Mental Health Services

Lord Graham of Edmonton Excerpts

Thursday 25th June 2015 Lords Chamber

[Lord Graham of Edmonton (Lab)]

My Lords, it is a pleasure and a privilege to take part in any debate in this House but I am very grateful to have put my name down to make a small contribution in this Short Debate. The House demonstrates the quality of its service to the nation when people are able to stand up from their own experiences and ideas to stimulate the Government and others into thinking again about how things are done. I begin, as I have many times before, by thanking the staff of the Library for producing such an excellent document to give us a guide. It is not the first time and they never let us down, so I am very grateful. The trouble is that it is like going into a self-service just for a snack. By the time you have decided to be serious, you have read all the briefing—and I did read it all—so you realise that you rely upon other people to give you a nudge and a guide.

It is at least 80 years since I could say that I was a young person of the kind we are talking about. I was 90 about a month ago, so I can reflect on the nature of childhood as it was when I was a child and childhood now. Of course, there is no comparison for the bleakness of the ability of your mum and dad to provide you with toys, outings, books or encouragement, as my dad was on the dole for 10 years from 1930 to 1940. I passed my 11-plus but could not go because of my circumstances. Eventually, I got a degree from the Open University—a BA. I got an honorary MA afterwards and then became a member of the Privy Council. We need to recognise that the challenges before young people and their parents in the present years are completely different from the challenges when I was a boy in the 1920s and 1930s.

I congratulate my noble friend Lady Thornton on the comprehensive way in which she introduced the subject. She has a point of view and she has answers to the questions. I do not have many questions and I have no answers to any of them. The Minister will realise, as I do and the House does, that the money available in the budget plays a major part. The problems can be exposed, as they are in this debate. Every person who has spoken has a contribution to make. The idea that there is a solution to every problem is not new. There is a solution but it is a question of priorities with the money available. One thing that strikes me about where we are falling down is that there is a lack of co-ordination among the various services. In other words, this is not a political issue—except on the budget, which we could say something about if it was necessary. It is about co-ordination between the services.

One gets terrible news almost every week of a problem among the police, the press or media, or the schools. In the phrase that came before, what has happened to all the reports? What we are debating is not brand new. There is very little in it that we have not had warning about in the past. We have to try to recognise that, while the heart is in the right place, it is sometimes difficult to exercise what one knows to be needed because there are priorities. I would be happy to speak about my own list of priorities but that is not the point here. The problem that the Minister and his colleagues have is: what can we do with the limited resources that we have? It ever was that the amount of money available at any time is insufficient to do everything that one needs.

I have been very impressed by what I have heard this afternoon. What we need is a Minister who will go away and look at the manner in which people slip between the various services. With all the various agencies that there are, it ought not to be possible to slip between. Yet whenever there is a scandal of some kind, it is revealed that the evidence which could have been acted upon was available but not conveyed to the proper people. One thing that the Minister should take away, in a busy life and with limited capacity as far as money is concerned, is to ask his colleagues to come up with ways in which they can collectively make sure that they look at the needs of young people now. More than ever before, they are at risk.

Health and Social Care Bill

Lord Graham of Edmonton Excerpts

Monday 13th February 2012 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, one by one, the pillars holding up the Government’s reasons to justify the mayhem they are raining on the NHS are being kicked away. The Prime Minister promised “no top-down reorganisation” of the NHS, yet it is faced with the biggest change since it started life 64 years ago. The Government implied that the NHS was failing, yet the 2010 British social attitudes survey put public satisfaction with the NHS at its highest-ever level. The Government have said that falling productivity is a problem, yet Professor Nick Black, writing in the Lancet, described this as a myth. The Government said they wanted to encourage collaboration and the integration of services, yet Mr Lansley spilled the beans this morning by making it clear that competition between doctors and nurses is really what he is about.

