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.

Health: Local Healthwatch Organisations

Lord Harris of Haringey Excerpts

Tuesday 5th November 2013 Lords Chamber

Asked by

[Lord Harris of Haringey]

To ask Her Majesty’s Government what assessment they have made of the number of local Healthwatch bodies whose budgets are less than the amount that has been allocated to the relevant local authorities for that purpose.

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

My Lords, the Government have made no assessment. We believe that local areas are best placed to make funding decisions to ensure that local needs and circumstances are best taken into account. In total, we have provided £43.5 million to local authorities for funding Healthwatch this year. We believe that transparency on funding is important. We will be requiring each local Healthwatch to publish the funding it receives from local government in its annual report.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the noble Earl for that response. I am, however, amazed that he says that he has no direct information on this matter. Is he aware that at least 23 local Healthwatch organisations have budgets lower than those of their predecessor organisation and that one of them—the one covering the Mid Staffordshire area—has a budget 19% lower than its predecessor LINk organisation? Are the Government nonchalant about how this money is being spent and about how patients are to be represented at a local level because they want to ensure that there is no vociferous view from patients about the scandalous way in which local health services are deteriorating as a result of both the top-down reorganisation that this Government have imposed and the real-terms cuts in budgets that have taken place?

[Earl Howe]

No, my Lords. As the report from Robert Francis identified, the patient voice has to be at the heart of the health and care system, and Healthwatch plays a crucial role in supporting that as the new consumer champion for health and social care. It is very easy to get fixated on the amount of money that is going into Healthwatch. One additional consideration could be the investment that a local authority may be making in other areas to ensure that the voice of service users and the public is heard—for example, through the voluntary and community sector. Surely what matters are the outcomes that are achieved for service users and the quality of those services.

Emergency Services: Paramedics

Lord Harris of Haringey Excerpts

Wednesday 15th May 2013 Lords Chamber

[Earl Howe]

My Lords, the London Ambulance Service has advised that the article in the Sunday Times was slightly misleading, in that the two members of staff who attended that particular patient were student paramedics in their third and final year of training and so were sufficiently qualified to work unsupervised. It is inaccurate to call them “unqualified”. The issue in this case was that, despite their qualifications and experience, the crew did not act in accordance with their training or the procedures that were laid down. That has been acknowledged by the London Ambulance Service, which has said that it believes that the failings are not reflective of the hundreds of ambulance staff who provide a high level of patient care to Londoners every day.

[Lord Harris of Haringey]

My Lords, the Minister has suggested that, on the issue raised by the noble Baroness, Lady Gardner of Parkes, it is really down to the management of ambulance trusts to make all those decisions. There is widespread concern around the country about the delays in ambulances reaching emergency cases. For example, I am told that the police now find that they are the first responders and end up having to take people to hospital. Is this a problem with the management of ambulance trusts or is it about the level of resources being made available by commissioners for emergency services and ambulance services?

[Earl Howe]

The noble Lord is quite right that certain areas of the country have seen unacceptable delays in ambulance response times—I am aware of two trusts in that regard. However, this is not an issue around a lack of trained paramedics. Projections by the Centre for Workforce Intelligence show that there is a secure supply of paramedics until 2016. The College of Paramedics has stated that training posts on courses are always filled and, currently, 900 ambulance technicians are training to become paramedics. We are seeing an increase in paramedic numbers, which is encouraging.