General Practitioners: Appointments

Lord Hunt of Kings Heath Excerpts

Thursday 17th March 2016 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the noble Earl, Lord Attlee, for allowing us to debate this very important question and congratulate him on the quality and range of his contribution, which was extremely interesting. I echo his initial comments about the value of the National Health Service. However, he also referred to the considerable challenges we face, not least the amount of money that is being made available. I note the comments that the noble Lord, Lord Rennard, made and I will be most interested in the Minister’s response to his suggestion that we need to move to hypothecated taxation. Interestingly, we have a recommendation from the Liaison Committee—of which I am a member—which I hope will come to the House next week to establish a special Select Committee in the next Session looking at the long-term sustainability of the NHS. I think that that will be a very interesting discussion, not least because it is clear, as the noble Earl said, that alongside A&E and ambulance services, general practice is facing considerable pressure.

Like my noble friend Lord Turnberg I am very lucky to enjoy an exceptional GP practice, which is a small branch of a large inner-city practice. It is clear from the comments of noble Lords and from the regular GP patient survey that people’s experiences are very mixed. The noble Earl focused on economically active members of society, but his comments could have applied to all patients. Noble Lords are often fond of quoting the Commonwealth Fund’s international comparators, which do not always compare with the OECD research covering the same ground. I was interested in its latest report on public perception of primary care in the UK and the fact that there has been a dramatic drop in the positive view of how primary care works, with the percentage of those expressing satisfaction going down from nearly 50% in 2009 and 2012 to just over 20% in 2015. So there has no doubt been an appreciable change in attitude by the public in relation to GP services. The GP patient survey shows, for instance, that only 70.4% of patients find it easy to get through to someone at their GP surgery on the phone. This is down from previous figures. It also showed that 6.5% book their appointments online, up from 3.2% in December 2012. It is really disappointing that such a low number of people actually take advantage of online booking or, indeed, that such a low number of practices promote online booking. Obviously, it would make life so much easier if it were easier for people to do that, and it would deal with the problem that the noble Earl, Lord Attlee, described, about the differentiation between an urgent appointment and one that is important but does not have to take place within 48 hours. Many GP practices seem quite unable to devise a system to cope with those circumstances.

It is also interesting that the GP patient survey showed that 23.1% see their preferred GP a lot of the time. We need to think through the implications of that, particularly with seven-day working, because I suggest that with the move into larger federations, which I support, the seven-day working concept inevitably means that people will have less opportunity to see their preferred GP—particularly, as we know, when many GPs do not want to work full time any more. That seems to me to depend on information, particularly electronic information, being available, so that a patient does not have continually to tell different GPs in a practice about their conditions, because they actually have systems where that is noted down.

I also note that in the survey 57.7% were happy with the amount of time that they had to wait for an appointment. Again, that is down—it is not a great figure. The overall satisfaction with GP opening hours, at 74.8%, is down and again not very satisfactory.

The noble Lord, Lord Rennard, referred to the PAC report on access to general practice, which came out only a couple of weeks ago. I thought that it was a very interesting report and, no doubt, the Government will respond in due course. But it showed that we have problems with retention and recruitment, that good access to GP care is too dependent on where patients live, and there is an unacceptable variation in patients’ practices and in the appointments system. Tellingly, it said that the Department of Health and NHS England do not have enough information—that is a point that the noble Lord made—on demand, activity or capacity, which one would have thought might have been of interest to NHS England. I think that it is clear that both the department and NHS England has really failed to ensure that staffing in general practice has kept pace with growing demand. I think that they have been complacent about general practitioners’ ability and, indeed, willingness to cope with the increase in demand caused by rising public expectations and the needs of an ageing population.

