NHS: Health and Social Care Act 2012

Debate between Lord Brooke of Alverthorpe and Earl Howe

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

Debate between Lord Brooke of Alverthorpe and Earl Howe

Thursday 26th February 2015 Lords Chamber

[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

Debate between Lord Brooke of Alverthorpe and Earl Howe

Wednesday 21st January 2015 Lords Chamber

[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

Debate between Lord Brooke of Alverthorpe and Earl Howe

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

Debate between Lord Brooke of Alverthorpe and Earl Howe

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

Debate between Lord Brooke of Alverthorpe and Earl Howe

Wednesday 22nd October 2014 Lords Chamber

[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

Debate between Lord Brooke of Alverthorpe and Earl Howe

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

Debate between Lord Brooke of Alverthorpe and Earl Howe

Wednesday 9th July 2014 Lords Chamber

[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.

Health: Liver Disease

Debate between Lord Brooke of Alverthorpe and Earl Howe

Tuesday 6th May 2014 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will produce a strategy to reduce liver disease.

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

My Lords, improving outcomes for people with liver disease is a priority. Public Health England has a wide-ranging programme aimed at tackling its three major causes—viral hepatitis, alcohol abuse and obesity—through strengthening local action, promoting healthy choices and giving appropriate information to support healthier lives.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I gather from that that the Government are not prepared to consider introducing a strategy, which is a great pity given that liver disease is now the fifth biggest killer and we have some of the worst figures in the whole of Europe. How does the Minister see a more general approach, rather than a specific target in a strategy, producing a change in the terrible figures which we now see in the number of deaths, given that the deprived areas of the country where most of them occur, such as Manchester, had a reduction in the funding to commissioners and GPs for this purpose last month?

[Earl Howe]

My Lords, as the noble Lord is aware, NHS England is responsible for the overall national approach to improving clinical outcomes for people with liver disease. At the moment, it has no plans to produce a strategy specifically for liver disease, but it is adopting a broad strategy to reduce premature mortality, including mortality from liver disease. There is a major emphasis in the work being done by NHS England and Public Health England on prevention. They are supporting clinical commissioning groups and local authorities with a suite of tools to help them maximise the best possible outcomes for their local communities, such as local authority profiles. That can help local authorities and CCGs indentify the significance of liver disease in their area compared to the rest of the country, and the actions they could take to tackle it.

Alcohol: Calorie Labelling

Debate between Lord Brooke of Alverthorpe and Earl Howe

Thursday 13th March 2014 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government, further to the answer by Earl Howe on 11 February (HL Deb, col. 535), whether they will publish a list of the alcohol producers and retailers who have pledged themselves voluntarily in the Responsibility Deal to display the calories and sugar content of the drink on the labels of their alcohol products.

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

My Lords, we welcome companies such as Sainsbury’s, which have taken action in this area. While there is no responsibility deal pledge to voluntarily display energy and sugar content on the labels of alcohol products, we will continue to consider what more can be done through the responsibility deal to improve public health, including through consumer information.

[Lord Brooke of Alverthorpe (Lab)]

I am truly grateful to the noble Earl for the efforts he has been making to try to persuade the drinks industry and the supermarkets that they have to accept some responsibility for the damage to health that alcohol causes. From the pledges he has been given by the producers and the supermarkets, can he say how many have as yet actually displayed calories and sugar on the labels of their lagers and beers? While I acknowledge that progress is happily now being made with wine, will he say what he intends to do, given that Tesco and Morrisons have now publicly stated that in no way will they go down this route?

[Earl Howe]

My Lords, I mentioned Sainsbury’s, which is setting a very good example in this area, but I can tell the noble Lord that Waitrose and the Co-op have also taken steps to display calories on their own-brand alcohol labelling. Naturally, we hope that others will follow their lead. As yet, none has, and it is a pity that Tesco has said that it will not, but we will continue to work on this issue. Work is also going on at a European level, and the noble Lord may like to know that the UK pressed for mandatory energy declarations during negotiations on the EU Food Information for Consumers Regulation. It met with significant resistance, and we did not succeed, but we are still pressing for that.

