Social Care

Lord Elystan-Morgan Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I will certainly be happy to do that. I absolutely endorse the ultimate finding of that report about the valuable contribution that the arts have to make. I shall investigate whether a letter has perhaps gone astray.

[Lord Elystan-Morgan (CB)]

Have Her Majesty’s Government given any thought to a far-off, divine event, by which I mean the total merger of the services aspect of social services with the NHS, thus cancelling out a great deal of imperial rivalry between the two bodies? At a personal level, such rivalry often means a whole platoon of people beating a path to a patient’s door, unco-ordinated with each other and duplicating each other’s services.

[Lord O'Shaughnessy]

I think that everyone in this House endorses the idea that health and social care should be better integrated. That statement is easy to make but difficult to achieve, as I think we would all agree, not least because the funding bases are very different. The NHS is taxpayer funded and free at the point of use; social care is funded on a different basis. That is one of the factors, as well as the bodies responsible for commissioning and so on. A practical way forward is to seek integration at a local level. That is happening now, for example, in Greater Manchester, which has powers over both services and is looking to integrate, and it lies at the heart of NHS England’s five-year forward view, which is about bringing services together in 44 areas, known as STP areas, to provide that level of integration. Patients do not want to have to flit through different bodies all the time. They want a sense that there is one service looking after them throughout their needs.

NHS: Junior Doctors’ Contract

Lord Elystan-Morgan Excerpts

Wednesday 6th July 2016 Lords Chamber

[Lord Prior of Brampton]

I am not aware that there have been any resignations directly related to the junior doctors dispute.

[Lord Elystan-Morgan (CB)]

My Lords, is it not the case that there is an application before the High Court to be adjudicated upon, I believe on 11 July, seeking a declaration as to whether the Minister now has or ever did have the power of diktat to impose this upon the junior doctors? If it be the case that the junior doctors are successful in their application, does it not cast this issue in a wholly different mode?

[Lord Prior of Brampton]

My Lords, the strong advice that we have is that the Secretary of State does have the power to introduce the new contract along with the NHS employers.

Junior Doctors: Industrial Action

Lord Elystan-Morgan Excerpts

Monday 25th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I completely agree with that. When the dust has settled, we have to take a wholly new and independent look at how junior doctors are trained. As the noble Lord will know, Sue Bailey, chair of the Academy of Medical Royal Colleges, has been asked to look at this, but I do not think it is possible to do that sensibly while the dispute is ongoing. We need the full co-operation of junior doctors in that review. I would personally welcome an independent assessment of the way we train junior doctors once this dispute has been settled. I share my noble friend’s views entirely: it would be wonderful if the junior doctors would agree to provide emergency cover on Tuesday and Wednesday this week. But it is now 8.15 pm on Monday and time is rapidly running out.

[Lord Elystan-Morgan (CB)]

My Lords, the High Court will adjudicate in the first week of June on whether the Secretary of State ever had the authority to dictate to the junior doctors. There are different views on that question, but it does not really matter if the judgment goes against the junior doctors; the question is whether it is politic, sensible and proper in all the circumstances for the Minister to proceed by way of diktat. I urgently ask the House to consider these words; they are not mine but those of Sir David Nicholson, who up to two years ago, as your Lordships will remember, was the head of the NHS in England. They are addressed directly to the Secretary of State:

“Our future consultants, leaders and chief executives will forever remember you win by the exercise of power and imposition a catastrophe for the NHS”.

[Lord Prior of Brampton]

My Lords, as I have said, this is not a place where we ever wanted to be. Imposition was absolutely a last resort and I again try to assure the House that it was arrived at only after three years of negotiation, an independent review by the DDRB and countless meetings. It was felt that, after all that time had elapsed, we had no choice but to impose the contract.

NHS: New Junior Doctor Contract

Lord Elystan-Morgan Excerpts

Monday 18th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Baroness talks about a proper negotiation. This negotiation has gone on for three years and there have been 75 meetings about this contract. It is hard to know what a proper negotiation is when you have that number of meetings over that period of time. The junior doctors may not recognise this but the Government feel that 73 different concessions were made during that period. In many ways this has gone on for too long, and that is why, when Sir David Dalton got involved towards the end of the contract negotiations, his advice was, “You’ve got to settle this”. We cannot go on and on negotiating and discussing these matters.

On the other point that the noble Baroness raised, the pressure on our emergency services is huge at the moment. She is right that the A&E performance in January was very poor, but it is simply the case that demand on our A&E departments is huge.

[Lord Elystan-Morgan (CB)]

My Lords, is not the reality of the situation that for many months the Secretary of State has used the language of coercion rather than compromise? It is abundantly clear that he never had the statutory authority to impose such a contract of service on the doctors. At what point was he first advised that he had no such authority?

[Lord Prior of Brampton]

I do not think that the Secretary of State has been under any misapprehension about his powers in this matter. The BMA, on behalf of the junior doctors, is judicially reviewing his powers, but those powers are clearly set out in Section 1 of the 2006 Act. It is our position that he has always had those powers, but we expect that to go to a judicial review on 8 and 9 June.

Francis Report: Update and Response

Lord Elystan-Morgan Excerpts

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

My Lords, the role of the guardians will be primarily to provide advice to those who have concerns and feel that they are not being listened to. They will be able to report directly to trust chief executives on not just individual issues but on progress in general in stamping out any bullying that may be occurring, or the intimidation that Sir Robert says is all too common. I do not think that the creation of a freedom-to-speak-up guardian will in itself inhibit the process. Of course, we are open to views. If that concern is widely held, we will have to take it into account.

