Mental Health Services
Lord Crisp Excerpts(10 years, 2 months ago)
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Earl Howe
My Lords, it is unacceptable for a child in a mental health crisis to be taken to a police cell. The mental health crisis care concordat, launched in February this year, reinforces the duty on the NHS to make sure that people aged under 18 are treated in an environment that is suitable for their age, according to their needs. It also makes it clear for the first time that adult places of safety should be used for children if necessary so long as their use is safe and appropriate. We have seen a reduction in the use of police cells across the country but there is still further work to do.
Lord Crisp (CB)
My Lords, I understand that child and adolescent mental health services are under pressure anyway, and therefore that puts greater pressure on those who are hardest to reach. Perhaps I may therefore ask the noble Earl two specific questions. First, what is being done to ensure that private children’s homes have as good access to CAMHS services as local authority homes? Secondly, when a looked-after child is placed out of an authority or experiences a change in placement, what measures are in place to ensure that he or she receives priority in the new waiting list?
National Health Service
Lord Crisp Excerpts(10 years, 7 months ago)
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Lord Crisp
To ask Her Majesty’s Government what plans they have to give citizens and patients more power in the National Health Service.
Lord Crisp (CB)
My Lords, I am very glad to have the opportunity to initiate this debate and I am very grateful to noble Lords who are taking part. I am looking forward to hearing what they have to say. People are coming from a range of different backgrounds and experiences, which should be very illuminating. I am also conscious that the Government have already said a great deal about patient empowerment and patients taking a greater role. Therefore, to some extent I am pushing at an open door in this debate. I am trying to make sure that the progress being made is accelerated and that specific things happen to change the dynamic.
We are talking about one of the most important things happening in health over this decade. I know that discussions about patient and citizen empowerment have been going on for much longer than that but there is a building global momentum. Most noble Lords will know that six all-party parliamentary groups have recently published a report on patient empowerment in which we looked at the global picture as well as the UK picture. I will come back to that.
The UK is part of, and can be a significant leader in, what is happening globally. There is a change from everything within health and healthcare being defined by the professionals to things being defined much more by the citizens, the public and the patients; that is, everything, including what quality consists of in healthcare, being defined much more by the patients, the citizens and all of us, involving of course the professionals.
I have a confession to make. As the NHS chief executive for some years I, like lots of other people, said that patient empowerment was a top priority. But in reality, although we said that for a number of years, not a great deal has happened in this area. As I will say in a moment, I think that England is ahead of much of the rest of the world, but there is very much further to go. We all said it because we were sincere about it, but we did not well understand how to make it happen in reality. It is now beginning to be well understood. I think that people can understand how to make the change. Of course, we now have technology and science that is literally putting things into patients’ hands in ways that enable them to be more empowered as patients and citizens.
I deliberately included patients and citizens in the Question, recognising that both are the same people. I wanted to draw attention to the fact that patients have particular roles but there are particular roles for citizens as well. I mean the whole range of citizens, including the very important group of carers, whom I suspect we may hear more about in due course.
Before turning to the specific all-party parliamentary group report and its recommendations, which I will ask the Minister about, I will say a few things about citizens and why it is really important that citizens have more power. I will give three reasons although there are others. There is enormous epidemiological change going on, as every Member of the Committee will understand as well as I do. We are moving towards a world where the biggest issues facing us are non-communicable diseases. As we all know, those will be significantly affected by people’s behaviour. People themselves will be part of the problem and part of the solution as well.
However, this is not just about individual behaviour but about societies and serious changes in society. Programmes are developing across Europe that come under the title of “Health in all Policies”, which are about making sure that education, employment, commerce and every other part of society has a role to play in improving health and in not damaging health. Over this parliamentary Session, we will no doubt see examples such as discussions about the impact of sugar on people’s health. Wider society has a significant role in improving health. The best estimate that people make is that health services contribute about 20% to our health improvement and wider society contributes about 80%. That in itself is an argument for citizens being much more empowered within our NHS.