Food and Soft Drink Industry: Sugar

Debate between Lord Brooke of Alverthorpe and Earl Howe

Tuesday 11th February 2014 Lords Chamber

[Earl Howe]

My noble friend raises a series of important issues. I can tell her some encouraging news on this front. Sainsbury’s and Tesco, for example, have pledged to reduce the sugar content in their own-brand soft drinks. We are asking other supermarkets to follow suit. I think that the noble Baroness will be aware that Lidl made an encouraging gesture the other day in pledging not to display sweets at till exits. However, we are working across a range of areas, not just reformulation of food but pack size, introducing low-sugar or no-sugar alternatives, and looking at ways in which food is promoted.

[Lord Brooke of Alverthorpe (Lab)]

Will the Minister please explain why in his first Answer he referred only to the food and soft drinks industry? Why did he not refer to the alcoholic drinks industry? Is it not true that, in the 130 meetings which the Government have had with the drinks industry since 2010, no progress whatever has been made on persuading it voluntarily to show calorific effects and sugar content on the labels of its products?

[Earl Howe]

No, my Lords, that is not so. Ninety-two producers and retailers committed through the responsibility deal to having 80% of bottles and cans on sale in the UK displaying unit and health information and a pregnancy warning by the end of 2013. The three elements that industry has committed to display on labels are: the drink’s unit content, the Government’s guidelines for lower-risk drinking, and pregnancy warnings. I argue with the noble Lord that this is progress.

Public Health Responsibility Deal

Debate between Lord Brooke of Alverthorpe and Earl Howe

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My noble friend is absolutely right to place his finger on a central point that, in the end, it is up to individuals to take responsibility for their own state of health.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, if individuals are required to take responsibility but they do not know what they are consuming because the manufacturers or producers do not let them know, or indeed the Government are complicit in not pressing those manufacturers to let people know what they are consuming, should there not be a responsibility on the Government? For example, no one knows the calories in alcohol. There has been no change since this responsibility deal was introduced and there is no change in prospect.

[Earl Howe]

My Lords, under the responsibility deal, 92 producers and retailers have committed to having 80% of bottles and cans in the UK displaying unit and health information and a pregnancy warning by the end of last year. That is a worthwhile step forward. As regards the calorie labelling of alcoholic drinks, that, as the noble Lord will know, is an EU competence. It is subject to discussion at this time, but most large retailers include the calorie content of alcohol products on their websites, and that information is also available elsewhere.

NHS: Walk-in Centres

Debate between Lord Brooke of Alverthorpe and Earl Howe

Tuesday 10th December 2013 Lords Chamber

[Earl Howe]

Yes, my Lords, and that is exactly why Sir Bruce Keogh has been tasked to look system-wide not simply at walk-in centres but at the entire community and urgent and emergency care network to make sure that patients go where is most appropriate for them, that there is not undue pressure on any single part of the system, and that tariffs reflect the right balance of patient flows.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, if there is an expectation that there should be consultation with patients and it does not take place, who is accountable for that failure?

[Earl Howe]

In some cases, a change of services will be so minor that formal consultation with patients is not required under the existing rules if, for example, a service moves a few yards down the road or something of that kind. However, it is the responsibility of the commissioner—either NHS England or a clinical commissioning group—to make sure that consultation where appropriate does take place.

Health and Social Care Act 2012: Risk Register

Debate between Lord Brooke of Alverthorpe and Earl Howe

Wednesday 4th December 2013 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government whether they will now publish the risk register prepared in advance of the passage through Parliament of the Health and Social Care Act 2012.

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

My Lords, it remains the Government’s position that they will not be publishing the transition risk register. The decision to withhold the risk register was based on the principle that Governments, together with their civil servants, need to be able to consider all aspects of policy formation, including its risks, in private. It remains our view that a full and candid assessment of risk and the mitigating action required to manage it is carried out within a safe space.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, the House will be grateful to the Minister for reminding us of the Government’s position and of what is in the public domain, but I remind him that the Question is about what the Cabinet and the Secretary of State decided should not be in the public domain. Is there no shame or embarrassment on the part of the Government, who have imposed, quite rightly, a duty of candour on the NHS but who decline to practise that policy themselves by being candid with the public, particularly with those of us who use the NHS? What are the Government hiding? If it is nothing, they should publish the register tomorrow and put it away.

[Earl Howe]

My Lords, the Government are fully committed to transparency and openness, but they need also to be able to manage large and complex projects and programmes efficiently and effectively. If requests for information are made that threaten to compromise their ability to do that, as is the case here, then the Government have to weigh up whether releasing what is being asked for is, on balance and bearing in mind the consequences, in the public interest. Up to now, we have taken the view that the public interest is not served by publication.

