Children: Obesity

Lord Collins of Highbury Excerpts

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

Yes, my Lords, it is very much linked.

[Lord Collins of Highbury]

My Lords, I am going to take two bites of the cherry because I shall also briefly address the second Question. The noble Lord, Lord McColl, constantly reminds me that eating too many calories, not simply not exercising, is what causes me to be overweight, although I do exercise. However, when I pick up and eat a tub of low-fat yoghurt, which I have been doing for the past few years, thinking that I am eating healthily, I have not been able to read the very small print that states that this “low-fat, healthy” tub of yoghurt is packed full of sugars and calories. Actually, just before Christmas, I stopped eating low-fat yoghurts and I hope that noble Lords will appreciate the effect it has had on me. However, my specific question is: when will the noble Earl take the necessary statutory steps to ensure proper food labelling?

[Earl Howe]

My Lords, as the noble Lord will know, food labelling is largely governed by EU law and, at the moment, the EU directive is permissive about front-of-pack labelling. However, I take his point that it is very important that consumers are properly informed about what they are eating, and we are working with food manufacturers and retailers to ensure that there is much greater transparency in this area, across the piece, whether it relates to sugar, fats or salt.

NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012

Lord Collins of Highbury Excerpts

Tuesday 5th February 2013 Lords Chamber

Moved by

[Lord Collins of Highbury]

That this House regrets that the NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012 (SI 2012/3094) fail to guarantee sufficient representation of local patient interests and, despite Government assurances given to the House at Committee stage of the Health and Social Care Bill on 15 December 2011, have through restrictions on campaigning deliberately tied the hands of Local Healthwatch bodies from giving public voice to those patient interests.

Relevant document: 23rd Report from the Secondary Legislation Scrutiny Committee.

[Lord Collins of Highbury]

My Lords, this is my second Motion of Regret in relation to the regulations on Healthwatch, the body—or perhaps I should say the brand—created in the Health and Social Care Act.

A central theme in the Act is that local people should be able to influence improvements to local health and social care. To succeed, Healthwatch needs the trust and confidence of the public. To win that trust and to become an effective organisation for patients, it must have independence from the providers, commissioners and regulators of health services, because a patient’s complaint may involve the need to challenge any or all three of those interests. It must also have genuine grass-roots representation from groups and individuals, no top-down organisation, and work and comments derived from sound local information.

In our previous debate on Healthwatch England, I welcomed the appointment of Anna Bradley as its new chair. She has the right skills and experience, and I do not doubt her commitment to try to make the organisation work. However, the fact remains that it is a sub-committee of the CQC and it does not have anywhere near the same levers to pull or incentives to use to drive changes in the system. It simply does not have the power and authority of the three big players in the NHS: the Commissioning Board, the Care Quality Commission and Monitor.

In the regulations that we are considering tonight, that problem is mirrored locally. Local Healthwatch is potentially a powerful mechanism, but it is structurally weak because it relies on local authorities for funding, and it is local authorities that provide the social care that it is meant to monitor.

However, my real concern tonight is that, when local Healthwatch eventually opens its doors, it will be bound and gagged by these regulations. This is contrary to the comments and commitment given by the noble Baroness, Lady Northover, to my noble friend Lord Warner on the sixth day of Report of the Health and Social Care Bill, when she made the following statement:

“The noble Lord, Lord Warner, asked again about campaigning. I said in Committee that HealthWatch England and local healthwatch can campaign. I followed that up with a letter confirming that, which I hope he got—but perhaps he did not—and I reiterate it here. I hope that that is of help to the noble Lord”.—[Official Report, 8/3/12; col. 1958.]

No one would condone a local Healthwatch campaigning against or for a political party but these regulations go well beyond that. They effectively ban local Healthwatch from leading campaigns to change poor services and amend legislation. As Healthwatch England has said in its briefing today, its independence is crucial to ensure that patients and NHS users can share their views and experience and to ensure that those will be acted on appropriately without undue influence.

The noble Earl the Minister will no doubt tell us tonight that the words used in the regulations do not have the meaning that I am placing on them—that in Section 36(2) local Healthwatch has the necessary freedom to undertake campaigning and policy work related to its core activities. However, I am not alone in expressing concern at the actual wording of the regulations. Healthwatch England’s briefing states that paragraphs (a) and (b) of Section 36(1):

“should have been worded more appropriately to avoid any potential confusion around the active role local Healthwatch will have in undertaking policy and campaigning work on behalf of consumers of health and social care services in their areas”.

