NHS: Keogh Review

Lord Elystan-Morgan Excerpts

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

It was not £3 billion that was spent on reorganising the health service. As the noble Baroness knows, it was probably less than half that figure. The important point is that the saving in this Parliament will be at least £5.5 billion, with a £1.5 billion saving every year thereafter. I therefore suggest to her that it is meaningless to bandy that figure around. I am very glad that Basildon hospital is taking the action that it is. It has recently undergone significant leadership changes. A transformation programme is under way, and that is part of it.

[Lord Elystan-Morgan]

The Statement repeated by the noble Earl makes the point that the story does not end with the 14 failed trusts. Does he agree that there is clear evidence of the acceptance of standards that are not worthy of our community or of the National Health Service, and that, very probably, such a situation is not unassociated with the lack of a hierarchy of discipline in nursing? Will the Government therefore give an undertaking that, by way of an agonising reappraisal of the situation, they will concentrate on establishing whether the institution of the hospital matron could be considered again, as a post that was effective and seemed to operate well? Many people the length and breadth of this land believe that to some extent we should revert to that system, rather than worshipping at the altars of accountancy and management.

[Earl Howe]

The noble Lord makes an extremely important point. Those hospitals that I have visited where the standard of care is manifestly excellent have all had nurse leaders at board level whose responsibility it is to make the quality of nursing care absolutely centre stage at every board meeting and to transmit to every nurse in that hospital what good quality care looks like. Whether we call that person a matron or not is perhaps a matter that we can discuss at leisure—but the point that the noble Lord makes is extremely valid.

Health: Obesity

Lord Elystan-Morgan Excerpts

Monday 12th November 2012 Lords Chamber

[Baroness Jolly]

My Lords—

[Lord Elystan-Morgan]

My Lords—

[Lord McNally]

I suggest we hear from the noble Lord, Lord Foulkes.

Care Homes

Lord Elystan-Morgan Excerpts

Monday 28th May 2012 Lords Chamber

[Earl Howe]

My Lords, the Government are working with the Association of Directors of Adult Social Services and the Care Quality Commission. We are gathering greater intelligence on the social care market and its major providers, which will be used to give early warning of impending problems. We will continue to meet regularly with the major care providers to discuss their trading performance, their financial situation generally and how they are addressing any issues which put pressure on their ability to continue trading.

[Lord Elystan-Morgan]

My Lords, perhaps I may raise a technical point in relation to a situation that exists under the Companies Act where a company is threatened with financial difficulties. The noble Earl will be aware that under the Act, to continue trading is a serious offence if there is a danger—not just a certainty—that the company will not be able to meet its financial obligations. Successive departments in successive Governments have properly intervened in the interests of patients. They were probably committing a serious criminal offence. Will the Minister look at the situation so that the law may be relaxed in the interests of patients and of the community in general?

[Earl Howe]

The noble Lord made a very good point. As he will know, there are existing oversight and regulatory frameworks, with the CQC regulating the quality of care and support services and local authorities overseeing local providers. The point made by the noble Lord is a major part of why the Government are engaging with the sector, as I described just now to my noble friend. The main point to stress is that under the existing system no one will be left homeless should a provider fail. In an emergency, local authorities have a duty to provide accommodation to anyone, whether they are publicly funded or self-funded, who has an urgent need for it.

Health: Funding

Lord Elystan-Morgan Excerpts

Tuesday 1st November 2011 Lords Chamber

[Earl Howe]

My Lords, I appreciate everything that the noble Lord has said. He may like to know that the protocol to which I have referred states as follows:

“The patient’s safety and well-being must be paramount at all times. No treatment must be refused or delayed due to uncertainty or ambiguity as to which”—

local health board or PCT—

“is responsible for funding the healthcare provision”.

I think that that should give patients in Wales every reassurance.

[Lord Elystan-Morgan]

My Lords, does the Minister accept that there is one very specific matter in relation to transborder matters in Wales, and that is in relation to Powys? Despite strategic policy decisions of many years ago, Powys has never had a district general hospital, with the result that there is a very considerable flow from north-east Powys to hospitals in the Shrewsbury and Telford area. Will he give an undertaking that, whatever happens, that system will continue?

[Earl Howe]

My Lords, nothing in the Government’s plans will impede the flow of Welsh patients into England. I can give the noble Lord that reassurance.

Southern Cross Care Homes

Lord Elystan-Morgan Excerpts

Tuesday 12th July 2011 Lords Chamber

[Earl Howe]

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

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

[Lord Elystan-Morgan]

My Lords, has the Minister considered the legal question of fraudulent trading, which seems to be apposite not only to the case of Southern Cross, but indeed—according to the comments made by the noble Baroness, Lady Thornton—to other care companies as well? Does the Minister recollect that exactly 50 years ago, in a case called Wellfield, this House, sitting in its judicial capacity, defined fraudulent trading as a situation where the directors of a company continue trading, knowing that there is a risk that debts will not be able to be cleared as they arise? Bearing in mind that as far as Southern Cross is concerned, many months ago, it announced that it would not be able to pay its tax liabilities, nor indeed to pay more than 70 per cent of the rents due to lessors, would it not seem that there was a clear breach of what is now Section 993 of the Companies Act 2006?

[Earl Howe]

My Lords, my advice is that Southern Cross is not insolvent in either sense of the word. Its assets, I am told, exceed its liabilities, and it is able to meet its commitments as they fall due, thanks to the agreement reached between the company, its landlords and its bankers. The process announced on 15 June is the key to this: the company’s restructuring committee is developing a plan to stabilise the ownership and operation of Southern Cross care homes. We expect, as I have said, that there will be an orderly process of reassigning homes to landlords and new operators. That process will take place between now and October, during which time continuity of care will be maintained. Nothing that I have said changes the outlook for the medium term, and I believe that we can say, and that the company can say, that insolvency is not an issue at present.