Sugar Tax

Lord Clinton-Davis Excerpts

Wednesday 3rd February 2016 Lords Chamber

Asked by

[Lord Clinton-Davis]

To ask Her Majesty’s Government whether, in the light of the World Health Organisation’s analysis in the Report of the Commission on Ending Childhood Obesity, they support the proposal of the National Health Service to introduce a sugar tax.

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

My Lords, we are interested to see the results of the consultation on NHS England’s proposals for a sugar tax. Urgent action is needed to tackle obesity, particularly in children, which is why we will shortly set out a comprehensive new strategy to tackle the problem.

[Lord Clinton-Davis (Lab)]

The World Health Organization and the NHS, both distinguished bodies, have proclaimed that a sugar tax is desirable, necessary and should be introduced as soon as possible. In that light, do the Government have any plans to revise their previous position and introduce proposals for a sugar tax by no later than April of this year?

[Lord Prior of Brampton]

My Lords, the Government are considering a whole range of options for tackling the scourge of obesity in young people, which include portion control, reformulation, advertising and many others. One issue they are considering is a sugar tax, but we will announce the results of that strategy in the very near future.

Sugar Tax

Lord Clinton-Davis Excerpts

Wednesday 13th January 2016 Lords Chamber

Asked by

[Lord Clinton-Davis]

To ask Her Majesty’s Government what plans they have to impose a sugar tax on fizzy drinks.

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

My Lords, we will be launching our childhood obesity strategy soon. It will look at everything, including sugar, that contributes to a child becoming overweight and obese. It will also set out what more can be done by all sides.

[Lord Clinton-Davis (Lab)]

If we had a league of government U-turns, this one would surely head the list. Not so long ago, the Prime Minister said that a sugar tax was not worth while. Now, urged on by experts and MPs of all parties, he says that it is not a bad idea. What should we now do? My view is that we should follow the example of Mexico. Why wait for many months when the evidence is very clear? Why do the Government not act immediately?

[Lord Prior of Brampton]

My Lords, I think the Prime Minister’s position is that he will want to think long and hard before imposing a tax that would fall by and large on those least able to afford it. On the other hand, the Prime Minister and the Secretary of State for Health recognise that obesity is a scourge in this country, affecting young people in particular, and will want to implement a comprehensive range of measures to tackle it.

Winterbourne View

Lord Clinton-Davis Excerpts

Tuesday 30th October 2012 Lords Chamber

[Earl Howe]

My Lords, the commissioning of this type of care will, in the future, be the joint responsibility of clinical commissioning groups and local authorities. We are encouraging as much close co-operation as possible at a local level. The noble Viscount will know that across-government funding is tight. However, we as a Government took the decision to protect the health budget, which is in fact rising in real terms every year of this Parliament. That does not reduce the pressure placed on the budget, because historically the pressures on the health budget have been higher than the rate of inflation; nevertheless, in protecting the health budget, we are also supporting local authorities to the tune of more than £7 billion over the spending review period to ensure that their social care services are not seriously depleted or damaged. It would be idle of me to say that there is no problem, but the funding available should be enough to support these services over the medium term.

[Lord Clinton-Davis]

This is not a simple matter. Does the Minister agree that an interim report will not provide all the answers and that this matter ought to be kept under constant review by Parliament in due course?

Health: Stroke Care

Lord Clinton-Davis Excerpts

Monday 13th February 2012 Lords Chamber

[Earl Howe]

My Lords, we are well aware of the issue raised by the noble Baroness. Indeed, it was raised during the listening exercise last year. PCT commissioners are identifying all their clinical contracts as part of a stocktaking exercise and over the next year will be using the information collected to identify those contracts that are due to transfer to the new commissioning organisations next year. We will work with both providers and commissioners to ensure that there is a smooth transition and continuity of care for patients and service users.

[Lord Clinton-Davis]

Is the Minister able to give an assurance that stroke care networks and the help given by the NHS stroke improvement programme will survive after the current review undertaken by the Government?

[Earl Howe]

My Lords, I can give the assurance that the noble Lord seeks. The NHS Commissioning Board authority has made it very clear that stroke networks have been immeasurably helpful to patients and there is every intention of continuing with them.

