Victims and Prisoners Bill

Debate between Earl Howe and Lord Wills

Committee stage
Tuesday 13th February 2024 Lords Chamber

[Lord Wills (Lab)]

My Lords, I am grateful to everyone who has spoken to this group of amendments. I think everyone, with the exception of the Minister, has spoken broadly in support of them. As always, I am particularly grateful to the Minister for his extremely courteous and open response to quite a weighty volume of amendments which covered quite a lot of ground.

On the basic question of further engagement with Ministers and officials, I would be delighted. I am extremely grateful for the offer, and I hope we can arrange something in the very near future, in good time before Report, to deal with some of these questions. Quite a lot of them are details of drafting, and I may well have misunderstood the intent of the drafting. It may be that some further clarification is needed. These are details in the drafting of the amendments, and I am very grateful to move forward on them. The review question, dealt with in Amendment 133ZA, is similarly complex, and I am glad that, when we spoke a few days ago, the Minister and the noble and learned Lord, Lord Bellamy, seemed to welcome the principle. It would be good if we could clarify that and bolt it down to something practical that will work.

Amendment 124A is on the crucial question of fact-finding and transparency. I think the noble Lord, Lord Marks, referred to it as a modest amendment. If I had any hope of the Government accepting something more radical, I would have been far less modest, but I do not, I am afraid. The Minister’s response confirmed my worries about this. He repeated what has always been the Government’s position: that the role of the advocate is essentially a pastoral one—that advising the Secretary of State, as the Minister just described, is really only a baby step away from what is essentially a pastoral role. That really is not sufficient. Merely reiterating the Government’s purpose does not justify the purpose; it only shows that, for some reason I really do not understand—I really do not understand it, because I can see no practical benefit of it at all, to anybody—the Government are resistant to giving the public advocate further powers.

It is not a question of defensiveness over a particular issue. As the Minister said, the Bill is not retrospective at the moment, although I welcome his indication that he may be able to introduce that element of retrospection. I am frankly baffled. Timeliness is so important for victims who are suffering unimaginable trauma and grief, and all of whom, in their different ways, are seeking closure, because they fail to understand what has happened to their loved ones, out of a clear blue sky, and are given no explanation for why what happened has happened. As the magisterial report on Hillsborough by Bishop James, the former Bishop of Liverpool, shows, these delays allow those in power to construct false narratives about what happened. We saw that graphically at Hillsborough, when the Sun newspaper and the former Prime Minister told lies about football fans who lost their lives because of the negligence of the police.

[Earl Howe (Con)]

I meant to respond to the very pertinent points the noble Lord made on the cost and duration of public inquiries. He is, of course, quite right. This is a matter of concern. It is not for a trivial reason that your Lordships’ House is looking at this very issue in one of its special committees at the moment. However, one of the advantages, as we see it, of the IPA will be that he will be able to recommend to the Secretary of State a non-statutory route to inquiring or looking into incidents. I am sure that his or her voice in making such a recommendation will, for entirely the reasons that the noble Lord cites, be a very powerful lever in the process.

[Lord Wills (Lab)]

I am grateful to the Minister; he pre-empted me, as he could see where I was going to go next with this. He is quite right that the Inquiries Act 2005 is increasingly widely recognised as clunky and in need of revision, but that is not for now. That is inevitably going to be a lengthy process, and certainly for another Parliament, but we have this Bill in front of us.

Giving the public advocate power to advise the Secretary of State has no teeth at all. We know how Ministers take advice: sometimes they do and sometimes they do not. In the meantime, the victims, for whom this Bill is intended, go on suffering. While the Secretary of State decides and deliberates and moves on, is sacked, reshuffled and all the rest of it, the victims go on suffering the agony of not knowing what has happened to their loved ones, while over and again those in power use taxpayers’ money to construct false narratives. There is no end in sight to that in this Bill.

We have the opportunity to give real power to the independent public advocate, speaking on behalf of victims who have been left abandoned, over and again, for years and decades. The person who is meant to represent them “may” be given the power to advise the Secretary of State, who can then do what he or she likes, with no accountability—nothing. I urge the Government to look again at this.

Notwithstanding the obvious problems with public inquiries, here is a chance to do something. We have the model. The Hillsborough Independent Panel, which was set up by a Labour Government and championed by a Conservative Home Secretary and Prime Minister in the right honourable Theresa May MP, with cross-party support, is universally accepted as a model of how these things can operate. Yet the Government persist in rejecting the possibility for the independent public advocate to set up something like that in future.

Why? We know that it can save money. We know that it can produce a timely explanation of what happened, which is of incalculable benefit to victims. Yet the Government go on resisting it. Timeliness, cost benefits and transparency; what is not to love about those virtues? Yet the Government resist it. As I say, I am baffled. We will return to these issues on Report. I am grateful to everyone, and particularly to the Minister, for his approach to all this. I beg leave to withdraw the amendment.