It goes on to say:

“Healthwatch England would welcome that these concerns be resolved in future statutory instruments. In the interim, Healthwatch England proposes that it works with the Department of Health and the Local Government Association to produce guidance for local Healthwatch and local authorities to assist them to correctly interpret the regulations”.

I say: for once, why can we not have regulations that mean what they say?

Coming just before the publication of the Francis report on the disasters at Mid Staffordshire hospital, in moving these regulations the Government are putting at risk the one prerequisite that Healthwatch needs to do its job, which is the trust of patients and the public. It will undermine the effectiveness of local Healthwatch as the people’s watchdog in health and social care.

--- Later in debate ---

[Earl Howe]

The noble Lord’s first point is a fair one. I was coming on to address it as it is quite clear that at least part of the wording of these regulations has seemed complicated and unfathomable to many noble Lords. I have to acknowledge that that is the case.

To address the noble Lord’s other point, we are talking about the difference between being a genuine voice for local people and simply being an adjunct of a political party. Local Healthwatch organisations should not be swayed or influenced by the activities of any political party. They must act independently. The only influence that matters to them is that of local patients and the public in seeking ways to improve the quality of care for people.

In that sense, the regulations tie down a local Healthwatch no more and no less than any other social enterprise. The wording of the regulations has been constructed in a very similar manner to the wording applied to other social enterprises in regulations. Regulations 36(1) and (2), against which so many missiles have been hurled this evening, are designed simply to reflect the standard community benefit test.

[Lord Collins of Highbury]

My Lords, if I have read Healthwatch England’s briefing correctly, it says that social enterprises are being treated differently in this statutory instrument, particularly as regards the 50% that could be retained. Perhaps the Minister could clarify that.

[Earl Howe]

I am surprised to hear that. My understanding is that that is not so and that local Healthwatch, as a social enterprise, is being treated on the same footing. My advice is as any other, but if I am wrong about that, naturally I will write to apologise to the noble Lord and copy all speakers into my letter. As I have said, I completely understand that the wording of parts of these regulations appears complicated. In answer to the noble Lord, Lord Collins, I should say that for that reason I can commit to my officials working with Healthwatch England and the Local Government Association to publish clarificatory material on this.

Having said that, I was slightly surprised that the noble Lord, Lord Warner, cast aspersions on Regulation 41. He asked how small organisations could understand the requirements set out in it. The matters set out in Regulation 41 are matters to be included in local authority contracts with local Healthwatch. In fact, these are based largely on the existing regulations on LINks. I have to say that it has not been previously suggested to us that these have been difficult to understand or are disproportionate.

The noble Lord, Lord Collins, asked me who was consulted before the draft regulations were published and whether Healthwatch England was consulted. We consulted a range of stakeholders, including LINks, local authorities, voluntary and community organisations, NALM, Social Enterprise UK, the Charity Commission and providers on the issues relating to the drafting of the local Healthwatch regulations. That included the Healthwatch England interim team.

--- Later in debate ---

[Earl Howe]

They are two different things, and I say to the noble Baroness that we are dealing here with a relationship that she may characterise as overly arm’s length. It is in the direct interests of a local authority to make sure that it has a good, thriving relationship with its local Healthwatch but that it is not tarnished by party political considerations that are irrelevant to the concerns of local people. The very fact that a local Healthwatch comes out with a political statement is not to damn its activity. What makes it vulnerable is if that local Healthwatch cannot show that it is truly representing local people as it speaks out. That is a matter of evidence and of fact.

The independent arbitration that the noble Baroness talks about should not be necessary. The matter could, in the final analysis, be decided in a court, although one hopes that that would never happen. However, in the end, the local authority has to exercise its judgment, and in doing so has to act reasonably and in good faith as a public authority. If it does not, it is acting unlawfully. I hope that that is of help to the noble Baroness.

