Adult Social Care Contracts

Debate between Earl Howe and Lord Laming

Wednesday 11th February 2015 Lords Chamber

[Lord Laming]

To ask Her Majesty’s Government what assessment they have made of the use of an auction-style process by some local authorities to tender for adult social care contracts.

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

The new Care Act directs local authorities to put the well-being of people at the centre of all decisions about care and support. Commissioning high-quality social care is ultimately a matter for local authorities. We are aware of electronic marketplace systems that, together with professional judgments by authority staff, help to embody this well-being principle by prioritising quality above cost while achieving value for money.

[Lord Laming (CB)]

My Lords, I am very grateful to the noble Earl for that thoughtful response. Does he agree that advertising a block of services in an impersonal way is entirely different from advertising a vulnerable individual, stripping them of their humanity and dignity? Would he be willing to take forward the point that he made about the legislation and examine whether these authorities are disregarding the duty placed on them by Parliament to carry out a proper assessment of need for each individual, to produce a care plan and to make sure that that care plan is related to the individual’s developing situation? Will he ask the Care Quality Commission to make unannounced inspections of these authorities to see whether they are complying with the law?

[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.

Women: Postnatal Depression

Debate between Earl Howe and Lord Laming

Thursday 5th February 2015 Lords Chamber

[Earl Howe]

The role of the father, as well as of course that of the mother, is emphasised in all the guidance—certainly in the healthy child programme but also in the work done under family nurse partnerships, which targets the most vulnerable families. That programme provides intensive support to young first-time mothers and their babies. It explicitly involves fathers—and/or other family members as well—as long as the mother wants the father to take part.

[Lord Laming (CB)]

My Lords, does the Minister agree that two elements need to be addressed? First, there is the safety and well-being of the mother but, secondly, there is the important issue of helping the mother to bond with her new baby. That requires quite intensive work at a critical time in the life of the new baby and of the mother. Could he assure us that these matters are being addressed in these new arrangements?

[Earl Howe]

The noble Lord makes some extremely pertinent points. The family nurse partnership programme that I mentioned is important in this context, and our aim is to expand that to 16,000 places by April 2015. We launched the NHS Start4Life information service for parents. Parenting classes are available through the CANparent network and we are developing a population measure to show child development at two to two and a half years for inclusion in the public health outcomes framework, so that we can measure the progress we are making.

Mental Health Services

Debate between Earl Howe and Lord Laming

Wednesday 26th November 2014 Lords Chamber

[Earl Howe]

My Lords, both of those issues will be looked at by the task force. There have been concerns on both fronts that the noble Lord raises about access to services, and we are clear that the task force must come up with recommendations in those areas.

[Lord Laming (CB)]

My Lords, does the Minister agree that when the state assumes the parenting of a child or young person it takes on an enormous responsibility and a moral commitment to be a good parent to that child? Will the noble Earl assure the House that every effort is made for these children to be given access to all the services, including often some of the basic, ordinary health services that we assume there will be access to?

[Earl Howe]

My Lords, I fully agree with the noble Lord. He may like to know that my department is currently working with the Department for Education to revise the statutory guidance on promoting the health and well-being of looked-after children. We plan to consult on this later this month and to publish the final guidance early next year. It will make it clear that the CCGs and local authorities are responsible for providing services for looked-after children to give equal importance—parity of esteem—to their mental and physical health and to follow the concordat that I referred to.

Mental Health: Beds

Debate between Earl Howe and Lord Laming

Tuesday 29th July 2014 Lords Chamber

[Earl Howe]

My Lords, I am certainly aware that a number of concerns have been raised about the lack of mental health beds and that there are occasions when patients do not receive care quickly enough because approved mental health professionals cannot locate an appropriate bed. As I said in my original Answer, that is essentially a failing of local clinical commissioning. However, AMHPs—approved mental health professionals—should not be put in that position. We are consulting at the moment on a revised code of practice for the Mental Health Act. That consultation includes a specific question which asks what additional guidance should be included to ensure that AMHPs are not put in that position.

[Lord Laming (CB)]

Does the Minister accept that depriving a citizen of their liberty is one of the most serious matters that can be undertaken in our society and that it should be done only for very sound reasons, certainly not because of the absence of provision for their needs? When the Minister kindly replied to a Question for Written Answer from me earlier in the year, he said:

“Local areas are expected to … deliver their own ‘Mental Health Crisis Declaration’”.—[Official Report, 18/6/14; col. WA70.]

Can he tell the House how many local areas have signed up to a declaration, and more particularly, how many have failed to do so?