Victims and Prisoners Bill

Debate between Earl Howe and Lord Wills

Committee stage
Wednesday 7th February 2024 Lords Chamber

[Earl Howe (Con)]

My Lords, I am grateful to noble Lords for bringing forward the amendments in this group. All but one relate to the important issue of the definition of a major incident and its scope. I will address them in turn.

First, I will respond to Amendments 119A, 119B and 119C from the noble Lord, Lord Wills. These amendments seek to expand the scope of the independent public advocate scheme to include an event or series of linked events which have occurred prior to this section coming into force. In practical terms, as he has made clear, they would introduce a retrospective element to the scheme, allowing the Secretary of State to declare historic events as major incidents and to appoint an advocate accordingly. The noble Lord has brought this important issue to the Government’s attention. It is right that we should debate it.

At the outset, I need to state the Government’s position. Incidents which occur wholly—I emphasise “wholly”—before this part is commenced are not in the scope of this scheme. I recognise that the tragic events of the past and the experiences of those impacted by them have clearly highlighted the need for the independent public advocate. I do not mean to suggest otherwise. However, the IPA is designed as a forward-looking initiative to assist victims in the immediate aftermath of a major incident when there are investigations, inquests and inquiries into what happened. The scheme is intended as a way of providing support at an early stage. Given this, the Government believe that there would be limited additional benefit in appointing an advocate to support victims of incidents where the official processes are at an advanced stage or may have already concluded.

As the Bill stands, I can confirm that the definition of a major incident already covers either a single-time incident, or a series of linked incidents. It does not allow for the advocate to support the families of those who died or individuals who were seriously harmed by any linked incidents which occurred prior to the Bill’s commencement. Having said that, I recognise the point made by the noble Lord, Lord Wills, that recent events have shown that it can take time for events and their circumstances to become clear. There may be instances where these events do not occur during the same time period. I was grateful for the observations of the noble Lord, Lord Marks, on that theme.

I understand the importance of getting right the definition of a major incident. I have therefore asked my officials to consider it further. If it would be helpful, I would be happy to continue engaging with the noble Lord about this so that we can return to it on Report.

I turn to Amendment 120 from the noble Lord, Lord Ponsonby, which seeks to expand the definition of a major incident and therefore the IPA scheme. The amendment would allow the Secretary of State to declare a major incident in circumstances that do not meet the threshold of a significant number of deaths or those suffering serious harm but attract a significant public interest.

It is important for me to make it clear that the impetus for establishing a public advocate has been the experience of victims following past disasters that were exceptional, presented unique challenges and involved multiple organs of the state, which victims found difficult to navigate or have their voices heard by. The Government believe that it is important that the scope of this scheme is controlled and is clearly focused on assisting victims of major incidents which are, by their nature, rare. This amendment would set a possible expectation that the IPA might be appointed to support victims who have been involved in smaller-scale incidents, especially those where there are very few injuries or fatalities, which is not the policy intention.

There is a further and possibly helpful point that I can make. Arguably, the Secretary of State already has a broad discretion in the Bill to declare a major incident and to interpret the term “significant”. For those reasons, the Government, at this time, do not believe that this change is necessary. The public interest will also be one of the considerations that the Secretary of State will have in mind when making their decision, and more detail on this will be included in the policy statement.

Lastly, proposed new subsection (2B)(a) of this amendment seems to imply that blame or liability must have been found prior to this power being exercised. If the Secretary of State were to act quickly, they may risk prejudicing any subsequent investigation, which would not serve the interests of victims.

I am afraid that the amendment runs counter to the Government’s policy intention, but I hope that it is helpful that I have pointed out that potential element of discretion that is built into the wording in the Bill, and I hope that the noble Lord, Lord Ponsonby, will understand why we cannot support the amendment.

Lastly, I turn to Amendment 126 from the noble and learned Lord, Lord Thomas of Cwmgiedd, which would require the Secretary of State to obtain the concurrence, or in other words the agreement, of Welsh Ministers before appointing an advocate in respect of a major incident occurring in Wales. The purpose of the independent public advocate scheme is to support victims of major incidents. This Government agree that these functions fall within the devolved competence of the Welsh Senedd, with the exception of the amendments to the Coroners and Justice Act, which Clause 34 provides for.

The Ministry of Justice has engaged with officials in the Welsh Government during the development of this policy. It is clear that there is great benefit to having a single scheme that covers England and Wales to provide consistency of service. Our discussions with the Welsh Government are ongoing, as we seek a legislative consent Motion for these measures. Ministers in the UK Government will write to Welsh Ministers shortly, setting out a proposal for their role with regard to declaring a major incident which occurs wholly in Wales, and the subsequent appointment of an advocate in respect of that major incident.