Tobacco Products Directive

Debate between Lord Brooke of Alverthorpe and Earl Howe

Tuesday 15th October 2013 Lords Chamber

[Earl Howe]

My noble friend is right. E-cigarettes certainly have the potential for being a force for good in helping smokers to quit. At the same time, we do not want them to become a gateway into smoking. The aim is to have licensed products that have demonstrated safety, quality and efficacy, and for such products to be available as widely as possible.

[Lord Brooke of Alverthorpe (Lab)]

Will the Minister take note of the fact that people have moved from heroin to methadone, which is less dangerous to them than heroin? In fact, we now have hundreds of thousands of people parked on methadone and there is no way in which we can get them off it. That is extraordinarily expensive for the country and bad for their health.

[Earl Howe]

I recognise the issue that the noble Lord raises, but perhaps that is a debate for another time.

NHS: Foundation Trusts

Debate between Lord Brooke of Alverthorpe and Earl Howe

Tuesday 16th July 2013 Lords Chamber

[Lord Brooke of Alverthorpe]

My Lords, given the Government’s commitment to the duty of candour in the NHS, can the Minister give us an indication of some of the reasons why there has been a long delay in the production of Sir Ian Carruthers’s report?

[Earl Howe]

My Lords, I am not aware of the underlying reasons why Sir Ian Carruthers’s report has not been released. As far as I am aware, that is a matter for NHS England. However, if I can enlighten the noble Lord, I will be happy to write to him. I can say that the programme for bringing trusts to foundation trust status has to be taken slightly more slowly than we thought was appropriate perhaps a couple of years ago. That is because of the Francis report. I make no apology for that, because it is right for trusts to take a longer and harder look at the issues that Robert Francis flagged up.

NHS: Accident and Emergency Units

Debate between Lord Brooke of Alverthorpe and Earl Howe

Wednesday 19th June 2013 Lords Chamber

[Earl Howe]

My Lords, yes, the whole patient journey should be looked at, including the role of social care in making sure that patients who are not seriously ill but need care can be looked after in their own homes or in a suitable residential setting.

[Lord Brooke of Alverthorpe]

My Lords, will the Minister be kind enough to enlighten us as to whether Ministers are under instructions these days to blame the NHS and its different levels for failings but to accept no responsibility for putting it right? I watch with increasing fascination the number of Ministers who are now attacking the way that A&E operates, although they are to blame. I heard a Minister the other day attacking GPs for failing to act in the way they should. At the end of the day, I wonder who is responsible for putting this right. The noble Earl said earlier that this is a not a “top-down” operation now. Who, then, is going to accept responsibility for the failings which are now starting to take place within the health service?

[Earl Howe]

My Lords, Ministers are responsible to Parliament for the provision of the health service so I do not duck that responsibility for a second. Nevertheless, Ministers do not manage the health service day-to-day and have never done so. We are involved day-to-day in the plans to ensure that we have a health service that is properly configured to meet the needs of patients. My right honourable friend the Secretary of State could not be more assiduous in the work that he is doing to make sure that that happens. Responsibilities are not being ducked; nobody is being blamed. The fact is that demand is going up considerably, and has been for a number of years. We need to address that and we need to do it cleverly. It is not always a question of piling more money in; it is looking at how the services are configured and delivering care in the right place.

NHS: Healthcare UK

Debate between Lord Brooke of Alverthorpe and Earl Howe

Thursday 14th February 2013 Lords Chamber

[Earl Howe]

My Lords, potentially that is an area at which Healthcare UK could look. Certainly, some of our conversations with our partners in the Middle East have indicated that they are very interested in taking advantage of our world-class facilities in highly specialised areas.

[Lord Brooke of Alverthorpe]

My Lords, given that EU funds for investment and research will be increased between 2014 and 2020, and given the reluctance of British companies to participate in drawing down on that research money, will the Minister ensure that in the health service field we get involved, we partner with others and we use it to our best advantage?

[Earl Howe]

Yes, my Lords. Again, Healthcare UK will be in a position to foster collaborative research partnerships all over the world.