Health: Stroke Care

Lord Clinton-Davis Excerpts

Monday 30th January 2012 Lords Chamber

[Lord Clinton-Davis]

My Lords, I thank my noble friend for promoting this debate. I know only too well that a stroke can have devastating effects. Often, it kills. It can often lead to serious disability, mental and physical, and it can disrupt families. The commitment to long-term support is vital, as is the training of carers in suitable cases. The Government should indicate their unwavering support for the recommendations of the CQC report, and there should not be wide discrepancies in the country in the care of stroke sufferers. In my experience, physiotherapy is an absolute must, yet it is not always available on the scale necessary or sometimes not at all. Speech and language therapy and rehabilitation are too often woefully inadequate. Local services should be more widely known. So many organisations—PCTs, adult social services and providers—have a substantial role to play, which should be recognised much more widely.

There is so much to say about this and I thank my noble friend Lord Rodgers. He and I have suffered from this. Unfortunately, there is so little time to say everything, but this scourge demands a much more positive response from the Government. They should recognise how valuable this work is. I join with others in paying tribute to the Stroke Association for the work that it has done in focusing upon the essential issues.

Health and Social Care Bill

Lord Clinton-Davis Excerpts

Tuesday 11th October 2011 Lords Chamber

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

My Lords, this is a Bill of profound importance for the quality and delivery of health and care in England, for patients and for all those who care for them. As such it has been, quite rightly, the subject of intense scrutiny, not only in another place, but also more widely. Indeed, the intensity of the spotlight directed at its content over the last few months is borne out by the number of your Lordships who wish to speak today and tomorrow. I look forward to the debate ahead of us.

In approaching this Bill, I believe it is instructive to look backwards to its roots as well as forward to what it seeks to achieve. In opposition, the two coalition parties asked themselves the same simple question: “How can we make the NHS better?”. In asking that question we were clear about several things. We were clear that the founding principles of the NHS—that it should be a comprehensive service, free at the point of use, regardless of ability to pay, and funded from general taxation—should remain sacrosanct. We were also clear that we should reject any system that discriminated between rich and poor. The NHS should aspire to the highest standards of service for all our citizens, but in seeking ways to make the health service better, it was necessary to identify the challenges that it faces. What are they?

The first, and most obvious, is rising demand for healthcare from a growing and ageing population and the increase in long-term conditions. The second is the rising expectations of patients about what should be on offer to them from a health service in the 21st century, including new drugs and technologies. The third is the financial challenge—the inexorably rising costs of providing services against an increasingly constrained budget.

Two key principles emerge from this analysis: the need for maximum efficiency in the way the health budget is spent; and the need to make the service patient-centred. For many years, politicians have spoken of the NHS as a patient-centred service, but how can a service be truly patient-centred if decisions about the treatments and pathways of care that are available to patients are taken at several removes from those who know best what the needs of patients are—namely, the patients themselves and the healthcare professionals who look after them?

How can a health service be patient-centred if the measures of its performance overlook what for patients matters most, namely the outcomes that it achieves and the quality of care that patients receive? What of NHS efficiency, when so much of its budget is consumed by layers of administration, when its productivity over the last few years has fallen, and when patients experience poor handovers between different parts of the NHS and between the NHS and social care?

There is a fundamental problem, too, in NHS accountability. The original National Health Service Act 1946 provided for a comprehensive health service, but it did so by employing a simple legal precept—that responsibility for everything that happened in the NHS should lie with the Secretary of State. That may have held good in the 1940s, when the challenges facing the NHS were largely the management of acute short-term conditions, but it does not hold good now. The Secretary of State has for decades delegated his functions for the commissioning and provision of healthcare services to other bodies. The reason for that is simple: managing the range of healthcare needs for our diverse population is now so complex that no one would argue that it is a task best carried out from Whitehall. This has resulted in a vacuum in NHS accountability, with no measures or mechanisms whereby PCTs and trusts can be held locally to account. We in Parliament can only turn to the Secretary of State: he in turn can only give one answer—PCTs and trusts are autonomous organisations, their decisions are taken independently, in accordance with local priorities, and it is not appropriate for these decisions to be subject to interference from the centre. So the fact that the Secretary of State is responsible for making sure that there is an NHS available to all clashes with the fiction—for that is what it is—that he is somehow responsible for all clinical decision-making in the NHS. This results in a poor deal for the person at the centre of things—the patient.

