NHS: Management Consultants

Lord Campbell-Savours Excerpts

Monday 13th February 2012 Lords Chamber

[Lord Campbell-Savours]

Have civil servants been sharing information during the course of meetings with McKinsey people which McKinsey has been giving to its corporate clients? In other words, has McKinsey been discussing what has been going on in the formation of the Bill and the potential business benefits which arise from the Bill with its corporate clients? Have civil servants at any stage received any sponsorship for their travel or entertainment from McKinsey during the development of the Bill? Is it true that some meetings with civil servants and McKinsey have taken place at McKinsey headquarters in Jermyn Street in London? Does not that whole area of activity by McKinsey suggest that there is a conflict of interest which the public should know about at this stage in the development of the Bill?

[Earl Howe]

The noble Lord is, I think, insinuating some impropriety on the part of McKinsey and, perhaps, on the part of civil servants. I know of no such impropriety. Indeed, as I said earlier, there are clear and strict rules about transparency and openness. Declaring hospitality received is something that all civil servants and Ministers have to do. The results are published regularly. I will of course ask the question of McKinsey, which I have not yet had time to do. If I discover that there is any substance to the questions that the noble Lord has asked, I shall of course write to him and place a copy in the Library, but I very much doubt that I shall find any substance to them.

Health and Social Care Bill

Lord Campbell-Savours Excerpts

Wednesday 7th December 2011 Lords Chamber

[Lord Campbell-Savours]

My Lords, a number of Members of the House have suggested alternative ways forward. The best suggestion came from my noble friend Lord Richard. He made the perfectly reasonable suggestion that the Report stage be deferred until we get a ruling on the appeal. I am a mere mortal Back-Bencher, making the offer on behalf of colleagues, but I would imagine that my own Front Bench would support that proposition. Why do we not simply defer it? It is a perfectly reasonable suggestion. The Government will get their way and we will get our way in the sense that we will then be informed when we get to the Report stage of the Bill.

In reality, what is happening today is that the Government are simply using an appeal procedure to delay, knowing this will ensure that certain issues, which should be freely discussed on the Floor of the House during the course of consideration of the Bill, are not going to be discussed. It may be worth noting the comments of Justine Greening when she experienced similar problems under, regrettably, the previous Labour Government. These are her words:

“The DfT’s refusal to release the register until ordered by the Commissioner”—

which we subsequently did, of course—

“shows that Ministers have truly lost all integrity on being open with the public they are there to serve”.

If that was the attitude taken by the noble Earl’s colleagues at that time, why should it not be our attitude today? Perhaps in the light of Justine Greening’s comments at that time, he may wish to reconsider his own position on these matters.

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[Earl Howe]

Having anticipated that question before this debate, I made a point of asking but I am afraid that I do not have a definite answer to give the noble Baroness at this stage. As soon as I am able, I would be delighted to do so.

Our appeal is based on the belief that the commissioner has not given sufficient weight in his judgment to the considerations embodied in the relevant provisions of the relevant FOI Act. As the noble Lord, Lord Butler, made clear on 28 November, the ruling has serious implications across government in the precedent it sets for all risk registers.

[Lord Campbell-Savours]

The noble Earl said that he could not give us an idea of the timetable, but he does have something under his control: he has control of the timing of Report. He could say, “We will defer Report stage until the appeal result”. Why does he not just do that?

[Earl Howe]

The noble Lord knows that that is a matter for the House and the usual channels and not for me. However, I have no doubt that his suggestion will be registered in the appropriate places and will be considered. He must understand that it is not solely in my gift to order the business of this House.

I am of course acutely aware of the concerns of noble Lords on this issue. However, I would just ask those noble Lords who may at first blush be inclined to side with the noble Baroness in her amendment to recognise that there is room for an honestly held difference of view on this matter, that the principle involved is very important for the workings of government and that the Government have acted both properly and reasonably in asking the Information Tribunal to reconsider the merits of the case.

Health and Social Care Bill

Lord Campbell-Savours Excerpts

Monday 28th November 2011 Lords Chamber

[Baroness Thornton]

I thank the Minister for that statement, of which I did not have more than two minutes’ notice. It is very disappointing indeed. Basically, the noble Earl is saying that the Government are choosing what they do and do not disclose to the Committee on this matter. It is an issue of trust—whether or not we can trust that we will know what we need to know to make judgments about whether this Bill will work.

I thank the noble Earl for the issues that he has decided that the Government can let us know about, but of course I am therefore concerned about what the issues are that the Government have decided that we should not know about. What are the risks that we cannot know about? That is a matter of grave concern to the Committee.

I shall be looking in detail at the Minister’s statement to the House and I reserve the right to return to this matter if I feel that we need to. For example, during the last two days in Committee I put two direct questions to the Minister about whether certain matters—one concerning children—were on the risk register and what the register said about them. I have not received answers to either of those questions. I shall continue to put my questions in that context and I suggest that other noble Lords do the same.