[Earl Howe]

My Lords, on the very last point, I do not have up-to-date figures, but I will certainly write to the noble Lord. However, on his main question, detention as a mechanism solely to secure access to hospital treatment would not be lawful. If hospitals or local authority staff think that that is happening or feel pressurised to admit people in that way, they should report it to their trust and, if necessary, to the Care Quality Commission. Sectioning under the Mental Health Act, which denies people their liberty, is a very serious matter. It should be done only when a person is a risk either to themselves or to other people and, as the noble Lord knows, it is a legal process. A patient cannot be sectioned merely to secure a bed.

Learning Disabilities: Community-Based Support

Debate between Earl Howe and Lord Laming

Tuesday 22nd July 2014 Lords Chamber

[Earl Howe]

My Lords, I have every confidence that the programme will continue as we had hoped it would, and indeed with a renewed momentum. The noble Baroness is right that NHS England has asked Sir Stephen Bubb, the chief executive of the charity leaders’ network ACEVO, to head a new group of experts and advisers to develop a national guide on how we provide health and care for those with learning disabilities. We have every confidence that Sir Stephen, with his immense experience in these areas, will be able to bring everybody together to a good result.

[Lord Laming (CB)]

My Lords, will the Minister assure the House that the only criteria that will be used in making these arrangements is the way to improve the quality of life of the user of the services rather than any bureaucratic processes set by NHS England?

[Earl Howe]

The fundamental principle that must underpin and inform all decisions in this area is about ensuring that we respect people with learning disabilities as individuals who have the same rights as everyone else, including the opportunities to make informed choices about where and with whom they live. The noble Lord is absolutely right.

Health: Dementia

Debate between Earl Howe and Lord Laming

Monday 14th July 2014 Lords Chamber

[Earl Howe]

The noble Baroness makes a series of extremely important points about the care of people with dementia. She is absolutely right. That is why we need to place greater emphasis on professional training and awareness, not only among NHS professionals but among social care staff, so that they appreciate the full dimension of the condition. Of course, we must remind ourselves that dementia is not a single condition. There are several conditions along that spectrum and each one has its own particular characteristics. We are emphasising to the NHS and local authorities that individual care planning is vital in this area.

[Lord Laming (CB)]

My Lords, will the Minister reinforce the point that he just touched on, that dementia—as a generic term—affects individuals in very different ways? As we have already heard, individuals’ circumstances vary enormously in terms of the position of their carers. Will the Minister do everything he can to ensure that in the future services will continue to respect the unique qualities of the individual who is affected by this condition?

[Earl Howe]

Again, the noble Lord makes a central point. As he will know, dementia can range from mild cognitive impairment to difficulties in organising daily life, right through to confinement to bed and very serious cognitive impairment. Knowing this is very distressing for people in the early stages of dementia. All this is why we are laying such emphasis on NHS staff receiving training. By October 2013, 108,000 NHS staff had received tier 1 training on dementia, and more than 100,000 social care workers have received some form of dementia awareness training through workforce development funding. We are aiming to increase those numbers substantially over the coming years.

Mental Health: Social Work

Debate between Earl Howe and Lord Laming

Monday 23rd June 2014 Lords Chamber

[Earl Howe]

My Lords, we need more social workers, particularly in mental health. The Think Ahead programme is certainly one way in which we hope to improve the numbers. Social work is not always seen as an attractive career option. We know that there is a growing appetite among graduates to work in mental health; unfortunately that enthusiasm has not filtered through to the social work profession. We need to focus on that. Much will depend also on finding a greater number of placements in social work, particularly relevant to mental health, so that there is on-the-job training for those trainees.

[Lord Laming (CB)]

My Lords, does the noble Earl agree that the very least we must do for social workers operating in this very complex area of work is to ensure that they all have the appropriate training, which is not just about classic mental health problems but about the abuse of drugs and alcohol, and indeed now extends into the great impact that dementia has on patients and their relatives?

[Earl Howe]

The noble Lord is quite right. The importance of mental health knowledge across social work in its entirety—adults, children, adolescents and families—is vital. Mental health is a key factor for people with substance abuse problems and other complex social and health needs that defy neat categorisation. The Chief Social Worker for Adults, Lyn Romeo, is working with the Chief Social Worker for Children and Families, Isabelle Trowler, to produce a statement of the knowledge and skills required across children’s and adult services and the need for students and qualified social workers to be able to work with mental health issues in all contexts.

Independent Living Fund

Debate between Earl Howe and Lord Laming

Monday 12th May 2014 Lords Chamber

[Earl Howe]

My Lords, I do not have that figure in my brief but the number of people receiving payments from the Independent Living Fund is relatively few in comparison to the total number of people receiving adult social care and support. If I have any further figures that I can supply to the noble Baroness, I shall be happy to write to her.