The second argument is about carers, which I will not dwell on very long. The last time I looked at the figures, if you monetised the informal care systems and attempted to estimate their value in cash terms, the amount that they contributed to England was roughly equivalent to the total cost of the NHS. As we all understand, if those informal systems were to fail for whatever reason, the burden would fall on the NHS. If those informal systems were to be strengthened, as they should be, that would help the formal health system to become more sustainable. We need the engagement of carers and citizens as carers—and most of us will be carers at some point in our lives—within the NHS for its continuing success.
However, this is also about democracy, values and priorities. Here in England and in the UK, we have had in recent years debates about the future of the NHS—what it is and what its core values are. Those will no doubt continue. For all those reasons—the epidemiological, the role that informal care plays in our society and democracy—it is fundamental that citizens have more power. It will be interesting to hear what the Minister has to say about that.
I turn specifically to the patient empowerment review. First, I put on record my thanks to the many people who contributed from six all-party parliamentary groups and to Meg Hillier MP, who chaired the review. As we noted in that report, the NHS is ahead of the field in many ways. There are many good examples, from personal budgets to expert patients’ programmes and so forth. The NHS has been moving, but it has not yet reached a position where this is central to where the NHS is and wants to be. As we noted in the report, there are many good global examples as well. Those come from low and middle-income countries as well as from rich countries. Our simple message in the report is that we need to give renewed emphasis and investment to patient participation to improve health, satisfaction, quality and sustainability.
Let me touch briefly on two examples which illustrate that very well. The first is the pure and simple example of diabetes. A patient with diabetes—a person with diabetes—may be involved in something like 500 hours a year of self-care, but have only two 15-minute sessions with a professional. It is just as important that those 500 hours, or however many they are, are handled well and appropriately to improve health and, indeed, keep pressure off the formal health system.
I turn to satisfaction and quality. Maureen Bisognano, who is president of the Institute for Healthcare Improvement in America, has a very good expression about what the future should look like. The question between the clinician and the patient has often been, “What’s the matter with you?”. She says that the future question should be that, but also, “What matters to you? What are the things that you need in terms of your request for help, if you like, from the National Health Service?”. She makes the very simple point that most patients have complex conditions. If you have something such as Parkinson’s disease, you may have many different symptoms and, therefore, many different things that can be done to control them. It should be about your choices, not just the clinician’s choice. “What matters to you?” seems to me to be the watchword for the future.
My questions for the Minister are, first, of course: what are his plans, as the title of the Question asks? Secondly, I would like his response to the modest four recommendations that we make in the report. The first is that patient empowerment should be a top priority and that that means that all the systems and incentives should be aligned behind it to make it happen—something we have not done satisfactorily in the past. The second is to ask whether the Government will revive the revolution that was started in decision-making tools earlier this century. Decision-making tools are about helping patients to be able to make shared decisions with their clinicians. That is the area of “What matters to you?”, which I just talked about. The third is to ask whether the Government will give patients co-ownership of their records, by which I mean that they should own their health records. The only other co-ownership should be that the anonymised information is available for research. That is where we were coming from as an all-party parliamentary group. We see no reason why patients should not just have access to records—why should they not own them? Fourthly, what are the Government going to do to encourage patients to ask more questions and support them? That happens in some countries: the example we give is Denmark, which has a programme called Just Ask about encouraging patients to do just that.
With that list of questions, I am delighted to have the opportunity to initiate this debate and look forward very much to hearing what noble Lords have to say.
NHS: Black and Minority Ethnic Nursing Directors
Lord Crisp Excerpts(11 years ago)
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Lord Crisp
To ask Her Majesty’s Government how many Executive Directors of Nursing in the National Health Service are of black or minority ethnic background.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
Data from September 2012 estimate that there are 195 nursing directors. Of these, five, representing 3%, identified themselves as being from a black or minority ethnic background. The Government recognise that there needs to be better progress in promoting talented BME nurses to senior and influential positions. Last month, NHS England launched a coaching and mentoring scheme, and it is currently working on a strategy alongside the Chief Nursing Officer’s Black and Minority Ethnic Advisory Group.