I am very grateful for the Statement as far as it goes but I do not think that this is an end to the matter. I can see why the Government might think that there is a cross-government issue here. However, no other department is in the position in which we find ourselves here—that of discussing a Bill that is going through the House right now. We need full information on this matter in order to be able to make proper decisions but I believe that we still do not have that. Therefore, I thank the noble Earl so far as this goes but I reserve the right to return to the issue in due course.

[Lord Campbell-Savours]

Perhaps I may ask the Minister a question. He gave us a list of all the areas which he thought it was not possible for Parliament to scrutinise in some detail. Did the Information Commissioner have access to all the document headings to which the Minister has referred, and did he have the opportunity to read all the documentation under those headings? If the Information Commissioner did have access to information on, for example, the handling of the legislation as it goes through Parliament, why did he, throughout the whole report, repeatedly say that these matters should be placed in the public domain? Again, is it not clear that the Government are trying to hide something from Parliament? The Minister’s first reference was to the handling of the legislation by Parliament. Why should not Parliament see what considerations took place within the department concerning how legislation should be handled as it goes through this House?

[Earl Howe]

My Lords, my clear understanding is that the Information Commissioner had full access to the risk register so that he would be able to see for himself what it contained. I do not believe that anything material was withheld from him. The whole purpose of risk registers of this type is to record all risks, even the unthinkable and the highly unlikely actual risks, as well as potential risks—in other words, risks that may not arise in the future but which could be mitigated with action today. Such risk registers record mitigating actions so that the risks identified do not become a reality. In our clear view, exposing that kind of information could cause needless concern, set hares running and seriously undermine confidence in the programme of work. No Government of any persuasion have routinely made risk registers of this type public for the very reason that to do so would undermine open and frank discussion among policy-makers for fear that the policy would be made public before it was fully developed.

The department has published and discussed its proposals for reform at every stage of this process. It has debated them at length in both Houses. It has even released some detail about the associated risks and what it is doing to address these in impact assessments. Therefore, I firmly believe that the Committee has all the information that it needs to discuss the proposals in detail.

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[Lord Elton]

My Lords, I hope that the noble Baroness, Lady Thornton, will remember those words when she is considering her next intervention on this matter. Bear in mind that what she says then will be taken as the yardstick of what any Government of her colour are expected to do when they eventually—one hopes at a great distance of time—take our place.

[Lord Campbell-Savours]

My Lords, I understand there is a precedent—a Department of Transport one. Therefore, there is a discretion and the Government are in a position on this occasion and not on a further one. I do not really see that that case is relevant.

[Earl Howe]

My Lords, I am very grateful to the noble Lord, Lord Butler, whose understanding of these matters is one that noble Lords will respect greatly. He is absolutely right—this is not an issue that solely affects the Department of Health: it affects all government departments. That is why the stance taken by the BMA to this Bill was not material in our decision. We regret that stance but it did not come into our thinking in any way.

On the question of precedent, I am aware that during the course of the last Government three separate recent requests were made to the Department of Health to release risk registers. All three requests were declined. I have the letter here that was sent when the right honourable Andy Burnham was Secretary of State, citing exactly the same kinds of reasons I have given.

I was asked how long the appeal would take. I do not know but my understanding is that the process should come to a conclusion reasonably early in the new year. I cannot be more definite than that because it is not up to us—it will be up to the tribunal to order its business as it sees fit. Will the Government accept the result? Clearly, we will have to take a view whatever the result; I cannot pre-empt the decision today. My noble friend Lady Williams asked whether we had considered releasing a redacted version—the decision before us was whether to comply with the Information Commissioner’s decision in full, or not to and appeal. We did not have the option of redaction but I am grateful to my noble friend for her suggestion, which I will take away and consider.

Health and Social Care Bill

Lord Campbell-Savours Excerpts

Monday 7th November 2011 Lords Chamber

[Baroness Oppenheim-Barnes]

My Lords, I intervene at this point because I have all too real personal experience that may be helpful to the movers of the amendment. When she was still a teenager, my daughter was the subject of a terrible error made during a simple investigative measure. It was covered up by all concerned, who said what a tragedy it was that such a young girl should have got this illness, which was inexplicable. Because she was a private patient, we were able to bring in other advice that led to a conclusion which was that a very serious mistake had been made. She was hospitalised for three months. She suffered several operations as a result and, when she was finally recovering, we sought in law to get some kind of satisfaction.

We were not without means or influence, but no single lawyer would take the case. They said it was not in their interests because their main clients were usually health service providers or medical providers and therefore our case was not going to be taken. The noble Lord, Lord Harris of Haringey, made the point that these people may or may not want to follow legal processes. I make the point that if that were one of the objectives of the amendment—which I hope it is not—they would have no chance whatever.

[Lord Campbell-Savours]

My Lords, I intervene briefly to do precisely what the noble Baroness has just done; namely, to draw attention to an individual case that might influence the judgment of the Committee. In a former incarnation as a Member of Parliament, I received in my post an anonymous letter from a person in the north of England, which made major allegations about a hospital in the north of England where a child had been badly brain-damaged as a result of negligence in that hospital. The letter was unsigned, as I say, and the child's name was not included. I had the task of asking around in the community to find out whether they know anyone who the child might be or whether they knew anybody in the hospital who knew about the incident that had taken place. I suspected that the letter had come from a member of staff.