The Government argue that they will end micromanagement by the Secretary of State and introduce democracy. Last week, the noble Earl, Lord Howe, on the first day of Report, sought to persuade your Lordships that the Government are aiming to free the service from micromanagement by the Secretary of State. Indeed, the noble Earl went further and said that Mr Lansley is the only Secretary of State,

“who has not succumbed to the temptation of micromanaging the NHS”.—[Official Report, 8/2/12; col. 349.]

The noble Earl went further when he said that the NHS Commissioning Board will have a facilitating role to promote guidance, and is,

“not … a replica of the kind of line management that the NHS has seen to date”.—[Official Report, 8/2/12; col. 352.]

I say gently to him that the reality seems a little different. Indeed, since your Lordships started to debate the Bill, the Secretary of State has shown no inclination whatever to keep his hands off the National Health Service. He has announced a set of indicators for patient outcomes for NHS trusts to meet; he has pronounced that hospitals are admitting too many patients; he has pronounced that patients are being discharged from hospitals too quickly; the A&E four-hour indicators have been extended; primary care trusts have been told to speed up treatments for patients waiting longer than the 18-week waiting limit; hospitals have been ordered to remove advertisements for personal injury lawyers in NHS-branded leaflets from being distributed in casualty wards; primary care trusts have been told to identify three services that can be handed over to the private sector; and the Prime Minister—no less—has announced that there will be hourly nursing rounds to check that patients are properly fed and hydrated. I might have missed a few examples in my recording of the interventions that have taken place in a short period of time.

[Lord Graham of Edmonton]

Keep going.

[Lord Hunt of Kings Heath]

My noble friend urges me to keep going. I will certainly continue to note down the evidence on whether the Secretary of State is not micromanaging the National Health Service.

Let me make it clear to the House that I do not have a problem with those kinds of interventions. In fact, I wish the NHS could be left to get on with dealing with some of those issues rather than having to be diverted by this centrally imposed top-down restructuring.

I do not think that we should let the Government get away with the myth that what they are proposing is some kind of anti-bureaucratic Minerva or kid us that they are standing back from interfering in the NHS. I have no doubt that the noble Earl, Lord Howe, will regale us with how many reductions there are in the number of bureaucrats employed in the NHS. He will probably pass over the huge redundancy costs that are being paid out. He might also pass over the possibility of there being a cost-shift as clinical commissioning groups, for instance, hire the very people made redundant by strategic health authorities and primary care trusts.

The fact is that the Government are busy constructing a huge edifice of confusion and a multilayered decision-making process. I remind the House that the Commons Health Select Committee report on 24 January concluded that the Nicholson challenge, the £20 billion efficiency challenge,

“can only be achieved by making fundamental changes to the way care is delivered”.

It continued:

“The reorganisation process continues to complicate the push for efficiency gains. Although it may have facilitated savings in some cases, we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings”.

Let me be clear. In criticising the Government's approach, I do not seek to undermine the role of managers and leaders in the NHS. They are at a premium, and I have been somewhat concerned by the tenor of some of the Government's remarks about the role of managers in the health service. We need good managers to lead and support change on this vast scale. What we do not need are layers and layers of bodies without any clarity in organisational responsibilities. We do not need systems and practices that mean that the same information is collected many times over, and we certainly do not need the increasingly complex paperchase that the internal market will morph into when it becomes a real market.

In essence, the Government are replacing a managed-system bureaucracy with a market bureaucracy. Monitor and the national Commissioning Board will grow and grow, mostly by spending on external consultants to mask the baseline costs. Here I return to the point made by my noble friend Lord Graham. Again, one sees a plethora of organisations in the new structure. We have Monitor, with its hugely contradictory role in both supporting the foundation trusts and being the economic regulator for the NHS. We will have the national Commissioning Board overseeing the system in accordance with a mandate given to it by the Secretary of State. However, the board, which the noble Earl, Lord Howe, talked of as being a facilitating organisation, will none the less have a massive £20 billion commission of services. The national Commissioning Board will also have four regional outposts and 50 local outposts. The noble Earl called them field forces last week, but I suspect that the jargon has moved on since then.