Lord Crisp (CB)
My Lords, I thank the noble Earl for that detailed response, and I am pleased to know that NHS England is taking some steps on this. This is a hidden problem, with fewer than 3% of nursing directors coming from black and minority ethnic backgrounds. This underrepresentation, which is mirrored elsewhere in the NHS, is particularly important because it affects morale, and staff morale in turn, as noble Lords will know, inevitably affects patient care and outcomes. In other words, this is a health issue and not just an equal opportunities one. Will the Minister say a bit more about his plans to deal with this problem and, crucially, whether he will arrange for progress to be monitored and reported on publicly by the Care Quality Commission, the Equality and Human Rights Commission or some other independent body?
Earl Howe
My Lords, I fully agree with the noble Lord about the importance of this issue. A strong focus on equality and diversity is essential to create services and workplaces that are equitable and where everyone feels that they count. The position at present is highly unsatisfactory. The Chief Nursing Officer has personally assured me that this is a priority for her, and she is working closely with BME nurse leaders to address how to support BME nurses to prepare themselves for promotion. Forty-six million pounds has been invested at the NHS Leadership Academy in schemes on leadership development being led by the Chief Nursing Officer. At last year’s BME nursing conference, she made a public commitment to renew efforts to develop BME nurses more effectively, and that will include monitoring.
World Innovation Summit for Health
Lord Crisp Excerpts(11 years, 2 months ago)
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Lord Crisp
To ask Her Majesty’s Government what is their response to the recommendation for improving mental health globally made at the World Innovation Summit for Health.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, we welcome the recommendations made at the World Innovation Summit for Health and outlined in its report, Transforming Lives and Enhancing Communities. Mental health and well-being is a priority for this Government. Our overarching goal is to ensure that mental health has equal priority with physical health, and that everyone who needs it has timely access to the best available treatment. We hope that other countries will afford it equal priority.
Lord Crisp (CB)
My Lords, I thank the noble Earl for his reply. I should have made it clear when I tabled the Question that I was really looking for a reply from the Department for International Development. I will, however, ask two questions.
I know that the Minister will be as appalled as everyone else by this report and its finding that 700 million people with mental health problems worldwide are not getting treated, as a result of which some find themselves chained up or caged. Does he think the report’s findings and recommendations are relevant in the UK as well as elsewhere, although, obviously, not in relation to being chained up or caged? DfID currently spends, essentially, nothing on mental health. What is it planning to do post-2015 to make sure that nobody is left behind, as the Prime Minister has set out in his report?
Earl Howe
My Lords, the principles espoused at WISH do indeed apply with equal force to mental health services in this country. Those principles are several, but I would draw the noble Lord’s attention to the need to draw on evidence-based practice; to strive for universal mental health coverage; to respect human rights and to take a life-course approach. We try to embody all those things in our mental health services. Regarding DfID, I can tell the noble Lord that there are a number of multilateral and bilateral programmes which are in train and supported by the Government. We are supporting work in the Caribbean and Bermuda and promoting work in a number of countries in sub-Saharan Africa. I would be happy to write to the noble Lord with a complete list of these.
NHS: EU Legislation
Lord Crisp Excerpts(11 years, 3 months ago)
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Lord Crisp (CB)
My Lords, this argument has been going on for a very long time—at least a decade. Will the Minister let us know when he expects the review to report and when he thinks that some action will come about as a result of it?
Ageing: Public Services and Demographic Change Committee Report
Lord Crisp Excerpts(11 years, 3 months ago)
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Lord Crisp (CB)
My Lords, this is an excellent report. I very much agree with the recommendations and with the disappointment of the noble Lord, Lord Filkin, at the Government’s response. I add that I am not a member of the committee that produced the report. I also agree with many noble Lords who said that this issue cannot be avoided or just left to muddle through. I congratulate the committee on not letting it go, and on continuing life after its committee proceedings.