After some time, I managed to identify a family. I knocked on the door and a lady answered. She said, “Yes, it was our child and the health service has basically converted our garage and put a bed in it”—for this boy who was very badly brain-damaged and remains so to this day. The family had been to lawyers and been advised that that was the best deal they could get. The reason why that happened was because there was no duty of candour and because the health service covered up what had happened. I told the family that they should go to Manchester and pick a very smart lawyer whom I knew and ask him to handle their case. It took six years, at the end of which there was a multimillion pound settlement covering a lifetime's provision of care for this child.

There are many cases of negligence in the National Health Service. I have probably spent more time in hospital in my lifetime than a large number of Members of this House put together and I have seen it myself. You hear stories in hospitals all the time when you are sitting in a bed, although some of them are not so much about negligence as stupidity. I wonder whether we are really being sufficiently transparent in the way we ensure that the information is made available to patients and their relatives. I hope that the amendment goes through.

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[Earl Howe]

I will come on to talk about GPs and primary care providers in a moment, if the noble Baroness will bear with me. I listened with great care—

[Lord Campbell-Savours]

Will this cover private contractors where they provide a service to the National Health Service? What would happen in a dual provision facility whereby, let us say, half the clients were private and the other half were from the National Health Service? Would this provision apply only to those who were in effect being funded by the National Health Service?

[Earl Howe]

Clearly, our concern is for NHS patients. We cannot legislate for private patients who may have completely different terms in the contract. However, the point is that if an independent provider comes forward as an accredited provider for the health service, we should subject that provider to exactly the same kinds of duties that apply to an NHS provider.

I was about to say that I listened with great care to the noble Lord, Lord Winston, and my noble friend Lord Lucas, who I thought spoke wise words in their respective speeches. We have made it clear that we think that services should be commissioned by those who are closest to patients and who best understand the needs of their patients—the clinicians. Therefore, we think it is right that the duty of candour is set out in the contracts that clinical commissioning groups will enter into with service providers. CCGs will be responsible for holding providers to account and therefore will in any case need to consider patient safety events in doing so. In future, the Secretary of State will ensure that this contractual duty is introduced consistently, as the Bill already contains powers for the Secretary of State to set standard contractual requirements where necessary using “standing rules” regulations under new Section 6E of the National Health Service Act, inserted by Clause 17.

The noble Baroness, Lady Masham, suggested that there was nothing in the Bill about patients. I confess that I am disappointed that she has come to that conclusion, as the Bill is all about creating a patient-centred health service—for example, through placing clinicians at the forefront of commissioning, strengthening patient involvement and ensuring that quality is at the heart of all that the NHS does. She suggested that if a duty of candour were in the contracts, perhaps all CQC standards should also be in the contracts. I disagree. A duty of candour is best suited to the contract because, first, the CQC has specifically stated that it is unable routinely to enforce such a duty, unlike the contents of its core standards. Secondly, the issue is very difficult to monitor effectively. Placing the duty closer to patients and clinicians maximises the chances of it working, and placing it in contracts does exactly that.

I would not want the noble Baroness to think that we have chosen the contracting route as in some way a lesser option, showing that this issue is not of importance to the Government. That is absolutely not the case. We propose a contractual duty of candour because we feel strongly that it has the best chance of working. If I may say so, I believe that the noble Baroness has been rather too quick to dismiss the Government’s proposals, which, I say again, represent a considerable advance on the current position.

It has been pointed out that the contractual duty will apply only to providers with an NHS contract and that GPs, for example, without a standard contract will not be covered. We have explicitly acknowledged that primary care contractors will not be covered under the current proposals for a requirement in the NHS standard contract, and we have asked for views on this as part of the ongoing consultation. We recognise that we should aim for an holistic system that applies to every provider of NHS-funded services, but we still need to consider what legislative and contractual changes will work best within primary care.

It should also be remembered more widely that the policy of openness still applies to all NHS services, regardless of the existence of any contractual requirement. For example, primary medical services contractors must have regard to the NHS constitution, the professional codes of conduct and any guidance issued by PCTs or the Secretary of State. Once they are registered with the CQC, a failure to be open with patients will contravene clear expectations set out in CQC guidance. Therefore, not including a requirement in primary care contracts now does not provide a reason for primary care contractors to avoid telling their patients about things going wrong with their healthcare.

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[Earl Howe]

That is exactly why I referred to the need for a culture of openness rather than encouraging a situation in which we simply try to catch people out when they are not open. The amendment tabled by the noble Baroness looks to me like yet another way for people to get into trouble, rather than a way in which an organisation can take ownership of things that go wrong, encourage openness and look in-house to put things right. That is my fear about the amendment.

The noble Baroness, Lady Hollins, asked whether the consultation that we are undertaking covers whistleblowing. No, the consultation is focused on the duty of candour; whistleblowing is a separate, but linked, issue. Since coming to office, we have, as she may know, taken a number of important steps to promote it in NHS settings.

