Psychiatric Units: Child and Adolescent Patients

Lord Harris of Haringey Excerpts

Wednesday 13th April 2016 Lords Chamber

Asked by

[Lord Harris of Haringey]

To ask Her Majesty’s Government what assessment they have made of the number of deaths amongst child and adolescent patients in psychiatric units, in the light of the investigation conducted by the charity Inquest.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, every death of a young person in in-patient psychiatric settings is a tragedy. It is essential that each case is fully investigated and lessons learned. Four children have died in in-patient child and adolescent mental health services since NHS England came into existence in 2013. The Minister of State for Care Services plans to meet Inquest to consider what more can be done.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the noble Lord for that response. It is obviously at odds with the comments made by his honourable friend the Minister of State, who told “Panorama” that the department simply did not know how many young people had died in psychiatric care. Does the noble Lord accept that he and his ministerial colleagues have a duty of care under Article 2 of the European Convention on Human Rights towards those in their care in psychiatric units? If so, as he said he was in favour of the principle of all those deaths being adequately investigated, will he ensure that in future there is a requirement on psychiatric units to report on premature deaths of all patients and that they are independently investigated by a body separate from the psychiatric unit concerned? He and I have discussed that in the past in his previous incarnation as chair of the Care Quality Commission.

[Lord Prior of Brampton]

My honourable friend Alistair Burt, the Minister for Care Services, and I accept that the lack of clear knowledge on how many deaths there have been in psychiatric care settings is not satisfactory or acceptable. I think the difference from the figure of nine in the “Panorama” programme is partly because the figure of four is from 2013 whereas the figure of nine probably goes back to 2010. Nevertheless, it is essential that we clear that up and get those facts straight. Alistair Burt has agreed to meet Inquest to do so.

As far as investigating these awful tragedies when they happen and learning from them, where someone is detained under the Mental Health Act and a suicide happens there is a requirement to inform the CQC, as the noble Lord will know. For example, where a child is not detained under the Mental Health Act, there is no such requirement. We are looking at this very thoroughly and when my honourable friend in the other place has completed his work I will write to the noble Lord with our findings.

Allied Health Professionals: Training

Lord Harris of Haringey Excerpts

Monday 8th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I entirely agree with the noble Lord that the role of speech and language therapies, particularly in treating people with stroke and other serious conditions, is absolutely vital. Perhaps I may correct a previous answer that I gave to the noble Baroness, Lady Walmsley. Therapeutic radiographers have gone down slightly but diagnostic radiographers will go up slightly.

[Lord Harris of Haringey (Lab)]

My Lords, the Minister told us that the increase is among paramedics, which presumably balances the cuts in other areas. Is this the Government’s strategy for sorting out the problems in the ambulance service, which around the country is failing to meet emergency targets? Do the Government hope that by training some more paramedics, they will somehow solve the problem and money will magically become available for the ambulance service to function?

[Lord Prior of Brampton]

My Lords, having more paramedics is part of the solution, but the major part of the solution is to treat more people outside A&E departments, so that people do not require ambulances to take them into A&E departments but are treated at home.

Southern Health NHS Foundation Trust

Lord Harris of Haringey Excerpts

Thursday 10th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I do not think anyone was told that no one was to blame as a result of the investigation into Mid Staffs. There were failures at all levels within the NHS with the regulation, the professions and the management of that particular trust. I believe that transparency is the right way to deal with the systemic problems that we have in many of our hospitals.

[Lord Harris of Haringey (Lab)]

My Lords, if you are to achieve transparency, is it not the case that, first of all, as the noble Baroness, Lady Walmsley, has suggested, there should be an independent element in deciding whether a particular death is going to be investigated at all, and, secondly, there must be some independence in the nature of that investigation? Too often those investigations are too close to the establishments concerned. Does there not also need to be some oversight of those independent investigations so that general conclusions of a systemic failure can be picked up, acted upon and brought to his attention as a Minister?

[Lord Prior of Brampton]

My right honourable friend the Secretary of State for Health is committed to having a blame-free, independent investigation service looking at incidents of this magnitude in the NHS. That is why, on the recommendation of the PASC, he set up the investigations branch which will be up and running in March.

Police: Ambulance Support

Lord Harris of Haringey Excerpts

Thursday 16th July 2015 Lords Chamber

Asked by

[Lord Harris of Haringey]

To ask Her Majesty’s Government what assessment they have made of police forces supporting ambulance services by taking patients to accident and emergency departments.