I hope that that reassures the noble and learned Lord that this is a live issue that is very much on the radar of my noble and learned friend Lord Bellamy. He is very much aware of the devolution implications, and we are actively working to find a solution. The Government will bring forward any necessary amendments on Report, and I am happy to return to this topic at that time.

[Lord Wills (Lab)]

My Lords, I am grateful to everyone who has spoken in this short discussion and to the noble Lord, Lord Marks, for his remarks, and particularly for his cogent justifications for these amendments in terms of retrospection, which were an extremely valuable contribution to the debate. I am very grateful to the noble Baroness, Lady Sanderson, and to my noble friend Lord Ponsonby, for their support too.

I am also extremely grateful to the Minister for his open mind on this issue, if I may take it that far—or at least a willingness to continue discussion on what is quite a crucial question. I am very happy to do that, and I shall withdraw the amendment shortly.

I just want to say a few words about the Minister’s comments. He stressed the word “wholly”—major incidents that happened wholly in the past. That is a very important word, because it means when the incident no longer has any impact on the victim. In most cases—to think of the bereaved or those who suffered, not necessarily directly but indirectly, as in the examples from both the noble Lord, Lord Marks, and my noble friend Lord Ponsonby—such incidents are by definition not wholly in the past. The postmasters’ suffering is not wholly in past, even though the damage was done in the past. Similarly, for the victims of blood transfusions and their relatives, and the victims of nuclear tests in the 1950s and 1960s, these are ongoing traumas. They are the people who need the support of the independent public advocate.

I am, as I say, very happy to carry on this discussion in the hope that we can find some sort of resolution. A large number of people are still grievously affected by these major incidents, and I hope that this rare legislative opportunity to help them can be seized. With that, I beg leave to withdraw the amendment.

NHS: Health and Social Care Act 2012

Debate between Earl Howe and Lord Wills

Monday 16th March 2015 Lords Chamber

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

My Lords, the Act created the architecture within which NHS England’s innovation, health and wealth strategy is being implemented. As part of this, the innovation scorecard shows a real improvement in the uptake of certain NICE-approved innovations. The NICE implementation collaborative has also resulted in increased national spend on key technologies. The department and NHS England have commissioned an independent evaluation of innovation, health and wealth, which is expected to be completed by winter 2017.

[Lord Wills (Lab)]

I am grateful to the noble Earl for that Answer, but does he recognise that there is a significant gap between those fine words and what is actually happening on the ground? To take the case of giant cell arteritis, for example, 2,000 to 3,000 people go blind needlessly as a result of it. I hope the House will indulge me for a few seconds if I set out this important example. The condition is easily treatable. Professor Dasgupta, in Southend, has pioneered a fast-track pathway for diagnosis and treatment which has reduced the numbers of people going blind by two-thirds. Rolled out nationally, that would save thousands of people every year from going blind. It would save them and their families needless misery and suffering and would save the taxpayer hundreds of millions of pounds every year.

In January, Sir Bruce Keogh, the medical director of NHS England, wrote to me and said that this “represents a new way of doing things which is better and costs no more. We must learn from such innovative examples”. Is the Minister aware of what has happened since he wrote to me? Thousands of people have gone blind—

[Lord Wills]

Noble Lords opposite ought to listen to this; the people who suffer most from this are elderly and it is very much in their own interests to listen. Nothing has been done to roll out this innovative pathway. Can the Minister not accept that having a few guidelines is simply not good enough? Can he not accept that since the Health and Social Care Act came in, there has been no good example of good practice in this area?

[Earl Howe]

My Lords, I recognise the noble Lord’s close interest in this important topic. We recognise that early diagnosis and treatment of giant cell arteritis is extremely important to preventing sight loss. I am aware of the interest in the Southend GCA pathway developed by Professor Dasgupta. I recently raised the issue of the pathway with NHS England and understand Sir Bruce Keogh will be writing to the noble Lord very shortly about this. As he may be aware, the Royal College of Physicians has produced a best practice guideline on the diagnosis and management of GCA, which Professor Dasgupta has helped to develop. That is good progress and provides a very good framework for disease assessment, immediate treatment and urgent referral.

Mesothelioma: Research Funding

Debate between Earl Howe and Lord Wills

Thursday 16th January 2014 Grand Committee

[Earl Howe]

My Lords, as this is a time-limited debate, perhaps the noble Lord would accept my undertaking to write to him with those details. I am not sure, in fact, that I have them, because the letter, although extremely welcome, is quite brief in the detail it gives on the source of the funding.