The noble Baroness, Lady Morgan, asked about the timing of the consultation response. She is right to say that the consultation finishes on 2 January. The government response will follow in due time after that. Unfortunately, I cannot be more specific. I shall be happy to write all noble Lords upon publication of the government response and I encourage noble Lords to take part in the consultation before it closes.

My noble friends Lord Mawhinney and Lady Williams referred to mediation. I take their point. They will know that mediation can mean a number of different things. As part of the proposed contractual requirement, we suggest that providers will have to offer an apology and an explanation and provide further information as appropriate, all in person with the patient, their representative, the relevant clinicians and other hospital or trust representatives as appropriate. That might well involve a mediator. I am all for mediation if legal fees and all the expense and heartache that goes with them can be avoided.

[Lord Campbell-Savours]

Following up on what the noble Lord, Lord Walton, said in his intervention about professional bodies, why can we not build into consumer law a requirement on private providers to provide a contractual obligation to their private customers?

[Earl Howe]

My Lords, unfortunately, I am not an expert in consumer law. My noble friend Lord Marks might be able to enlighten us on this, but there are, of course, consumer protection laws, which every organisation has to abide by, as provided for in the Consumer Protection Act. I think there are probably consumer protection aspects to contracts relating to healthcare services, but we have to tailor the contracts to ensure that we cover the issues that healthcare gives rise to.

The noble Lord, Lord Warner, asked me about the NHS Redress Act and whether the provisions of that Act were capable of taking forward some of the issues raised in the debate. I understand why he has asked that question, but there is a difference between redress for negligence and openness and it is important to distinguish between the two. As such, some of the issues raised this afternoon fall into the remit of redress and associated legislation rather than being specifically linked to a duty of candour. However, I note that, notwithstanding the long hours that we spent debating the NHS Redress Bill some years ago, the previous Government chose never to bring it into force; it is potentially on the statute book, but it is not in operation.

I shall reflect carefully on the points made in this debate. I hope that I have in some way reassured the noble Baroness, Lady Masham, that we are putting systems in place to introduce the duty of candour. To answer my noble friend Lord Mawhinney, we have a strategy. There are good reasons for the contractual route that we have chosen as well as a real potential downside if we were to go down the statutory route proposed here. So against that background, I hope that the noble Baroness will feel able to withdraw her amendment.

Hospitals and Care Homes: Hydration

Lord Campbell-Savours Excerpts

Monday 7th November 2011 Lords Chamber

[Earl Howe]

I think that my noble friend asked about the period of time after an inspection. The CQC has flexibility depending on what it finds. As my noble friend will know, there is a whole succession of increasingly strong measures that it can take, depending on the concern. It can mandate immediate action to be taken, and in those circumstances it will return, typically, for a further inspection within a fairly short space of time to ascertain whether the action has been carried out.

[Lord Campbell-Savours]

Is not this hands-off attitude to dealing with this matter costing the health service a fortune on urinary tract infections?

[Earl Howe]

My Lords, the noble Lord is right to express concern about urinary tract infections. There is a programme of work designed to bear down on that, as there is for hospital-acquired infections generally. He is absolutely right to raise that concern, which has a direct bearing on the Question on the Order Paper and the need for proper hydration at all times.

Southern Cross Care Homes

Lord Campbell-Savours Excerpts

Tuesday 12th July 2011 Lords Chamber

[Earl Howe]

My clear understanding is that many homes will continue in operation with the same staff, and that the residents of those homes will therefore not be required to move. We hope most earnestly that no resident of any Southern Cross care home will be required to move. I am not aware of the precise situation in the north-east of England, but my noble friend’s comments suggest to me that there is no undue cause for concern in that part of the country. The plan certainly would be, as far as possible, to maintain the residents in their current homes, and they should notice no difference in the quality of care that they are receiving.

To the extent that residents are required to move—and as I have said, we hope that that will not be necessary—yes, of course there will have to be a process of monitoring the welfare of those people in those circumstances. The duty to do that falls primarily on local authorities, where they are the commissioner of the care, but I have absolutely no doubt that the CQC will wish to add to that oversight. I believe that it is too soon to speculate—because we are not sufficiently far down the restructuring process—on the extent to which residents will be disrupted, but the number of homes that do not in the end prove viable as businesses will emerge in due course.

[Lord Campbell-Savours]

My Lords, first, I noticed that the noble Earl did not respond to the question asked by my noble friend on the publication of the names of the property companies that stand behind many of these homes. Will a special regime be introduced by the CQC of random unannounced visits for homes managed by property companies? It is important that we get an assurance that it will carry out random unannounced visits as against other forms of visits which are possible. Secondly, given that Regulation 13 of the CQC registration regulations 2009 requires a service provider to,

“take all reasonable steps to carry on the regulated activity in such a manner as to ensure the financial viability”,

of the operation, who then is going to monitor compliance with Regulation 13? Should we not now have—set and enshrined in some regulatory arrangement —some authority given the power to seek to secure compliance, or are we simply going to leave it to an offence, as the noble Earl has referred to in an Answer he has given to me, whereby no one is actually monitoring these matters?