I speak as a former permanent secretary of the Department of Health and chief executive of the NHS, and declare that I work in health, although globally, not in the UK. This is, of course, a global issue, as the noble Lord, Lord Livingston, said in his excellent maiden speech. I agree with the analysis that the committee has made of the problem. Very simply, we are using a 20th century model of health and social care to deal with 21st century problems of health and social care. It does not work, and we see that every day in the newspapers and will continue to see it in the newspapers, in our A&E departments, in the number of elderly people who are stuck in hospital—and in everything that we all know.
As noble Lords have said, and as the report says, we still do not have a clear strategic vision for the future of health and social care, and that is fundamental. I will mention two areas where the report could go even further—and I hope that the Government will. There is a lot of agreement, as has been said already in the House, about the nature of the problem. People are all aware that we need a much more community-based system that is much more focused on prevention. We also seem to accept a lot of the implications of that, which will involve bringing together health and social care much more closely, closing some acute hospitals, and investing in technology and in the community. However, agreement falls apart when we get to some of the detail, and the issues of winners and losers. Because we do not have a strategic vision that spells out all the implications, we have too many initiatives that are piecemeal and that often tackle symptoms rather than causes. Camilla Cavendish’s review of healthcare assistants, which was mentioned in the government response, is a good case in point. It was a good review, but it would have been even better if it had been in the context of a genuine, strategic vision for the workforce. Healthcare assistants do not operate in a vacuum.
This is the biggest failure at the moment. The biggest factor to take into account is the workforce. I do not think that it is mentioned in the report or in the Government’s response. I may have got that wrong, but clearly it is not in any of the headlines. Of course, the workforce never is. If you are going to have radical change in the service that is provided, you will have to have radical change in the workforce, as well. I will give some radical examples, although I am not necessarily advocating them. Are we going to be talking about having far fewer specialist doctors and more generalists? Are we talking about nurses doing many more of the things that doctors do now, and other people doing things that nurses have done in the past? We need graduate nurses, but do all nurses need to be graduates? What about the links between health and social care and the workforce? How radical are we going to be in taking this on? I am a member of the Lancet commission on the future of professional education. That has produced some radical notions about the role of senior professionals and team leaders as agents of change who are constantly searching for quality and cost improvements. Are we going to be that radical?
Of course, this is the biggest cost in the NHS; around two-thirds of the cost is in the workforce. In Africa, where I work, we have long recognised that the scarcest commodity is not money but skilled health-worker time. Do we in the UK use skilled health-worker time to best effect? Do we always make sure that people are working, as the Americans say, at the top of their licence, as opposed to doing things that other people in the system can do? This is not just about getting rid of paperwork for professionals; it is about making much more radical changes.
While Africa leads the way in changing health roles globally, the UK leads the way in developed countries—for example, with the expanded role of nurse prescribers and of nurses more generally. As I said, this is the highest cost, which is one reason why it is the most difficult area to tackle, and why people never tackle it. I understand the political traps of taking on the doctors or nurses to make some of these changes, and I understand that it would create winners and losers. However, it is not good enough to leave this to the local level. First, they cannot do it; you cannot make the changes necessary at local level. The headquarters has the responsibility of ensuring the capacity and capability of an organisation, and it is not doing so at all at the moment. Of course, this need not be top-down; it should be developed with practitioners and people at local level. However, as many people have said, the Government have a responsibility to ensure that there is an appropriate framework here for the future. Of course, if it is not sorted out, we will not see change.
