NHS: Reform

Lord Brooke of Alverthorpe Excerpts

Thursday 16th July 2015 Lords Chamber

[Lord Prior of Brampton]

Interestingly, the number of consultants has increased very significantly over the past 15 years across not all but most specialities. The noble Lord refers to dreadful weekends, and how he dreaded them, particularly bank holidays. That is really why we are here today, so that in future patients like him do not dread them.

If I indicated earlier on that I blame the 2003 contract for the difference between five days’ and seven days’ working, and if that was the implication of what I said, I withdraw it. What I meant to say was that I felt that that contract to some extent de-professionalised the profession.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, most people will welcome much of what is in the Statement.

I would like to come back to the issue of seven-day working that in principle this side supports and accepts. Some of the problems that we have at the moment in the NHS are the top issues with patients. We keep talking about patients being “top of the tree” and being in charge. Can the Minister tell the House what issue about NHS performance at the moment disturbs patients most of all? We have a list of issues where we are doing well: tell us what is worst.

The worst is the inability to access a GP, on a timely basis, five days a week, not seven days a week. This is not new. The position was bad in 2010, when Labour, my party, was in power, but it deteriorated while the Lib Dems and the Conservatives were in the coalition. I can point to Questions in Hansard raised in 2012, when we were promised by the noble Earl, Lord Howe, that discussions were taking place in the profession about trying to improve access to GPs, particularly where there were problems in London. I speak as a patient with a GP in London, who asks how he is to provide a seven-day week service when he cannot get the GPs and does not have the money to do it.

My noble friend Lord Hunt asked a basic question which is of prime concern to people, particularly in London. Will spreading this over seven days until such time as you can provide the 5,000 trained GPs who were promised, which will be seven years down the road, lead to a further deterioration in the ability to access a GP during the week?

[Lord Prior of Brampton]

There is no doubt that, looking forward over the next five years, the resource to be put into primary care will be greater, relatively, than it has been in the past. We wish to deliver more care outside hospital. That is why we are committed to training and having in place 5,000 more doctors in general practice by the end of this Parliament—not just GPs, but others who will support GPs.

The model of primary care will change significantly over the next five years, and it is fundamental to the five-year forward view that we reduce the number of people going into acute hospitals and that we discharge people at the other end of their journey through an acute hospital much quicker.

NHS: GP Clinics

Lord Brooke of Alverthorpe Excerpts

Thursday 25th June 2015 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will provide an annual report to Parliament regarding the operation of seven-day opening of general practitioner clinics.

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

My Lords, we are committed to seven-day GP access. We have already invested £175 million in 57 schemes covering 2,500 practices, offering improved access including evening and weekend appointments. The 2016-17 mandate to NHS England, to be published later this year, is expected to reflect Government commitments, including on access. The Government hold NHS England to account for progress against these objectives and publish an annual assessment of NHS England, including progress in delivering the mandate.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for the information he has just given. Will he recall that earlier in the week, in reply to a Question about the number of GPs in practices, he said that the general practice model “is largely broken”? His second statement was that it “is probably broken”. In the light of that expression of his concerns about what was happening in GP practices, I presume that he was associating himself with those millions of NHS patients who increasingly find it difficult to see a GP within the time they want, or to see a GP of their choice. If so, can he say whether moving from what is broadly a five and a half-day weekly GP practice to seven days for all will improve matters for those patients or make matters worse, especially as it is being done on a broken model, to use his own words? In those circumstances—

[Noble Lords]

Too long!

[Lord Brooke of Alverthorpe]

In those circumstances will he say what the new model will be, spell it out to the public and say how many GP practices will have to close?

[Lord Prior of Brampton]

The noble Lord makes a number of interesting points. One of the leaders of the BMA talked yesterday about the need for a renaissance in general practice, which was about the only thing in that speech that I agreed with. We need a renaissance and a complete transformation in general practice because the structure of primary care is largely unchanged since being set up in 1947, and the population’s requirements have changed fundamentally. So over the next five years, I expect primary care to go through a renaissance and be transformed from the bottom up.

NHS: Health and Social Care Act 2012

Lord Brooke of Alverthorpe Excerpts

Monday 16th March 2015 Lords Chamber

[Earl Howe]

I do agree. That idea is being taken up by a number of the vanguard sites, which are looking at the new models of care that were foreshadowed by the five-year forward view. It is, I think, the shape of things to come.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, it would be churlish not to accept the noble Earl’s remarks that there have been some changes which have been beneficial. But does he not agree that the public at large recognise that overall there have been many downsides? Many of those downsides have been hidden and continue to be hidden by politicians, who refuse to release the risk register that was drawn up prior to that Act going through.

[Earl Howe]

My Lords, we are back to that one. As the noble Lord knows, the strategic risk register for the department is something that we are entitled to keep confidential, as all Governments have done. The Cabinet took the decision that the transition risk register should remain confidential because of the principle of the need to preserve private space for civil servants when advising Ministers.

