Hospitals: Patient Transport

Lord Bishop of Oxford Excerpts

Tuesday 4th April 2017 Lords Chamber

Asked by

[Lord Harries of Pentregarth]

To ask Her Majesty’s Government what steps they are taking to reduce waiting times for patients using hospital patient transport.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, it is the responsibility of local NHS commissioners to decide how best to deliver patient transport services. We do not centrally monitor these waiting times. The eligibility criteria for patient transport services stipulate that patients should reach appointments in a reasonable time, in reasonable comfort and without detriment to their medical condition. Where local issues arise in the delivery of these services, we expect commissioners to take swift action.

[Lord Harries of Pentregarth (CB)]

I thank the Minister for his reply. Recently, I had to take my wife, who is extremely disabled, to hospital using hospital patient transport. After a satisfactory medical appointment we then had to wait three and a half hours for hospital transport to take us home. The following day I took her to another hospital and there we had to wait one and three-quarter hours. In the light of this experience, I asked around and discovered that some people are having to wait as long as six hours—and these are people who are extremely disabled, and some of them are without escorts to take them to the loo. Does the Minister agree that this is totally unsatisfactory and that there needs to be a proper system of monitoring and, if necessary, sanctioning the private companies that are now operating this service?

[Lord O'Shaughnessy]

I am sorry to hear of the wait faced by the noble and right reverend Lord’s wife, and indeed others. Those delays do not sound acceptable. There are clear guidelines in the standard contract for commissioners to outline the quality of patient services, and they are inspected by the CQC. I would certainly be happy to meet him to talk about this in more detail and find out exactly what is going on.

NHS: Junior Doctors’ Pay

Lord Bishop of Oxford Excerpts

Wednesday 27th January 2016 Lords Chamber

Asked by

[Lord Harries of Pentregarth]

To ask Her Majesty’s Government what assessment they have made of the remuneration of junior doctors.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the review body on doctors’ and dentists’ remuneration stated, in its 2015 report, that total pay for junior doctors compares favourably with comparator groups. This will remain the case under the proposed new contract. Average total earnings range from £31,000 in the early stages of training to £53,000 for those in the later stages when they have specialised.

[Lord Harries of Pentregarth (CB)]

My Lords, I thank the Minister for his Answer and declare a personal interest with a wife and son who are doctors. As the Minister will know, medical students do three years after they graduate before they obtain their first job at the age of 24, at which point they will have accumulated between £100,000 and £120,000-worth of debt, and their starting salary will be about £20,000 a year. I heard recently of somebody newly graduated being offered a job in computers for £60,000 a year, and another person newly graduated—at the age of 20 or 21—being offered £60,000 for a job in management consulting. Do the Government agree that there is something fundamentally out of balance in this system, and is the Minister convinced that the Government are doing all they can to ensure that junior doctors get a fair settlement, not just for themselves but for the whole future of the NHS?

[Lord Prior of Brampton]

My Lords, I should also declare a personal interest, as my son is in his fourth year as a medical student. It is actually two years after undergraduate training when you qualify fully. The base salary is about £23,000—the noble Lord said £20,000—but the average is more like £30,000, when you take into account the supplementary pay that they receive. I, too, see what other people are being paid in other sectors, but the fact of the matter is that, when a young man or woman opts to go into medicine, pay is not their main motivation: there are all kinds of other things as well. One has to take into account the whole package that is offered, not just the salary.

Care Bill [HL]

Lord Bishop of Oxford Excerpts

Wednesday 9th October 2013 Lords Chamber

[Lord Cormack (Con)]

My Lords, I would like very briefly to support what my two noble friends have just said. Surely this is not the Government conceding to a secular society and surely they recognise that for many sick people, the spiritual dimension is extremely important. It is not a question merely of healing physical ills and curing physical diseases, it is a question of recognising that many people, particularly as they near the end of their lives, have a great need to fall back upon their faith, and that should be recognised and encouraged. For the life of me, I cannot see what the Government are doing here and I hope that my noble friend will be able to give us a satisfactory answer. I am only sorry that the Bishops’ Benches appear to be empty this afternoon because one would have liked to have heard a contribution from them.