I was asked a number of other questions by my noble friends Lady Jolly and Lady Cumberlege. My noble friend Lady Cumberlege asked me whether, if there were a controversial policy, say, to close an A&E department, a local Healthwatch would be permitted to provide evidence about patient experiences to campaigners on that issue. Yes. In that scenario, we would envisage a local Healthwatch taking those very views and evidence of good standards of service directly to the commissioners or decision-makers. A local Healthwatch can also make a referral to the health scrutiny function of the local authority, which would be required to keep a local Healthwatch informed of any action taken. If a local Healthwatch thought, as part of its Section 221 activities—patients’ public involvement activities—that local people need to know what their community’s experience of its A&E is, we would certainly expect the local Healthwatch to be transparent and make that evidence known.

My noble friend asked whether people who had been active in a national campaign could be decision-makers in local Healthwatch organisations. The regulations do not set out membership of a local Healthwatch, so it will be down to the local Healthwatch to decide whether such people can add value to the outcomes that it wishes to achieve for its local people. Local Healthwatch has to be different; it has to build up its reputation and credibility in order to secure the public’s confidence that it can have a mature relationship with local authorities, which was the point that I made just now. The regulations seek to ensure that local Healthwatch does not carry out the relevant political activities as its only or main activity. That would not meet the community benefit test.

Would local Healthwatch be subject to purdah? No, it would not. I repeat that it has been set up to be the local consumer champion, and as such its role becomes very important in getting people’s serious concerns listened to and acted upon.

My noble friend Lady Jolly asked me several questions. She expressed the fear that the regulations would render local Healthwatch a mere proxy voice. I emphasise to her in the strongest terms that that is not so. As I have explained, we have sought through the regulations to be as inclusive as possible of people who may wish to give up their time to do what they feel passionately about doing. To be frank, LINks, which is the arrangement that we have at the moment, have all too often been associated with white, middle-class men, and we need local Healthwatch to embrace diversity much better.

Could the manager of a care home sit on its local Healthwatch? Yes, he or she could get involved in their local Healthwatch, but it would be good practice for the Healthwatch in its governance arrangements to have procedures for a code of conduct, and, as set out in Regulation 40, it would be required to have and publish procedures before making any relevant decisions. That is essentially about transparency.

Could a local profit-making provider of primary care be a local Healthwatch contractor, and could its manager sit on the local Healthwatch decision-making group? Again, it would be up to the local Healthwatch whom it wishes to contract with for their expertise to help it deliver its statutory activities.

On the role of local Healthwatch to provide information and signpost people to choices, the decision rests with that individual seeking out the options available to them. We would expect local authorities’ arrangements with local Healthwatch to be robust so that it acts effectively. The local authority will be under a duty to seek to ensure that the arrangements are operating effectively and provide value for money.

My noble friend suggested that the department’s interpretation of lay involvement boils down simply to the foot soldier role. I do not agree. It would be a wrong picture to paint to the public about how a local Healthwatch discharged its obligations. The obligations are quite clear. Engagement, consultation and participation are all words that can be used to describe different types of involvement activity. Referring to “involvement” therefore provides for flexibility, as I indicated earlier.

Could the decisions listed in Regulation 40(2) be made by a decision-making body within a local Healthwatch composed of a majority of people who happen to be health or social care managers? No. Regulation 40(2) must be read with Regulations 40(3), 40(4) and 40(1)(a). The requirement to be imposed on local Healthwatch in the contracts is to have and publish a procedure for involving lay persons or volunteers in such decisions. As stated in the advice to the Secondary Legislation Scrutiny Committee, the plain provision of information would not in most cases comply with the obligation to involve; the involvement has to be in the making of the decisions.

I hope that I have covered satisfactorily all the questions put to me, and I hope that the noble Lord, Lord Collins, will be sufficiently reassured to withdraw his Motion.

[Lord Collins of Highbury]

I thank all noble Lords and particularly my noble friends for their comments. I also express my appreciation to the noble Baronesses, Lady Jolly and Lady Cumberlege, who drew attention to some fundamental issues here. They are fundamental in relation to the conflicts of interests, particularly in local authorities. The noble Baroness, Lady Cumberlege, referred to the draconian restrictions and reminded us that guidance does not have statutory force. Here I take the words of Healthwatch England: the Department of Health could and should have done better with these regulations. In my opinion, they have failed. I am afraid that the Minister has not given me satisfactory reassurances, certainly not in relation to the issues that the noble Baronesses, Lady Jolly and Lady Cumberlege, raised. In the light of that, and of the briefing we had from Healthwatch England itself, it is important that the department should think again. The only way I can do that is to ensure that we pass this Motion of Regret, and therefore I would like to test the opinion of the House.

