Deregulation Bill

Debate between Earl Howe and Lord Rooker

Tuesday 18th November 2014 Grand Committee

[Earl Howe]

My Lords, I am grateful to the noble Lord for his comments and questions. I shall certainly write to him on the two issues that he raised: first, in relation to the CQC and to extending statutory regulation to non-doctor public health specialists.

[Lord Rooker]

I did not want to interrupt the noble Earl but perhaps I may intervene as he has raised that point at the beginning of his speech. I know that it will take time to write to my noble friend but in two days’ time this Committee will be discussing the growth duty. It would be useful to have a response before we start that debate because there are a couple of amendments relevant to the growth duty. The Joint Committee fully supported the Government’s response on the growth duty in January, but the committee received representations from certain regulators. I do not recall whether the CQC was one of them—I do not think that it was—but there was an open discussion when we were taking evidence about this. Therefore, it would be quite useful to have an answer by Thursday to the specific question raised by my noble friend because there would still be time to table an amendment. Sometimes it takes a few days or even weeks to get a letter, even with the best intentions of the Minister.

[Earl Howe]

I note the request from the noble Lord, Lord Rooker, and I can only undertake to do my best on that front. If I can get an answer to the noble Lord, Lord Hunt, by tomorrow, I will. I cannot promise that but I shall use my best endeavours to get an answer to him as quickly as I can.

The noble Lord referred to the administration process at Mid Staffordshire. He is right that the cost of administration has been significant. I cannot confirm the precise cost at this stage but it is substantial and I think that that serves to illustrate that the administration process is not one that any Government, or indeed Monitor, should give the green light to wantonly or ill advisedly. It is a last-resort solution and should always remain so. Clearly, in a challenged health economy, as that has been and still is, it is not surprising that the net result of the exercise is not just a substantial bill in terms of the trust special administration but a very substantial capital commitment by the Department of Health to augment the facilities in the trusts concerned to ensure that the quality of care is as we would all wish it to be. From memory, that net investment will be about £0.25 billion. Therefore, the people of that area should feel satisfied that this process has led to a result that will give them significantly enhanced facilities.

As for the noble Lord’s question about public consultation, this amendment has nothing to do with the process by which a decision is reached on a trust in administration or the consultation requirements that go with it. It merely streamlines the process that takes place after that final decision is taken so that it is not cumbersome.

The noble Lord asked me about the indemnity associated with PFI agreements in relation to a trust that has been taken over. My understanding is that the indemnity does transfer. That is the advice that I have received, but if I need to qualify it in any way, I will correct it immediately after Committee.

As regards the Secretary of State’s approval for trust mergers, it is important to point out that Section 56A provides for the acquisition by an NHS foundation trust of another FT or an NHS trust, and it confers on the sector regulator, Monitor, the power to grant an application for an acquisition. The section was intended to enable acquisitions to take place expeditiously with a minimum level of bureaucracy. The decision to undertake an acquisition, if it is between two foundation trusts, is taken by the FTs themselves with Monitor undertaking a minimal administrative function to implement the decision as long as the set legal process has been followed.

Mental Health: Parity of Esteem

Debate between Earl Howe and Lord Rooker

Monday 23rd June 2014 Lords Chamber

[Earl Howe]

The noble Lord is quite right about the importance of mental health research. Unfortunately I do not have the figures in my brief, but I will gladly write to him on the research that is currently under way which my department is helping to fund.

[Lord Rooker (Lab)]

My Lords, will the Minister do what he can in government to lock in the policy of the programme that he has announced today? I remind him that—I think it was in 2004—the former Social Exclusion Unit published a seminal report on mental health and social exclusion, with 27 action programme recommendations. As Ministers come and go and as civil servants get recycled, things go off the boil and we have to start doing it all over again. That does not serve the citizens of the country on an issue such as this, which transcends all our other divisions. We need to concentrate on it so that we do not lose it as people come and go.