[Lord Laming (CB)]

Will the noble Earl share with the House the objections to ring-fencing this fund during the initial period to make sure that we have certainty that the money will be used for the purpose for which it is intended?

[Earl Howe]

My Lords, the issue is that we essentially have a two-tier system. That is at the heart of why the ILF is being disbanded over the next year or so. As a result of that, we know that there is some cross-subsidisation, with local authorities using ILF money to off-set the cost of social care. We are rechannelling that money to local authorities in the expectation that they will use it for adult social care, as I have said. It is not, however, ring-fenced.

NHS: Bed Capacity

Debate between Earl Howe and Lord Laming

Thursday 20th March 2014 Lords Chamber

[Earl Howe]

My Lords, many hospitals have been under pressure, particularly during winter, as they always are. It is telling that if one looks at the tell-tale signs of pressure, such as bed occupancy, the rates have remained stable for a number of years. In fact we have more clinical staff on the front line, particularly in A&E, than we had a few years ago. There is no doubt that there are times when hospitals feel acutely under pressure. However, despite rising demand, average waits for assessment in A&E are around 30 minutes at the moment, compared with over 70 minutes in 2009-10.

[Lord Laming (CB)]

My Lords, would the Minister use his good offices to reinforce again with the National Health Service that all unplanned moves that are not determined by clinical need, be it during the day or at night, have the potential to cause disorientation to patients and considerable distress to their relatives?

[Earl Howe]

The noble Lord is absolutely right. That is why my ministerial colleague, Dr Poulter, has written to Sir Bruce Keogh. This issue lies at the heart of the NHS constitution: the patient’s dignity and shaping care around the needs and preferences of patients is absolutely at the centre of the constitution. This is why it is entirely appropriate for Ministers to make their views known and for Sir Bruce to ensure that all hospitals are aware of this principle.

Professional Standards Authority

Debate between Earl Howe and Lord Laming

Thursday 7th November 2013 Lords Chamber

[Earl Howe]

My Lords, as my noble friend knows, this is a complex policy area. There have been delays to the Government’s original proposals around the regulation of herbal medicine practitioners. One of our main concerns here is to ensure safety for those who wish to use the products. Given that complexity, my honourable friend Dr Poulter announced his intention to set up a working group to consider matters relating to patient protection when using unlicensed manufactured herbal products. Officials are currently working through the details of that group, including its terms of reference.

[Lord Laming (CB)]

My Lords, will the Minister use his good offices to ensure that the Government continue to keep an open mind in respect of complementary medicines, and allow patients the greatest possible choice in these matters?

[Earl Howe]

Yes, my Lords. The Department of Health does not maintain a position on any particular complementary or alternative medicine treatment. It is for patients, in conjunction with their medical practitioner, to decide whether a treatment is appropriate for them.

NHS: Out-of-Hours Services

Debate between Earl Howe and Lord Laming

Monday 29th July 2013 Lords Chamber

[Earl Howe]

My Lords, the NHS 111 service is not unsafe—it is a safe service. In the vast majority of the country it has been provided very well for patients. We were confident that the service could be provided well, and so it has proved. The isolated cases where the service has fallen short are highly regrettable, but there is no issue about the quality of NHS Direct’s provision of NHS 111. I am afraid the issue there is that it got its sums wrong and cannot provide the service economically.

[Lord Laming]

The noble Earl will recall that in his response last week on the pressure on accident and emergency services, he referred to the change that had taken place in the GP contract that relieved them of the opportunity of being on call. Are the Government going to renegotiate the GP contract? If not, is there a possibility of placing a primary care service in every accident and emergency unit in the country?

[Earl Howe]

My Lords, we are straying a little from the Question before us, but I understand the relevance of the noble Lord’s point to the urgent care pathway generally. We are obviously looking very carefully at the GP contract. I cannot tell him at the moment how far negotiations have reached, because we are only at the start of the process. However, his point about primary care services in A&E departments is well made, and many A&E departments do indeed provide that to ensure safe triage of patients on arrival.

Health and Social Care

Debate between Earl Howe and Lord Laming

Wednesday 5th June 2013 Lords Chamber

[Earl Howe]

There are a number of indicators in the NHS Outcomes Framework and, indeed, in the public health outcomes framework and the adult social care outcomes framework relating to the vulnerable elderly groups in our population. I shall need to write to the noble Lady with a specific answer to her question. However, her question is extremely pertinent to the issues that have been very high profile recently, the resolution of which depend, in part, on ensuring that we can avoid unplanned admissions to hospital and keep people securely in their own homes.