No doubt the Minister will tell us about recent initiatives, which are welcome in themselves, but a lot of changes will come about because GPs themselves will make them happen. I am really impressed by the large federations that have been established. There is one very large one in west Birmingham and the Black Country, which has had some incredibly impressive results in relation to access. It is through having a large enough federation that you can meet the work patterns of individual GPs, and it is through the simple use of phone and email to have much more flexible appointments. I do not know whether the noble Lord has read a report from David Pannell, the chief executive of Suffolk GP Federation, which complains that the department is not really giving support to the development of provider networks and federations and that the only initiative promoting working at scale was the Prime Minister’s GP access fund, which was doing little to diverge from the traditional model of contracting with individual practices.

The point being made here is that every single contract which is part of the PM’s access fund has been a traditional primary medical services or general medical services one with an individual practice. Would the Minister be prepared to have a look at this and to talk to the National Association of Provider Organisations? Its chair has commented:

“Whereas NHS England supported the vanguards programme, there has been virtually no support for the leadership of federations which are not part of a vanguard”.

I have quoted from a story in the Heath Service Journal and I have also looked at comments which have been made on it. One comment, which was anonymous—I do not know why—said:

“Brighton and Hove CCG have been developing a really innovative and ambitious contract with GPs working at scale which the LMC have supported”.

It may well be worth looking at that to see whether more can be encouraged.

Finally, I wonder if the development of federations means that the Government need to look at CCG governance. If you have a large-scale federation covering an area roughly the same size as a CCG, I can see a potential conflict of interest. The federation could dominate the election of members to the CCG board. The contracts should be at that level, not held by NHS England, so I wonder if we need to go back to the issue of CCG governance and have a majority of lay people on CCG boards. That would enable the Government to be much more proactive in supporting these federations. I am convinced that they are the only way we can deal with the problems raised by the noble Earl.

Royal National Orthopaedic Hospital: Redevelopment

Lord Hunt of Kings Heath Excerpts

Thursday 17th March 2016 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, mea culpa. The noble Lord certainly got me bang to rights. As noble Lords have heard, many noble Lords and Ministers have commented on the position of the RNOH. I start by paying tribute to it for its outstanding work. I certainly paid a ministerial visit. I do not know about the noble Lord, Lord Lansley, but I remember digging a hole in the ground there. Alas, I think that the hole is still there. I have no doubt he too has been to see the site to look at where the development would take place.

Clearly, a powerful case for this wonderful hospital’s development has been made by my noble friend. It is significant that the NHS TDA gave business-case approval a year ago. Therefore, it is absolutely right to press the Minister to say what on earth has happened and why the NHS TDA apparently, if not reversing its decision, does not seem to be able to take it any further forward.

I pay one other tribute to the RNOH and that is to the partnerships that are developing. We have already heard about UCL, but my noble friend Lady Dean is also aware of the work that is being done with the Royal Free. That is very encouraging in relation to the comments made by the noble Lord, Lord Lansley, about the importance of specialist hospitals working with other hospitals.

I shall put four or five points to the Minister. First, it is always risky to ask a Minister for a straight answer, but it seems to me that the time has come when a straight answer needs to be given. If it is no, no should be said, and the hospital can make other dispositions. It surely cannot be left in abeyance for another one, two or three years because it must be impossible for the people running this institution to know whether to invest any money in the current infrastructure, whether they should wait, what they should do about the staff and how they retain staff. An honest answer is required at the very least.

Secondly, is the state of the current public capital programme within the Department of Health having an impact? I know of the Department of Health’s financial difficulties towards the end of this financial year, and the five-year forward look at money for the NHS involves a transfer of capital to revenue. What has happened to the public capital programme? Is that the real reason that the NHS TDA cannot give approval?

The noble Lord, Lord Tebbit, and I probably disagree about PFI because, although some of the contracts were clearly badly negotiated, we have very fine buildings and hospitals as a result of it. However, if there is no public capital—and public capital is much less than was expected—and we do not use PFI, how are we going to see investment in health infrastructure over the next five to 10 years? It is a very serious question which the noble Lord, Lord Prior, is, no doubt, looking at very carefully.