NHS: Private Companies

Debate between Lord Brooke of Alverthorpe and Earl Howe

Monday 11th February 2013 Lords Chamber

[Earl Howe]

My Lords, the system will operate in a way that ensures that non-NHS providers who provide services to the National Health Service pass a quality test with the Care Quality Commission. They will be obliged after that, should they receive the benefit of contracts from the NHS, to demonstrate that they have abided by the terms of the contract.

[Lord Brooke of Alverthorpe]

My Lords, as the Government are contemplating introducing a new factor into contracts in which government work is let out to international companies to ensure that they are paying their tax properly, what will they do about the NHS? Have they any plans to apply that kind of system to letting contracts for NHS services?

[Earl Howe]

My Lords, the answer to that question will need to wait until Monitor has reported to the Secretary of State, which it has not yet done. I know that it is considering a number of aspects of the fair playing field generally, and that may well be one of them. When I am in a position to answer that question, I will be happy to do so.

Health: Sugar Consumption

Debate between Lord Brooke of Alverthorpe and Earl Howe

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

My Lords, my noble friend may know that a UK-wide consultation on front-of-pack labelling was held last year. We published a formal response to it at the end of January. The responses identified a number of issues which we need to consider further and officials are working on those. However, my noble friend is absolutely right that not just the calorie content but the clarity of the messages around calories need to be clear not only to adults but to children.

[Lord Brooke of Alverthorpe]

Does the noble Earl know that drinking alcohol is a big factor in introducing sugar into the body? The drinks industry is totally exempt from any requirement to show the calorific effect of alcohol, or indeed its energy factors. Is the Minister happy that the partners in the responsibility deal within the drinks industry are taking no action on that issue, or is he prepared to say that the Government will push through the responsibility deal to try to bring about some change?

[Earl Howe]

My Lords, our alcohol strategy includes a commitment for the Responsibility Deal Alcohol Network to seek to make further progress on including energy information as part of the responsibility deal alcohol-labelling pledge. We have already secured provisions in recent EU labelling legislation that will enable companies to provide this information on a voluntary basis. The pledge on improving information for consumers in the off-trade area already includes a commitment to raise awareness of the energy content of alcoholic drinks, and we will continue along those lines.

NHS: Clinical Commissioning Groups

Debate between Lord Brooke of Alverthorpe and Earl Howe

Wednesday 16th January 2013 Lords Chamber

[Earl Howe]

Yes, my Lords. In this case, the board concluded that the formula proposed by ACRA accurately predicted the future spending requirements of CCGs, but it was concerned that the use of the formula on its own to redistribute funding would predominantly have resulted in higher levels of growth for areas that already have the best health outcomes compared with those with the worst outcomes. In other words, the formula on its own would have disadvantaged precisely the areas that the noble Lord is most concerned about. On the face of it, this would appear to be inconsistent with the board’s purpose, which is to improve health outcomes for all patients and citizens, and to reduce inequalities, which is a key aspect of the mandate.

[Lord Brooke of Alverthorpe]

My Lords, as patients are to be at the heart of the new NHS from April, will it be the Commissioning Board or the Government who are responsible for advising patients throughout the country of their rights and responsibilities?

[Earl Howe]

My Lords, the NHS constitution is currently under revision. It is a task for the Department of Health to take forward but, as the noble Lord will know, in the mandate and indeed in the Health and Social Care Act the Commissioning Board is charged with upholding and promoting the NHS constitution. The process of updating the constitution is, of course, subject to full public consultation.

NHS: Walk-in Centres

Debate between Lord Brooke of Alverthorpe and Earl Howe

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

I can only express my gratitude to my noble friend for pointing that out. I will ask my officials to review the information provided on the DoH website and to ensure that it is as up to date as possible.

[Lord Brooke of Alverthorpe]

My Lords, reverting to the earlier question about access to GPs, I hope that the NHS and the Minister will have information on the length of waiting times for patients to see their doctors. Indeed, we had questions on this issue earlier in the year. What steps have been taken to reduce the ever-increasing length of waiting lists to see doctors, particularly in the London area?

[Earl Howe]

My Lords, the noble Lord raises an important point. I am aware that in certain parts of the country there is considerable concern about the length of time that patients sometimes need to wait for a GP appointment. However, that is not the case all over the country. We expect GP practices to configure themselves so as to ensure that the waiting time is kept to a minimum. It is an area on which we are working closely with the profession to resolve.