[Lord Laming]

My Lords, will the Minister assure the House that when the separate inspectorates are established they will reinforce integrated working rather than operate in separate identities?

[Earl Howe]

I can indeed, and I can do so with confidence because the three chief inspectors that we propose to create—one of whom, the Chief Inspector of Hospitals, has already been appointed—will be working as part of the Care Quality Commission. They will be senior employees of the CQC and their job will certainly be to align the methodology that they use to assess good and poor care.

NHS: GP Services

Debate between Earl Howe and Lord Laming

Tuesday 21st May 2013 Lords Chamber

[Earl Howe]

My Lords, I think that the GP contract is but one element of a more complicated picture. It is not the only issue or, indeed, is it the only solution. It is true that access to out-of-hours care in some parts of England is simply not good enough. We are not saying that family doctors should necessarily go back to being on call in the evenings and at weekends. They work hard and have families, and they need a life too, but we must take a serious look at how out-of-hours NHS care is provided. My right honourable friend the Secretary of State will be talking to GP leaders about how we can do that over the coming weeks.

[Lord Laming]

My Lords, the noble Earl has indicated that there is a need to look again at the availability of community-based services. Hospital-based services are available seven days a week but community ones for much less, and that includes social care services. While not wanting staff to work all hours, is it not possible to move towards a situation where the services will be available at all hours while we protect staff working time?

[Earl Howe]

The noble Lord, Lord Laming, has summed up the situation extremely well. I am sure he knows that Sir Bruce Keogh, the NHS medical director, is currently looking at how NHS services across the piece can be provided seven days a week in a much fuller way than they are at the moment. Access to GPs out of hours is part of that wider consideration and NHS England is working with the royal colleges and professional organisations to develop a set of standards that will apply to seven-day services. Some trusts are already thinking about treating patients at weekends for non-urgent operations and procedures. We want to encourage that trend.

NHS: 111 Telephone Service

Debate between Earl Howe and Lord Laming

Monday 13th May 2013 Lords Chamber

[Earl Howe]

On the issue of A&E, there is no doubt that the NHS has been under very heavy pressure over the past few weeks. I am pleased to say that over the past two weeks the NHS as a whole has met the 95% standard, but obviously that statistic masks difficulties that are still being experienced in particular locations. The challenge now is to ensure that we are ready for next winter, and all the work that is now being done in NHS England, by clinical commissioning groups and within providers is designed to ensure that we are much readier for the pressures to come.

[Lord Laming]

My Lords, does the Minister accept that, although we refer to “primary care services”, they are not primary in that they are available for the shortest number of hours per week of any part of the health service? Unless things change dramatically, it is inevitable that accident and emergency will be seen as the first point of call for more and more people, especially in out of office hours.

[Earl Howe]

I take the noble Lord’s point. That is why the 111 service has been created; there is no doubt that there was a very confusing landscape in which people did not know who to call out of hours, and they did not necessarily have the telephone number of the out of hours provider in their area. The 111 service is designed to simplify all that, and across the vast bulk of England people are getting a good, if not fantastic, service. Unfortunately, in two areas of the country, the south-east and the south-west, we are still seeing problems arising, and those are being gripped.

Care Quality Commission

Debate between Earl Howe and Lord Laming

Thursday 14th March 2013 Lords Chamber

[Earl Howe]

The noble Baroness is right to focus on that issue. There are a number of things that we can do. We will shortly introduce new minimum standards to improve training for care staff, which will help in that regard. We aim to double the number of apprentices in care services by 2017 because there is clearly a workforce imperative here. We are proposing to expand the current care ambassador scheme, which promotes a positive image of the sector. That again will assist in recruitment. We are also launching an online tool to support recruitment and provide information about working in care and support, all of which is designed to address workforce concerns and concerns around skills.

[Lord Laming]

My Lords, will the noble Earl assure the House that the Government, when considering the report referred to by the noble Baroness, Lady Wheeler, will look at it in the context of another report published today by a House of Lords committee chaired by the noble Lord, Lord Filkin? Together, these reports pose one of the greatest challenges to our society, and it is very important that the Government take these matters as seriously as possible, for the benefit of us all.

[Earl Howe]

I quite agree with the noble Lord. He will know that we have an Oral Question next week on the report published today by the noble Lord, Lord Filkin.

NHS: Clinical Commissioning Groups

Debate between Earl Howe and Lord Laming

Wednesday 16th January 2013 Lords Chamber

[Earl Howe]

I am very grateful to my noble friend. I have meetings from time to time with the chairman of the NHS Commissioning Board, as does my right honourable friend the Secretary of State. I also meet regularly with the chief executive of the Commissioning Board. It is important that there is that interaction between Ministers and the board if there is to be proper accountability.