I want to come back to the point made by the noble Lord, Lord Lansley. We have already heard of the number of reviews that have taken place. All have come to the conclusion that this hospital should be redeveloped on its current site, yet he will be aware that within the NHS managerial culture there is opposition to single-site specialty hospitals. I wonder whether at heart the issue is that, although Ministers and reviews have said this hospital should be redeveloped, the truth is that the managerial cadre at NHSE and in London do not think it should take place. That was always my suspicion. When I answered that debate in 2001, the distinct impression I had was that actually the powers that be, below ministerial level, simply did not want this to happen because they do not believe in specialist hospitals. The noble Lord mentioned Oswestry. He could have mentioned the Royal Orthopaedic Hospital in Birmingham as well, which is another stand-alone hospital. I have always got the impression that senior executives in NHS England now and before in the department think these hospitals should not be stand-alone and should move into DGHs. It is legitimate to ask whether this is the real reason. Given that NHS TDA officials almost all come from NHS managerial backgrounds, I ask whether this is the real reason, alongside the squeeze on capital.

The noble Lord, Lord Lansley, asked about the tariff. It is my impression that NHS England is not favourably disposed towards specialist services in general and that the squeeze on specialty tariffs is because of that. I remind him of the order that he forced through this House taking away the right of providers to object to tariff proposals. They can no longer use the arbitration system because they need commissioners to object as well, and frankly the chance of a commissioner objecting to any tariff proposals by NHS England is a little remote.

Finally, will the Minister arrange for the NHS TDA to meet parliamentarians to discuss this urgently? The NHS TDA has new leadership: its chief executive and its chair. Mr Ed Smith will bring a great deal of fresh thinking to the work of the NHS TDA, and I would appreciate an opportunity for noble Lords to talk with him further rather than either the decision being delayed for many more months or years or it simply not going ahead.

NHS: Hospital Overcrowding

Lord Hunt of Kings Heath Excerpts

Tuesday 15th March 2016 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the latest NHS performance figures and the concerns expressed by the Society for Acute Medicine that overcrowding in hospitals may result in avoidable deaths.

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

My Lords, a significant increase in emergency demand in January put the NHS under great pressure. Compared to January last year, the NHS had almost 175,000 more attendances in A&E in January 2016. We recognise this rise in demand is not sustainable, which is why we have invested £10 billion in the NHS’s five-year forward view.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister, but he will know that the January performance was the worst A&E performance of the NHS on record. The Society for Acute Medicine has warned that this is bound to have an impact on the number of avoidable deaths that take place. Ministers cannot just blame the public for coming to A&E departments. The fact is: they have cut nurse training places; they have cut social care; they have squeezed the NHS budget; and today the Public Accounts Committee says that the NHS has no chance whatever of clearing the financial deficit. I would simply ask the Minister when he thinks the NHS will next meet the four-hour target.

[Lord Prior of Brampton]

My Lords, there was a 10% increase in demand in January, which put the NHS under huge pressure. It is much to the credit of A&E services that we saw 111,000 more people within four hours than we did the previous January. It is also worth mentioning that, over the last five years, the number of consultants working in A&E has increased by 49%. The number of people working in emergency care as a whole has increased by 3.7%. It does not alter the fact, which I recognise, that A&E departments are under tremendous pressure—they often are in winter. We hope that that pressure reduces as spring approaches.

E-cigarettes: Regulation

Lord Hunt of Kings Heath Excerpts

Monday 7th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the benefits of e-cigarettes are well understood. The figure of 1 million people who have given up smoking by taking up e-cigarettes is a valid and true one. The tobacco regulation that the noble Viscount refers to does not have any proposals for an excise tax—it purely relates to ensuring that these products are used safely and are of a given quality.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will know that the impact of this directive is to make it much more difficult for e-cigarettes to be promoted. Why is that, given the clear benefit to public health? The answer is that public health programmes can substitute for it—but this Government have slashed those programmes. Given the Prime Minister’s success in EU negotiations about a change in direction, can the Minister confirm that we will not now have to implement Article 20 if we do not want to?