[Lord Harries of Pentregarth (CB)]

My Lords, as someone who remains a Bishop, on behalf of my old friends on the other side of the Chamber, I would like to support this amendment. As the Bishop of Oxford, I remember visiting one of the brand new universities, which thought of itself in very secular terms. Nevertheless, the university was adamant that it should have a chaplain because it believed in whole-person care, and an essential element of whole-person care was the spiritual dimension. We need to take that into account.

We also need to take into account the fact that we now live in a multifaith society, and for those of some religions in particular, it is very important that they have someone with religious authority in contact with them in the final stages of their life. There are good reasons for supporting this amendment.

[Baroness Barker (LD)]

My Lords, I apologise for not being in my place for the start of this debate. As noble Lords will know, on these occasions such amendments are often tabled by myself and the noble Lord, Lord Hunt of Kings Heath. We do so because we support the right of Christian Scientists to have their beliefs respected, in particular their right to refuse treatment. That said, when we discussed this matter in Committee, while at that point the Minister was as sympathetic as always, he failed to draw a distinction that is important to people of faith, which is that between the use of the words “emotional” and “spiritual”. People of faith believe that matters which are spiritual are of a different order from those matters which are emotional. I have a degree of sympathy with their view. However, I also have a degree of sympathy with the Minister, who does not wish to put things into legislation that are unnecessary. I hope that he will, in this case, perhaps be a bit more sympathetic to the arguments that are being put forward.

The noble and right reverend Lord, Lord Harries of Pentregarth, is right that as a society not only are we becoming much more diverse, but in our everyday life we understand the importance of faith and spiritual matters to other people. For example, we would not for a moment think it acceptable to present somebody with a diet that was not reflective of their cultural and religious beliefs. In our modern day health and social care services we are increasingly adept at recognising people’s differences and accommodating them. All told, this is a small amendment which costs nothing but means an awful lot. I hope that the Government will be able to take it on.

NHS: Private Finance Initiative Costs

Lord Bishop of Oxford Excerpts

Wednesday 11th July 2012 Lords Chamber

Asked By

[Lord Harries of Pentregarth]

To ask Her Majesty’s Government what steps they are taking to ease the burden of Private Finance Initiative costs falling on healthcare trusts.

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

My Lords, a lot has been done. All PFI schemes are having their contracts reviewed for potential savings, following a Treasury-led pilot exercise last year. We are providing the seven trusts worst affected by PFI schemes access to a £1.5 billion support fund over a period of 25 years, which will be available from 2012-13 directly from the department. We have worked with another 16 to address their long-term sustainability.

[Lord Harries of Pentregarth]

I thank the Minister for his reply and I am glad to hear about the support fund. Is it not the case that the contracts at this time of national financial crisis need to be renegotiated in order to bring them more in line with the austerity being suffered by the rest of the nation? Not only are they being required to pay 14% or 15% interest, they are having to pay maintenance charges such as those quoted to me of £500 to put in a new lock and £80 to change a light bulb. As the Minister knows, there are now 20 healthcare trusts responsible for 60 hospitals in serious financial trouble.

[Earl Howe]

The noble and right reverend Lord is right. We believe that a number of the PFI schemes from the previous Administration were not soundly based in terms of their sustainability. As part of the work that we are doing on the Foundation Trust Pipeline, we have had to work on long-term sustainability solutions to help NHS trusts with PFI schemes, hence the direct financial support that I have referred to.

We have also organised PFI trust forums to disseminate the lessons learnt and to share experiences. We have earmarked resources to support the front line in ways to secure savings and we are currently in negotiation with people who have experience in the NHS and private sector to form a new team to support existing contract managers and, where necessary, to support negotiations with private sector PFI companies.