Drugs: Prescribed Drug Addiction

Debate between Lord Brooke of Alverthorpe and Earl Howe

Thursday 12th July 2012 Lords Chamber

[Earl Howe]

The noble Baroness is absolutely right, and I am very pleased that both the Royal College of General Practitioners and the Royal College of Psychiatrists have been keen participants in the round table group on addiction to medicines convened by my colleague Anne Milton. The actions agreed by the group have included greater recognition of the risk and the treatment of dependence on prescription drugs within the core competencies of psychiatrists and the further development of training and guidance on this issue for GPs and other healthcare practitioners.

[Lord Brooke of Alverthorpe]

My Lords, does the Minister agree that one of the biggest obstacles to recovery for people with addictions to alcohol and drugs is stigma? Will he confirm that there is no thought in mind of moving down the avenue suggested in the Question because that would lead to greater stigma?

[Earl Howe]

I am well aware of the point that the noble Lord appropriately raises. Stigma is an issue and we need to take account of the risk of it. That means that quite often when treatment services are provided to those who are addicted to medicines, they take place in a different setting from those administered to addicts of illegal substances.

Health: Local Healthwatch Organisations

Debate between Lord Brooke of Alverthorpe and Earl Howe

Monday 11th June 2012 Lords Chamber

[Earl Howe]

My Lords, I firmly believe that, and that is why the NHS outcomes framework specifically includes a domain relating to patient experience. As we go forward, I think patients will come to realise that their voice really counts. It is about a culture change—I do not wish to wriggle out of that. This is not going to happen overnight, but it is very important that commissioners and providers in the health service are fully engaged with patients, and vice versa, to ensure that the patient’s voice—and indeed the patient’s needs—are right at the centre of commissioning and provision.

[Lord Brooke of Alverthorpe]

My Lords, on the same theme, if patients are to be at the centre of the new arrangements, and the Government are handing this over, at least for the time being, to local authorities to ensure that they are participating in the new structure, is the Minister content that this arrangement will truly ensure full patient involvement right across the whole country? When will there be a review of the arrangements if they are not working?

[Earl Howe]

My Lords, of course we want to see the system working properly. It will be part of the role of Healthwatch England to provide information and best practice advice to local Healthwatch to make sure that local authorities are commissioning both effectively and efficiently. In that sense, there will be national oversight of what happens. Inherently, with the reports that local Healthwatch organisations will have to produce annually on the way that they fulfil their role, there will be transparency on how effective they are being, not just in delivering services but in involving all sections of the community in what they do.

NHS: Risk Register

Debate between Lord Brooke of Alverthorpe and Earl Howe

Tuesday 15th May 2012 Lords Chamber

[Earl Howe]

My Lords, the decision to exercise the veto, which is a decision provided for under the Freedom of information Act, was made by my right honourable friend the Secretary of State for Health. However, he would not have been able to exercise the veto without the collective approval of the Cabinet, and that approval was secured.

[Lord Brooke of Alverthorpe]

My Lords, last Thursday I asked the Minister a question that he answered in part. The part that he did not answer was whether the transitional risk register drew to the Government’s attention the risk that patients would have to wait longer to see their GP. Speaking as someone who uses the NHS and as part of the British public, I fear that the delays are getting longer and will continue to do so. Could he please now answer the question about whether or not this was in the risk register?

[Earl Howe]

I acknowledge that I did not answer that question and apologise to the noble Lord for not having done so last week. The whole issue of stakeholder support is one that the risk register addresses, as he will see from the document that we published. I do not recall the specific issue of waiting times to see one’s GP arising in the risk register for the simple reason that, although I acknowledge that it is currently a problem in some parts of the country, particularly London, that is not a direct result of anything that the Government are doing in our reform programme.

Health Transition Risk Register

Debate between Lord Brooke of Alverthorpe and Earl Howe

Thursday 10th May 2012 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. The answer to his final question is no, I do not believe that there is a difference of approach. I do not have data relating to all government departments but, as I said earlier, the previous Administration refused to release the Department of Health’s strategic risk registers in response to three freedom of information requests. Indeed, one of those was responded to by the right honourable gentleman Mr Burnham in language not dissimilar to that which I have used today. A search of my department’s freedom of information database indicates that, since the Act came into force in January 2005, the department has received six specific requests for risk registers. In no case was the request granted. My noble friend also referred to the Welsh example, which is a very interesting one. In April of this year the Labour Assembly Government in Wales refused to disclose a risk register, and it was a health register. The reasons given for withholding that register mirrored exactly those that we are using currently.