[Lord Prior of Brampton]

My Lords, this directive originated partly because a number of European countries wanted to ban these products. The fact that there is a directive, which will lead to a regulated market, means that British manufacturers will have access to those large European markets. As I understand it, the main issue that the noble Lord may be concerned about is that where the nicotine content goes above 20 micrograms per millilitre, there will have to be MHRA approval, which may mean that the higher strength nicotine substitutes are less readily available. But that is done on safety grounds.

Pharmacies: Funding

Lord Hunt of Kings Heath Excerpts

Wednesday 2nd March 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Lord raises an important point which I regret I cannot answer. I will have to write to him on that matter. However, for community pharmacy to play the important role in primary care that we expect it to do, it will have to have access to integrated patient records. The confidentiality that surrounds those records is very important.

[Lord Hunt of Kings Heath (Lab)]

My Lords, this is all very well but will the noble Lord confirm that one of the ideas of his department is for doctors to prescribe medicines for a longer period so that fewer trips are made to the pharmacy, thereby compensating for the closure of up to 3,000 pharmacies? However, is he aware that it is estimated that £300 million-worth of medicines are wasted every year? I understand that a third of that is in medicines that are never opened by patients. Surely it is not cost-effective to extend the length of the prescription time because all you will do is add to wastage of medicines.

[Lord Prior of Brampton]

My Lords, there is no intention to extend the prescription time just for the sake of it. But there are many people who have stable long-term conditions, for whom a 90-day prescription period might be appropriate. We are not saying that all prescriptions should be for that length of time but some of them might be.

Health: Black and Minority Ethnic Psychiatric Patients

Lord Hunt of Kings Heath Excerpts

Monday 29th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the Government are committed to putting more resources into mental health. There is a recognition, across all parties in this House, that mental health has been a Cinderella service for ever. We are all committed to parity of esteem between mental and physical health and more resources are now going into mental health.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in his Answer, the Minister mentioned the Mental Health Taskforce report. It points out that, while there is a workforce race equality standard, there is no equivalent standard for access to services. He said that the Government will appoint a champion, but why not agree to set a standard and appoint a national director to make sure that it is implemented?

[Lord Prior of Brampton]

My Lords, there are two separate things there. We are committed to the recommendation of appointing an equalities champion. Extending the workforce race equality standard to carers and patients was recommended by the noble Lord, Lord Crisp, and welcomed by Paul Farmer in his report. I hope that we will adopt that recommendation, but I cannot promise it.

NHS (Charitable Trusts Etc) Bill

Lord Hunt of Kings Heath Excerpts

Friday 26th February 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am highly indebted to my noble friend Lady Massey for introducing the Bill. I congratulate her on a remarkable 50th wedding anniversary today. I also congratulate the noble Lord, Lord Bird, on his remarkable maiden speech. The noble Lord, Lord Patel, was so right when he described it as extraordinary, inspiring and heart-warming. As the noble Lord, Lord Cormack, rather subtly put it, it is a great advert for the benefit of an appointed House of Lords.

The point raised about the message to trustees of charities is important. The noble Baroness, Lady Barker, rightly described the last 12 months as being a very difficult time for charities. One does not need to go through the various issues that have arisen. It is clear from what she said—I very much agree with her, certainly in the context of the Bill—that the role of charitable trustees over the years has become ever more onerous and transparent. It has sometimes brought considerable pressure on those trustees. In supporting the Bill, it is right to pay tribute to charitable trustees, but also to say to the Minister that at a time when it is easy to criticise those trustees, the Government need to look at ways trustees can be collectively supported in the very difficult job that they are sometimes called on to do.

The first part of the Bill has arisen mainly from representations from the Association of NHS Charities and a number of individual NHS charities that have called for reform. I very much support the change that would be made. My understanding, and maybe the Minister could confirm this, is that there is a view that removing the current ministerial involvement in the appointment of trustees may encourage donors rather more in the future than in the past. I do not know whether the Minister agrees with that, but if it is true it is certainly to be welcomed.

I can only support Clause 3, on the transfer of rights to “Peter Pan” royalties. We all see Great Ormond Street as a hugely important national and international institution. The more it can be supported the better. My noble friend Lady Blackstone eloquently described the reason for the Bill, and the Opposition are wholly in support.