[Lord Wills]

I am very grateful to the noble Earl for giving way. I shall be brief. Will he write within the next three months to everyone who has spoken today reporting on the progress of the conversations with the ABI about the range of options he has just referred to?

[Earl Howe]

I would be happy to do that.

Both the Government and the industry recognise the potential for insurers individually to sponsor specific research infrastructure or projects in mesothelioma, which would provide an excellent way for the industry to remain engaged following the earlier donation. I am pleased to report that the Department of Health is convening a high-level meeting with the association and the British Lung Foundation to explore practical ways to take that forward.

The noble Lord, Lord Alton, spoke powerfully about the need for sustainable funding in this area. I re-emphasise the point that I made a minute ago: research funding is available for good-quality research and what we lack are research applications. What we need, in our view, is to get innovative research ideas that will make a real difference, and that is what the NCRI meeting will hopefully do. The research ideas put forward by the noble Baroness, Lady Finlay, in her intervention are of course very pertinent. She speaks with great authority in this area. They are all questions that the NCRI discussions can address. That meeting will be an opportunity to take a strategic approach, and it requires getting the right people together. The NCRI event will involve researchers from within the mesothelioma community, and from a wider field, and research funders.

It is worth noting that spend on lung cancer research by the NCRI member organisations, including the main public funders of cancer research, has more than quadrupled over the past decade. It has increased from £3.5 million in 2002 to £14.8 million in 2012. That is because of the quality of research proposals that have come forward and the interest shown by the research community.

In conclusion, the Government are strongly committed to ensuring progress is made in research into how best to diagnose and treat this dreadful disease, and care for those affected. A number of very powerful points have been made in this debate. I will pick up those that I have not been able to cover and will write to noble Lords. I have outlined the steps that we are taking, and I hope that noble Lords are assured that these measures will deliver what they, and indeed we in the Government, are seeking.

South London Healthcare NHS Trust

Debate between Earl Howe and Lord Wills

Thursday 31st January 2013 Lords Chamber

[Earl Howe]

My Lords, the facilities at Lewisham A&E are indeed very good, and a lot of money has been spent on them. I would hope that the noble Lord will therefore welcome the fact that we are keeping an A&E department open. That department will be comparable with many other A&E departments around the country. It will be a fully functioning department other than for those difficult and critical cases which, by common clinical agreement, need more specialist care where clinical resources can be concentrated. That is increasingly the view of senior clinicians in the royal colleges around London.

The other point that the noble Lord may need to factor in is that many of the services in an area of the country, whether it is London or anywhere else, depend on networks. What we envisage for Lewisham and Woolwich, taken together, is that they will be part of an active network, with staff rotating between the two. There will be an understanding of what each hospital is capable or incapable of doing, and an understanding on the part of ambulance trusts as to where best to take patients. We have already seen the results of that policy. This is not idle speculation. There is proof positive from the decision to decrease the number of acute stroke units in London from 32 to eight; the mortality rate has more or less halved since that decision was taken. So there is clear clinical underpinning.

I note the noble Lord’s understandable regret that Lewisham has been caught up in the problems of its neighbour. However, as the Statement made clear, the people of Lewisham also depend on the services of South London Healthcare Trust, so to say that there is somehow an island of patients who simply go to Lewisham would not be fair.

The noble Lord asked me about publication of the legal advice. I can confirm that the decision of my right honourable friend has been taken in the light of consideration of the legal issues and advice to him that it is lawful. The normal position is that the Government do not publish legal advice; there is a long-standing precedent. However, I can tell him that the legal advice backs up his decision.

[Lord Wills]

I am very grateful—

--- Later in debate ---

[Earl Howe]

If the noble Lord will allow, I will just cover the final point made by his noble friend.

Given the need to reassure local patients that the changes will indeed lead to better outcomes for them, my right honourable friend took the decision proactively to publish Sir Bruce Keogh’s letter to him, setting out his clinical advice, as it has had a large bearing on his decision. So we have been as open as possible about the clinical basis on which this decision has been taken.

[Lord Wills]

I am very grateful to the Minister and apologise for intervening inappropriately. On the question of legal advice, notwithstanding the convention, will he agree that it is open to the Government to waive legal privilege in exceptional circumstances and that this might be such a case, since these are clearly exceptional circumstances?

[Earl Howe]

My advice is that there is no case for waiving that practice. As I said, it is a long-standing principle and indeed the practice of successive Governments that legal advice is given to Ministers in confidence. Therefore I am afraid that I cannot accommodate the noble Lord’s suggestion.

To answer the question asked by the noble Lord, Lord Kennedy, about visiting Lewisham Hospital, I have not done so personally. I try to visit as many hospitals as I can. If I am able to fit Lewisham into my programme, I would be happy to do so.