[Lord Laming]

Will the Minister say whether poverty was the only element that was removed and, if so, why was this singled out?

[Earl Howe]

Poverty was not removed. As I hope I have outlined, there are various criteria reflecting deprivation which are most certainly relevant to the fair allocation of resources. Age is clearly another factor, because it would be difficult to envisage an allocation formula that did not take it into account; it is the key factor in determining an individual’s need for healthcare. That is not to say that other factors such as deprivation should not continue to be considered.

Department of Health: Budget

Debate between Earl Howe and Lord Laming

Thursday 6th December 2012 Lords Chamber

[Earl Howe]

My noble friend makes an extremely important point. He will know that the Government have made it clear that mental health problems should be treated as seriously as physical health problems. That commitment has now been made explicit in the Health and Social Care Act 2012. As he mentioned, the Government’s mandate to the NHS Commissioning Board explicitly recognises the importance of putting mental health on a par with physical health. It tasks the NHS Commissioning Board with developing a collaborative programme of action to achieve that and it will be held to account accordingly.

[Lord Laming]

My Lords, does the Department of Health and its Ministers monitor the number of people who today are in hospital and whose treatment is being completed, but who are there because alternative arrangements have not been made for them?

[Earl Howe]

Yes, my Lords. As the noble Lord will know, the problem of delayed transfers of care is not new. We have seen a drop in delayed transfers in terms of the number of days but there has been a levelling off in recent years. However, it is up to the NHS and social care services to collaborate to ensure that proper and appropriate community services are available to patients when they are discharged from hospital. That planning process begins the moment the patient enters hospital.

Social Care: Apprenticeships

Debate between Earl Howe and Lord Laming

Thursday 29th November 2012 Lords Chamber

[Earl Howe]

My Lords, a great deal of work is going on, not least in the field of leadership. As I have mentioned, the National Institute for Clinical Excellence, soon to be the National Institute for Health and Clinical Excellence, will be issuing quality standards in this area. Skills for Care is also working to refine and improve the standards that social workers need to adhere to—and, of course, social workers as opposed to social care apprentices are statutorily regulated.

[Lord Laming]

My Lords, the noble Earl and the House will have been shocked by a number of recent reports about the exploitation of the vulnerability of people who are receiving social care, either in institutions or in their own homes. Can the noble Earl assure the House that the Government will do everything they can to ensure clear managerial accountability for the quality of care that is delivered, and will ask the inspectorates to make sure that they will do what they can to assess the quality in the different parts of social care services?

Winterbourne View

Debate between Earl Howe and Lord Laming

Tuesday 30th October 2012 Lords Chamber

[Lord Laming]

My Lords, the Minister has made it plain that it has been the Government’s position for some time that people with learning disabilities should be enabled to live with local personalised services, supported in the community. The fact that some former residents of Winterbourne are now living with their families is an indication that this policy has been implemented all too slowly. There are too many units like that around the country. Will the Minister tell the House what levers are being employed to speed up this policy so that people have a range of local services designed to meet their personal needs?

[Earl Howe]

My Lords, I am absolutely in agreement with the noble Lord, Lord Laming, that it is really important that people are held to account for making change happen. We have indicated what we think that change should be, and that is why we have developed a concordat with key partners to get them to commit to the actions they will take. We also plan to strengthen the learning disability programme board, in particular to make sure that key delivery partners—such as the NHS Commissioning Board, the CQC, ADAS and the Local Government Association—are core members. The board will review progress on implementing the action set out in the final departmental report and the concordat. We have tried to address the issue that the noble Lord homed-in on—which is speed of action—but the core of his point was that there are too many people currently in specialist in-patient learning disability services, including assessment and treatment units, and that they are staying there for too long. This is often due to crises which are preventable or which can be managed if people are given the right support in their own homes and in community settings. That is the agenda that faces us.

Mental Health Act

Debate between Earl Howe and Lord Laming

Monday 29th October 2012 Lords Chamber

[Lord Laming]

We are all grateful for the way in which this matter has been handled, and particularly pleased that it will not result in any fundamental change in mental health legislation. I come to this from a point of ignorance, so I hope that the Minister will excuse what seems an innocent question. Does this mean that the future emergency legislation that will come to the House is aimed at deeming that the practitioners who dealt with these cases are now licensed to deal with them, or does it mean that the patients have been deemed to be appropriately assessed?

[Earl Howe]

The question that the noble Lord, Lord Laming, asks is not a naive one at all—it is a very important one. The draft legislation that has been prepared is very narrowly drawn and its effect will be to ratify retrospectively those decisions taken by the panels that assess doctors for approval and treat those decisions by the panel as if they had been lawfully made. So it does not apply directly to patients but to the approval of the clinicians involved.