[Earl Howe]

First of all, the CQC is an independent body; it is not under the jurisdiction of Ministers, and it must be free to organise itself as it sees fit. I cannot undertake on its behalf that it will perform random unannounced visits. It does, however, do that as a matter of course, and it generally does so on a risk-based basis so it would surprise me if, where the CQC saw that there was an enhanced risk to residents, it did not make it its business to perform inspections. Looking ahead into the medium term, should the Health and Social Care Bill pass through Parliament, as the Government propose, local HealthWatch will be in a position to enter and view care homes, as LINks are at the moment, but I believe that HealthWatch will be, in most areas at least, in a better position to undertake such inspections on a random basis.

The financial liability will of course not be the province of HealthWatch, but any concerns about the welfare of residents would be subject to the powers of HealthWatch to refer up to HealthWatch England, and in so doing, through HealthWatch England to the CQC. The financial viability of care homes is of course a live issue. I have commented on this in the past, and we are certainly considering whether Clause 57 of the Health and Social Care Bill could be used to extend the regulatory regime that we are proposing for the NHS to care homes. That is something that we will need to discuss because it would amount to a regulatory burden on care homes. Nevertheless, I do not belittle the issue. My ministerial colleagues in the Department for Business, Innovation and Skills are looking at the issue of private bodies that provide publicly funded services and whether there are implications in the sense that the noble Lord has indicated.

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[Earl Howe]

My Lords, we are reverting to the question asked by the noble Lord, Lord Campbell-Savours. The CQC already has some duties to ensure that the care homes it registers are able financially to sustain their business, as well as simply providing a quality service. But this is clearly an issue that needs to be looked at. As I have mentioned, we are taking powers in the Health and Social Care Bill which potentially could see the care-home sector subject to the kind of financial regulation that we are applying to the NHS. This is a work in progress.

[Lord Campbell-Savours]

My Lords—

[Earl Attlee]

My Lords, I am very sorry, but we are out of time.

Abattoirs

Lord Campbell-Savours Excerpts

Monday 11th July 2011 Lords Chamber

[Earl Howe]

My Lords, smaller abattoirs are extremely important to the rural economy, as the noble Countess rightly says. They are more likely to be rural. The support to be provided to those abattoirs processing up to 5,000 cattle—a higher threshold than was previously proposed—is intended to help preserve the provision of local services to the livestock industry. That will helpfully reduce the impact on small livestock producers, the rural economy, animal welfare and indeed consumer choice. As regards mobile abattoirs, I am not aware what initiatives are being undertaken, although I believe that there are a few around, so it will be necessary for me to seek further advice on that point.

[Lord Campbell-Savours]

My Lords, was not this so-called risk-based approach used in the monitoring of care homes? Has that not been a disaster?

[Earl Howe]

No, my Lords, it has not been a disaster. It is sensible to look at accreditation and such devices to ensure that regulation is directed where it is most needed.

Southern Cross

Lord Campbell-Savours Excerpts

Thursday 16th June 2011 Lords Chamber

[Earl Howe]

My noble friend raises an important issue. As she knows, care providers have to be able to demonstrate to the Care Quality Commission that they have the financial resources needed to continue to provide services of the required quality. We have embarked on a wide-ranging programme of reform for social care. We are currently considering the Law Commission’s recommendations for modernising social care law and, as my noble friend mentioned, the report of the Commission on Funding of Care and Support is imminent. There are many lessons that have to be learnt from the events of recent weeks. We want to reflect on them as part of our wider reform agenda for social care.

On private equity finance, I simply make my own observation to my noble friend: I do not think that private equity finance is at the root of the problems that we have been seeing but the business model, which is rather a different issue. It was the choices and decisions made by the management of Southern Cross that made the business fundamentally unsustainable. I do not see that as a reflection directly on private equity providers. We have been clear that we were going to take action to ensure that there was proper oversight of the market in social care. That is why the Health and Social Care Bill specifically allows us to extend to social care, if we chose to do so, the proper financial regulatory regime that we are putting in place for the NHS. However, I suggest that regulation is not the only solution; we need to approach this in a measured way, not least because there are complex negotiations under way. We need to look at social care reform as a whole, which is exactly what we have committed to doing.

[Lord Campbell-Savours]

My Lords, on the question of the business model that the Minister just referred to, does not this whole sorry saga reveal how completely out of touch with the world of reality were the main board and executive directors of Three Delta, who advised the Qatar Investment Authority to spend billions buying property in the healthcare sector on the back of inflated and totally unrealistic rent levels paid by companies such as Southern Cross? Were the Qataris made aware of the huge risk involved? What were the so-called great and the good like Sir Peter Middleton, Nick Land, Sir Christopher Howes and David Mellor—a former government Minister—doing when any estate agent in the commercial property sector could have told them that the commercial care property market was both overgeared and overpriced?

Finally, will Messrs Scott, Murphy, Sizer and Colvin, formerly directors of Southern Cross, be prosecuted for insider dealing in Southern Cross shares when they privately promoted the sale of shares in the months immediately prior to their profits warning and collapse in the share price? Is this whole affair not riddled with greed and stupidity?

[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.