Dementia

Debate between Earl Howe and Lord Wills

Thursday 28th June 2012 Lords Chamber

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

My Lords, I begin by congratulating the noble Lord, Lord Touhig, on securing this debate and thank him for his compelling speech. As all noble Lords have emphasised, dementia is one of the most important health and social care issues that we face as a society. The statistics are staggering. The 670,000 people with dementia in England will double over the next 30 years, and the current £19 billion cost will inevitably spiral.

Dementia affects not only health and social care but all of society, and the speeches today have brought that dimension graphically to life. We need to be better prepared. Dementia is a priority for this Government, and we are working to ensure that it becomes a priority for every part of our society—communities, banks, supermarkets and transport. All need to become dementia-aware and dementia-friendly. That is why, on 26 March, the Prime Minister set out the Government’s challenge on dementia, to go further and faster in implementing the national dementia strategy in three key areas: driving improvements in health and care, creating dementia-friendly communities and improving research into dementia.

I was grateful to my noble friend Lady Barker for what she said about the challenge. We do mean business in this important area. Nationally, three champion groups are driving delivery. The first meetings of the three groups have already taken place and work is well under way to make progress on the challenge. The champion groups will report their progress in September 2012 and again in March 2013.

People with dementia, their families and carers have told us what is important to them and what will help them to live well with dementia. They want to receive an early diagnosis and timely, good-quality information that will help them to make informed choices about their care. I listened with dismay to the story the noble Lord, Lord Wills, told us about his own mother in that context. They want the treatment and support they receive to be the best for their dementia and their life, regardless of whether they are cared for at home, in hospital or in a care home. They want the care they receive at the end of their life to be compassionate and appropriate and to support their exercise of choice.

Early identification of those who care for people with dementia is crucial so that they can be directed to the information, advice and support that will help them in their caring role. The NHS operating framework requires the NHS to work more closely than ever before with local carers’ organisations and councils to agree plans, pool their resources and make sure that carers get the support and breaks they deserve.

However, there are other reasons why change is so important. The challenging economic context, as noble Lords have emphasised, makes it even more important for new and more efficient models of service delivery. That is why we have launched an innovation challenge prize of £1 million for NHS organisations to develop ideas for transforming dementia care. Through the dementia care and support compact, the social care sector is committing to leading initiatives to improve the quality of care for people with dementia. That includes work to ensure that people with dementia are clear about what they have a right to expect of care services.

The noble Lord, Lord Wills, asked about the funding for all this. The Government have already made increased funding available to the NHS and many of the aims of the challenge should deliver savings. For example, the CQUIN goal of improving the recognition of dementia in hospital should lead to people with dementia spending less time in hospital, and ensuring that people with dementia are diagnosed early should stop them going into crisis. The Prime Minister’s challenge is about the NHS and social care making better use of the resources already available to them.

The noble Lord, Lord Touhig, asked about the eligibility criteria for care. The imminent White Paper on care and support—I stress that it is imminent—will set out our plans to transform the care and support system for everyone, including people with dementia. The noble Baronesses, Lady Pitkeathley and Lady Wheeler, asked me for further and better particulars on our plans for publishing the White Paper and indeed for reforming the funding of social care. The care and support White Paper and the progress report on funding reform for social care will be published simultaneously and, I hope, very shortly. I believe that I can go no further than I did the other day in responding to the noble Baroness, Lady Wheeler, but I can reaffirm the Government’s intention to legislate on both funding reform and the reform of the law on social care as early as possible in this Parliament. Clearly, following the publication of the White Paper and the draft Bill that will go with it, we will wish to hear from all sides of the House and indeed from all sectors of the community about the direction of travel and the detail of our ideas.

The noble Baroness, Lady Pitkeathley, asked about the role of GPs. As part of the Prime Minister’s challenge, we are actively working with the royal colleges to identify how best to improve early diagnosis through awareness, education and training at GP level. Early and accurate diagnosis is, as the noble Baroness and others emphasised, very important in ensuring that people with dementia can access the support and information that everyone needs when they receive the dismaying news of this dreadful condition.

My noble friend Lady Barker spoke about adaptations for those with multiple disabilities. I agree with what she said. It is important that designers think about people with dementia when designing products for older people. The department provided funding to the Design Council to run a project to encourage design for people with dementia. There were 185 entries, which shows that designers take this seriously and that the design community is very definitely rising to the challenge.

The noble Lord, Lord Wills, spoke about the Swindon project and innovation. I can tell him that we very much want to see good, innovative practice spread out across the NHS and social care. That is why we have launched the innovation challenge prize for dementia, to which I referred. We are very much looking at innovation as part of the implementation of the Prime Minister’s challenge. Incidentally, the dementia challenge is to achieve a dramatic reduction in the proportion of people who have undiagnosed dementia, with evidence of a step-change in the diagnosis rate and a strong service response. The challenges in this and other areas will be open for a minimum of three years, which should encourage health communities and organisations to confirm their intention to apply for a prize.