Abortion

Debate between Earl Howe and Lord Laming

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Baroness for acknowledging that my right honourable friend is entitled to express his long-held personal view, which he did the other day. With regard to her first main question, however, successive Governments have taken the view that they should rest on the evidence. There is currently no call from the main medical bodies for a review of the Act in relation to time limits, and the British Medical Association and the Royal College of Obstetricians and Gynaecologists support that view. I hope that the noble Baroness regards that as a clear enough answer in support of my initial Answer. As regards the work that is being done in my department, it is expected that the sexual health strategy will be published within a few months.

[Lord Laming]

My Lords, can the noble Earl assure the House that he will use his very well respected skills to persuade colleagues across government and indeed more widely that this matter needs to be handled with great care and sensitivity for the well-being of children and women and indeed for the well-being of all the adults involved in the process? This matter can have a life-long effect on everyone involved and it needs to be handled with care.

[Earl Howe]

I agree fully with the noble Lord. This is a highly sensitive issue on which the Government have, as I indicated, traditionally been led by the science and the medical profession, and I think that we should bear that principle very closely in mind.

Care and Support

Debate between Earl Howe and Lord Laming

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

My Lords, the short answer to my noble friend is that we need to look in detail at the funding implications. At this stage all I can say is that our intent is to introduce this at the earliest opportunity. However, I am afraid I have not been given the green light to give him chapter and verse at this stage. As soon as I am able to do that, I will gladly do so.

[Lord Laming]

My Lords, may I ask the Minister two quick questions about domiciliary care? First, do the Government accept that during the past decade, there has been a marked deterioration in the availability and quality of community care? It has deteriorated so much that, as the Minister said, it now often seems to be measured in minutes, depriving very vulnerable people of dignity both in feeding and in toileting. Secondly, if that is the case, what mechanism are the Government going to employ across 150 local authorities to make sure that they deliver the standard of domiciliary care about which he spoke?

[Earl Howe]

The noble Lord is quite right; there is huge concern about the sometimes tick-box attitude to domiciliary care, very often resulting in nugatory time spent by care workers with those they look after, which one is tempted to say is hardly worth while in some cases. We are very aware of this. Part of the answer lies in our plans for personal budgets, which should give service users much greater scope to define what they want and what their needs are. The service should then work around those needs and requirements. However, we are also talking about the workforce here.

We are clear that the minimum standards for health support workers and adult social care workers in England that are being developed by Skills for Care and Skills for Health will set a clear national benchmark for the training of support workers and their conduct when delivering care. We expect that the standards produced will inform proposals for a voluntary register for adult social care workers in England, which could be in place by next year. This will allow unregulated workers to demonstrate that they meet a set of minimum standards and are committed to a code of conduct.

All those things combined should move us away from the kind of culture that in some places, although not in all, is degrading the quality of care that is delivered.

NHS: General Practitioners

Debate between Earl Howe and Lord Laming

Wednesday 23rd May 2012 Lords Chamber

[Lord Laming]

To ask Her Majesty’s Government what steps they are taking to increase the public accessibility and range of services provided by general practitioners in the National Health Service.

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

My Lords, from April 2013 the NHS Commissioning Board will be responsible for commissioning primary medical services. As a single organisation the board will be able to ensure that a consistent approach is applied to defining and delivering accessible and high-quality GP services. Clinical commissioning groups will also actively seek to improve care delivered by general practice because of their inherent interest in enhancing the wider quality and cost-effectiveness of NHS care.

[Lord Laming]

My Lords, I am grateful to the Minister for that very helpful reply. He knows better than most that if the intentions of the new Health and Social Care Act are to be realised, locally based community health services will need to be transformed. Will he say a little about the process, and in particular whether the users of services—the patients—will be given an opportunity to contribute to that transformation?

[Earl Howe]

The noble Lord raises a central issue that is certainly a major part of the Government’s programme—to shift services in general out of acute settings, where appropriate, and into the community. We expect that clinical commissioning groups will wish to engage with health professionals from across the full range of disciplines to design care in better ways, and in particular to ensure that the shift goes on. The noble Lord mentioned patient input, which is another key responsibility of clinical commissioning groups—and a legal duty that we made sure was in the legislation.

NHS: Management Consultants

Debate between Earl Howe and Lord Laming

Monday 13th February 2012 Lords Chamber

[Earl Howe]

My Lords, I received notice of this Question just over an hour ago so I do not have precise figures about McKinsey. What I can say is that whereas the previous Administration in 2008-09 spent £100 million in the Department of Health on consultancy, my department has spent under £10 million on consultancy this year—very considerably less.