During the last few years, it became clear to politicians of all persuasions that there was another nettle that the NHS had to grasp: the need to improve quality. We know that, measured against accepted benchmarks, the outcomes experienced in the NHS sometimes fail to match up to those achieved in comparable countries. The OECD has reported that if the NHS were to perform as well as the best performing health systems, we could increase life expectancy in the UK by three years.

Towards the end of the previous Government, the noble Lord, Lord Darzi, sounded a clarion call to managers and clinicians around the quality imperative. The focus of the noble Lord’s work—to define what quality means and to drive forward that agenda by fostering innovation, transparency, and choice, by strengthening regulation and by encapsulating the rights and legitimate expectations of patients and staff in an NHS constitution—was unarguably right. But his time in office was short. There was much more that still needed doing.

Our plans for the NHS therefore focused on three main themes: accountability, efficiency and quality—keeping at the centre the most important theme of all, the interests of patients. Modernisation of the health service, we were clear, had to involve a fundamental shift in the balance of power, away from politicians and on to patients themselves through increased choice and information, and on to doctors and health professionals, giving them real budgets and empowering them to use those resources in a cost-effective way to drive up quality. That shift would have two advantages: it would serve to depoliticise the NHS; and it would promote efficiency and quality by making those who take clinical decisions on behalf of their patients responsible for the financial consequences of those decisions. Both GP fundholding in the 1990s and, more recently, practice-based commissioning showed that empowering clinicians directly could improve the quality of care that patients experience. The potential is truly enormous: allowing doctors, nurses, hospital specialists, social services and other professionals the freedom to design care pathways that are integrated, and to commission them on behalf of their patients, will, we firmly believe, transform the quality of care and treatment that the service delivers.

At the same time, the clinicians on whom this greater autonomy is bestowed should be held accountable as never before—not only for their use of public money but also for the outcomes they achieve for patients. Unlike the largely illusory accountability of the present system, we were clear that doctors should be held to account in a transparent way by the patients and the communities whom they serve. Success and failure have to be measured in better and more meaningful ways, by reference to outcomes, not processes. For their part, elected politicians should be held accountable in a dual fashion: first, to Parliament, for the performance of the health service as a whole, defined principally in terms of outcomes; and, in parallel, for directly overseeing and delivering the public health agenda so critical for the long-term health of the nation—an agenda which, too often, has tended to assume a lower priority for government at times when the NHS budget has come under strain.

The fruits of this deliberation were laid out in various Conservative and Liberal Democrat publications from 2006 onwards, including a White Paper, in our manifestos at the last election, the coalition agreement and, finally, a government White Paper from which this Bill directly stems. The democratic mandate for our proposals is absolutely clear.

This brings me to the amendment tabled by the noble Lord, Lord Rea. It is important that we remember what the Labour Party manifesto said on health at the last election:

“We will continue to press ahead with bold NHS reforms. All hospitals will become Foundation Trusts … Failing hospitals will have their management replaced. We will support an active role for the independent sector working alongside the NHS in the provision of care … Patient power will be increased”.

Even Labour accepted at the last election that doing nothing is not an option for the NHS. Many of the principles in this Bill were ones that they wholeheartedly embraced. But the nature of the change must be different. Instead of putting in tiers of management and controlling everything from the centre, we are removing bureaucratic structures so that the front line is empowered as never before to deliver better patient care. This Bill achieves that by means of a better framework which allows power to be devolved from the centre so that innovation is unleashed—

[Lord Clinton-Davis]

Why was none of this mentioned in the Conservative manifesto at the election?

[Earl Howe]

I commend the manifesto to the noble Lord because our plans were very clearly set out in it. It allows power to be devolved from the centre so that innovation is unleashed from the bottom up, supported by clear lines of accountability. It is, in fact, the inverse of a topdown reorganisation.