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[Earl Howe]

I am grateful to the noble Baroness, and I am also clear about the position of the noble Lord, Lord Beecham. She is of course right. Our first concern should be for the safety and welfare of residents. That is why, as I said earlier, some time ago we asked the Care Quality Commission to engage in close discussion with Southern Cross when the news of the impending redundancies was made public. We did that precisely to ensure that standards would not be compromised. My understanding is that there are no concerns on that front. Southern Cross has, in that sense, behaved impeccably in ensuring that residents have not suffered, other than from the inevitable uncertainty that the publicity over this matter has generated. Going forward, the principles that the noble Baroness has articulated are absolutely right. However, she would agree with me—as I think she did—that questions need to be asked about the financial models adopted by care homes or, indeed, by any independent business providing public services.

[Lord Campbell-Savours]

Were we not told after Jon Manel of the BBC's exposure of what was going on in care homes in 2008 that lessons would be learnt and that there would be a review; and was not an inquiry set up by the department at the request of the then Minister, the noble Baroness, Lady Thornton? Were we not given assurances that that would not happen again? Is not the reality that these reviews and statements about lessons to be learnt all end up in the long grass, because this area of care is basically out of control?

[Earl Howe]

I do not agree with the noble Lord that this area of care is out of control. The situation that arose at the time to which the noble Lord refers was of quite a different nature from the one we are looking at at the moment. As I recall, it was about the quality of care delivered in particular care homes. We now have the CQC, which is responsible for policing quality of care across the NHS and social care. The previous Government put that arrangement in place. We are content with it. We think that the arrangements are robust. The CQC does very good work.

Of course, with the best will in the world, mistakes occur. One can easily point the finger at the CQC. As I said, in the case of Winterbourne View, that would be an easy but unfair thing to do. All that the CQC can be expected to do is to take a snapshot at any given moment of what it sees and hears. When I say that lessons need to be learnt, I reiterate to the noble Lord, Lord Campbell-Savours, that my counterpart in the Department for Business, Innovation and Skills is considering the lessons to be learnt about the business models that apply not just to the care home sector but generically where public services are provided.

Care Homes

Lord Campbell-Savours Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. That is entirely the aim of the modernisation programme for the NHS that we have laid out. It must be a much more patient-centred and user-centred service. As regards Southern Cross, we have said that there will be effective protection for the residents involved; no one will lose out. We are clear that we are putting the interests of residents first.

[Lord Campbell-Savours]

My Lords, does the Minister recall that, on the wind-up of CSCI—which he will recall because he was involved in the debate—we were given absolute assurances that the new successor body, the CQC, would target with random and unannounced visits all those care institutions in the United Kingdom where it was thought that people might be at risk? In so far as Southern Cross had a very bad track record and the CQC has failed to fulfil that promise, should not people at the top of the new body—the CQC—now consider their positions and, indeed, resign?

[Earl Howe]

My Lords, that is a rather harsh suggestion regarding Southern Cross. The noble Lord will know that care providers must demonstrate to the CQC that they have the financial resources needed to continue to provide services of the required quality. Clearly, there are lessons to be learnt from this episode with Southern Cross, which we all hope will resolve itself successfully. I am sure the CQC will take on board the lessons. From the briefing that I have had on the financial model that Southern Cross adopted, it is extraordinarily complex even for an expert to understand. We need to get that right. I know that my right honourable and honourable colleagues in the Department for Business, Innovation and Skills will be looking in general at business ownership and the issues surrounding that to see whether there are actions that we can take to prevent this kind of thing happening again.

Health: Obesity

Lord Campbell-Savours Excerpts

Monday 4th April 2011 Grand Committee

[Lord Campbell-Savours]

My Lords, I would like to intervene briefly to express some marginally politically incorrect sentiments, because I share concerns expressed by Members of the Committee about the scale of the problem of obesity nationally, which I think is huge.

[Baroness Garden of Frognal]

Perhaps the noble Lord will forgive me, but we were not notified that he had his name on the speaking list.

[Lord Campbell-Savours]

I did not know that there was a speaking list.

[Baroness Garden of Frognal]

I am afraid that there is; this is a timed debate. However, as one of the speakers has scratched, the noble Lord can speak for four minutes in the gap.

[Lord Campbell-Savours]

I intend to intervene only briefly. I support the noble Lord, Lord McColl, and congratulate him on introducing this debate. His speech is worthy of passing around our friends and colleagues because it would have made a very good after-dinner speech. Although it was amusing, it dealt with an extremely serious subject.

My noble friend Lord Patel raised the issue of calorific information on food products sold in stores and particularly in restaurants. The other week I went into a Harvester restaurant which I had never been into before. I noticed that every item on the menu had its calorific content in bold lettering, so much so that I cannot believe that people who eat in those restaurants are not aware of and do not take into account the calorific content when they order their food. I am told that in parts of the world, particularly in America, the authorities in some cities insist on calorific information being provided on all menus in restaurants.

I wonder why we cannot do something similar here in the United Kingdom. I know that the Government are not over-wedded to the principle of too much regulation, but when so much is at stake arising out of problems of obesity and their consequences for health service expenditure, why can we not grasp the nettle in this area and introduce a regulatory framework for food manufacturers whereby the general public really do have to sit down and consider what they eat daily? If we were to do that, I believe that it would certainly have some consequence for obesity.