I read the article in the press this weekend which probably prompted the noble Baroness’s Question. I think we need to be careful before casting doubt on the integrity of public servants—and, indeed, of McKinsey. The article referred to Monitor. Those at Monitor are bound by very strict rules and procedures to ensure transparency and openness in all their dealings and to avoid any possible conflicts of interest. They follow those rules and procedures to the letter.

[Lord Laming]

My Lords, does the noble Earl take from this important Question the significance of having in place a robust implementation strategy should the Bill become law, because translating the aspirations of the Bill into day-by-day practice will be a considerable challenge? Can he assure the House that that will be attended to in the proper way?

[Earl Howe]

Yes, I can. The reform of the NHS is a major project. Frankly, it would be irresponsible if the Government were not to commission expert professional advice in undertaking a project of this kind. Consultancy, if used judiciously, can be highly cost-effective. I assure the noble Lord that the implementation of the Health and Social Care Bill is occupying our minds night and day and, so far, I am pleased to report that it is going well.

Health: Pathfinders

Debate between Earl Howe and Lord Laming

Thursday 12th January 2012 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. I think everybody agrees that integrating services, however one defines that—although the common denominator is surely from the point of view of the patient—is a good thing. We do not wish to lose sight of the lessons that have been learnt so effectively in the places mentioned by my noble friend. It is true that other areas have yet to catch up. We recognise that, and the focus over the next 12 months will be very much on sharing the lessons that have been learnt by the pathfinders that we know are working well.

[Lord Laming]

Does the Minister agree that the success of this scheme depends a great deal on the facilities within the health service becoming much more community orientated and much more available to people in the community? It is not either social services or the health service. Both have to play their part. What are the Government doing to achieve that?

[Earl Howe]

I do recognise that. It gave rise to the fairly famous quote by Sir David Nicholson, the chief executive of the NHS, who went down to Torbay to see the work being done there. He came away saying:

“I have seen the future and the future is Torbay”.

There was good reason for him to say that because Torbay has established close relationships between social workers, district nurses, therapists and allied health professionals through a single point of contact so that intermediate care services are delivered effectively, thus avoiding the need for patients to be admitted to hospital.

NHS: Hinchingbrooke Hospital

Debate between Earl Howe and Lord Laming

Thursday 10th November 2011 Lords Chamber

[Earl Howe]

My Lords, there was extensive consultation, but the important point for my noble friend to understand is that this was a locally led process. Ministers—and, for that matter, civil servants in the department—were not involved in the decision process. The decision was made by the strategic health authority board and the recommendation then came to Ministers. However, I can tell my noble friend that support for this decision has been very widespread, not least among the medical community in the area.

[Lord Laming]

My Lords, will this hospital continue to provide the same range of facilities as it does now? I understand that it does not provide A&E, for example, but will it be given the freedom to reduce the range of services in the future or will it have to carry on with the same services that it provides now?

Hospitals and Care Homes: Hydration

Debate between Earl Howe and Lord Laming

Monday 7th November 2011 Lords Chamber

[Earl Howe]

My noble friend raises a very good idea. I have heard of similar ideas in different trusts, all designed to meet the same objective. The key point my noble friend makes is that patients who may be malnourished when they enter hospital or have difficulty feeding or accessing drink for themselves should have their condition assessed straightaway so that the nursing care is there for them when they need it.

[Lord Laming]

Could the Minister assure the House that the Government will do everything possible to increase the number of unannounced inspections, both in hospital and in care homes, to make sure that these basic and very important matters are being properly attended to?

[Earl Howe]

My Lords, since the publication of the CQC summary inspection report, my right honourable friend the Secretary of State has requested a further 500 inspections of dignity and nutrition in care homes and 50 further visits to hospitals, which will start in the new year.

Winterbourne View

Debate between Earl Howe and Lord Laming

Wednesday 8th June 2011 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend. My understanding is that all patients at Winterbourne View have been regularly reviewed by a multidisciplinary clinical team in the past six months on behalf of the primary care trust that commissioned their care, and most of them in the past three months. I am sure she is right to say that those who have conducted such reviews should examine their processes and my understanding is that that is exactly what will happen.

We have endorsed the CQC’s proposal to launch a programme of risk-based and random unannounced inspections of a sample of the 150 hospitals providing care for people with learning disabilities. They will work in conjunction with local government improvement and development, ADAS, Mencap and with experts with experience of this programme. The spirit of my noble friend’s question is amply addressed in the programme.

[Lord Laming]

Will the Minister encourage the Government to reinforce messages about managerial accountability wherever vulnerable people are being cared for and about the fact that the greater the degree of vulnerability, the greater that accountability must be held by the managers of the service?