Health: HIV Strategy for England

Lord Collins of Highbury Excerpts

Tuesday 15th January 2013 Lords Chamber

Asked By

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to publish a cross-departmental HIV Strategy for England, in line with the Political Declaration made at the United Nations General Assembly in 2011.

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

My Lords, tackling HIV remains a priority for the Government. We believe the way forward is to develop a framework that covers both HIV and broader sexual health issues. We therefore plan to publish a policy document on sexual health and HIV shortly.

[Lord Collins of Highbury]

I thank the Minister for that response. One issue that is obviously of big concern is testing. Half of the people diagnosed with HIV are diagnosed late. With the commissioning of HIV testing being highly fragmented under the new NHS arrangements in England, how will the Government ensure that HIV testing recommendations from NICE and the British HIV Association are implemented consistently across the country?

Health: Hearing Loss

Lord Collins of Highbury Excerpts

Monday 17th December 2012 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend for raising a very important issue about war veterans. My department is doing a lot of work in this area. I will write to him if I have anything more specific.

[Lord Collins of Highbury]

My Lords, I note what the Minister said in terms of the previous review but we now have an increase in retirement age and people are working longer. Hearing loss is not simply a personal health issue; it also becomes a bigger public health issue and a health and safety issue. Can the Minister therefore better understand the importance of national screening?

[Earl Howe]

My Lords, the Government fully recognise that hearing loss is not just a health issue. For example, it can lead to isolation and loss of independence; it can impact on education and employment; and it can impact in the various ways mentioned by the noble Baroness, Lady Wilkins, in her earlier question. We believe that health outcomes for people with hearing loss should be among the best in the world. To achieve that it is necessary to think and act differently. Therefore, we are developing a cross-government strategy to maximise the current effort to prevent hearing loss and to support those suffering from it. In particular, that will focus on identifying the potential better to join up services provided by the different agencies.

Health: HIV

Lord Collins of Highbury Excerpts

Thursday 29th November 2012 Lords Chamber

Asked By

[Lord Collins of Highbury]

To ask Her Majesty’s Government whether they intend to endorse the standards of care for people living with HIV published by the British HIV Association on 29 November.

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

My Lords, the Department of Health commends the British HIV Association for these important standards, which we welcome. The NHS provides excellent care for people living with HIV. These standards are important in setting out best practice to support continuing high-quality HIV care services for all HIV patients. They will provide a valuable resource and inform the commissioning of comprehensive HIV care services.

[Lord Collins of Highbury]

I thank the Minister for that response. One recommendation made by BHIVA related to self-management. As with many other long-term conditions, this approach can help people with HIV to gain confidence, skills and knowledge to manage their own health, with resulting improvements in the quality of life and independence. In the light of changes in the commissioning process, who will now have responsibility for funding the excellent self-management services currently provided by organisations such as the Terrence Higgins Trust and Positive East?

[Earl Howe]

My Lords, the noble Lord is quite correct. Self-management is one of the BHIVA standards. I agree that self-management and supporting patients to manage their own care, both for HIV and, for that matter, any other long-term condition, are very important for promoting the best treatment outcomes for individuals. A variety of approaches will be needed to support individuals to self-manage their HIV. There are already some innovative programmes, such as the online resource, My HIV, for people living with HIV, delivered by the Terrence Higgins Trust. The key to this is for commissioners of services to work together in future to ensure that self-care is part of the HIV care pathway, and GPs will have a role to play in that.

NHS: Diabetic Services

Lord Collins of Highbury Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Collins of Highbury]

My Lords, I, too, thank my noble friend Lord Harrison for initiating this very timely debate. Five years ago I stopped smoking and subsequently put on weight. I stress that this was not through drink; I had a weakness for sweets. I thank my noble friend for reminding me of that. I had an eye infection and had taken on a very stressful job. My infection got worse and, after using all the available creams from the local chemist, I was finally persuaded to drop into the walk-in centre in Victoria Street, which unfortunately, as we heard recently in a debate, has since closed. The centre nurses helped me with my eye and also gave me a quick check-up that covered blood pressure and heart rate. The result was an urgent referral to my GP for very high blood pressure. The GP undertook a series of tests that led to an early diagnosis of diabetes type 2. I am therefore acutely aware of the need to raise awareness of diabetes, not only to help prevent the condition but to promote early diagnosis.