[Earl Howe]

The noble Lord is right and I can say to him that the coalition Government have tried as far as possible to continue the good work on mental health of the previous Administration. One has to keep renewing the momentum on this. Situations do not stand still, and that is why our new mental health action plan Closing the Gap reminds everyone in the system of the most important gains to be made in 25 areas where people can expect to see and experience the fastest changes. I am glad to say that that document has been well received by all stakeholders.

National Health Service: Hospital Beds

Debate between Earl Howe and Lord Rooker

Wednesday 11th June 2014 Lords Chamber

[Earl Howe]

My noble friend has encapsulated the point very well. One cannot correlate bed numbers as a stark statistic with the quality of care that a health system delivers. Our system is dependent not just on acute settings but on care in the community, and that is where the focus should rightly lie at the moment.

[Lord Rooker (Lab)]

Then can we look at outcomes rather than beds as far as the OECD figures are concerned? For the United Kingdom, I will take just three factors: infant mortality, cancer survival rates and obesity. We are beyond the 20 best performers in terms of outcomes—20 OECD countries do better than us. Why are we operating so poorly compared with these other countries?

[Earl Howe]

There are a number of issues there. The noble Lord is right to raise obesity, in particular, where only one solution is available to us, which is a public health policy which embraces all parts of the system and, indeed, individuals. The issues that he raises are too complex for me to encapsulate in a short answer but I will be happy to write to him about what we are doing in all three areas. He is of course absolutely right to raise them as very important issues for the health service.

Health: Folic Acid Fortification

Debate between Earl Howe and Lord Rooker

Wednesday 2nd April 2014 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government when they expect to be able to make a decision in respect of folic acid fortification of white bread flour as part of a policy to reduce pregnancies affected by neural tube defects.

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

My Lords, we have previously stated that we were waiting for data on the folate status of the population from the National Diet and Nutrition Survey before making a decision with respect to fortification of flour with folic acid. The noble Lord is aware that delivery of these data has been significantly delayed. However, we will make a decision by Easter and will communicate it as soon as possible thereafter.

[Lord Rooker (Lab)]

That is very good news because the congenital anomaly register, which the Minister will be aware of, currently shows that, on average, every week in England and Wales, 13 pregnancies are terminated due to neural defects and three babies are born with spina bifida and other conditions. Two-thirds of those tragedies could be avoided by fortification. Although the delay in the checking of samples is to be criticised in some ways, is it not ironic that British blood samples have been sent to America for checking and delaying, when America has fortified flour since 1998 based on the UK’s Medical Research Council’s work in the 1990s? When are we really going to get a decision so that we can use this for the benefit of our own people?

Health: Folic Acid

Debate between Earl Howe and Lord Rooker

Monday 24th February 2014 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government, further to the answers by Earl Howe on 18 December 2013 (HL Deb, col 1261) and 21 January (HL Deb, col 567), what was the population sample of females of child-bearing age used in the National Diet and Nutrition Survey for folate status; and on what dates the survey data were collected.

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

Blood samples for folate-status analysis were collected from more than 600 females of childbearing age—15 to 49 years—as part of a UK representative sample of adults and children in the National Diet and Nutrition Survey. Blood samples were collected over four years from 2008-09 until 2011-12.

[Lord Rooker (Lab)]

My Lords, will the Minister accept that those figures are much smaller than recent research samples such as the 50,000 people involved in the Lancet-published research last year and the 500,000 women in England over a 12-year period in the research published last week that showed that the quantity of folic supplements taken by them was actually falling, which is the current policy? Given that the UK has the highest rate of neurological defects in the whole of Europe—80% of which pregnancies are terminated—is it not time to make a decision, talk to industry, the medics and science and join the other 70 countries protecting women from those births?

[Earl Howe]

My Lords, I recognise that this is an extremely important decision for the Government to make, affecting many people’s lives. I do not accept the implication behind the noble Lord’s question that the numbers involved in the analysis were somehow statistically invalid. I am assured that they represent a valid statistical base. We welcome all robust new evidence around the issue of fortification, such as the study published last week by the Wolfson Institute, and I can assure the noble Lord that we will take a decision on this matter as soon as possible.