The noble Lord, Lord Wills, also referred to human rights. We very much welcomed the publication of the report of the EHRC inquiry into human rights in home care for older people. The report found evidence of mixed practice. While we should be positive about those who deliver good-quality care services—and there are many—there is no excuse for bad practice. We believe that the report performed a valuable service by shining a light on the care and support provided in that most private of spaces—people’s own homes. We cannot tolerate poor quality in any of our care services. I completely agreed with what the noble Baroness, Lady Greengross, said about training. Care and support that respects human rights must be the foundation on which we build to make a reality of our vision of better health and well-being and better care for all. We will continue to work with the EHRC, the Care Quality Commission, local authorities and care providers to ensure that poor practice is rooted out.

The noble Baroness referred, quite rightly, to workforce issues and training. We know that two-thirds of people in care homes have dementia, so it is vital that the workforce is trained in dementia care. Indeed, 10 leading care home and home care providers have already signed the dementia care and support compact to which I referred, and we aim to have 50 organisations signed up by September this year. The compact sets out the organisation’s commitment to deliver high-quality, relationship-based care and support for people with dementia. I think that that statement of intent gets the process off to the right start.

The noble Baroness, Lady Pitkeathley, rightly reminded us of the vital contribution that carers make to society, a theme taken up, very perceptively, if I may say so, by the noble Baroness, Lady Wheeler. The Government have taken strong action to support carers. We set out our priorities in Recognised, Valued and Supported: Next Steps for the Carers Strategy, published in November 2010, and we are providing additional funding of £400 million to the NHS between 2011 and 2015 for carers’ breaks. As we set out in Innovation Health and Wealth, published last December, from April 2013 access to all CQUIN rewards will be dependent on commissioning support for carers in line with NICE and SCIE guidelines.

Furthermore, the 2012-13 NHS operating framework requires the NHS to work more closely than ever before with local carers’ organisations and councils to agree plans, pool their resources and make sure that carers get the support and break that they deserve. I very much hope and believe that that will have a positive effect on the thousands of carers of people with dementia in England.

Although dementia can be a crushing condition, we must not lose sight of the fact that people do live well with it. We need a profound shift in culture and behaviour if we are to reduce the stigma of dementia. All too often dementia is ignored, and the work of carers and other professionals goes unrecognised. Business and civic organisations are part of the solution. They can help to create dementia-friendly communities where people with dementia and their carers can remain and do the things that we all take for granted, such as travelling around and shopping. As so often, my noble friend Lady Barker was completely right in what she said on this theme. We need to create communities in which people are not ashamed of or embarrassed by dementia.

As we have a few minutes in hand, with the leave of the House I will continue a little longer. We need to create communities that show a high level of public awareness and understanding about dementia, communities where people with dementia and their carers are encouraged to seek help and where people know enough about dementia to be able to help someone with the condition. By 2015, there will be at least 20 places recognised as working towards being a dementia-friendly community. Places and organisations that meet the criteria being developed as part of the Prime Minister’s challenge will be awarded dementia-friendly status. I can say to my noble friend Lady Barker that, as part of the dementia-friendly communities strand of the challenge, we are working with banks to ensure that they and their staff understand the needs of people with dementia and that staff are dementia-aware.

The noble Baroness, Lady Greengross, mentioned an important part of the Prime Minister’s challenge, dementia research, spanning basic research through to living well with dementia and increasing capacity and capability across the entire research system. It commits the National Institute for Health Research, the Medical Research Council and the Economic and Social Research Council to increasing funding for research into dementia from £26.6 million in 2009-10 to an estimated £66.3 million in 2014-15.

Over the next three years, the NIHR will support the four new NIHR biomedical research units for dementia, projects resulting from the recent NIHR-themed call for research on dementia, and additional work depending on the volume of high-quality applications received. In addition to the increase in funding for dementia, the MRC will spend over £3 million to support the UK brain banks network. This connects all the UK brain banks for the benefit of donors, researchers and future patients. This money includes £500,000 a year to improve the process for donating brain tissue by meeting the costs of collection through the NHS. The ESRC is making £5 million of additional funding available to fund research into the prevention of dementia and interventions to maximise the quality of life for people with the condition.

There is much that the Government are doing and much more yet to be done. To address the challenges of dementia, we need a response not only from the NHS but from society as a whole.

[Lord Wills]

My Lords, as there is a little time—this is not my intervention—I want to place on record how enormously heartening I found the Minister’s response to the debate. I feel inspired by much of what he said and I want to put on record my thanks to him for his response.