The Bill is long and complex because for the first time in statute it seeks to define the functions and duties of every element in the chain of accountability within a reformed healthcare system, and to join up those functions and duties into a coherent whole. Whereas in the past it has been possible for a Government to change the NHS simply by direction, in the future it will be impossible to do so without recourse to Parliament. Much that was defined in regulations and directions is now to be covered clearly in statute. Daunting as it may seem to some of your Lordships, we were clear that this was an ambition whose realisation was well worth the effort. At the same time as introducing change, it is a Bill which seeks to build on much of the existing and therefore familiar features of the NHS architecture put in place by the previous Administration. Noble lords will know of the Nicholson challenge: to deliver up to £20 billion of savings in the NHS over the next four years, all of which money will be ploughed back into patient care. Savings on this scale are not possible to achieve without system-wide change, and the measures in this Bill are inseparable from that process.

Let me now focus on its content. This Bill is about several things. It is about liberating the NHS and those within it to enable them to work better and more accountably in the interests of patients. It is about streamlining the architecture of the NHS to make it more efficient and transparent. And it is about creating a public health service that is configured to tackle the major challenges to the nation’s health and well-being that face us over the years ahead. The key to achieving this, we believe, is a strengthened and more logical spread of accountabilities. Put simply, the Bill provides that the Secretary of State should remain accountable to Parliament, as he has been since 1948, for promoting a comprehensive health service and for the funds voted each year by Parliament for the health budget.

Let me be clear—the Bill does not undermine the Secretary of State’s ultimate accountability for the NHS or the responsibility that he carries for a comprehensive service. I am fully aware of concerns raised on this point, and I respectfully refer your Lordships to the response we published yesterday to the Lords Select Committee on the Constitution on this very matter. We are unequivocally clear that the Bill safeguards the Secretary of State’s accountability. However, we are willing to listen to and consider the concerns that have been raised and make any necessary amendment to put the matter beyond doubt.

The duty to commission and provide healthcare day to day, which hitherto the Secretary of State has delegated to the NHS, will instead be conferred on NHS bodies directly. Clause 6 proposes that below the Secretary of State there should be a new body, the NHS Commissioning Board, directly responsible for holding and distributing the NHS commissioning budget and for assuming many of the functions now performed by strategic health authorities and patient care trusts, which will be abolished. But the board will not operate without political oversight. The Secretary of State will issue a mandate detailing the outcomes for which the board will be held accountable. The mandate will be subject to public consultation and laid before Parliament, creating a clear line of political accountability. Unlike the current operating framework, the Bill gives the Secretary of State an explicit duty to report on how the board has performed against the mandate. But, as an independent body, the board will be a buffer against the short-term, politically motivated whims of government.

Clause 7 creates clinical commissioning groups as statutory bodies authorised by the board which will commission local healthcare services. CCGs, consisting of groups of GP practices and with doctors in control, will be stewards of the bulk of the NHS commissioning budget and will be held transparently and rigorously to account for the use of those funds against a set of quality and outcome measures. The defining characteristic of CCGs as compared to PCTs will be their clinical ethos. It is doctors and their fellow clinicians, not managers, who know the needs of patients best. By making clinicians financially responsible for the clinical decisions that they take, we will not only drive efficiency but also achieve a step change towards a genuinely patient-centred service.

Real accountability to the patient will be achieved in a number of ways. It will be achieved by empowering patients with information and involving them in decisions around their care. But it will also be achieved by empowering local groups of patient representatives to be involved in how services are commissioned, provided and scrutinised. Clauses 178 to 186 propose the creation of HealthWatch. Local HealthWatch will be based on the existing local involvement networks, or LINks, but with added clout. Funded through local authorities, they will act as the independent eyes, ears and voice of patients and service users in a local area. At the national level, a new body, HealthWatch England, will be established to support local HealthWatch and to act as the national care watchdog wherever quality of care is called into serious question. By making HealthWatch England a committee of the Care Quality Commission, as is proposed in the Bill, we will enable the voice of patients and the public to be heard at the very heart of health and social care regulation.

But liberating the NHS goes further. It means enabling the governors of foundation trusts, who represent the public, patients and staff, to exercise more meaningful influence over strategic decisions made by their trust boards. It means freeing foundation trusts from the private income cap; a constraint which they repeatedly tell us is arbitrary and unnecessary, and whose removal will enable them—without jeopardising their NHS focus—to generate income which can be deployed for the benefit of NHS patients. Clauses 148 to 177 cover these proposals. Noble lords will recall the debate we had on this subject two years ago.