Health: Flour Fortification

Debate between Earl Howe and Lord Rooker

Tuesday 21st January 2014 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government what is their assessment of the public health impact of the current programme of fortifying flour; and whether they have plans to extend the programme.

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

My Lords, the Government considered the health impact of the current programme of fortifying flour as part of the Red Tape Challenge review of the bread and flour regulations and concluded that it does deliver public health benefits. We are currently considering the case of mandatory fortification of flour with folic acid and will reach a decision when we have considered new data on the folate status of the population due early this year.

[Lord Rooker (Lab)]

I thank the Minister for his Answer but ask him to speed up that review. Is he aware of the major new peer-reviewed research from the Wolfson Institute, which surveyed half a million women over a 10-year period and found out that folic supplementation is going down? It concluded that the current policy is failing and creating health inequalities. We know that now. Is this not a real worry?

[Earl Howe]

My Lords, I am not aware of that study but I shall of course make myself familiar with it. I do not doubt that it will feature in the consideration that we give to this issue, which I can assure the noble Lord we will do as speedily as we can. It is important to say that adding to the list of fortificants would be a major step and we need to be absolutely sure that it is the right one.

Health: Birth Defects

Debate between Earl Howe and Lord Rooker

Wednesday 18th December 2013 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government what is their current approach to reducing the number of children born with neural tube defects; and whether they will consider fortifying white bread flour with folic acid as an additional measure.

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

My Lords, we encourage women to plan pregnancies, and advise those seeking to become pregnant to take folic acid supplements before conception and for the first 12 weeks of pregnancy, and to increase their intake of folate-rich foods. We are considering our nutrition advisers’ full recommendation to fortify flour with folic acid and will take into account new data on the folate status of the population in reaching our decision.

--- Later in debate ---

[Lord Rooker (Lab)]

My Lords, given that folic supplementation needs to be taken before most women know that they are pregnant, is the Minister concerned that less than 6% of 20 year-olds actually take folic supplements? The follow-up research published earlier this year is now available—on top of the scientific advice that the Government received in 2007 from independent committees and the Food Standards Agency—and shows that putting folic acid in flour causes no side effects for males. Is it not therefore time to change policy and put folic acid in white bread flour, which the BMA says is the most cost-effective way of avoiding the misery of hundreds of affected pregnancies, and to join 50 other countries that are doing the same?

[Earl Howe]

My Lords, mandatory fortification of food is, by any standards, a big step; it is not a decision to be taken lightly. The issue that we have been facing is that the survey data used by the Scientific Advisory Committee on Nutrition is more than 10 years old. The latest data available on the folate status of the population will be available early next year, and we feel that it is prudent to use that information to assess the risks and benefits of fortifying flour with folic acid before we make our decision.

Health and Social Care Bill

Debate between Earl Howe and Lord Rooker

Monday 28th November 2011 Lords Chamber

[Lord Rooker]

I, too, welcome the Minister’s statement. He will know that I have no qualifications in this but I have raised the issue of nurse training twice in the House this year—in the debate in March and at Question Time in October. I just want a point clarified. The amendment of the noble Lord, Lord Patel, refers to the board promoting but,

“having taken note of the responsibilities of the regulatory authorities”.

Does the Minister include possible changes and recommendations to the regulatory authorities in terms of their aspect of education and training?

[Earl Howe]

My Lords, no, because the Bill does not cover the duties of the regulatory authorities themselves, the professional regulators that is to say. My undertaking should be read as relating to the Bill itself and the bodies and structures it sets up.

--- Later in debate ---

[Earl Howe]

I have already outlined a number of funds that are held centrally to enable that to happen. That is happening at the moment. I am pleased to say that we have had very encouraging take-up of those funds. The Social Enterprise Investment Fund has been in place for some time. What I cannot do at the moment is say how much money will be available next year. A lot of these funds will continue in the next year and we will be making announcements in due course. However, we are clear that there is a role for this type of lever to ensure that social enterprises and voluntary sector organisations can be supported in the way that the noble Lord, Lord Warner, indicated was important—and I agree with him.