Access to Medical Treatments (Innovation) Bill

Lord Hunt of Kings Heath Excerpts

Friday 26th February 2016 Lords Chamber

[Lord Patel (CB)]

My Lords, I am delighted to support this Bill and hope that it will have a swift passage through this House and become legislation. I congratulate the noble Lord, Lord Saatchi, on presenting it in great detail and in his usual style, and—given the difficulties his predecessor Bill had—on his tenacity in listening to people in and outside this House and getting to the position whereby the Bill is now acceptable to all the professionals I have spoken to.

Perhaps I may briefly go off the Bill and come on to some comments that have been made. Before I do that, I will declare my interests. I am, as everybody knows, a doctor by background. I am the chancellor of the University of Dundee, which is one of the key UK universities for life sciences. I chaired until recently the UK cancer research centre in Dundee. I now chair, as a board member, another research group in Dundee that is looking at the scientific evidence as to why cancer outcomes can be worse among people from a poorer background, where they are disastrously worse. I was also responsible in this House for chairing a report on genomic medicine. That led, thankfully, to the developments in genomic medicine in the United Kingdom and the research centre which the Government support through the research councils.

It is true that as we learn more and more about genomics and genetics, we will need to have a huge database from which we can learn. What the noble Lord, Lord Ryder, said is correct: there will be patients who would be appropriate for stratifications of medicines that we know now and which are found to be effective because they are used more generically. If we learn from genomic medicine that stratification makes them more suitable for that treatment, because of their genetic make-up, such drugs will be very beneficial.

It is also true that innovations occur in the United States at a faster rate—the noble Lord, Lord Ryder, referred to this—because the processes of the different trial phases there are much more efficient. Some say they are too quick; I do not subscribe to that view. Let me give one example. The noble Lord referred to this concept briefly. Some of the breast cancer treatments do not work in all women. We know that the drug that is given will work but that it cannot be given in the quantities required because most drugs, as we know, are poison. You can use it in a dosage that will treat the disease but if you exceed that dose, you are likely to do more harm than good. But if you can limit that treatment to only the cancer cells, those drugs will be effective. We now have innovations whereby this can be done by identifying the molecular make-up of the cancer and then loading the drug with that molecular marker, so that it will attack only the cancer cells and leave the normal cells alone.

We need a different way of innovating. My own university also has a drug discovery unit. We have contributed to the development of several drugs, two of which would be regarded as blockbuster drugs, through understanding the science of disease processes—the biology of disease. Such understanding is crucial before you develop a treatment.

However, we need to move away from that to other ways of developing drugs. We try to do this by using 70,000 compounds that were previously identified by pharmaceutical companies but not used because they were not found to be effective in treatment. We are seeing if any could be used for the treatment of so-called tropical diseases that are not infectious, which a huge number of people are affected by. We do this in collaboration with other countries by supplying them with these compounds. I agree that we need to look at different ways of innovating drugs and treatments, particularly as the science develops. There will be other ways of dealing with diseases, such as gene-editing, which was how Layla, a young girl in Great Ormond St, was treated. That may also require the development of other drugs to make sure that side-effects are suppressed.

The point I am trying to make is that the Bill may well act as a catalyst. The noble Lord, Lord Saatchi, should be pleased that people are thinking more widely and outside the box. We have an opportunity to develop good databases, as the noble Lord indicated, and to use them for innovative development of treatments. I hope this will happen. I hope that the Government will bring in wider legislation on the issues that the noble Lord, Lord Ryder, referred to, such as better ways of conducting clinical trials. We need transparency and openness. I do not think the medical profession is averse to that, and it is what the public need. We have to be honest: not all the treatments we try will work, but if we try harder, we will find treatments that work which we have been ignoring.

I have to admit to something here, which I hope the GMC does not hear me say—although it might, and if it does, I do not care. I have used off-licensed drugs on several occasions, with the full consent of the patients I was treating, when no other treatment was working. Lots of my colleagues do this. If any doctor stands up and says they never do it, I would not suggest that they might not be telling the truth, but I would be surprised if they were innovators in the true sense.