My point is that this is not just about economic costs. The other question that needs to be looked at alongside it is: who will give the care? I will take 30 seconds more to refer to the fact that this is not just about professionals. We must not slip into the lazy assumption that the NHS is like a commercial insurance system, and that patients are simply customers. Care is not given just by professionals but by many carers. It is given by neighbours and voluntary organisations; it is given in a wide range of different ways. The NHS and social care form a social system rather than an insurance system. There are roles for carers, patients and families, and we need to redefine those as well. People can do more for themselves. We see examples in other countries of people doing much more in the way of monitoring. We see them delivering dialysis for themselves. Of course, these examples also produce improvements in quality and in cost.
In conclusion, I would be very interested to hear what both the Government and the Opposition say about the challenges that the report sets them in setting out the position for the future and a long-term vision. I will also ask the Minister a specific point, as a first step towards that. Does he accept that a changed, new NHS of the type described here will require a new, radically different workforce strategy, with changed roles for doctors and nurses, and changes in professional education? If he says that that is the responsibility of NHS England, as I suspect he will, will he then ensure from the Government that NHS England, in developing its strategy, will take proper account of the 60% of the NHS budget and of the changes that need to be made there as well as elsewhere?
Antibiotic-Resistant Bacterial Infections
Lord Crisp Excerpts(11 years, 6 months ago)
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Lord Crisp
To ask Her Majesty’s Government what is their assessment of the risks posed by antibiotic-resistant bacterial infections; and what plans they have to reduce such risks.
Lord Crisp
My Lords, first, I thank noble Lords who are taking part in this debate and say how much I look forward to their insights, which I know will come from very different perspectives. I suspect that there will be an enormous amount of agreement. I know that the Government are taking this matter extremely seriously and that, in the words used in my Question, they recognise the risks and are developing plans to reduce such risks. I hope that this debate will enable them to be even more bold and creative in their approach.
I will talk for a moment about that shared understanding, which I will put in very simple layman’s terms. No doubt others will expand on it. The first point is that antibiotics have been a great benefit to humanity in tackling everything from TB and pneumonias to sexually transmitted diseases and bacterial infections of all kinds—not just in this country of course but world wide, including in some of the poorest countries of the world. I happen to chair Sightsavers, which uses an enormous amount of antibiotics in dealing with trachoma in the poorest countries of the world.
Antibiotics are the basis of much modern practice. We assume now that we can tackle infections. Infamously, it was the American Surgeon General who said in 1968 that,
“the war against diseases has been won”.
Those words no doubt came back to haunt him. The problem is that the bacteria are fighting back, in large part due to misuse—people failing to complete courses of treatment and therefore to wipe out the infection. The bacteria did not know that the war was over; evolving and becoming drug resistant, the stronger ones survived. The result, as we know, is that globally we have multidrug-resistant TB, and infections that cannot be treated in countries as disparate and different as India and Israel. This has been known for a long time, and the problems coming forward have been known for a long time. It was the House of Lords Science and Technology Committee’s 7th report in 1998 that first drew attention to this. In the same year, the World Health Assembly raised it as a serious issue.
There has been considerable research over many years. I am indebted to one of the world’s experts, Professor Otto Cars of Uppsala University in Sweden, for setting out the evidence for me. It is compelling. Imagine a world without effective antibiotics. Our English Chief Medical Officer, Dame Sally Davies, said that if we do not take action, we may all be back in an almost 19th-century environment where infections kill us as a result of routine operations. We will not be able to do a lot of our cancer treatments or organ transplants.
It is not just the burden of disease that is at issue here but the economic impact. It has long been known to be significant, but new work coming forward from Professor Richard Smith of the London School of Hygiene and Tropical Medicine, and Professor Joanna Coast of the University of Birmingham, suggests that, when wider impacts are taken into account, the costs are even higher than anticipated. These economic arguments are extremely important in raising the issue up the world priority list. It is significant that the World Economic Forum sees antibiotic resistance as a major threat. There are other important issues around animals that I will not mention in this short debate. My noble friend Lord Trees will say something about them.