My early diagnosis and the excellent response of the NHS have meant that I have a chance of avoiding the worst consequences of diabetes. Early preventive action saves not only lives but money. As my noble friend Lord Harrison was right to point out, there is a worrying tendency to put the onus on the individual—it was the Tory Back-Bench MP for Bracknell, not Slough, I must add to the noble Viscount, Lord Falkland. Instead, as other noble Lords have indicated, we should focus more on the food industry that since the war has pumped out high-salt, high-fat and high-sugar products without any proper warnings.

However, as we have heard in today’s debate, there is a genuine fear that, at a time when the priority of diabetes should be enhanced, the new NHS arrangements seem to be removing diabetes-specific leadership, dedicated staff and specific plans. Many noble Lords have referred to the National Audit Office investigation into diabetes care, which found that:

“Diabetes care in the NHS is poor, with low achievement of treatment standards, high numbers of avoidable deaths and annual spending reaching an estimated £3.9 billion”.

In its response, the Public Accounts Committee highlighted how barely half of people with diabetes get the nine basic checks they need to manage their condition, and fewer than one in five has the recommended levels of blood glucose, blood pressure and cholesterol, leaving an unacceptably high number at risk of developing complications, being admitted to hospital and costing the NHS more money. As we have heard from the noble Lord, Lord Kakkar, the Public Accounts Committee also criticised NHS accountability structures for failing to hold commissioners of diabetes services to account for poor performance. He expressed optimism about the future, but I wonder how the new structures will stand up to the challenge of diabetes.

As the noble Lord, Lord Rennard, said, both type 1 and type 2 diabetes can lead to costly and life-shattering complications, including kidney failure, blindness and amputations, which my noble friend Lady Thornton focused on. Amputation is not only devastating, it is expensive. In England between £500 million and £600 million is spent each year on foot ulcers and amputations. I am lucky to see a podiatrist at regular six-monthly intervals. Speaking to my podiatrist, I discovered that as a consequence of the service being moved from the PCT to the local hospital trust, recruitment was frozen. His concern, as he was looking at my feet, was that without sufficient staff regular check-ups would not be carried out, so that instead of preventive treatment, he would be dealing with an increasing number of ulcers and other serious infections.

My noble and learned friend Lord Morris also pointed out that although the major rise is in type 2 diabetes, type 1 is also rising. As was referenced in a Question I put down, the first ever report into mortality from the national diabetes audit was published just under 12 months ago. It found that up to 24,000 people with diabetes are dying in England each year from causes that could be avoided through better management of their condition. About three-quarters of those are aged 65 and over. However, the gap in the death rate between those who have and those who do not have diabetes becomes more extreme when comparing those who are younger. It was truly shocking to learn that so many young people are dying from diabetes. Type 1 is a particularly difficult condition to live with, as my noble friend pointed out, and we need to raise awareness in schools and workplaces. At the end of the day, we need a huge public awareness campaign to help both to prevent and to detect diabetes.

The focus of today’s debate has been on the need for action. As I said at the beginning of my contribution, early diagnosis is key to both saving lives and saving money. We have heard about the NHS Health Check programme, which can help to detect and prevent the onset of type 2 diabetes. As my noble friend Lord Harrison said, implementation of the programme has been poor, and patchy at best. A number of PCTs failed to offer a single person an NHS health check last year, and so far this year the poor performance has continued, with two PCTs having offered no health checks to date. There is considerable variation in the way that PCTs have delivered the programme, and overall its implementation has been poor.

As the noble Baroness, Lady Masham, said, in April next year the responsibility for commissioning the NHS Health Check programme will shift to local authorities as part of their new public health duties. She is right to be concerned about the impact of this transfer on the future sustainability of the programme and the potential for further variation in its implementation.

This morning, I said in my Oral Question on HIV services that supporting self-management is critical. This approach helps people to gain the confidence, skills and knowledge to manage their own health, with resulting improvements in quality of life and even independence. My personal experience of the DESMOND programme has taught me how important this resource can be. Proper care planning, structured education and access to psychological and emotional support are essential if we are to deal with the challenge of diabetes.