Health Transition Risk Register

Lord Bishop of Oxford Excerpts

Thursday 10th May 2012 Lords Chamber

[Earl Howe]

I can do little but thank my noble friend for his kind remarks. Indeed, if I may say so, during the passage of the Health and Social Care Bill, I always attempted to be as open as I possibly could with the House on all the matters that we debated. I think that that resulted in a much better Bill. I hesitate to do this, but it is instructive to look at the evidence given to the Justice Select Committee in another place last month by Jack Straw. He put the case that we are making in very graphic terms with which I agree. He said:

“If you talk generally about risk registers, it has to be possible for officials to say to Ministers that there are these risks without these going public. Given the assiduity of the British press, if you publish a raw risk register without any more information, you will set all sorts of hares running, but the document was not designed or prepared in that way. You have to say, ‘We think that we could be at risk here. We think we could be at risk there. Have you thought about this?’ In my view, that sort of information must be protected”.

I could not have put it better.

[Lord Harries of Pentregarth]

My Lords, I thank the Minister very much for his helpful Statement. The whole House agrees totally with the noble and learned Lord, Lord Falconer, that officials must have their private space to make their frank comments. Does the Minister agree that you have to draw a distinction between those frank comments and the risk register itself, which is something of a more formal document? The risk registers that I have seen lay out formally whether the risk is high, medium or low, and you could publish the risk register without at the same time publishing any frank advice that was given. Because the risk register has not been published, does that not itself give rise to possible misrepresentations? There is always the possibility of misrepresentation. If it is published it will possibly be misrepresented; if it is not published, it could also be misrepresented. Finally, I ask for further clarification about the noble Earl’s remark that if the risk register had been published that would set a precedent for the future so that advice would all be anodyne. That was the word the Minister used. Would not the opposite be the case? Officials who were trying to make their judgment about possible risks would be more likely to exaggerate the risks. If the risk register was published and it was discovered that proper risks had not been identified, those officials would be held responsible for not identifying those risks and weighing them with due seriousness. I was slightly surprised by the use of the word “anodyne”.

[Earl Howe]

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

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

Public Bodies Bill [HL]

Lord Bishop of Oxford Excerpts

Monday 28th March 2011 Lords Chamber

[Lord Harries of Pentregarth]

My Lords, I have three brief questions for the Minister, which concern the HFEA database, research and the role of the Care Quality Commission.

First, under one of the options under consideration, the extensive and complex HFEA database will be managed by the NHS body that is at present charged with collecting and analysing all health data. There seems to be some confusion among your Lordships about the exact name of this body; it seems to be complex and changing, but I think that the Minister knows what I am referring to. As he also knows, the remit of that body covers only England, whereas the HFEA is responsible for collecting and analysing data for the whole of the United Kingdom. Furthermore, that body does not collect data from private clinics, whereas the HFEA is responsible for collecting data about IVF and its associated techniques from both NHS and private clinics, of which there are, of course, a good many. Can the Minister explain how these incompatible remits can be reconciled? One body is concerned only with England, but the HFEA is concerned with the UK as a whole; one body is concerned only with NHS data, but the HFEA is concerned with both private and NHS clinics.

My second question is on research. The Government are, I know, very interested in the recommendations in the Rawlins report and have it in mind to bring forward a Bill with a view to centralising all licensing for medical research in the proposed medical research agency, to which a number of your Lordships have referred. There is no doubt that in principle this is a welcome step in the direction of cutting out duplication and time wasting for medical research. However, the Rawlins report did not specifically recommend that research that is at present licensed by the HFEA should be passed to the proposed body; in fact, it simply left that matter to ministerial decision. If the research function of the HFEA is transferred to the new body, research involving embryos will still, because of the HFE Act, need both separate licensing procedures and separate inspection. The law will demand that. This will involve setting up a panel and inspection teams with the necessary specialised scientific expertise and specialised legal advice. What possible savings or advantage can there be in doing this? It would require the re-creation of a mini HFEA within the new parent body.

My third question is on the role of the Care Quality Commission. By October of this year, the HFEA and the Care Quality Commission will already have co-located and will be sharing back-office staff. They are working on how they can share inspections. They are already in the process of saving the kind of money that the Government have in mind. Does the Minister not agree that legally transferring some of the functions of the HFEA to the Care Quality Commission will add to the cost, entail the long drawn-out process of consultation and legislation that he mentioned in his letter to us and result in the break-up and reformation of a specialist team, with all the consequent disruption as well as the expense?