I congratulate the Chief Medical Officer on drawing this issue to the attention of the country and of the world in her 2011 annual report. I also congratulate the Government on supporting her to raise the matter at the World Health Assembly at the G8 summit and, I hope, at the UN in September. Her report sets out the issue in detail and notes that there are some drugs that are the last line of resistance, to which we should give special attention now. She and the experts who wrote Chapter 5 of her report drew attention to a number of solutions.
The first is new drugs, but at the moment there are few antibiotics manufacturers and few new antibiotics in the pipeline. Thanks to AstraZeneca, I understand more about the business model and the problems in dealing with drugs of last resort. The simple issue is that they are kept on the shelf; they are in reserve. It is important that we have them, but they do not get used very much and they do not lead to sales. Therefore, the economic model does not work. Even with the more common antibiotics that we use more regularly, we only use them for a short period as therapeutic drugs, not as long-term drugs that will produce a long-term income and therefore provide a return on the massive investment required for development.
AstraZeneca and many others argue that there is a need for very substantial changes to regulation to allow for shorter and easier development times, and even for antibiotics to be treated as a different category of drugs. They also point to the need for investment to secure development. This also makes the argument that vaccines are important in heading off disease. I well understand that not every new drug or vaccine is a significant advance, but there is enormous scope here for Government, and the public and private sectors, to work together to develop a new way of developing these drugs. My noble friend Lady Mar will say a bit more about vaccines in a moment.
Another aspect of the issue is the development and use of new diagnostics. If we can get people into treatment faster, we will be quicker to control the bacteria. At the moment it can be days before technicians know what strain they are dealing with.
The third and perhaps biggest point is about better stewardship and conserving what we have. This is even more difficult, but it is the basis for everything else. The CMO’s report describes good practice that will achieve this. There are 10 top tips for effective antibiotic prescribing that should be followed in this country. Imagine for a moment the situation in every country in the world; every clinic or village in China or India needs a battery of actions. There is a need for education professionals in those areas to have the equivalent of our 10 top tips, as well as for greater public awareness and education. That is no easy task. We should remember that many of us in our country do not take drugs in the way that we should. Also, in those countries we must tackle counterfeit medicines and restrict over-the-counter sales. We should also see changes to harmonise regulation. This is phenomenally difficult, but it is not enough to put our own house in order; we will be affected by what happens elsewhere in the world.
We need all these approaches combined: new drugs, new diagnostics, better practices and stewardship, action across the whole healthcare system and, indeed, across the whole world. Here I come to the point that I really want to talk to the Government about: this needs remarkable political effort. It is about reframing the issue and building political support, and I will be interested to hear what the Government have in mind.
I will make two points. First, this is an enormous threat. Indeed, you can galvanise people around the threat: it is real and it will impact in terms of illness and economy. However, it is also an opportunity. I am indebted to my friend and colleague Dr Ilona Kickbusch, and to Professor Cars, for pointing out that we should treat antibiotics as a global public good and that there is an alternative way of seeing this problem. It is about a vision of a world in which the peoples of the world really do in practice have a right to health and healthcare, something most nations have signed up to—many, like ours, since the UN declaration of 1948. In that world, nations develop, share and look after those things, such as antibiotics, which are a benefit to us all.
We have already seen how this can be done in tackling other threats such as global pandemics. Although there is always controversy about that, nevertheless great progress has been made in creating a network for surveillance and tackling issues. There is more to do. We have also seen it with the millennium development goals, working towards a vision where no woman dies as a result of pregnancy, although there is much more to do there as well. In other words, I am arguing for setting ourselves the goal of preserving antibiotics for the future as one of science’s great benefits for humanity, and for driving this forward politically and technically, in every way in which we can.
My second point is simply that the UK can play an extraordinarily important leadership role here. It is well respected in health. We have the credibility of having a health system which seeks to look after every person within it. We also have credibility because of the world-leading role that has been played in development; here I compliment both this Government and the previous one. We can be bold and ambitious in taking a lead. No nation is better placed to do so, with our connections in the Commonwealth, across the Atlantic, and in Europe. The key is to bring together a group of like-minded countries, as this and previous Governments have done on other things, starting with those who are already taking this seriously. We should set out a vision and pathway, and take on these issues step by step. The Chief Medical Officer has already started this, but it is important to add political weight and depth to her work. It is not just about health but about economics and foreign policy. It is a step in building a better world, where we have and share the means to offer better health to everyone.