In conclusion, I have a number of specific points, many of which have been raised by noble Lords today, but there is one that I want to focus on in particular. Will the Minister ensure that diabetes is given sufficient priority? There is an absolute need for a clinical lead in, and function for, diabetes within the national Commissioning Board. As we have heard, multidisciplinary networks working across all aspects of diabetes care are vital, and local commissioning work is going well for diabetes care.

My final point concerns the health checks. Will the Minister ensure that there is national delivery and national promotion of this vital work to prevent people developing diabetes? Unless there is urgent action on diabetes, thousands more people a year will be condemned to debilitating complications and early death. The time for action is now.

Care Quality Commission (Healthwatch England Committee) Regulations 2012

Lord Collins of Highbury Excerpts

Wednesday 21st November 2012 Lords Chamber

Moved by

[Lord Collins of Highbury]

That this House regrets that the Care Quality Commission (Healthwatch England Committee) Regulations 2012 (SI 2012/1640) fail to provide sufficient safeguards to ensure the independence of Healthwatch England from the Care Quality Commission, despite Government assurances given to the House at report stage of the Health and Social Care Bill on 8 March 2012, and that the regulations fail to provide for effective national patient representation in the health service.

[Lord Collins of Highbury]

My Lords, my purpose in tabling this Motion is to highlight how these regulations, in their present form, may undermine the one thing Healthwatch England needs to succeed: public trust and confidence.

As my noble friend Lord Harris of Haringey argued so brilliantly on Report, an effective organisation for patients must be measured against three basic criteria: first, independence from the providers, commissioners and regulators of health services, because a patient complaint may involve the need to challenge any or all of these interests; secondly, genuine grass-roots representation from groups and individuals—no top-down organisation; thirdly, that its work and comments be derived from sound local information.

Over the past 40 years, we have seen community health councils, then patient participation forums and, most recently, LINks. They may not have always fully met these criteria, but each built on the progress of its predecessor in delivering greater patient involvement. No matter how often the Government assert to the contrary, the arrangements proposed in these regulations do not pass the test of independence. They say that Healthwatch England will have genuine operational independence by ensuring that the majority of its members are not also members of the Care Quality Commission. However, under the regulations the Healthwatch England chair must consult the CQC chair before the first appointments are made. That does not exactly reinforce the notion in my mind of independence. However, even with this measure and some of the others in place, it remains difficult to see how Healthwatch England can build public trust when its governance is controlled by the CQC, a body whose own organisation and resource problems have been so publicly aired.

The fear for many is that that the Healthwatch England committee will be rapidly absorbed into, and moulded and overwhelmed by, the dominant culture and infrastructure of the CQC. The Government have told us how important the duty of collaboration is within their reformed NHS. If that is the case, why not use this duty rather than leave Healthwatch England within the governance structure of the CQC?

The skill and ability of the new Healthwatch England chair will no doubt be a significant factor in whether it succeeds. I congratulate Anna Bradley on her appointment. Having worked at Which? for many years and been a former chief executive of the National Consumer Council, she is extremely well qualified to meet the challenge. From her public statements, it is clear that she fully appreciates that for Healthwatch England to succeed it must meet the challenge of independence and effective patient representation.

A key to this will be the strength of the local Healthwatch network. As local Healthwatch develops during the next six months, it must show that it listens to patients and service users and captures their feedback, a role that LINks have performed with distinction in many areas.

However, with no clear rules in law, we are potentially left with a range of different local social enterprises determining national representation. By not providing statutory status to local Healthwatch, the Government missed the opportunity for them to be organisations that were fully trusted and supported by patients and public alike. At the launch of Healthwatch England, Anna Bradley also acknowledged that, with stretched health and social care budgets, an ageing population and significant systems reform, it was essential that HWE be focused on real people, their experiences and their needs. She said that Healthwatch England would actively seek out evidence from all sections of the community and collate it to find out what needed to change. I fully understand her desire to ensure that such evidence is not dependent on those who shout the loudest. She said that Healthwatch England would go out of its way to hear from those who sometimes struggle to be heard. However, I fear that, with these regulations, we will have a body that is perceived to be appointed from high—a top-down organisation which is not representative. The 10 members recently appointed to Healthwatch England have highly relevant knowledge and experience, and I have no doubt that their specific skills and expertise will be a tremendous asset to its work—three have been appointed because of their specific local involvement. However, to be genuinely representative, there is a case for more, if not a majority, to be drawn from local Healthwatch.