I return to being slightly politically incorrect. There is another problem as well. Families are often simply not prepared to raise the issue internally. There is an embarrassment about fatness. People just do not want to talk about it. Even among one’s colleagues, here or anywhere, we do not talk about whether people are fat or thin. We have to get over that because a huge problem is developing, in part due to an element of political incorrectness which is reflected in how the media and the industry treat the subject.

I am sorry if I did not comply completely with the rules. Having come from the Commons, and as I normally speak only at Report, in Committee and on Third Reading, I am not used to listings during debates.

--- Later in debate ---

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

My Lords, I thank my noble friend for raising this important issue, about which he knows a very great deal. I value the insights that he was able to give us in his most informative introductory speech.

Obesity is one of our biggest public health challenges. In England, three-fifths of all adults and more than a quarter of children aged two to 10 are overweight or obese. The noble Baroness, Lady Thornton, reminded us of some other statistics in that connection.

Already, more teenagers and young adults are being diagnosed with type 2 diabetes. Experts tell us that if obesity stays at anywhere near its current high levels the health of the population will deteriorate dramatically in the years ahead. For instance, the National Heart Forum has predicted that, by 2050, the number of people getting diabetes because of their weight will nearly double and those with heart disease caused by obesity will rise by 44 per cent.

Our first thought has to be the human cost. Just as obesity cuts years from a person’s life, it also takes life from a person’s years. Statistics do not really convey the long-term effects of diabetes. They include limb amputations, long-term disability, chronic pain and heart disease, robbing people of their energy, their independence and their chances of a decent quality of life.

The other consideration is financial cost. Obesity already costs the NHS £4.2 billion. That figure is set to double by 2050. The prognosis is simple: make rapid progress or face a personal and financial catastrophe within a generation. As a country, we need to change our behaviour. The White Paper on public health sets out a new approach to improving people’s health that is locally centred, outcomes-driven and professionally led.

New local health and well-being boards will help to bring together the NHS and local government under a shared local strategy. The outcomes framework for public health will provide consistent measures to judge progress, and this includes two potential indicators covering obesity. Public Health England, a new, dedicated national public health service, will provide the resources, ideas and evidence to support local strategies. A specific obesity document will follow, setting out how the new system will work to reduce obesity levels.

However, as important as systems and structures may be, this is also about changing cultures. It is about encouraging greater personal responsibility. We have found that the state does not have all the answers, and the more the state intervenes, the more individual responsibility shrinks back. Rather than nannying people, we must nudge them, as the noble Lord, Lord Patel, reminded us, giving them the support and encouragement they need to look after their own health.

Although the noble Lord, Lord Patel, raised this subject, he expressed some doubts about its efficacy. I simply say to him that the Government cannot change people’s behaviour; what they can do is help people to change their behaviour themselves by encouraging them, rewarding them, making it easier and making it the norm. We can provide information to individuals to help them to make informed decisions about their health and we can provide encouragement, which we are already doing.

The noble Lord was doubtful whether the voluntary approach would work. I share his wish for an evidence-based evaluation of whatever we do. That is a core component of the responsibility deal and we are investing in it. However, as part of our new approach, we will consider what can be achieved through voluntary approaches before considering regulation. People’s lifestyle choices are affecting their health. The Government cannot address that challenge on their own. We believe that collective voluntary effort can deliver more progress and do so more quickly than regulation. Through the public health responsibility deal, we can tap into the unrealised potential of a wide range of resources that can promote healthier lifestyles and support people in achieving them. We have examples of working with industry, and this approach works. Change4Life is a recent example of how we have successfully worked with industry. We firmly believe that collective voluntary efforts can deliver real progress. The responsibility deal and deliverables arising from it have to deliver real improvements to public health, and we are looking at what independent monitoring or evaluation will be needed to that end.

While obesity often has complex social, psychological and cultural foundations, its basic cause is simple. My noble friend Lord McColl spoke about energy balance in its broadest sense. He is right: people become overweight because they take in more calories than is necessary and they do not burn off the excess calories that they do not need. I do not think that my noble friend was arguing against that proposition. It is a point clearly made in the NICE guidance on obesity and being overweight, and it is central to the Government’s approach. The NICE guidelines on obesity address the prevention, identification and management of obesity. They stress the importance of addressing both diet and energy out. The guidelines were based on the best available evidence that NICE had at its disposal at the time. However, my noble friend will be reassured to hear that NICE’s clinical guidelines are updated as required so that recommendations take into account important new information, and the obesity guideline is no exception to that.

My noble friend referred to the work of Professor Wilkin. The department is familiar with the EarlyBird diabetes study by Professor Wilkin. The study makes some useful points concerning the importance of early-life experiences for future health. It provides some useful messages on the importance of a child’s early years and the impact that this can have on the child’s future health and behaviour. However, this is one study which needs to be seen alongside other research with different findings on physical activity and weight.