Everybody knows that the Minister commands huge respect in this House, but the questions that I and others have posed cannot be answered at the moment and it would be in the Government’s best interests simply to accept this amendment.

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

My Lords, I am grateful to noble Lords for providing us with a further opportunity to debate the future of these two bodies. As is clear, these amendments would have the effect of putting the Human Tissue Authority and the Human Fertilisation and Embryology Authority outside the scope of the Public Bodies Bill. The Government recognise that a number of your Lordships remain unconvinced of the merits of our plans to reform these arm’s-length bodies. The concerns that various speakers have raised are ones that we have debated previously and are therefore familiar. I hope, nevertheless, that I can address them.

To begin, I strongly feel that we cannot continue with the parallel systems of regulation that are currently running. There must be some scope for rationalisation and relieving the overall burden on those regulated. However, in looking to achieve that, I fully recognise the need to retain regulatory rigour and expertise in the fields of embryology and human tissue. I therefore offer further reassurance on those issues that have proved of most concern: the retention of expertise, public consultation and the potential savings offered by our proposals.

First, expertise will not be lost. It is envisaged that the expertise invested in individuals will follow functions —for instance, through staff transfers and establishing expert reference groups. There will be a carefully managed transition between regulators, which will ensure that key skills and knowledge are passed on to receiving organisations.

Secondly, there will be extensive consultation later in the summer on where functions are best transferred and, subsequently, on the orders to effect the transfers. We envisage that our consultation will cover two main areas. It will set out our proposals for the transfer of the regulation of treatment and research, and set out the options and considerations for other functions where there may be several different possible destinations, such as those related to the collection and sharing of information or policy decision-making. Let me be clear that these functions, which are required under the Human Fertilisation and Embryology Act and the Human Tissue Act, will continue. A number of your Lordships have voiced the fear that, for instance, the HFEA’s registers and databases will be dissipated or lost. That will not happen. The consultation document will set out a number of different options for how these functions might be delivered in the future, and we will listen to people’s views about this. I can reassure the House that, in considering how to transfer functions, we will want to maintain the best aspects of the current regulatory system and avoid action that might undermine them.

Thirdly, I turn to financial savings. Together, the budgets for the HFEA and the HTA total £13.6 million. Through the streamlining of regulatory functions, we envisage scope for savings in three areas. The first will be in grant-in-aid for reduced overall running costs. The second will be for the regulated bodies in licence fees. The third will be for those bodies in the preparation and demonstration of compliance with the regulatory system. A leading clinician licensed by the HFEA recently said:

“We pay over £100,000 per annum in fees to the HFEA. Since 80% of our work is NHS funded that means that over £80,000 of the money that the PCT pays for fertility treatments goes straight to the HFEA”.

That is money which in large measure could be saved and used to deliver healthcare to patients. The department will undertake more detailed analysis of current costs and potential savings to inform an impact assessment which will be developed as part of the consultation process, so the whole set of equations will be transparent.

[Lord Harries of Pentregarth]

I thank the Minister for giving way. In relation to that last point, when the impact assessment is made will it be possible not only to assess the impact of what the Government are proposing but that of simply telling the existing bodies that they have to cut costs by a certain amount, so that the one can be weighed against the other?

[Earl Howe]

My Lords, I do not think that I am chancing my arm by saying that that is my understanding of what the impact assessment ought to look like in that a typical impact assessment will have within it several alternatives so that it is possible to compare different options. I would be happy to come back to the noble and right reverend Lord with a definite answer on that but my understanding from previous impact assessments is that that kind of benchmarking ought to be possible.