Healthwatch England will be looked to by 152 local Healthwatches as an organisation that understands and has experience of both national and local problems and issues, including the special needs of deprived communities, people suffering as a result of health inequalities and people living in rural areas. The connection between local Healthwatch and Healthwatch England must be more than a brand, a name and a conversation.

The decision to restrict local Healthwatch membership of Healthwatch England to only four members, one from each of the four NHS regions, Greater London, North, Midlands and South, appears totally inadequate. In addition, the decision to restrict from 2013 local Healthwatch membership of Healthwatch England to people described as “directors” of local Healthwatch organisations is limiting and confusing.

Not only is there a risk of reduced funding with local authorities commissioning local Healthwatch, some of which we have already seen in the tendering process that has commenced, but there is also huge potential for conflicts of interest. Can we really ask a patient or carer to have confidence in a complaint being properly pursued when it involves a regulatory failure in a local authority social service? I am sure that patients will see the potential conflict of interest even if the Government cannot.

We are facing the prospect of fragmented services being delivered by multiple providers even within a single local authority. One issue of particular concern for me, which I have raised previously in the House, is the patient advocacy service, used by adults, young people and children wishing to make a complaint about NHS healthcare. There are currently three providers of the Independent Complaints Advocacy Service in England, commissioned by the Department of Health centrally. In future, this will be commissioned instead by 152 local authorities. It has been estimated that this will add £2.2 million to the cost of the service—which currently costs £11.7 million—massively reducing what is available for other patient services provided by the Local Involvement Networks.

Further, while there will be only one local Healthwatch contracted in a single local authority, this body will be permitted to subcontract most, if not all, of its activities. This will result in some areas in multiple contracts, solicitors’ fees and all the other on-cost of commissioning. The waste of public money on contracting is absolutely appalling.

In the end, it will come back to how the structure proposed in these regulations will play out in practice and how conflicts of interest between Healthwatch England and the CQC, or indeed Healthwatch organisations in local authorities, will be dealt with. The issues that the Minister must therefore address and questions that he must answer tonight are: how will public trust be maintained when a complainant about a CQC investigation into a care home discovers that the body investigating the complaint or championing improved quality of care on behalf of patients is a committee of the CQC itself? How will the culture clash between Healthwatch and the CQC be addressed and managed? How will the Minister, to quote the word used by many in this House, stop CQC “suffocating” Healthwatch England? How will he ensure that potentially serious conflicts of interest are dealt with?

I conclude with the issue I started with: public perception and understanding of, and confidence in, the independence of Healthwatch. It is important that Healthwatch is seen to be credible and truly independent, able to challenge and to scrutinise the work and decisions of the regulators, both CQC and Monitor. We need an independent Healthwatch England and we need local Healthwatch bodies that everyone can rely on to be genuine patient representatives. I am afraid that these regulations give us neither.

--- Later in debate ---

I ask the noble Lord, Lord Collins, and noble Lords opposite in particular, to support Healthwatch England, with Anna Bradley at the helm, to achieve our common goal, which is to build confidence among the public that they will be heard—that confidence is important—and to do that in the interests of health and social care services, and the outcomes that those services deliver.

[Lord Collins of Highbury]

My Lords, I thank the Minister for his response, and all noble Lords for their contribution. The noble Baroness, Lady Jolly, said that this was a missed opportunity and I am glad that she recognises that on this occasion. I wish that, on Report, we could have pushed through some of those concerns in a much more positive way. I am afraid that it is still a missed opportunity in view of the contribution from the noble Earl. As my noble friend Lord Whitty says, there was an opportunity today to state publicly not only a genuine commitment, but how we can translate that commitment into the assurances that the public will want. I hope that the Government will keep this matter under review. It is a sad fact that we have an organisation whose formal governance is under the Care Quality Commission. The chief accounting officer of Healthwatch England will not be Anna Bradley; it will be the Care Quality Commission. That poses some fundamental issues for the public.