Health: Obesity

Lord Brooke of Alverthorpe Excerpts

Thursday 26th February 2015 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what assessment they have made of the Local Government Association’s report Tackling the causes and effects of obesity.

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

My Lords, we welcome the Local Government Association’s report, which provides a valuable contribution to this debate and demonstrates the contribution that local authorities can make and are making. This Government see local authorities as key to tackling obesity and other public health issues. Local communities know best how to tackle obesity, based on local understanding and need. To support this, we have given local authorities £8.2 billion of ring-fenced funding over three years for public health.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful for that reply, but as the Minister will recall from his reading of the report, LEAs say they are the people to do the job but they simply do not have the cash to do it. They have had a 40% cut in their grant aid over the past five years and they do not have the money available to carry out this work. Will he look again at whether, particularly with what is happening in Manchester, some freedom might be given for people at LEA level to raise additional funding themselves?

[Earl Howe]

My Lords, there is always scope to raise additional funding from charities and, indeed, from industry. Alongside the ring-fenced budget we have given to local authorities—it is the first time that this has been done for public health—we have a number of programmes in train which can work side by side with local authorities, such as the work going on in NHS England’s five-year forward view programme. Public Health England, in conjunction with the Local Government Association and ADASS, is commissioning work to support local authorities to take a whole-systems approach and look more widely in the way that the noble Lord has suggested. Public Health England’s Healthy Places programme is also relevant here, looking at how we can use the planning system to promote public health.

Alcohol: Impact on Accident and Emergency Services

Lord Brooke of Alverthorpe Excerpts

Wednesday 21st January 2015 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what discussions they have had with the drinks industry about contributing to National Health Service accident and emergency costs.

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

My Lords, the alcohol industry has responsibilities to reduce harm caused by its products. We have challenged the industry to deliver action through the responsibility deal. It is important to recognise that individuals also have responsibility for their behaviour. The Government set the legislative framework, and the United Kingdom has relatively high taxes on alcohol, which are the main way to compensate society for its costs. Our alcohol strategy seeks to prevent and reduce harm from alcohol.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful for the pleasant words from the Minister, but I omitted to pick up on just what action the Government intend to take. Does he share the concern of his new CEO for the NHS, Sir Simon Stevens, that more than 1 million people are now presenting at A&E each year with alcohol problems? Not only that, but they are in the main accompanied by their friends and often family, who swell the numbers and are equally intoxicated. They are creating great difficulties for nurses, doctors and other A&E patients. Many of those people do not come from their home; they come from drinking establishments from which some of them have been ejected. Many of those establishments have personnel there looking after security for the protection of the interests of the drinks industry. If the drinks industry can pay for those people to protect its interests, why cannot it be required to pay to protect the interests of nurses, doctors and other people in A&E who are intimidated by people who are drunk?

[Earl Howe]

My Lords, alcohol-related attendances at A&E are certainly a matter of concern; we fully recognise that. Having said that, there is no evidence to suggest that current pressures in A&E departments are related to trends in alcohol-related attendances. We are taking a range of actions to prevent and reduce harm both nationally and in many local areas. We are certainly not just treating this as a financial issue. This is an issue to do with people’s health, and it is important. The industry is playing its part through the responsibility deal, which is already yielding some encouraging results.

Alcohol: Addiction

Lord Brooke of Alverthorpe Excerpts

Monday 12th January 2015 Lords Chamber

[Earl Howe]

My noble friend is absolutely right. More than 90% of liver disease is due to three main, preventable and treatable risk factors—alcohol, hepatitis B and C, and obesity. Alcohol accounts for 37% of liver disease deaths, but obesity is indeed a major factor in this.

[Lord Brooke of Alverthorpe (Lab)]

Will the Minister explain to the House why, when his Government came to power, they tore up the draft strategy on liver disease that had been prepared by the previous Government? What are they going to do to put one in place and, given the complaints we have heard, make sure that the growth in the number of deaths is reversed?

[Earl Howe]

My Lords, Public Health England has a programme of work to ensure that all the bases are covered. It is producing a report for government that will be published later this year. Over the next 18 months, there will be a longer programme of work on such things as a framework for liver disease, setting out the evidence base for the introduction of a minimum unit price for alcohol and using alcohol as the trail-blazer for a new whole-system approach that establishes what works and is clear on the return on investment, to enable government to take action based on evidence.