[Lord Elystan-Morgan (CB)]

Does the Minister agree that while of course it is right and proper that, in relation to whistleblowers, Sir Robert’s recommendations should be given every opportunity to see whether they succeed in removing this scourge from our society, the situation should be monitored and should it be the case that it is not possible to remove this disgraceful practice of victimising whistleblowers, stern, swingeing criminal sanctions should be considered if necessary? It is a drastic proposal, but the practice it would be designed to meet is disgraceful.

[Earl Howe]

I take full note of the noble Lord’s proposals. Clearly, we will wish to monitor the effectiveness of these new arrangements once they are in place. It will be open to the next Government to make a judgment on that score and, if necessary, to come forward with more stringent proposals that could indeed involve legislation with penalties attached.

Children: Obesity

Lord Elystan-Morgan Excerpts

Monday 20th October 2014 Lords Chamber

[Earl Howe]

My Lords, although physical activity can have a role in maintaining a healthy weight, the Government agree with my noble friend that its health benefits are nevertheless subsidiary in those who are obese to the need to eat and drink less. My noble friend may be interested to know that NICE is currently consulting on its draft public health guideline on maintaining a healthy weight and preventing obesity among children and adults. It currently expects to publish this guideline in February next year.

[Lord Elystan-Morgan (CB)]

My Lords, does the Minister accept that many of us are obese because we are the proud but inevitable products of heredity? Further, does he accept the splendid words of the Scottish author, Eric Linklater, who, speaking of a person of ample frame, said, “His outline spoke not of greed but of grandeur, not of gluttony but of the magnanimity of the human form”?

[Earl Howe]

There is, I am sure, no more elegant way of describing the issue under consideration at the moment. The noble Lord makes a very important point about heredity. I do not think that sufficient is understood about the role of our genetic make-up in the way in which we all differ in our weight and size. However, for those who are obese, there are clear, evidence-based actions that they can take to lose weight if they have a mind to do so.

Mental Health: Funding

Lord Elystan-Morgan Excerpts

Tuesday 18th March 2014 Lords Chamber

[Earl Howe]

My Lords, the principle of parity of esteem applies in every clinical setting, including prisons. We have made it very clear in our document Closing the Gap that these matters are not only important in the wider community but also in prison. We will be monitoring the situation very closely, not least in women’s prisons.

[Lord Elystan-Morgan (CB)]

My Lords, does the Minister accept that successive Governments have shown a remarkable lack of kindness in giving information concerning the apportionment of funds between physical and mental health matters? Does he accept that what is asked for is not a detailed breakdown under various headings, but a broad, ballpark figure that will allow the public to judge whether or not mental health has been less than equitably dealt with in this situation? The failure to give this information, which clearly must be shared by all departmental Ministers, will only add to that suspicion.

[Earl Howe]

My Lords, the Government are committed to the principle of transparency in these areas. I can tell the noble Lord that last month NHS England published expenditure data from its programme budgeting data set for 2012-13 which show that expenditure on mental health in that year was £11.28 billion.

Public Health Responsibility Deal

Lord Elystan-Morgan Excerpts

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My Lords, there are certainly no grounds for complacency on obesity levels throughout the nation. However, the current data do not support the claim by the National Obesity Forum. In 2007, the Foresight team projected that, based on data from 1993-2004, more than half the population could be obese by 2050 if no action is taken. An analysis based on recent data suggests a flatter trend than the one projected by the Foresight team. I do not agree that we should belittle the responsibility deal. It has many worthwhile achievements to its credit and they are being added to month by month.

[Lord Elystan-Morgan (CB)]

Although appreciating this scurrilous attack on rotundity, does the noble Earl recollect the immortal words of Shakespeare in “Julius Caesar”:

“Let me have men about me that are fat; … Yond Cassius has a lean and hungry look”.

Health: Talking Therapy

Lord Elystan-Morgan Excerpts

Tuesday 3rd December 2013 Lords Chamber

[Earl Howe]

I can tell the noble Lord that IAPT is working with a number of BME groups to promote wider access to the service from all sections of the community. A grant scheme will shortly be launched to encourage community-based interventions to increase uptake of talking therapies, including from BME groups.

[Lord Elystan-Morgan (CB)]

My Lords, will the Minister kindly tell the House roughly what percentage of in-patients and out-patients suffer from mental health problems compared with those who suffer from physical health problems? Can he say, roughly, how the resources of the NHS are divided between the two camps on a revenue basis? I have the clear impression that traditionally mental health has been short-changed for very many years.

[Earl Howe]

My Lords, the noble Lord’s perception would be shared by many, which is why we have been very clear in our mandate to NHS England that parity of esteem is of the essence, and we will hold the service to account for that. I do not have the specific statistics that the noble Lord seeks but we know that more people are being treated in secondary mental health services now than two or three years ago. However, the proportion who needed to be admitted to in-patient psychiatric care fell over that period, and that reflects increasing emphasis on care in the community.

Cigarette Packaging

Lord Elystan-Morgan Excerpts

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

I answered as I did because it is important for us not to get too bogged down in semantics. Did Mr Crosby speak to the Prime Minister about tobacco issues or did he not? The answer is that he did not.

[Lord Elystan-Morgan]

My Lords, the issue is not whether or not he spoke to the Prime Minister but whether he, or any other corporate interest in which he is involved, sought any contact with government or any agency of government in relation to this matter.

[Earl Howe]

My Lords, I am aware that officials in my department—not Ministers, I emphasise—had face-to-face meetings with certain tobacco companies in the context of the consultation on plain packaging. That was done to clarify certain aspects of their written submissions and is as far as it went. I am not aware of which companies those were, but if I can enlighten the noble Lord I will write to him.