I therefore look forward to hearing the Government’s response to these points, and to knowing how they will turn their undoubted commitment in this area into something even bigger and bolder. Will they seek to take a global lead on this? How will they do so? I also greatly look forward to hearing from other noble Lords.
NHS: Health Workers
Lord Crisp Excerpts(12 years, 6 months ago)
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Lord Crisp
To ask Her Majesty’s Government what steps they are taking to promote changing the roles and skills mix of health workers in the National Health Service to improve access and quality, and reduce costs.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, local healthcare providers must be free to manage the composition and skills mix for their workforce so as to best meet the demands of the communities they serve. We are working together with the professions and partners on key initiatives that will help healthcare providers make more informed decisions on the shape of their workforce to achieve better outcomes in both patient care and value for money.
Lord Crisp
I thank the Minister for that reply. As he knows, changing job roles in the health service can be done well to great benefit or it can be done badly and be detrimental to services. Given that a recent report from the All-Party Parliamentary Group on Global Health has provided the evidence for what works, can I ask him, first, how will the Government make sure that Health Education England and other national bodies give this a much higher priority and provide the support that local organisations need to make this happen? Secondly, to avoid the problems of failure, how will the Government ensure that the Care Quality Commission and other national bodies provide the leadership needed to make sure that failures do not happen?
Earl Howe
My Lords, the noble Lord’s Question addresses the central issue facing the NHS, which is how to deliver the best outcomes for patients and do so in the most cost-effective way. He is right to single out the role of Health Education England because I believe that, in conjunction with local providers who will be feeding in their view of what the workforce priorities are in their local areas, together with the Centre for Workforce Intelligence, which has a horizon-scanning capability, we can at last crack a nut that has been so difficult to crack in the past, that of good workforce planning in the NHS to make the workforce as productive and effective as we can. He is also right to single out the CQC because in areas such as staff ratios, the commission has a role in making sure that providers have thought about the right way to deliver care in individual settings.
Drugs: Prescribed Drug Addiction
Lord Crisp Excerpts(12 years, 7 months ago)
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Earl Howe
I am well aware of the point that the noble Lord appropriately raises. Stigma is an issue and we need to take account of the risk of it. That means that quite often when treatment services are provided to those who are addicted to medicines, they take place in a different setting from those administered to addicts of illegal substances.
Lord Crisp
Will the Minister recommend that, given that withdrawal from legally prescribed drugs is every bit as dangerous as withdrawal from illegal drugs, more should be done, for example, to print warnings in bolder lettering on packaging, to put notices in doctors’ surgeries and to make the public and the patient more aware of this issue as well as making doctors more aware?
Earl Howe
I agree that dependence on prescription medicines can be just as devastating and debilitating as dependence on illegal drugs. The round table on addiction to medicines has agreed actions to improve public and professional awareness of the risk of dependence. They include a review of the updated warnings on prescription painkillers by the Medicines and Healthcare products Regulatory Agency and the development of further materials for GPs and other healthcare practitioners to support patients in understanding the risks.
Health and Social Care Bill
Lord Crisp Excerpts(12 years, 11 months ago)
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Lord Crisp
My Lords, I had not intended to speak on the amendment, but I want to say a word or two in support of what the noble Baroness, Lady Williams, has just said. She and others have referred to the rift that has been created as the Bill has gone through Parliament and been discussed in the country. I am sure the Minister recognises that, but I know that he also recognises that now is the time to move towards healing that rift. Many people have, for whatever reason, been scared by what has been said and many people have also been scarred by what has been said. The noble Baroness is absolutely right to draw attention to the second part of the amendment and the opportunity that it gives to start to bring people together around the practicalities. We talk about the legislation but many people out there have to talk about the practicalities and how you make it happen—something with which many Members of your Lordships’ House, including the noble Lord, Lord Newton, are very familiar.