We then have 244 clinical commissioning groups, at the last count, but because the clinical commissioning groups do not have the skills to commission services we are also to have 35 commissioning support units. Then there are the clinical senates—15, perhaps—but no one has any idea who they will be, what they will do or who they will be accountable to. We then have 165 local authorities taking over responsibility for the public health function, 165 health and well-being boards and the same number of local healthwatches. As we heard earlier, the local education and training boards are accountable to Health Education England. Then there is the leadership academy and the improvement body that the noble Earl referred to last week.

Health: Diabetes

Lord Graham of Edmonton Excerpts

Thursday 4th November 2010 Lords Chamber

[Lord Graham of Edmonton]

My Lords, I am delighted to have the opportunity to speak in this debate. I am lucky in the sense that, out of the blue, two friends wanted to see me. They provided me with information which I believe, when I read it into the record, will be helpful. In declaring an interest, I am a type 2 diabetic and my son is type 1, so we are familiar with the problems. Looking at the speakers list for today’s debate—I congratulate sincerely the noble Lord, Lord Harrison, on securing it—and noting all the bodies which contributed to the report, I think that some may ask how the Government will respond. I know how the Government will respond. They will say, “We welcome the report”. That is because it is all good news.

The front page of the report lists the many organisations with sympathy for and knowledge of this matter. They have combined, which in itself is quite a feat. Today, the Minister, who I know is sympathetic on all issues which affect people, has been given an opportunity to put his case, but he will have problems. I will concentrate my comments on obesity which clearly is stark among the younger generation. There are the issues of money and will, as well as the question of how can we deal with it.

Camden is used as an illustration. It is seeking to invite bids for weight management programmes for children between the ages of two and 18. That is laudable. In its publicity, its target groups include:

“Young carers; Homeless children: Children who are not in education; People from low socioeconomic groups; People living in the 4 priority wards: Kilburn, Kentish Town, Gospel Oak, and St Pancras and Summers Town; People of Irish, Black African, Black Caribbean and South East Asian backgrounds”.

From our knowledge, we know that all those groups are in danger of contracting certain aspects of diabetes. The document I have states:

“The maximum value of the contract is stated to be just in excess of £2m”.

We are not talking about small beer because £2 million is a large sum, but it is what the PCT in Camden is willing to put forward for this.

The worry is this. In children there is a weight measurement nexus, which is to the good. It starts when they are in the infant class and goes on until the changes are reported on in year six, which is the last year that they are in primary school. The problem is that, unless I am misinformed, the parent and child as the result of this weight measurement plan are meant to attend guidance meetings outside the school day. The document from Camden I have seen states that the programme will be delivered in community halls and other places. Single parents and others in the categories I have mentioned will be invited to give up their time, to bring their child along, to listen to advice and try to do things to improve the situation. But they have not got the time because they have other pressures on them. One might say that surely the greatest pressure is the future benefit of their child, but this would be much easier to deliver in the school day. If what we are after is value for money, we ought to have a programme of that kind.

I also have some information on a story that all noble Lords will have heard about, that of the mother of the five year-old child who appeared on BBC television news having received a letter saying that her child was overweight. The point to be made here is that she said that it would have been much better for her to have been given advice through a direct chat with a nurse than through a letter from a faceless central trust. There is a great deal more that we could say about that, and I am delighted to see my noble friend Lady Young. I wish her well and she will be heartened by the number of friends she will find in this House as she pursues her new interests.

This is not a knocking debate, but one for the Government to tell us what they are doing and listen to the problems as we see them. That will assist the Minister in delivering what has been in the national programme for years and years. The experience of many people, both in this Chamber and outside, can be tapped. I hope that the Minister will be sympathetic to the case that has been made.