In developing healthcare provision, the previous Government began to champion the cause of patient choice as a driver of quality, and in doing so moved us in the direction of a more plural service with the introduction of independent sector treatment centres, social enterprises and charities operating alongside mainstream NHS providers. We have long agreed that this was the right direction of travel. Competition and choice will no doubt prove a major theme in some of our later debates on the Bill, but let me say for now that we are absolutely clear from past evidence that where competition can operate to improve the service on offer to patients, or to address a need that the NHS fails to meet, we should let the system facilitate it. However, competition only has a place when it is clearly and unequivocally in the interests of patients.

This is where we were critical of one aspect of the previous Government’s policies. The playing field was levelled against the NHS. ISTCs were given guarantees and price subsidies that were not available to public sector providers. That is why we want to ensure that all providers of healthcare operate to the same clear rules. This, in turn, necessitates an independent body capable of holding the ring. That body, we propose, should be Monitor in its new guise as a sector-specific regulator for the health service, with functions and duties framed to enable it to bear down on unfair competition, conflicts of interest and unsustainable pricing. It will operate in accordance with the principles and rules for co-operation and competition, which were introduced by the previous Administration.

For a long time now, the idea of a local democratic mandate for healthcare provision has been a pipedream of many. For the first time, this Bill imposes duties on local authorities that will see the creation of health and well-being boards, bodies charged with assessing and addressing the health and social care needs of a local area. This represents a huge opportunity for improving the commissioning of health and social care. Health and well-being boards will consist of, as a minimum, representatives from clinical commissioning groups, social care, public health and patient groups including local healthwatch, plus elected representatives. They will provide a forum for joined-up decision-making on service configuration and local priorities. Joint health and well-being strategies will not simply inform clinical commissioning in a local area, CCGs will also be required to have regard to them when preparing their commissioning plans, with safeguards in place should they fail to do so. The democratic underpinning this gives to service provision is a major and exciting change.

At the same time, the Government’s clear focus on public health will usher in a new public health architecture. At a local level, for the first time since 1974, local authorities will become the hubs for commissioning and delivering public health services, led by directors of public health and supported by a ring-fenced budget. At the centre, under the direct auspices of the Secretary of State, a new executive agency, Public Health England, will bring together health protection functions currently distributed between a number of different organisations. In driving forward public health strategies at a national level, it will inform and support local authorities in their work, thus ensuring a joined-up system. We believe it is of vital importance that public health should receive the emphasis due to it, if we are to tackle the long-term challenges to the nation’s health and well-being that currently face us.

Alongside this, we will modernise and streamline the Department of Health’s arm’s-length bodies. The Bill abolishes bodies that are no longer required, thus releasing more money to the front line. At the same time, NICE and the NHS Information Centre will have their future secured by being established in primary legislation for the first time.

The changes we have set out will be introduced in measured stages over a period of years, and our plans for transition will ensure that the health service is well prepared; for example, no clinical commissioning group will be authorised to take on any part of the commissioning budget until it is ready and willing to so; Monitor will continue to have transitional intervention powers over all foundation trusts until 2016 to maintain high standards of governance during the transition; and to avoid instability, there will be a careful transition process on education and training.

In framing the provisions of this Bill, Ministers have talked and listened to a great many people; not only before the election but since, with a public engagement on our White Paper in 2010 and, in the spring of this year, the very productive two-month listening exercise. Throughout this time we have encountered consistent and widespread agreement for the key principles underpinning our policies; in particular, since the listening exercise, a shared view among professionals about the way those principles should be put into practice. At the same time, reform of the NHS is seen not just as an option but as absolutely essential for its future.

In addition to this consultation and engagement, this Bill has also undergone significant scrutiny in the other place. The Bill’s first Committee stage lasted 28 sittings—longer than any Bill in nine years. Following the Future Forum’s report, the Bill was recommitted for a further 12 sittings. The Bill was therefore scrutinised over more sittings in the other place—40 in total—than any other Public Bill in the whole period from 1997 to 2010. I direct that point in particular to the noble Lord, Lord Rea.