[Lord Brooke of Alverthorpe]

As the legislation focuses so much on GPs, can the noble Earl say whether the risk register made an assessment that there would be increasing delays for patients in getting to see their GPs during the transitional period and that those patients would be put at risk? Given that the Government abandoned the previously set targets for the time limit in which GPs have to see their patients, is he aware that patients in London have faced longer waits to see a GP, let alone the GP of their choice? Is that point covered in the recently published documents in the Library? If not, will he make sure that it is?

[Earl Howe]

There are two points in answer to that. I am aware that in London, in particular, there is an issue for some patients wishing to see their GP; indeed only two days ago I had a useful conversation with the Royal College of GPs about that very matter. However, that particular issue has nothing to do with the reforms that the Government have just enacted, but relates to the supply of GPs. We have many more GPs than we had 10 years ago. Unfortunately, however, we need more. There is a target every year for recruiting GPs but we have not quite reached that target in the past three years. We need to do something about that. Action is in hand to address the issue that the noble Lord has raised. However, I would impress on the House that it is not a reflection of the reforms. The reforms have only just been enacted, and we are only now just rolling them out.

Health: Diabetes

Debate between Lord Brooke of Alverthorpe and Earl Howe

Wednesday 1st February 2012 Lords Chamber

[Earl Howe]

I agree with my noble friend. We are firmly of the view that education is a major action area for primary care clinicians, and for those in secondary care too, if we are to avoid unplanned admissions to hospital, which are unpleasant for patients and very costly for the NHS.

[Lord Brooke of Alverthorpe]

Does the Minister agree—I am sure that he does—that the recommendation that there should be more comprehensive and effective preventive care is an important part of the report, and that it is important to highlight the link between obesity and this illness? Does he agree that it is now high time for the Government to introduce calorific labelling of alcohol products so that people know the number of calories they take in when they drink, and to stop citing the European Union as the reason why they are not doing it?

[Earl Howe]

The noble Lord is to be congratulated on bringing me back to the very important subject of the labelling of alcoholic drinks. I hope that the House will feel that he was a little unfair in blaming the Government for the line that they have taken on this. As the noble Lord knows, labelling is an area that is very largely a matter of EU competence. However, he is right that type 2 diabetes is closely linked to obesity and insufficient physical activity. We would like to see businesses use a more consistent front-of-pack nutrition labelling approach than has been achieved in the past, particularly with food.

Health: Obesity

Debate between Lord Brooke of Alverthorpe and Earl Howe

Wednesday 19th October 2011 Lords Chamber

[Earl Howe]

I agree with my noble friend about the campaign launched by our noble friend Lord Fowler, which was extremely effective. We recognise that excess weight is a really serious problem. That is why we have set out what we believe is an ambitious approach to dealing with it. We are radically overhauling the public health system. We are working with business to go further and faster on making it easier for people to make healthy choices for themselves and their families. We are also continuing to invest in programmes such as Change4Life. The Government cannot solve the problem on their own but we can encourage and support a wide range of partners to play their part. The call to action sets out how we are going to do that.

[Lord Brooke of Alverthorpe]

My Lords, will the noble Earl please explain how people can be expected to take personal responsibility for sorting out their health problems when so much information about the food and drink they consume is kept from them? Can he please also explain why the Government are failing to press the drinks industry to show the number of calories in alcoholic drinks on the labels, and declining to meet the industry and press it accordingly?

[Earl Howe]

I am not aware that we have declined to meet the drinks industry; the noble Lord may know something that I do not. We talk regularly to the drinks industry. As he will be aware from a Question tabled in this House the other day, the result of the European nutrition labelling regulation is that we now have the flexibility in this country to construct rules that suit us. That includes encouraging the drinks industry—and I believe that it is willing to do it—to place energy information on its labels.

Southern Cross

Debate between Lord Brooke of Alverthorpe and Earl Howe

Thursday 16th June 2011 Lords Chamber

[Earl Howe]

My Lords, I fear that I am unable to answer the noble Lord’s questions, for which I apologise, but I understand why he has asked them. If I have some concise answers that I can send him, I will certainly do so by way of a letter.