My question is this: are there any milestones in place to measure progress in meeting the Prime Minister’s challenge and, if so, what are they?

[Earl Howe]

My Lords, if the noble Lord will allow me, I shall write to him on that. The answer, broadly, is yes, we want to see progress made by certain steps of time. However, time does not permit me to spell that out now.

There are already significant signs of progress up and down the country. The Prime Minister’s challenge is about mobilising not only the NHS and local authorities but all the resources that our communities have to offer. A great deal of good work is already going on and is beginning to lead to a steady increase in diagnosis rates, which is promising. The result of that will, of course, be that many more people will get the treatment and care that they need and that their loved ones deserve. Long may this continue.

Health and Social Care Bill

Debate between Earl Howe and Lord Wills

Tuesday 13th March 2012 Lords Chamber

[Earl Howe]

No loophole is created by YL. That was closed in Section 145 of the Health and Social Care Act 2008. While I listened with care to the noble Lord, Lord Low, who set out the background to the YL case very ably, I disagreed with him completely. This is not unfinished business from YL. That matter was decisively closed by the previous Government in the 2008 Act.

I move to another point raised by my noble friend Lord Lester. The Government have established an independent commission, due to report at the end of this year, which is looking across the board at how human rights are protected in the UK to see whether things can be done better. The topic of Section 6 of the Human Rights Act featured in various responses to the commission’s consultation last year and has already featured in the commission’s discussions. The Government’s view is that the receipt of the commission’s final report will provide the right moment for us to consider rights protection in the round, including any issues surrounding the scope and operation of Section 6.

I recognise the noble Baroness’s point about the amendment made in 2008 to specify that providers of residential care are bound by the Human Rights Act. However, that does not change my argument. As the noble Lord, Lord Low, reminded us, the 2008 amendment was necessary in order to overturn the contrary court judgment in the case of YL, but the Government at the time deliberately resisted any wider change for the very reason that I am resisting wider change today. I realise that my response is not the one that many noble Lords wish to hear.

[Lord Wills]

I am grateful to the Minister for giving way. It was not the case that the previous Government resisted the amendment. I was deeply and intimately involved in this. It is true that we did not get our act together in time; we ran out of time. I refreshed my memory from my own papers on this point. I agree with the Minister that it is a difficult issue. It is absolutely true that there were different views within government, and no settled decision was reached. There was agreement at the highest level and agreement with the noble Lord, Lord Lester, that public function—the wider issue that lies at the heart of this issue—did need to be addressed. That is what this amendment is trying to do. However, we did not resist it in the way that the noble Earl is suggesting. I appreciate that he is not perhaps as painfully familiar with the details of the previous Government as I am afraid I am.

[Earl Howe]

I am grateful to the noble Lord. My main point is that, whether by accident or design, the previous Government did the right thing in our view, and that is clearly the advice of the Ministry of Justice, which is in the lead on human rights matters.

I hope I have explained why I cannot support this amendment, despite the Government’s wholehearted support for the principles involved, and that I have demonstrated how seriously we take the issues that the noble Baroness raised. To that end, I can today make four very clear statements. I can confirm that the Government maintain an expansive view of the interpretation of Section 6 and, where we have the opportunity and it is appropriate to do so, we would intervene in legal cases in support of that interpretation. I can confirm that human rights will of course be part of the underpinning framework in adult social care law. Any reforms to the law on care and support will need to ensure consistency with the obligations placed on local authorities by the Human Rights Act. I can commit to hosting a round table, along with my honourable friend the Minister of State for Care Services, to bring together all key partners, including, if she wishes, the noble Baroness, to establish how our strategy on adult social care ensures protection of human rights. Finally, I confirm that if the independent commission on human rights makes any recommendations in its final report about the reform of Section 6 of the Human Rights Act, the Government will give them serious consideration.

On this basis, I hope that the noble Baroness will recognise the extent to which we have tried to address her concerns and will feel able to withdraw her amendment. If not, I beg noble Lords to think twice before voting for it.

NHS: Transition Risk Register

Debate between Earl Howe and Lord Wills

Wednesday 18th January 2012 Lords Chamber

[Earl Howe]

My Lords, risk needs to be thought about and assessed thoroughly and often in worst case terms in order to inform policy development and implementation. Risk registers are therefore a basic policy management tool and, for robust risk management to take place, officials have to be free to record all potential risks fully and frankly, with absolute candour, in confidence that anything they say will not be disclosed. If officials knew or believed that what they wished to say was going to be disclosed, that would inhibit them in expressing views fully and frankly. That, in turn, would erode confidence in policy-making and impede good government.