I conclude with a brief word about the Motion tabled by the noble Lord, Lord Owen, which I shall speak to in detail when I wind up the debate. Suffice it to say for now that while I fully recognise the strength of his concerns, I regard the proposal he has made as posing an unacceptable risk to the passage of this Bill and hence to the Government’s programme for the health service. He is proposing an unusual process. The only basis on which such a process might be workable would be with the prior reassurance, for the Government, of a strict time limit on the Bill’s Committee stage as a whole. Regrettably, I was unable to reach agreement with the noble Lord that this was a reasonable basis on which to proceed. I therefore do not think that his Motion should be supported.

The case for change is clear and compelling, and I am personally in no doubt that the changes set out in this Bill are right for our NHS and—more importantly—right for patients. I hope very much that your Lordships, in reserving your powers to scrutinise the detail of the Bill with your usual care, will wish to endorse the ideas and the vision that it presents. This is a Bill with but a single purpose: to deliver, for the long term, a sustainable NHS, true to its founding principles. It is on that basis that I am proud to commend the Bill to the House, and I beg to move.

Amendment to the Motion

NHS: Hospitals

Lord Clinton-Davis Excerpts

Thursday 8th September 2011 Lords Chamber

Asked by

[Lord Clinton-Davis]

To ask Her Majesty’s Government what meetings they have held with private companies concerning the management of NHS hospitals; and what was the outcome of any such meetings.

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

My Lords, as part of standard policy development, officials in the Department of Health met UK-based companies and one international health expert to hear their experiences of intervening to improve underperforming organisations. These were background sessions to inform policy development. Any decisions to involve organisations such as the independent sector or foundation trusts in running NHS hospitals would be locally led. In all cases, staff will remain within the NHS and assets owned by the NHS.

[Lord Clinton-Davis]

Is there any suggestion by the Government of cutting staff or wage levels, thus putting greater emphasis on raising revenue rather than patient care, which we regard as highly important? This policy represents, does it not, the decline of the NHS rather than its reform?

[Earl Howe]

I am not sure what policy the noble Lord is referring to. There is certainly no concerted policy to decrease the pay levels of NHS staff. That is something we take very seriously. The proper remuneration of NHS staff, and their motivation, is of central importance to the well-being of patients. No, we are not diluting the NHS; the whole point of the Government’s programme is to bolster and boost the sustainability of the NHS for the long term.

Health: Stroke Care

Lord Clinton-Davis Excerpts

Monday 4th July 2011 Lords Chamber

[Earl Howe]

My noble friend makes an extremely important point about strokes in young people. It is of course true that, thankfully, fewer young people suffer these strokes, but he is right that sickle cell presents a warning sign. There are clear guidelines for ambulance crews and doctors more generally relating to those who have sickle cell disease. We had a debate a while ago on this topic in which the noble Baroness, Lady Benjamin, made some extremely important points which we continue to bear in mind.

[Lord Clinton-Davis]

My Lords—

[Lord Winston]

My Lords, various reports show that the mortality for stroke can be as high as 30 per cent. Sadly, in the United Kingdom mortality is higher than almost anywhere else in Europe, although there is great geographical variation all over the world. One of the issues that Professor Peter Rothwell, of the University of Oxford, has pointed out is that speed is the essence of success. Therefore, it is not merely a question of informing patients, but of making certain that the right availability is present in our hospitals. If we do that we can reduce the risk of a further stroke by 80 per cent and probably, as he says, reduce the cost to the National Health Service in primary care by somewhere between £100 million and £200 million annually. Would the Minister be kind enough to explain how that will work in the future of the health service?

Southern Cross

Lord Clinton-Davis Excerpts

Thursday 16th June 2011 Lords Chamber

[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.

[Lord Clinton-Davis]

If it becomes clear within a reasonable time that Southern Cross and others are unable to put the business on a stable footing, what will then happen, primarily to the residents but also to the workforce? Can the Minister suggest what he has in mind as a fallback position?