I think that the noble Lord and I agree that we are looking at a fundamentally unsound business model. As I understand it, it is a unique business model in the care home sector, where a deliberate decision was taken for the company not to own its own care homes but rather to pay the rent on them. The market clearly moved against it in more than one sense. The company’s problems are partly attributable to the occupancy levels of some of their care homes. Southern Cross occupancy levels have gone down, I understand, more than those of other care homes. It is not about fee levels; other providers of residential care are not in the same position as Southern Cross. I believe that Southern Cross’s problems relate to the rental agreements—the leases—that they entered into. It is those things that the restructuring aims to fix.

[Lord Brooke of Alverthorpe]

My Lords, I thank the noble Earl for his Statement. I listened carefully to what he said about the need for clarity on where responsibility lay. He also stated that there were lessons to be learnt. Will he say when the Government will conclude their review of these lessons, and when and how they will make them public? With the imminent privatisation of the Royal Mail, which has a lot of property worth quite a lot of money, will the Minister say whether some lessons learnt in this exercise might be useful in the context of ensuring that we do not run into similar problems there?

[Earl Howe]

My Lords, I would love to be able to comment on the Royal Mail, but noble Lords will be sorry to hear that I have not received the necessary briefing. On the timescale of our review, as I indicated to my noble friend Lady Barker, there are a number of elements to our review of social care policy. One is the Dilnot report, which we are expecting at the beginning of July. Another is the Law Commission report. However, a third is undoubtedly the lessons learnt from this episode. It is fair to say that it would be rash of me to give the noble Lord a date on which we will conclude all three strands of that review. It is likely that we will be able to be more definite later on this summer.

Health: Alcohol Minimum Pricing

Debate between Lord Brooke of Alverthorpe and Earl Howe

Tuesday 1st March 2011 Lords Chamber

[Earl Howe]

My noble friend makes an extremely important point. We estimate that alcohol harm costs the NHS around £2.7 billion a year. Forty per cent of all accident and emergency admissions are in some way connected with alcohol—I think a higher percentage on Friday and Saturday nights—and 7 per cent of all hospital admissions are accounted for in some way by alcohol. This is a very serious problem: 8,500 people die from alcohol in the UK every year and there are over 1 million hospital admissions relating to alcohol.

[Lord Brooke of Alverthorpe]

My Lords—

[Lord Brooke of Alverthorpe]

My Lords, now that the Minister and the Government have accepted that raising the price of alcohol is one of the ways in which we can minimise harm to those who are abusing alcohol, why have the Government’s recent proposals been so minimal? The cost of a can of lager will be increased, or minimised, to 38p under the new arrangements. This is hardly going to make any change whatsoever. We have to wait for the White Paper in the summer, but in the mean time why could a more positive approach to raising the cost of alcohol not have been taken and more fundamental changes made to the ever increasing easy access to alcohol, which is another problem that needs addressing?

[Earl Howe]

My Lords, we view the decision to ban below-cost sales of alcohol as very much a first step. We have announced a number of other measures, as the noble Lord may know, particularly a rise in the rate of alcohol duty by 2 per cent above inflation over each of the next four years, additional duty on high-strength beers and greater powers for local authorities over local licensing decisions. As I mentioned, there is no single solution to this problem, but we are looking at a number of additional measures.

Healthcare: Costs

Debate between Lord Brooke of Alverthorpe and Earl Howe

Monday 15th November 2010 Lords Chamber

[Earl Howe]

My Lords, my noble friend is quite right to identify dementia as a particular cost pressure over the next few years. The coalition Government signalled in their programme our intention to prioritise funding for dementia research. The spending review confirmed that and committed to real-terms increases in spending on health research. This investment is indeed essential if we are to increase the quality, productivity and cost-effectiveness of the NHS.

[Lord Brooke of Alverthorpe]

My Lords, I return to a question which I posed previously to the Minister and which remains unanswered. Does he not agree that if patients in the health service knew what the costs of their treatment, care and drugs were, as they do in the private sector, this would create a downward pressure, which would reduce costs overall?

[Earl Howe]

My Lords, I know that this is a question to which the noble Lord and other noble Lords regularly return, and it has a superficial attraction. The problem with it, I am advised, is that patients who are informed of the cost of their treatment—some patients, at any rate—take that as a deterrent to accepting the treatment in the first place. That is something we need to avoid. Nevertheless, there is an underlying point here; there is a need to provide better information to patients about their treatment so that they can take ownership of their state of health.