[Lord Harris of Haringey (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and draw attention to my interests in the register.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

The public deserve the right service from the right organisation at the right time. Only ambulances should be used to transport patients to A&E as only ambulances are clinically equipped and staffed to do so. Incidents where the police transport patients to hospital are very rare and the emergency services continue to work together to reduce them further.

[Lord Harris of Haringey]

I am grateful to the Minister for that Answer; however, I think he is incorrect in saying that it is a very rare occurrence. Freedom of information requests have shown that the number of cases of people being taken to hospital to accident and emergency departments runs in the thousands in recent times. He is also aware, because he sent the figures to me, that, for example, in London the ambulance service has failed to meet its emergency target in terms of time in every single London borough in each of the last three months. What exactly do the Government think they are doing about making sure that there is adequate coverage for the emergency services? Is the intention that, despite all the Minister’s fine words about the importance of ambulances, the reality is that the police will have to act as paramedics?

[Lord Prior of Brampton]

I do not think that the noble Lord is right. The actual number of times that police transport patients to A&E is less than 0.1% of all such conveyances. I agree that there are some particular problems in London. There is a shortage of paramedics and they have an active recruitment plan to correct that. There have also been management problems in the London Ambulance Service and its performance, to which the noble Lord correctly draws attention, has not been good enough. There is now a new chief executive of the London Ambulance Service, who is fully aware of the issues. She has recently published the report about the levels of bullying in the London Ambulance Service, which are very distressing. The fact that that has been published and that she has acknowledged it give me hope for the future.

NHS: Whistleblowing

Lord Harris of Haringey Excerpts

Tuesday 30th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness has probably read The “Snowy White Peaks” of the NHS, which sets out very clearly for all to see the really shocking lack of representation of people from BME backgrounds at senior levels of the NHS. This is an absolute priority. NHS England has appointed Yvonne Coghill to look at all the racial inequality issues, and she and NHS England have my full support in their endeavours.

[Lord Harris of Haringey (Lab)]

My Lords, I declare an interest as having two family members who work in the NHS. Further to the answer that he has given, will the Minister reflect on the fact that many trusts have contracts in which staff are warned that if they bring the trust into disrepute, they are likely to face disciplinary action? This has a stifling effect on whistleblowing and people raising issues of legitimate public concern with the media. Will he comment on that practice and what is going to be done about it?

[Lord Prior of Brampton]

In Robert Francis’s report, Freedom to Speak Up, he specifically mentions—I think it is in principle 13, from recollection—that there should be no such clauses in NHS contracts unless it can be demonstrated that there is indeed a true public interest. In any severance package in which there is a gagging clause of any kind, CQC is entitled to inspect those agreements during its inspections.

NHS: Financial Tariff for 2015-16

Lord Harris of Haringey Excerpts

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, no, Choose and Book will not be affected, although NHS England has plans to update it to make it a much richer and more informative system.

[Lord Harris of Haringey (Lab)]

My Lords, given the appalling performance of ambulance services—certainly in London, and, I suspect, in the rest of the country—what steps are the Government taking to ensure that the tariff means that people will receive the emergency call-outs that they would expect on the basis of the funding that should be being made available?

[Earl Howe]

This is part and parcel of the discussions going on at the moment. There is a balance of interests here—above all, the interests of NHS patients, but within the system, the interests of those who hold the budget and the interests of those who provide the service. The risks relate, on the one hand, to affordability, and, on the other hand, to financial and service stability, and the need not to sacrifice quality in the process.

NHS: Health and Social Care Act 2012 Reforms

Lord Harris of Haringey Excerpts

Wednesday 22nd October 2014 Lords Chamber

[Earl Howe]

I agree with my noble friend that the integration of health and social care services has a major part to play in making the system more efficient across the piece and more effective for the patient. That is why we are introducing the better care fund, which, at a local level, will channel at least £3.8 billion into pooled budgets to deliver that integration.

[Lord Harris of Haringey (Lab)]

My Lords, if the system is quite as wonderful as the noble Earl suggests, will he explain why so many people are waiting so much longer in accident and emergency departments and why so many young doctors completing their GP training decide to leave the country and practise overseas rather than participate in the grotesque mess that this Government have produced?

[Earl Howe]

I take issue with the phrase “grotesque mess”. If the noble Lord cares to look at the figures, he will see that waiting times are low and stable, MRSA and C. diff infections are at record lows, mixed-sex wards are down by 98% and the number of people waiting a long time for treatment is massively reduced. Yes, we know that many A&E departments are under pressure but many are coping. The work that we are doing, including channelling more money into the system for this winter, should, we hope, relieve the worst of the problems.