My noble friend Lord McColl made very clear his emphasis on diet as the more important ingredient in weight loss. However, I think he would agree that any planned weight management programme should be tailored to the person’s preferences—their initial fitness, their health status in general and their lifestyle. The NICE guideline recognises that relatively high levels of activity may be required by certain individuals wishing to lose weight or maintain weight following weight loss. However, it also emphasises that, while an individual’s ability to be physically active may be hampered by their initial level of fitness or comorbidities, physical activity recommendations can be built up gradually, be focused on everyday activities, such as walking, and be accompanied by a reduction in sedentary behaviour. The guideline includes a raft of recommendations for clinical practice on dietary management.

Therefore, what is to be done? First, we need to give people the information and the opportunities so that people can choose to change their diet and lifestyle. A powerful way of doing this is through the Change4Life brand, which helps people to cut down on fatty and sugary foods and become more active. Another is working with industry to guide people towards healthier choices. The noble Lord, Lord Campbell-Savours, asked why we cannot ask restaurants and so on to place calorific content on menus. Through the responsibility deal, we now have 29 partners who are committed to posting calorific content on their menus in more than 4,000 restaurants. The noble Lord, Lord Patel, mentioned trans-fats, and my noble friend Lord Addington also referred to the fat content of food. They are both quite right. They will be pleased to hear that businesses have already committed themselves to removing artificial trans-fats from foods so that people can keep the tastes they enjoy without suffering such negative consequences. We shall continue to work with industry on other measures to help people to reduce their calorie intake, including reformulation. We will say more in the obesity document when it is published later this year.

A second issue is improving access to healthier food. In some areas, local shops simply do not stock healthier options. We are working with the Association of Convenience Stores to make fresh fruit and vegetables more available. The scheme has expanded incredibly quickly, with participating stores seeing a marked increase in the sale of fruit and vegetables. Of course, even if people have fresh produce, they still need to know what to do with it, so education is vital. There are many great local initiatives—involving the NHS, local authorities and a range of partners—which provide cookery schools and other local healthier eating initiatives.

The noble Baroness, Lady Thornton, spoke very eloquently about school food, and I agree with a lot of what she said. The Government are committed to ensuring that pupils can eat healthy, nutritious school food. We are supporting the School Food Trust in its work to help caterers to become more efficient while continuing to provide healthy meals. The schools budget will increase by £3.6 billion in cash terms by 2014-15—the end of the spending review period. Although the school lunch grant will not remain as a specific grant, it will be one of the grants that make up schools’ baseline funding from 2011-12. It will, however, no longer be ring-fenced; it will be for schools to decide how to spend the money.

We have not changed the current rules for free school meals. Therefore, some 900,000 pupils in the neediest families—those without work—continue to receive free meals. We took the difficult decision not to extend eligibility to low-income working families because the previous Government had underfunded this plan by £295 million. The money saved by not extending eligibility will be used more directly to improve the educational attainment of disadvantaged pupils, which is key to extending opportunities for poorer children. We are continuing to support three pilot projects of extended free school meals. We will look at the evidence from these of the costs and benefits of extending free school meals before making any future decisions on this front.

The noble Baroness, Lady Thornton, also mentioned advertising. As she knows, the television regulator, Ofcom, has placed scheduling restrictions on the broadcast advertising of food high in fat, salt and sugar during children’s programmes and programmes of particular appeal to children up to the age of 16. Since January 2009, these restrictions have applied to all channels. The Ofcom review in 2010 showed a 37 per cent reduction in the exposure of children to television HFSS advertising, with the highest reduction for children aged four to nine years, and a fall of 22 per cent in children—

[Lord Campbell-Savours]

Perhaps I may stop the noble Earl for a moment. In the first few moments of his speech he spelt out the scale of the crisis, yet almost all the measures that he has referred to are voluntary. They are based on an agreement with the industry or with this or that body. If that is not working—and it clearly is not, because the noble Earl himself set out the nature of the crisis—why, at an early stage, cannot we go down a more regulatory route?

[Earl Howe]

I hope that the Committee will allow me a little extra time in view of that intervention. The answer to the noble Lord, Lord Campbell-Savours, is that if voluntary measures do not work, we will indeed consider regulation. I need to make that clear. We have a ladder of intervention at our disposal. However, as I also emphasised to him earlier, we think that we can make progress faster by means of voluntary measures. The food labelling regulations, for example, are governed by EU law, and the noble Lord will know how long it takes to change EU law. If we can make progress more rapidly by voluntary measures in this country, I am sure that he would welcome that as everybody else would.

On the other side of the coin, although equally important, is physical activity—the calories we burn rather than consume. My noble friend Lord McColl made some strong statements on that aspect of the issue but, as my noble friend Lord Addington indicated, physical activity is important in the wider context of people’s health. The public messaging on this clearly has to be balanced. We are currently reviewing the Chief Medical Officer guidelines on recommended levels of physical activity and we hope to publish those in the summer. Incidentally, I am delighted that my noble friend Lord Addington has underlined the importance of diet and exercise because I still believe that the two should be emphasised.

Finally, we need to make sure that those who need it can get the specialist help to reduce and manage their weight effectively. Weight management providers will continue to play a key role in this area. I believe that through the new public health system, with the responsibility deal and Change4Life, we can truly make a difference over the next few years.