The noble Baroness, Lady Thornton, has previously raised her concerns about where the ethical framework for any new arrangements will sit. Ethical safeguards, for example concerning the embryos and gametes that can be used in treatment, the need to consider the welfare of the child and the need for consent in respect of human tissue, are clearly enshrined in legislation in accordance with the wishes of Parliament. These safeguards will continue to remain firmly in place and will underpin the regulation of treatment and research as currently, by whoever is responsible for regulating. Where there are specific ethical issues surrounding new treatments, the department will consider how best to commission expert advice on an individual basis, as is currently being done for mitochondrial transfer, for example.

A number of noble Lords have shown interest in and support for the Government’s announcement last week, as part of the growth review, about streamlining research regulation and governance. The Government announced in the Plan for Growth on 23 March that they will create a health research regulatory agency to combine and streamline approvals for health research which are at present scattered across many organisations. As a first step, the Government will establish this year a special health authority with the National Research Ethics Service as its core. When established, the new agency will work closely with the Medicines and Healthcare Products Regulatory Agency to create a unified approval process and promote proportionate standards for compliance and inspection within a consistent national system of research governance.

This will reduce the regulatory burden on firms and improve the timeliness of decisions about clinical trials and hence the cost-effectiveness of their delivery in the UK, and has clear support from the Academy of Medical Sciences review of medical research regulation and governance.

In this context, it is important for me to remind the House of a key point. Here I refer particularly to the question posed by the noble and right reverend Lord, Lord Harries. The AMS report recognised at paragraph 9.5.1 that there are significant benefits in bringing all medical research regulation, including embryo research currently undertaken by the HFEA, within the remit of a single health research regulatory agency. Indeed, remarks made by Sir Michael Rawlins in the Guardian on 11 January firmly backed up that view. We agree with that proposition but again the consultation will invite views on it.

My noble friend Lord Willis expressed his fears about the Government adopting a piecemeal approach to reorganisation, as did some other noble Lords. I accept that our approach to the HFEA and the HTA may indeed seem rather complex. The powers of the Public Bodies Bill will enable us to transfer some of the functions of the HFEA and HTA to other bodies but they do not enable us to do everything that we have set out in the arm’s-length body review. In order to abolish the HFEA and HTA, or to transfer their research-related functions to any new research agency, we will require powers under future primary legislation.

It might help if I provided a rough outline of how and when we could take this forward. We intend publicly to consult on proposals to transfer all the HFEA and HTA functions to other bodies in the late summer of this year. During 2012-13, under the provisions of the Bill, we will prepare draft orders for formal consultation dealing with the transfer of functions, other than research functions. If appropriate, we would then be able to lay the orders before Parliament. This process would enable noble Lords and other interested parties to see, comment on and debate the proposals, as they progress.

Without the inclusion of these bodies in Schedule 5, we would have to provide for the transfer of their functions entirely within future primary legislation. I simply say again, particularly to the noble Lord, Lord Warner, that not including these bodies would significantly increase the risk that the underlying ethical provisions of the Human Fertilisation and Embryology Act and the Human Tissue Act were reopened for debate.

Human Fertilisation and Embryology: Regulation

Lord Bishop of Oxford Excerpts

Wednesday 13th October 2010 Lords Chamber

[Earl Howe]

My Lords, we intend to engage fully with all interested parties on this matter but it is early days. The noble Baroness quite rightly raises the specialist expertise available to the HFEA. We fully recognise that. We are very keen that the expertise is not lost but is made available to the CQC or to the new research regulator, if we set up one. I understand that, where a function of one organisation transfers to another organisation, it is customary for the relevant staff to transfer as well. I emphasise that matters are at a very early stage.

[Lord Harries of Pentregarth]

My Lords, given the special ethical status of the early embryo, does the Minister agree that the integrated function of the HFEA, whereby the licensing of the clinics, the licensing of research and the extensive database are held together, minimises the risk of unfortunate incidents? If the HFEA is dismembered, the likelihood of such unfortunate incidents is likely to increase.

[Earl Howe]

My Lords, I recognise, as will the House, the noble and right reverend Lord’s experience in these matters. At this early stage, we will look very carefully at the design of systems to ensure that the expertise and the scrutiny functions, which we associate so well with the HFEA, are not diluted or lost in any moves that we make in this area.