morgan (CB)]

Does the Minister agree that while of course it is right and proper that, in relation to whistleblowers, Sir Robert’s recommendations should be given every opportunity to see whether they succeed in removing this scourge from our society, the situation should be monitored and should it be the case that it is not possible to remove this disgraceful practice of victimising whistleblowers, stern, swingeing criminal sanctions should be considered if necessary? It is a drastic proposal, but the practice it would be designed to meet is disgraceful.

[Earl Howe]

I take full note of the noble Lord’s proposals. Clearly, we will wish to monitor the effectiveness of these new arrangements once they are in place. It will be open to the next Government to make a judgment on that score and, if necessary, to come forward with more stringent proposals that could indeed involve legislation with penalties attached.

Children: Obesity

Debate between Earl Howe and Lord Elystan-Morgan

Monday 20th October 2014 Lords Chamber

[Earl Howe]

My Lords, although physical activity can have a role in maintaining a healthy weight, the Government agree with my noble friend that its health benefits are nevertheless subsidiary in those who are obese to the need to eat and drink less. My noble friend may be interested to know that NICE is currently consulting on its draft public health guideline on maintaining a healthy weight and preventing obesity among children and adults. It currently expects to publish this guideline in February next year.

[Lord Elystan-Morgan (CB)]

My Lords, does the Minister accept that many of us are obese because we are the proud but inevitable products of heredity? Further, does he accept the splendid words of the Scottish author, Eric Linklater, who, speaking of a person of ample frame, said, “His outline spoke not of greed but of grandeur, not of gluttony but of the magnanimity of the human form”?

[Earl Howe]

There is, I am sure, no more elegant way of describing the issue under consideration at the moment. The noble Lord makes a very important point about heredity. I do not think that sufficient is understood about the role of our genetic make-up in the way in which we all differ in our weight and size. However, for those who are obese, there are clear, evidence-based actions that they can take to lose weight if they have a mind to do so.

Mental Health: Funding

Debate between Earl Howe and Lord Elystan-Morgan

Tuesday 18th March 2014 Lords Chamber

[Earl Howe]

My Lords, the principle of parity of esteem applies in every clinical setting, including prisons. We have made it very clear in our document Closing the Gap that these matters are not only important in the wider community but also in prison. We will be monitoring the situation very closely, not least in women’s prisons.

[Lord Elystan-Morgan (CB)]

My Lords, does the Minister accept that successive Governments have shown a remarkable lack of kindness in giving information concerning the apportionment of funds between physical and mental health matters? Does he accept that what is asked for is not a detailed breakdown under various headings, but a broad, ballpark figure that will allow the public to judge whether or not mental health has been less than equitably dealt with in this situation? The failure to give this information, which clearly must be shared by all departmental Ministers, will only add to that suspicion.

[Earl Howe]

My Lords, the Government are committed to the principle of transparency in these areas. I can tell the noble Lord that last month NHS England published expenditure data from its programme budgeting data set for 2012-13 which show that expenditure on mental health in that year was £11.28 billion.

Public Health Responsibility Deal

Debate between Earl Howe and Lord Elystan-Morgan

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My Lords, there are certainly no grounds for complacency on obesity levels throughout the nation. However, the current data do not support the claim by the National Obesity Forum. In 2007, the Foresight team projected that, based on data from 1993-2004, more than half the population could be obese by 2050 if no action is taken. An analysis based on recent data suggests a flatter trend than the one projected by the Foresight team. I do not agree that we should belittle the responsibility deal. It has many worthwhile achievements to its credit and they are being added to month by month.

[Lord Elystan-Morgan (CB)]

Although appreciating this scurrilous attack on rotundity, does the noble Earl recollect the immortal words of Shakespeare in “Julius Caesar”:

“Let me have men about me that are fat; … Yond Cassius has a lean and hungry look”.

Health: Talking Therapy

Debate between Earl Howe and Lord Elystan-Morgan

Tuesday 3rd December 2013 Lords Chamber

[Earl Howe]

I can tell the noble Lord that IAPT is working with a number of BME groups to promote wider access to the service from all sections of the community. A grant scheme will shortly be launched to encourage community-based interventions to increase uptake of talking therapies, including from BME groups.

[Lord Elystan-Morgan (CB)]

My Lords, will the Minister kindly tell the House roughly what percentage of in-patients and out-patients suffer from mental health problems compared with those who suffer from physical health problems? Can he say, roughly, how the resources of the NHS are divided between the two camps on a revenue basis? I have the clear impression that traditionally mental health has been short-changed for very many years.

[Earl Howe]

My Lords, the noble Lord’s perception would be shared by many, which is why we have been very clear in our mandate to NHS England that parity of esteem is of the essence, and we will hold the service to account for that. I do not have the specific statistics that the noble Lord seeks but we know that more people are being treated in secondary mental health services now than two or three years ago. However, the proportion who needed to be admitted to in-patient psychiatric care fell over that period, and that reflects increasing emphasis on care in the community.

Cigarette Packaging

Debate between Earl Howe and Lord Elystan-Morgan

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

I answered as I did because it is important for us not to get too bogged down in semantics. Did Mr Crosby speak to the Prime Minister about tobacco issues or did he not? The answer is that he did not.

[Lord Elystan-Morgan]

My Lords, the issue is not whether or not he spoke to the Prime Minister but whether he, or any other corporate interest in which he is involved, sought any contact with government or any agency of government in relation to this matter.

[Earl Howe]

My Lords, I am aware that officials in my department—not Ministers, I emphasise—had face-to-face meetings with certain tobacco companies in the context of the consultation on plain packaging. That was done to clarify certain aspects of their written submissions and is as far as it went. I am not aware of which companies those were, but if I can enlighten the noble Lord I will write to him.