Then, there is research. I have done research that I am not very happy about and that I wish I had not done, but at the time I did it with a clear conscience. In retrospect, I now know that it probably did not work as well as expected and was probably not all that good for the patient—I hope it did not do any harm—but if I had not tried it, I would never have known. It is important that we stop arguing at length and trying to regulate and control in the minutest detail innovations in medicine that we can drive forward. We do this more easily with innovations in surgical and other procedures. We are much freer about that and clearly understand that, as doctors, you work with people in other countries to introduce the same procedures and use a common database to learn.

[Lord Hunt of Kings Heath (Lab)]

Would many current surgical procedures have been authorised if they had had to go through the kind of clinical trial process that medicines do?

[Lord Patel]

We would not have had stents put in hearts, bypasses, ablations—

--- Later in debate ---

[Lord Hunt of Kings Heath]

My Lords, I thank the noble Lord for bringing the Bill to your Lordships’ House and I commend him for his perseverance and stamina as he sought to take it and the previous Bill through. I, too, pay tribute to the honourable Chris Heaton-Harris for taking the Bill through the House of Commons.

When the noble Lord opened his speech he referred to the adoption of new medicines, and I am very sympathetic to the point he raised. The fact is that we have a shocking record in the UK on the adoption of new medicines. We use fewer branded medicines per person than comparable countries; we tend to use older rather than the latest medicines; fewer patients in the UK receive new, innovative medicines than those in comparable countries; and we have a problem in that NICE-recommended medicines—even those that have been through the NICE process and have been shown to be clinically effective and cost effective—face further reviews and restrictions at local level, even though there is a legal requirement on clinical commissioning groups to make sure that NICE technology appraisals are put into action. For me, that adds to the concerns of the noble Lords, Lord Patel and Lord Ryder, about the position of the UK when it comes to investment in R&D by the pharmaceutical sector. We know that we have a very strong science base and at the moment we have a strong pharma R&D base, but those are at risk, partly for the regulatory reasons that noble Lords have already referred to. I do not think that that is so much the case in this country but I take the point made by the noble Lord, Lord Ryder, about European regulation.

The other big problem we have is that the NHS is hopeless at adopting new medicines. We have the Hugh Taylor Accelerated Access Review, which has been sponsored by Mr George Freeman, to whom I pay tribute for the work he is doing in this area. The review has produced an interim report and the final report will come out in the summer. It is concerned with access to innovative drugs, devices and diagnostics, which it aims to speed up. But however good the recommendations are and will be, unless the NHS and NHS England completely change their perspective and recognise that we have to adopt these fantastic new innovations that are coming to the UK or are developed here, in the end we will not be seen as a country in which it is worth investing. My experience—it may also be the noble Lord’s experience—is that the big problem is that there is a culture within the NHS that regards drugs as a cost rather than a benefit to patients. There is a need to take a very different approach, even in relation to new equipment and clinical staffing. There is a huge cultural barrier that we have to face up to.

Noble Lords, including the noble Baroness, Lady Masham, mentioned that we have received briefings from a number of medical bodies—the ABPI, the BMA and many of the royal colleges—which are still expressing concern, even though the Bill has changed considerably since the noble Lord took it through in the last Session. We know that they still have some concerns about the database and about what they regard as the perverse incentives. Is the Minister confident that his department can help to assuage those concerns? If we are to see this Bill progress—and we all want to see the benefit that the noble Lord wishes to bring to healthcare in the UK—it is important that there be some way of reassuring those bodies that what is intended here will not put at risk some of the things they have put forward.

I also hope that the noble Lord will respond to my noble friend Lord Murphy on the very important point about off-patent drugs. I am not convinced that the authorities in the UK have ever understood the importance of making progress in this area. In the end, only Ministers can kick people to make progress. I agree with him—let us hope that this database is at least a start in giving prescribers confidence to prescribe off-patent drugs.