Alcohol-related Disease

Lord Brooke of Alverthorpe Excerpts

Wednesday 17th December 2014 Lords Chamber

[Earl Howe]

My Lords, we have acted on alcohol pricing. We have to look at this in the round and in relation to what is happening. Alcohol consumption per head has fallen in recent years. Reduced affordability of alcohol—influenced, I may say, by tax rises above the RPI each year to 2013—has certainly been one factor in that, we believe. We are committed to reducing alcohol-related harm. We have already banned alcohol sales below the level of duty plus VAT, meaning that it will no longer be legal to sell a can of ordinary lager for less than about 40p.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I declare an interest as a patron of the British Liver Trust, which was associated with the Lancet commission report. I am sure that the Minister will agree that deaths from liver damage related to alcohol are increasing, not decreasing. Although the Government have made changes to pricing, why is Public Health England stating that there needs to be significant movement on pricing and easy access to alcohol before there will be any effect not just on deaths but the wider problems that arise from alcohol harm?

[Earl Howe]

My Lords, I take it that the noble Lord is referring to minimum unit pricing, among other things. The long-term trend in alcohol-related deaths is indeed upwards, although there has been a dip over the past four years. Minimum unit pricing is a policy that is still under consideration. It has only ever been one part of the Government’s alcohol strategy, which includes a range of national and local actions, including partnership with industry, as I said, and increased powers for local communities to tackle harm. There are various ways in which we can address the problem, which the noble Lord rightly highlights.

NHS: Health and Social Care Act 2012 Reforms

Lord Brooke of Alverthorpe Excerpts

Wednesday 22nd October 2014 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what is their assessment of the impact on National Health Service funds of the reforms introduced under the Health and Social Care Act 2012.

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

My Lords, this Government have taken tough decisions to increase the NHS budget by £12.7 billion between 2010-11 and 2014-15. During this period, the Government’s NHS reforms will enable total administration costs to reduce by one-third in real terms, to release funding to NHS front-line services. Already, savings arising from the reforms released £1.5 billion last year and £1 billion in 2012-13 to front-line services.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, did the Minister read, as I did, the headline “NHS reforms our worst mistake, Tories admit” in the Times last week? This was part of a devastating series of articles analysing what had happened to the 2012 reforms, along with the costs which had accrued or the savings which had failed to be achieved but could have been if the Government had not been diverted by the reforms. Who will be held responsible for this devastating and monumental failure in policy? It has been very costly to the country, especially at a time of austerity.

[Earl Howe]

First, let me make it clear that the Government have no regrets whatever about the NHS reforms. These reforms enabled massive savings to be made, all of which have been ploughed into the front line. Without investment in the cost of the reforms—which I concede were considerable—we would not have been able to realise these savings, nor would the NHS have been able to plough those savings back into the front line. This has enabled us to employ more than 7,700 extra doctors, and the NHS is now performing more than 850,000 more operations every year. That is the benefit of the reforms.

NHS: Cancer Diagnosis and Treatment

Lord Brooke of Alverthorpe Excerpts

Monday 13th October 2014 Lords Chamber

[Earl Howe]

My Lords, my noble friend mentions a particular type of radiotherapy, the CyberKnife. At present there is only limited research evidence of the clinical and cost effectiveness of stereotactic ablative body radiotherapy—the full name. Therefore, it is available only for certain patients with lung cancer. Having said that, NHS England has agreed to make £6 million available over the next few years for new clinical trials which will involve trials on prostate cancer, lung cancer, pancreatic cancer and biliary tract cancers. It is important that we generate that clinical evidence before encouraging the NHS to apply this form of radiotherapy to those cancers.

[Lord Brooke of Alverthorpe (Lab)]

Will the noble Earl give the House an indication of when the deteriorating waiting times for cancer treatment will be reversed?

[Earl Howe]

My Lords, clearly a lot of work is going on in the NHS to ensure that we are back on track with the cancer waiting times. Local area teams of NHS England are looking at the causes of those waits and whether there are diagnostic tests that are responsible for the dip in performance. But I can assure the noble Lord that we place a high priority on this area.

Health and Social Care Act 2012: Risk Register

Lord Brooke of Alverthorpe Excerpts

Wednesday 9th July 2014 Lords Chamber

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will publish the Risk Register drawn up for the Health and Social Care Act 2012.

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

The Government’s position has not changed since the noble Lord asked the same Question last December. We are not proposing to publish the risk register. This decision is based on the principle that Governments and their civil servants need to be able to consider the risks associated with policy formation in private. It remains our view that a full and candid assessment of risks and their mitigating actions should be carried out within a safe space.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, the logic of that is that no risk register should be released to the public and I do not believe that is the Government’s policy. Given the Secretary of State for Health’s recent encouragement and support for NHS whistleblowers, and as the original risk register was released into the public domain by a whistleblower, what would the Government do if the continuing cover-up was then blown by a whistleblower before the next general election?

[Earl Howe]

My Lords, I am sure the noble Lord would expect me to say that hypothetical situations are not in my domain, and that is true in this case. The Government’s position is that there is a balance to be struck between transparency of activity in government and the safe space required for effective policy-making. That is why, in November 2011, I laid out for this House a comprehensive list of the areas covered by the transition risk register, but also why, at the same time, the Government decided to withhold publication of the register itself.