This has also been about failing communication. I believe there is now more that unites people than divides them. There are many things that people agree on. There are still some very significant differences and, like the noble Baroness, Lady Williams, I am not a fan of the Bill. It has been a damaging process but now is the time for healing. It would be good to see some cross-party approaches to bringing people together in a positive fashion to deal with the practicalities, rather as is laid out in the second part of the amendment.
Earl Howe
My Lords, I think that it is important for me to begin by acknowledging fully the force of the wonderful speech by my noble friend Lady Williams, and indeed acknowledging the powerful points made by other noble Lords regarding the climate of opinion among the medical royal colleges and others in relation to the Bill. I cannot fail to be conscious of the suspicion and doubt expressed by many members of that community, although I have to say that opinions vary as to what the real views of some of the royal colleges are, bearing in mind that only a small percentage of their members were canvassed. However, I cast that aside because I am very aware of the validity of the points made by the noble Lord, Lord Owen. The Government are undoubtedly fighting a battle to convince the medical community of the merits of the Bill, a battle that we have so far not won. I can therefore very readily confirm to my noble friend that the first thing we would wish to do once the Bill reaches the statute book is to build bridges with the royal colleges, the BMA and all those who have an interest in seeing this Bill work, to make sure that its implementation is securely grounded. I completely agree with her that the Government should work with NHS staff, all our stakeholders and, indeed, patient groups during the coming months to make sure that implementation really is a collaborative process. I hope that the undoubted wounds that have been created will be healed, and healed rapidly.
I am grateful to all noble Lords who have spoken in this debate. In particular, I listened carefully to what the noble Baroness, Lady Thornton, had to say, as I always do. The question posed by her amendment is, on the face of it, “How can we improve Part 3?”. The answer that she has given us is, “To postpone it”. However, the subtext of her question is, “Why should we have Part 3 at all?”. I am happy to set out once more exactly why it is essential that we have Part 3 —and not just have it, but have it without delay. We need it for two compelling reasons: to protect patients’ interests, and to help the NHS meet the significant quality and productivity challenges it faces. They are benefits that I am afraid the amendment would stop in their tracks.
Part 3 sets out a clear, overriding purpose for regulating NHS services—to protect and promote patients’ interests. That contrasts with Monitor’s duty under the National Health Service Act 2006, which is merely,
“to exercise its functions in a manner consistent with the performance by the Secretary of State of his”
functions. That 2006 duty is not adequate as it stands. It does not mention patients’ interests and it is unclear. However, that duty is what would apply if Amendment 300A were accepted. The amendment would also discard the recommendations of the NHS Future Forum that Monitor should have additional duties: first, to involve patients and the public in carrying out its functions, as my noble friend Lady Cumberlege and the noble Lords, Lord Patel and Lord Warner, rightly emphasised; and, secondly, to enable integration.
It needs to be made clear that the provisions in the Bill interlock and are interdependent. Deferring Part 3 would not achieve the continuation of the status quo, but it would leave an NHS without strategic health authorities and primary care trusts and without a comprehensive and effective framework for sector regulation. There would be no organisation with the powers needed to support commissioners in developing more integrated services. That is something that the noble Baroness, Lady Finlay, and others have rightly demanded. There would be no organisation capable of enforcing requirements on providers regarding integration and co-operation. Neither would there be sector-specific regulation to address anticompetitive conduct that harmed patients’ interests. The powers that currently exist to enforce advice of the Co-operation and Competition Panel would no longer be available. Instead, it would be reserved to the OFT to consider complaints under the Competition Act, rather than by a sector-specific healthcare regulator with a duty to protect patients’ interests.
I mentioned protecting patients for a good reason.