Finally, I come to the recommendations in the Delegated Powers Committee’s report published on 25 February. I do not know whether the noble Lord has seen it but it makes reference to this Bill and I am slightly concerned about it. The committee is concerned about Clause 2, which,

“enables the Secretary of State, by negative procedure regulations, to confer functions on the Health and Social Care Information Centre … in connection with the database”.

In particular, the regulations may include requiring or authorising the centre to disclose information to specified persons. The Delegated Powers Committee has no problem with the use of subordinate legislation to do that, nor with the use of the negative procedure, but it says that,

“clause 2 appears to envisage no provision, either in the Bill itself or in the regulations, for the enforcement of conditions imposed by virtue of subsection (4)(b), and we draw this matter to the attention of the House so that it may seek an explanation, either from the Member promoting the Bill or from the Minister”.

I do not expect the Minister to be able to respond today. However, if the committee has identified a drafting issue, the question of how it is going to be dealt with is a concern.

I end with the point that the noble Lord, Lord Blencathra, made about timing. Presumably, he is basing his assumption on the Commons rising in May, but he seemed to be saying that 11 March would be the last time in this Session that the Commons would deal with it.

[Lord Blencathra]

My assumption is not based on when the Queen’s Speech would be or when the Commons rises. In the Commons, the days for Private Members’ Bills are announced at the start of the Session, and Friday 11 March has been announced as the last day. Even if the Commons ran into June or July, there would not be an extension beyond 2.30 pm on Friday 11 March.

[Lord Hunt of Kings Heath]

But on that basis, even if there were no Committee or Report stage, it would still be too late. Will the Minister join me in asking the usual channels whether we can find some time before 11 March to take this Bill through, even if the Government may need to table a technical amendment? Obviously, a recommendation from the Delegated Powers Committee cannot be ignored. We on this side of the House would certainly support the Minister in doing that.

National Health Service: Workforce Race Equality Standard

Lord Hunt of Kings Heath Excerpts

Wednesday 24th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the ability to undertake the duties of a post is absolutely fundamental. The tragedy is that so few people from BME backgrounds are encouraged to put their names forward. It is more important that we get the actual recruitment process right.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister should be commended on his approach to this issue. Has he seen the survey undertaken in 2015 which shows that when looking at the national bodies of the NHS such as NHS Executive Search, Monitor and the NHS Trust Development Authority, none of their boards had any BME representation at all? Given that those appointments are made by Ministers, can the Minister tell us what they are doing to rectify that?

[Lord Prior of Brampton]

My Lords, I am not sure that the noble Lord is quite right. I can certainly think of two people from BME backgrounds on the board of NHS England. We can influence this, but it is important that the appointment process is independent of political bias. We have to rely on the chairs and the boards of these arm’s-length bodies to make those appointments.

Accident and Emergency Services: Staffing

Lord Hunt of Kings Heath Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I can perhaps be excused for not following all that carefully Private Members’ Bills in the Welsh Assembly promoted by the Liberal Democrats. Safe staffing is obviously very important. I quote Mike Richards on this, who says that it is,

“important to look at staffing in a flexible way which is focused on the quality of care, patient safety and efficiency rather than just numbers and ratios of staff”.

That is extremely important.

[Lord Hunt of Kings Heath (Lab)]

My Lords, will the Minister tell me why the Government told NICE that they could not publish safe staffing levels for accident and emergency departments, when they accepted fully the recommendations in Sir Robert Francis’s Mid Staffordshire inquiry report, which said that safe staffing levels should be published? Will he also tell me how NHS trusts are enabled to achieve safe staffing levels when they have been told by the regulator, NHS Improvement, that they have to cut their workforce to cut their financial deficits?

[Lord Prior of Brampton]

My Lords, NHS Improvement never said that trusts should cut staffing levels to below safe levels. It has said that there is a right balance between efficient and safe use of staff. Getting that balance right is so important. That is what Mike Durkin, the national patient safety champion at NHS Improvement, is doing. His work will be reviewed by NICE and by Sir Robert Francis.