Nevertheless, we have had a good debate. Everyone on this side of the House wishes Healthwatch England every success. We certainly wish its new chair every success. In the light of the debate, I beg leave to withdraw the Motion.

Motion withdrawn.

NHS: Walk-in Centres

Lord Collins of Highbury Excerpts

Thursday 11th October 2012 Lords Chamber

Asked By

[Lord Collins of Highbury]

To ask Her Majesty’s Government how many NHS walk-in centres have been closed or had their opening hours restricted since May 2010, and how many are scheduled to close or have their opening hours restricted.

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

My Lords, since 2007, the local NHS has been responsible for NHS walk-in centres. It is for primary care trusts to decide locally on the availability of these services. No information on walk-in centre closures or opening hours is held centrally.

[Lord Collins of Highbury]

My Lords, I was expecting that response. Will the Minister acknowledge that these closures will channel, unnecessarily, patients towards accident and emergency departments at times when GP surgeries are also closed? This will almost invariably increase NHS costs in the medium term. Or is the Government’s strategy to blame local clinicians for cuts in NHS services?

[Earl Howe]

My Lords, the Government’s clear policy is that people should be able to rely on high-quality, 24/7 urgent and emergency care that is right for them, when they need it. That is our starting point.

I say to the noble Lord that since walk-in centres were invented the array of services available to patients has been considerably enhanced. It is not just a case of going to an A and E department as an alternative. There are now many GP health centres, minor injuries units, urgent care centres and, in the extreme case, ambulance services, so I do not necessarily accept the premise of the noble Lord’s question.

Diabetes

Lord Collins of Highbury Excerpts

Tuesday 10th July 2012 Lords Chamber

[Earl Howe]

My noble friend draws attention to an area of concern. Cereals of that kind are particularly attractive to children, although I would say that the good news here is that added sugar consumption among children has fallen during the past few years, which is perhaps a sign that the messages on the levels of sugar that children can safely consume is getting through to parents.

[Lord Collins of Highbury]

My Lords, I am grateful to the noble Earl for reminding us that a small reduction in weight maintained over time can reduce the risk of developing type 2 diabetes. I must admit that I wish that I knew that when I stopped smoking and piled on the weight. As a consequence, I am type 2 diabetic. It is true that small improvements in eating and drinking habits can reduce the risk. I ask the noble Earl, as I asked him last November, whether the Government will take this threat seriously and undertake to lead a major awareness programme about what to do to avoid type 2 diabetes.

[Earl Howe]

My Lords, there is a great deal going on in this extremely important area. I am grateful to the noble Lord for emphasising its importance. There is a ring-fenced budget for public health, and weight gain is one of the key indicators in the public health outcomes framework. There is the Change for Life campaign, which has, I think, gained enormous credibility among the public and professionals. We are engaging with the food industry through the public health responsibility deal to take forward the calorie reduction pledge. There are NHS health check programmes, which are being rolled out throughout the country, and at GP level there are the nine tests which GPs are advised to undertake with diabetic patients. The rate at which those tests are being done has gone up very encouragingly over the past few years.

NHS: Definition of Exceptional Case

Lord Collins of Highbury Excerpts

Monday 2nd July 2012 Lords Chamber

[Earl Howe]

My Lords, the UK National Screening Committee advises Ministers and the National Health Service in all four UK countries on all aspects of screening policy, including for group B Streptococcus carriage in pregnancy. The committee is currently reviewing the evidence for screening for that condition in pregnancy against its criteria. It will take into account the international evidence and a public consultation on the screening review will be opening shortly.

[Lord Collins of Highbury]

My Lords, the Minister said that this treatment is not routinely carried out. The doctor concerned, who works in the NHS, is aware that pancreatectomy is carried out in other PCTs. Can the noble Earl explain where it is being carried out so that we can understand what is routine and what is not?

[Earl Howe]

My Lords, I hope that my earlier answers gave a clear indication of the definition of exceptionality, which should demonstrate to the House that something that is exceptional is not routine. Our advice is that that treatment is not routinely available in the NHS. There is a handful of centres in England with doctors who are trained to carry out the operation, but although the technique has been in use since 1977, it is available only in a few centres worldwide, which does not suggest to me that other countries are ahead of us in this area.