[Earl Howe]

My Lords, the Department of Health is being very clear with the company that we expect it to maintain service continuity and quality of care while the restructuring process is going on. As I have said, our principal concern is for the safety and well-being of the residents of the care homes that might be affected. The CQC will pay particular attention to any care homes where there is a concern that quality may be at risk or inadequate. We are continuing to talk to ADASS, the LGA and the CQC to ensure that contingency plans are in place which will allow for the continuation of care under any eventuality. If the noble Lord will forgive me, I would rather not be drawn into hypotheses as to what might happen if the restructuring does not take place. We must encourage the company to believe that that is the prime and sole option before it. If there is ever a question of a change in the arrangements for providing residential care to any resident of a Southern Cross care home, or indeed any other, the rights of those residents remain absolutely clear in law. The duties of local authorities are absolutely clear in law. I believe that all residents in Southern Cross’s homes can rest assured that local authorities are well seized of those duties and processes.

Health: Stroke Treatment

Lord Clinton-Davis Excerpts

Wednesday 30th June 2010 Lords Chamber

[Baroness Thornton]

My Lords, I start by thanking the noble Lord, Lord Rodgers, for bringing forward this debate. It is almost exactly a year since we had a debate in your Lordships’ House in which the noble Lord mentioned stroke and, indeed, his questions were answered by me. I do not expect that the noble Lord imagined that he would be addressing his questions to a Minister who, one year on, is now his noble friend. I hope that the noble Lord, Lord Rodgers, is not going to let up on his consistent holding of the Government to account for what is going to happen to stroke services and the stroke strategy.

It is not often that I do this, but I intend now to quote myself from 25 June last year. In that debate, I said:

“The noble Lord, Lord Rodgers, raised the issue of stroke, as did several other noble Lords including the noble Lord, Lord Walton of Detchant”—

whose debate it indeed was. I continued:

“He was right to point out that we have a new national framework for stroke and we are endeavouring to give it the right kind of emphasis and prioritisation that stroke requires. I can confirm that the 10-year plan is on track, that the stroke strategy acknowledges that the networks are of great benefit and that all the stroke services in England now fall within one of the 28 networks. The work of the stroke improvement programme, including the networks, will be evaluated over the next year, after which future work plans will be considered”.—[Official Report, 25/6/09; col. 1750.]

There is no question that the Labour Government took the issue of stroke very seriously, for all the reasons that have been eloquently described by noble Lords today. I think particularly of the very fair summary of the history of this issue which the noble Lord, Lord Rodgers, gave.

I suppose, then, that my first questions to the Minister are: has the review been finished, what is its outcome and what are the government plans for taking forward the strategy? Indeed, will the coalition Government be following the stroke strategy, or will they be junking it to start all over again in a year’s time? Personally, I would counsel against such a course of action, given the widespread support that the strategy has across a whole range of medical and voluntary organisations and, indeed, the involvement of many of those organisations in the creation and continued monitoring of the strategy.

However, there are some worrying signs, to which other noble Lords have already referred. On the recent decision by the coalition Government, on 10 June, to remove ring-fencing conditions from the £15 million 2010-11 revenue grant to local authorities for implementing the stroke strategy, I can only quote the excellent briefing, for which I am very grateful, from the Stroke Association. It says that in its opinion this,

“makes the risk of cuts to current support service levels even more pronounced and in need of urgent attention”.

I agree with it and would really like to know how the strategy will now be delivered at local level.

The NAO and the PAC, which noble Lords have also mentioned, recognise the risk posed to improvements in the longer-term stroke strategy services by the end of additional funding for the implementation of the national stroke strategy after 2010-11 and the current financial pressures facing the NHS and local authorities. Under these circumstances, we need a commitment from the department that these improvements will continue in the long run. Indeed, as has already been mentioned, the PAC makes a number of key recommendations on how the department can sustain and improve further the standards of service for all stroke patients across the whole care pathway, and asks for reports on progress in areas within 12 months. I agree with that and would like to hear a commitment from the Minister to that course of action. Indeed, when we were in government we regarded the work of the PAC as extremely important in helping us to deliver the stroke strategy.

However, I am alarmed at the current risks to services. The NAO report shows that 76 per cent of local authorities surveyed have used the Department of Health’s ring-fenced funding to develop services with the Stroke Association. As mentioned by my noble friend Lady Pitkeathley, the number of contracts with local authorities to provide information and support has increased from 164 in 2005 to 268 in 2009. It seems that, at current levels, one in every two patients is able to access them. Around half the local authorities have also used the funding to establish their own dedicated stroke-related jobs, such as stroke care co-ordinators, stroke-specific social workers and occupational therapists, and a quarter have used some of the grant to fund breaks for carers.