[Earl Howe]

The noble Lord is quite right. There has clearly been a serious failing in management here. We are looking at that urgently and, no doubt, important lessons will be learnt. All agencies have acted immediately on being alerted to the situation by the “Panorama” team and, as I have mentioned, appropriate inquiries are under way.

Health: Multiple Sclerosis

Debate between Earl Howe and Lord Laming

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

The noble Baroness makes a very important point, and she is right. I will have to check whether the guide refers to that issue. I would be surprised if it did not. However, the central point that she makes is quite correct. The key to this, as so often, is good communication between those providing care at every stage of the care pathway. Sometimes, unfortunately, that breaks down.

[Lord Laming]

Can the Minister tell the House what means the Department of Health has for monitoring the reductions in these multidisciplinary teams to which he has referred? There is evidence, at a local level, of quite serious reductions at present.

[Earl Howe]

The problem is that, historically, there has been no requirement to publish information on the number of multiple sclerosis nurses. The NHS Information Centre for health and social care extracts data from the electronic staff record and quality-assures the data prior to publication in the non-medical workforce census. The qualified nursing, midwifery and health visiting staff group is broken down only by area of work, so it is quite difficult to keep a handle on this.

Homelessness: Tuberculosis

Debate between Earl Howe and Lord Laming

Tuesday 1st March 2011 Lords Chamber

[Earl Howe]

My Lords, I was very interested to hear about the noble Baroness’s experiences in the north-east and I would like to hear more. The points that she raises lie behind our intention in the Health and Social Care Bill to make GP consortia responsible not just for the patients on the GP lists but for all the population in the local area. The health and well-being boards, which we propose should be set up at local authority level, will bring together all the relevant stakeholders to look at how the health needs of an area can best be met and prioritised.

[Lord Laming]

My Lords, this is a group of our fellow citizens who are particularly vulnerable and can so easily be lost in the system. At a time when there is considerable pressure on budgets, will the noble Lord use whatever good offices he can to ensure that this remains a priority in all the public services and is not seen as a soft option?

[Earl Howe]

My Lords, the short answer to the noble Lord’s question is yes. We have committed to ring-fence the public health budget and I think that there is no better earnest of our intentions for public health than that.

Disabled People: Dementia

Debate between Earl Howe and Lord Laming

Monday 11th October 2010 Lords Chamber

[Earl Howe]

The noble Lord, Lord Ashley, as so often, is absolutely right. Those who have dementia and also suffer from sensory impairment have a particularly difficult time. That is why we have signalled, in the recently revised operating framework for the NHS, that improving dementia care will be a priority. However, the noble Lord may also like to know that we have today published a Written Ministerial Statement, which he can read in Hansard, showing that we aim to accelerate the pace of improvement in four ways in particular: by improving early diagnosis and intervention; by improving care in hospitals; by improving the care of dementia patients in care homes; and by reducing the use of anti-psychotic medications. Those are the four priorities that we think will make the most difference.

[Lord Laming]

My Lords, can the Minister inform the House what steps the Government are taking to ensure an adequate supply of community-based nurses who have been specially trained in dementia care, not least to support carers?

[Earl Howe]

My Lords, an informed and effective workforce is clearly central to the delivery of the dementia strategy. The Department of Health has recently published reports which map the current level of training, and these have been widely disseminated to key bodies involved in providing education and training. Professor Alistair Burns, who is the National Clinical Director for Dementia, is chairing an advisory group that will aim to ensure the development of proper education and training for all staff involved, and he will be engaging with all the key organisations in doing so.

Health: Dementia

Debate between Earl Howe and Lord Laming

Thursday 3rd June 2010 Lords Chamber

[Earl Howe]

We are looking at the implementation plan at the moment. I say to my noble friend that there are perhaps four key dementia priorities for us. One is promoting awareness and early diagnosis and referral; the second is the care of people in hospital; the third is the care of those in care homes; and the fourth is a reduction in the use of anti-psychotic medication. That is not to say that the other objectives are trivial—by no means—but we think that these will yield the most tangible results in the shorter term.

[Lord Laming]

My Lords, does the noble Earl accept that we are all familiar with frequent reports of research into other diseases, but much less so with research reports into dementia? Will he keep in mind the importance of developing more effective research into this growing problem?

[Earl Howe]

My Lords, we will be giving increased priority to dementia research. The work of the Ministerial Advisory Group on Dementia Research, in which the noble Baroness, Lady Greengross, is playing an important part, is key to that. The group is time-limited but very focused. We anticipate that once it has completed its work the dementia research community will be better positioned to compete successfully for available funding opportunities.