[Lord Rooker]

My Lords, if this was in the Bill, no one would have to take any notice of it at all. That is the reality. I am very grateful to those who have supported my amendment. There will be plenty of people in the sector watching the debate, metaphorically and reading Hansard, who will wonder what on earth we are doing. I realise it suits the Government to have this embarrassing debate on the twilight shift because that is very inconvenient for them. To be honest, I did not hear anything from the Minister that showed that he took on board the central points I made. Notwithstanding his answer to the noble Baroness, Lady Williams, I will test the opinion of the House on this.

Health and Social Care Bill

Debate between Earl Howe and Lord Rooker

Wednesday 9th November 2011 Lords Chamber

[Lord Rooker]

My Lords, I intervene briefly in this debate. It also gives me the opportunity to apologise to the House. I removed Amendments 35 and 36 at 10 pm on Monday because I could not guarantee to be here at 3.30 pm today. I apologise if it caused confusion, but I could not be here today at that time.

On Amendment 45, I would like to know the Government’s position, because the noble Baroness said that the Government maintain their position. In some ways, the temptation for fragmentation is enormous. I am not sure whether the NHS is still the largest employer in Europe. As a totality, I think it probably is. However, we are talking here about England—or are we? The issue of devolution is crucial. I served for 12 months as a direct rule Minister in Northern Ireland, and I came across problems there relating to people doing the same job here. Also, of course, moving around Whitehall, as the Minister probably discovered himself, you go into departments and meet people doing more or less exactly the same job on vastly different salaries. The temptation of fragmentation was accepted at the centre of government, and that has led to significant problems of mobility for people moving even around Whitehall.

I am no expert on the NHS—I only know it as a patient and a family member of patients—but as far as I am concerned, it is a team effort. It is a bit like the argument we had with the firefighters. You are sending people out on a team to do a job, and they are not going out on different rates of pay, different pensions and different contracts. The one way to keep it cohesive is to maintain national pay bargaining. It does not mean that one size fits all, but the fact is, as my noble friend who kicked this off said, the industrial relations implications are enormous, given the potential for disputes that nobody wants. A dispute is created because of a festering sore on something else. The facility is not there if you have a system of national pay bargaining for healthcare staff.

The amendment refers to,

“services for the improvement of public health”.

Quite clearly, there will be transfers of public health staff who are working in local government and who are perhaps working to and with NHS rates of pay. That in itself will be a difficulty if people are going to work with colleagues in local government under a different scheme. While the Government take account of that, the temptation will be to level down to local government to get one size fits all at the local level. I do not think that that temptation ought to be accepted.

As for the issue of regional break-up, there was an argument about this many years ago when there was an attempt to pay teachers more who were prepared to go and work in the inner cities. You can have a local premium, and you can do some local work where there are factors, but in the case of nursing staff, particularly the lower-paid, and their ability to move around the country for career opportunities and to move their family, they are working within one service. Everybody knows that it is the NHS—the “N” is still there—but they are faced with the issue that, for the same job in the next region or the next but one region, they may be paid up to 10 per cent less and their pension and terms and conditions may be different. That could cause enormous problems.

I only spoke in the mental health debate last week, but the overall theme of the Bill and the many allegations that have been sent to noble Lords, of which the Minister will be aware, are that this is a grand plan—not now, but in the end—to fragment and break up the National Health Service, a plot hatched in the 1980s by Members of the other House who are currently members of the Government. The introduction of market forces into both the provision of care and other providers, and the temptation then to break up national pay bargaining to fit the new regime, which is supposed to be patient-oriented, is an enormous pressure on the Government. Ministers will be told that this will make sense at the local level. It may be asking a lot for the Minister to give a definitive response to this tonight, but the issues of industrial relations and pay bargaining in the NHS have to be settled well before the passage of this Bill, if only because during the period of implementation we do not, as my noble friend said, want discord among the staff as they implement what will be, I accept, many positive changes in the Bill.