Health: Local Healthwatch Funding

Lord Harris of Haringey Excerpts

Wednesday 19th March 2014 Lords Chamber

Asked by

[Lord Harris of Haringey]

To ask Her Majesty’s Government what assessment they have made of the report from Healthwatch England that £10 million of the £43.5 million allocated for local Healthwatch in 2013–14 has not been used for its intended purpose.

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

The Government have made no assessment. We welcome transparency in funding for local Healthwatch—something we called for in response to the Francis inquiry report—and Healthwatch England’s findings are a helpful contribution to that. We remain of the view that local authorities are best placed to decide local funding arrangements based on local needs and priorities, which is why the funding made available to them is not ring-fenced for a specific purpose.

[Lord Harris of Haringey (Lab)]

So the noble Earl is telling the House that £10 million—almost a quarter of the money that his department allocated for local Healthwatch—has disappeared midway through the Department for Communities and Local Government to local government and not reached local Healthwatch. Was that not predictable and predicted? Why do the Government not now recognise that providing a local voice for the users of the health service is critical to the development of the health service and ensure that the funds are channelled through Healthwatch England for it to commission local services? If they cannot do that because it would require legislation, perhaps the Government could publish an indicative statement of what each local authority ought to be spending on local Healthwatch.

[Earl Howe]

My Lords, I would say that it is not the role of the Government to dictate what local authorities should be doing. It is up to local authorities to make judgments about what are the needs and priorities of their areas. I would also say that there cannot really be any direct comparison between the money made available by central government and the funding provided to local Healthwatch. It is not the case that £10 million has somehow disappeared. It is, rather, that councils have made local funding decisions which mean that £33.5 million was invested in local Healthwatch last year. What matters here is the transparency. That is what we very much welcome. It enables local Healthwatch to hold local authorities to account for their funding decisions and thereby, perhaps, influence them to give them a bit more money if that is required.

NHS: Clinical Commissioning Groups

Lord Harris of Haringey Excerpts

Wednesday 27th November 2013 Lords Chamber

[Earl Howe]

There are two elements to consider here. One is the target allocation, which is what NHS England is currently working on, and the other is the actual allocation—the money given to individual areas. The task for NHS England will be to decide how quickly or slowly to move from current allocations to the target. The key will be not to destabilise any NHS area in that process.

[Lord Harris of Haringey (Lab)]

I do not think the noble Earl answered my noble friend Lord Hunt’s Question about the discussions that have taken place between the Government and NHS England on this topic. Will he tell us what steer the Government have given on these matters?

[Earl Howe]

We give no steer. As I said to the noble Lord, Lord Hunt, the principles on which NHS England should operate are clearly of concern to Ministers—namely, equal access for equal need, the need to take account of health inequalities in an area, and not destabilising the NHS. We also believe that NHS England should be transparent in whatever it does. Those are legitimate concerns for Ministers, but we do not seek to steer NHS England in any particular direction.

NHS: Clinical Commissioning Groups’ Funding of Treatment

Lord Harris of Haringey Excerpts

Tuesday 12th November 2013 Lords Chamber

[Earl Howe]

They can appeal to the clinical commissioning group itself in the first instance under what is known as an individual funding request. That request has to be considered rationally and transparently. If the request is turned down, the reasons must be published.

[Lord Harris of Haringey (Lab)]

My Lords, 55 years ago—

[Baroness Wall of New Barnet (Lab)]

My Lords, as chair of one of the many trusts that are in financial difficulty—

[Baroness Royall of Blaisdon (Lab)]

I suggest that we hear from my noble friend Lord Harris.

[Lord Harris of Haringey]

My Lords, 55 years ago, I had my tonsils removed on the National Health Service. Had that not taken place and I now needed that procedure as an adult, according to figures from the Royal College of Surgeons I would be extremely unlikely to have them removed in the area in which I live—Haringey—but 22 times more likely to have the same procedure carried out in the Isle of Wight. Can the Minister explain why this Government’s arrangements facilitate that extraordinary postcode lottery, which means that there is no equity of treatment across the National Health Service?

[Earl Howe]

My Lords, what the noble Lord calls the postcode lottery is, as he knows, nothing new. That is why Sir Bruce Keogh, the medical director of the NHS, has commissioned a project to engage professional bodies, particularly the Royal College of Surgeons, to develop clinical commissioning guidance, in particular, where there is unwarranted variation in the rates of elective surgical intervention. They are currently looking at 28 common types of surgical intervention with more topics under development, and commissioning guidance will ensue from that work stream.