NHS: Keogh Review

Debate between Earl Howe and Lord Elystan-Morgan

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

It was not £3 billion that was spent on reorganising the health service. As the noble Baroness knows, it was probably less than half that figure. The important point is that the saving in this Parliament will be at least £5.5 billion, with a £1.5 billion saving every year thereafter. I therefore suggest to her that it is meaningless to bandy that figure around. I am very glad that Basildon hospital is taking the action that it is. It has recently undergone significant leadership changes. A transformation programme is under way, and that is part of it.

[Lord Elystan-Morgan]

The Statement repeated by the noble Earl makes the point that the story does not end with the 14 failed trusts. Does he agree that there is clear evidence of the acceptance of standards that are not worthy of our community or of the National Health Service, and that, very probably, such a situation is not unassociated with the lack of a hierarchy of discipline in nursing? Will the Government therefore give an undertaking that, by way of an agonising reappraisal of the situation, they will concentrate on establishing whether the institution of the hospital matron could be considered again, as a post that was effective and seemed to operate well? Many people the length and breadth of this land believe that to some extent we should revert to that system, rather than worshipping at the altars of accountancy and management.

[Earl Howe]

The noble Lord makes an extremely important point. Those hospitals that I have visited where the standard of care is manifestly excellent have all had nurse leaders at board level whose responsibility it is to make the quality of nursing care absolutely centre stage at every board meeting and to transmit to every nurse in that hospital what good quality care looks like. Whether we call that person a matron or not is perhaps a matter that we can discuss at leisure—but the point that the noble Lord makes is extremely valid.

Care Homes

Debate between Earl Howe and Lord Elystan-Morgan

Monday 28th May 2012 Lords Chamber

[Earl Howe]

My Lords, the Government are working with the Association of Directors of Adult Social Services and the Care Quality Commission. We are gathering greater intelligence on the social care market and its major providers, which will be used to give early warning of impending problems. We will continue to meet regularly with the major care providers to discuss their trading performance, their financial situation generally and how they are addressing any issues which put pressure on their ability to continue trading.

[Lord Elystan-Morgan]

My Lords, perhaps I may raise a technical point in relation to a situation that exists under the Companies Act where a company is threatened with financial difficulties. The noble Earl will be aware that under the Act, to continue trading is a serious offence if there is a danger—not just a certainty—that the company will not be able to meet its financial obligations. Successive departments in successive Governments have properly intervened in the interests of patients. They were probably committing a serious criminal offence. Will the Minister look at the situation so that the law may be relaxed in the interests of patients and of the community in general?

[Earl Howe]

The noble Lord made a very good point. As he will know, there are existing oversight and regulatory frameworks, with the CQC regulating the quality of care and support services and local authorities overseeing local providers. The point made by the noble Lord is a major part of why the Government are engaging with the sector, as I described just now to my noble friend. The main point to stress is that under the existing system no one will be left homeless should a provider fail. In an emergency, local authorities have a duty to provide accommodation to anyone, whether they are publicly funded or self-funded, who has an urgent need for it.

Health: Funding

Debate between Earl Howe and Lord Elystan-Morgan

Tuesday 1st November 2011 Lords Chamber

[Earl Howe]

My Lords, I appreciate everything that the noble Lord has said. He may like to know that the protocol to which I have referred states as follows:

“The patient’s safety and well-being must be paramount at all times. No treatment must be refused or delayed due to uncertainty or ambiguity as to which”—

local health board or PCT—

“is responsible for funding the healthcare provision”.

I think that that should give patients in Wales every reassurance.

[Lord Elystan-Morgan]

My Lords, does the Minister accept that there is one very specific matter in relation to transborder matters in Wales, and that is in relation to Powys? Despite strategic policy decisions of many years ago, Powys has never had a district general hospital, with the result that there is a very considerable flow from north-east Powys to hospitals in the Shrewsbury and Telford area. Will he give an undertaking that, whatever happens, that system will continue?

[Earl Howe]

My Lords, nothing in the Government’s plans will impede the flow of Welsh patients into England. I can give the noble Lord that reassurance.

Southern Cross Care Homes

Debate between Earl Howe and Lord Elystan-Morgan

Tuesday 12th July 2011 Lords Chamber

[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.

[Lord Elystan-Morgan]

My Lords, has the Minister considered the legal question of fraudulent trading, which seems to be apposite not only to the case of Southern Cross, but indeed—according to the comments made by the noble Baroness, Lady Thornton—to other care companies as well? Does the Minister recollect that exactly 50 years ago, in a case called Wellfield, this House, sitting in its judicial capacity, defined fraudulent trading as a situation where the directors of a company continue trading, knowing that there is a risk that debts will not be able to be cleared as they arise? Bearing in mind that as far as Southern Cross is concerned, many months ago, it announced that it would not be able to pay its tax liabilities, nor indeed to pay more than 70 per cent of the rents due to lessors, would it not seem that there was a clear breach of what is now Section 993 of the Companies Act 2006?

[Earl Howe]

My Lords, my advice is that Southern Cross is not insolvent in either sense of the word. Its assets, I am told, exceed its liabilities, and it is able to meet its commitments as they fall due, thanks to the agreement reached between the company, its landlords and its bankers. The process announced on 15 June is the key to this: the company’s restructuring committee is developing a plan to stabilise the ownership and operation of Southern Cross care homes. We expect, as I have said, that there will be an orderly process of reassigning homes to landlords and new operators. That process will take place between now and October, during which time continuity of care will be maintained. Nothing that I have said changes the outlook for the medium term, and I believe that we can say, and that the company can say, that insolvency is not an issue at present.