We know that there is also still an unmet need. It would seem that, at the moment, an estimated 50 to 60 services around the country could be under threat of not having their contracts renewed. This is a very serious issue. Some local authorities have already put recruitment on hold for vacant positions. I am concerned that the message being sent from the department is that this is no longer a priority for local authorities. How will the coalition Government re-establish the priority that we gave stroke, and how will they re-establish those networks that have been so important in improving the treatment of stroke across the country and for the future?

I have several other questions which the Government need to address. They relate to the issue of funding at local level. Do the Government have plans to monitor and evaluate the use of the ring-fenced funds to ensure that they continue to be a priority? Does the Minister feel that the premature ending of ring-fencing sends the message that I have already outlined—that this is no longer a priority? What on earth will they do about that? The Stroke Association and the voluntary sector have a right to be very concerned.

The Minister would expect me also to refer to FAST. The previous Government invested £10 million between 2008 and 2010 in awareness-raising activity around strokes, centred on the highly visible Act FAST campaign, which I demonstrated to your Lordships’ House twice last year. The PAC report describes this campaign as “excellent” and concluded that it,

“had improved public awareness of stroke and the responsiveness of ambulance and hospital staff”.

Given that the mantra we keep hearing is that the Government want an evidence base for the decisions that they take, I hope they will take on board the NAO’s public survey, which gives the evidence that this campaign has worked. Will the Minister confirm that the funding allocated for the continuation of the excellent Act FAST campaign will be spent? What plans does the department have to continue funding the excellent campaign to improve awareness of stroke over the medium to long term?

I am proud to have been part of the Government who transformed the treatment of stroke in this country. We made the National Stroke Strategy a priority and gave additional funding to strategic health authorities for its implementation. We ensured strong leadership at a national level with a national clinical director for stroke and the new NHS Stroke Improvement Programme. Progress was aided by the inclusion of implementation of the National Stroke Strategy of the NHS operating framework as a tier-1 “must do” national requirement. I am pleased that the tier-1 status continues to be there in the revised operating framework that this Government have just published. I hope that that is not just for this year, but for the duration of the strategy. Is that the case?

We know that the best way to reduce the human and economic cost of stroke is through prevention. I put it on record that I remain to be convinced that the coalition Government are taking seriously their commitment to issues of public health. The prevention of stroke is key to the whole of the Government’s public health drive. Smoking cessation, obesity campaigns and swimming are all linked to how we prevent stroke in the future. How will the Government’s work to prevent stroke happen in the current financial climate and given the freeze in advertising? Having a policy which just says that we are going to prevent stroke by doing the following things, but are cutting the budget that allows us to communicate that, makes it not at all a useful commitment. It is meaningless. It is important that we hear what the Minister has to say on that.

Finally, what does the moratorium on reconfigurations mean for stroke services? Following consultation, Healthcare for London planned to introduce eight hyper-acute stroke units, all of which it hoped would be up and running by April 2011. However, I have to ask, what is the future for these centres? The Secretary of State has said:

“I am fulfilling the pledge I made before the election to put an end to the imposition of top-down reconfigurations in the NHS … As part of this, I want NHS London to lead the way in working with GP commissioners in their reconfiguration of NHS services. A top-down, one-size fits all approach will be replaced with the devolution of responsibility”.

We have heard this many times before. However, this has potentially extremely serious implications for stroke services in London, which are beginning to deliver an absolutely excellent first-rate service which is saving the lives of Londoners. As someone who lives in London during the working week, I would like to know what would happen to me now if I had a stroke. Would I end up at one of these centres or have they now been reconfigured out of existence? I suggest that we probably need to keep a very vigilant eye on the future of stroke services.

[Lord Clinton-Davis]

I apologise for speaking in the gap. I did not know whether I could be here. However, it would be remiss if I were not to mention the debt that some stroke sufferers owe to the authorities of this place. I am one of them.

[Lord Shutt of Greetland]

My Lords, I am afraid that the noble Lord has missed the gap; it has gone.