The other issue that has to be raised, because we are talking about services to patients, is the pay and bargaining within service providers as the issue gets broken up. There will be some debates about charities, the third sector and social enterprise involvement where industrial relations and pay bargaining may be affected. However, there are other issues relating to the private sector doing jobs using NHS staff. It offers mobility as teams move. People do not have one place of work but may move between two or three different establishments, one of which may be the NHS, in which they may be based. They are expected to perform as part of the team locally, providing the services to patients in the round. What happens to pay bargaining in those situations?

If we allow fragmentation at a local level, it would be wise for the Minister to say that the status quo will be maintained. I accept that the status quo has flexibility built in, as the noble Baroness said, but it is a flexibility that does not appear to have been used. This is a bit like the Scottish Government. They had the flexibility to put up income tax by 5 per cent, but it has never been done. This is the reality. You put in that flexibility but for various reasons there are barriers to actually using it. In this case, the evidence is that the flexibility has not been used except perhaps in extreme circumstances. I do not think that it would be a good idea if we went down this route. I think there is enough evidence to keep people working together as a team with a national perspective that allows job mobility and promotion without people being afraid of moving within the same service because of the pay and conditions. I do not think that it is a good idea, and I hope the Minister will be able to take a more positive approach to this issue, even if he can only state it in general terms.

[Earl Howe]

My Lords, Amendment 45, tabled by the noble Baroness, Lady Wheeler, seeks to impose on the Secretary of State,

“a duty to maintain a national pay and bargaining system for healthcare staff, to cover those staff providing”,

both NHS and public health services. This would cover not only existing NHS organisations but any organisation providing services to the NHS. The amendment, as worded, goes against the Government’s view that employers are best placed to determine the most appropriate pay and reward package to ensure that they recruit and retain the workforce that they need.

Our clear view is that it would be inappropriate to require independent and voluntary sector providers to adhere to NHS pay when NHS foundation trusts, as the noble Baroness, Lady Murphy, rightly pointed out, already have such freedoms. The Government believe that to deliver the best care for patients, this freedom should be extended to all NHS organisations. I also take the noble Baroness’s point that while foundation trusts have the power to apply local terms and conditions for all staff, medical, clinical and administrative, very few trusts exercise those freedoms. There are around 400 trusts, and only one foundation trust—Southend—has departed from Agenda for Change, and the differences that it has negotiated are marginal.

--- Later in debate ---

[Lord Rooker]

For the public health directors, who will be the employer? Will it be the local authority? In the sense that you can pay a director of education or children’s services market rates around local government, will that be the same for the directors of public health, so that their salaries vary around the country? It would be the beginnings of a new service, in that sense. Do we know the answer to that?

[Earl Howe]

They will be employed by local authorities. It is too soon to say to the noble Lord what the pay grade of those people will be, but clearly they will be very senior officers within the local authority. Yes, strictly speaking, if there is freedom to set pay locally, there could be some variations around the country, but I would envisage that the pay grade of directors of public health will gravitate towards a certain figure, whatever that may be.

Nursing: Elderly and Vulnerable Patients

Debate between Earl Howe and Lord Rooker

Wednesday 19th October 2011 Lords Chamber

[Earl Howe]

My Lords, we do value the contributions that SENs provide, those who are still in practice. It is certainly the case that the NMC no longer approves programmes for nurses on part 2 of the register and there are no plans to reintroduce educational programmes to part 2 of the register. What we have done is to develop guidance on widening the entry gate to preregistration programmes for those individuals who show the necessary values and behaviours but who otherwise do not possess the traditional academic qualifications. I am aware of the report that my noble friend mentioned. Sheila Try has written to me and I have asked the department to consider the recommendations that she has made.

[Lord Rooker]

Does the Minister agree that it is a very valuable report? If I may remind him, on 31 March in this House when we had a debate on nursing care I asked him if he would meet Sheila Try. Following the question asked by the noble Baroness, I respectfully ask him to study the latest report by this trained nurse, who makes very valid points about what has gone wrong with the training of nurses in the last 25 years.

[Earl Howe]

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