[Lord Wills]

My Lords, apart from the specifics of this case, there is clearly an issue of constitutional significance when this House is being asked to scrutinise legislation without having available to it all the centrally relevant information. That is clearly the case here. Which committee of which House would the Minister recommend looks at this particular constitutional issue?

[Earl Howe]

My Lords, with respect to the noble Lord, I do not think that is a matter for me. Obviously, if there is a committee that feels able and willing to look at this matter, we shall of course co-operate and comply with that committee to the fullest extent.

NHS: Targets

Debate between Earl Howe and Lord Wills

Monday 20th December 2010 Lords Chamber

[Lord Wills]

To ask Her Majesty’s Government what they propose the role of targets in the National Health Service should be.

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

My Lords, from 2012-13 the NHS commissioning board will be responsible for the delivery of NHS services, based on the NHS outcomes framework. The operating framework for the NHS published last week sets out the priorities for the NHS for the transition year of 2011-12 and details how the NHS will move to a health economy driven by outcomes for 2012-13.

[Lord Wills]

I am grateful to the Minister for that Answer. He will recall that, in October, the Health Secretary said that the coalition never committed to a one-week target for cancer patients to get their test results

“because there is not enough clinical evidence to support it”.

However, in November, the noble Earl the Minister told this House that a

“one-week access target would not be the best use of the resources that we have”.—[Official Report, 11/11/10; col. 319.]

Why exactly did the Government scrap the target? Was it the cost, or was there a clinical justification? If it was both, which justification was the most important? If the clinical evidence played any part in this decision, could he please place the evidence in the Library of the House?

[Earl Howe]

My Lords, the announcement made by the previous Government for the one-week target was an unfunded, as well as very expensive, commitment. At the moment, the median wait for the 15 key diagnostic tests is 1.8 weeks—it fluctuates between 1.5 weeks and thereabouts. To bring that down to a maximum of one week would have cost many hundreds of millions of pounds. We judged that there are better ways in which to speed up access to diagnostic tests for a lot less money. That is why we recently announced that £25 million will be made available next year to help GPs to get direct access to tests for cancer without first having to make an appointment with a specialist. That money will buy up to 150,000 extra tests. We have thought round this problem—if I may put it that way—and thought around the conventional referral pathways. I believe that we will arrive at a very satisfactory result.

Mental Health

Debate between Earl Howe and Lord Wills

Wednesday 10th November 2010 Lords Chamber

[Earl Howe]

My Lords, the previous Government’s Delivering Race Equality in Mental Health Care programme ended in January of this year. That programme was delivered through working in partnership with service users, carers, clinicians and third sector agencies. A tremendous amount of information came out of it and the learning and findings from that programme will inform the work that we are now carrying out on a new mental health strategy, which we plan to publish in a few weeks time.

[Lord Wills]

My Lords, Professor Marmot’s review of health inequalities found that unemployment has a significant impact on both physical and mental health. In the light of that and indeed of the rest of that excellent report, what are the Government doing to implement its recommendations?

[Earl Howe]

My Lords, we very much welcome the Marmot review. Fairness and social justice are both key principles of the coalition Government. The Secretary of State for Health has said that he wants to build on the review’s findings and its six main policy objectives, from early years to ill health prevention. The forthcoming public health White Paper will set out our approach to tackling health inequalities and addressing the wider determinants of health.

.

Health: Spending Review 2010

Debate between Earl Howe and Lord Wills

Tuesday 26th October 2010 Lords Chamber

[Earl Howe]

My Lords, we believe that there is a long-term role for NICE, not least in the area of assessing the clinical effectiveness of drugs. In the longer term, we believe that the problem that my noble friend identifies can be addressed more satisfactorily by a system of value-based pricing for medicines, which will mean that the price of a medicine will reflect its value to the patient, as assessed. That is a longer-term exercise that we cannot bring in in a hurry, but we are extremely conscious of the problem that my noble friend alludes to. Having said that, I stress that NICE will remain at the centre of our plans to roll out quality in the NHS.

[Lord Wills]

My Lords, the Minister has just accepted that early diagnosis is key to the survival rates for cancer. Can he confirm that his Government is indeed scrapping the Labour Government's commitment to reduce to one week the wait time for test results for cancer? If he can confirm that, does he seriously believe that extending the prescribed time for diagnosis results is going to help the health outcomes of those living with cancer?

[Earl Howe]

My Lords, there is no question but that timely diagnosis of cancer is extremely important. I do not think that anyone would argue with that. However, we believe that there may be more cost-effective ways of improving access to diagnosis than just imposing a blanket prescription—which, incidentally, has a very high price tag attached. The spending review settlement includes funding for improving early diagnosis in the context of the cancer reform strategy that we are reviewing, and we will set out our plans on that in more detail later in the year.