Mental Health Taskforce
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Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the Minister for repeating this Statement. The final report, which came out recently, gave a very frank assessment of the state of current mental health services and describes a system which is said to be ruining some people’s lives. It is entirely consistent with the report by the noble Lord, Lord Crisp, on acute in-patient psychiatric care. It makes a number of recommendations which, if implemented in full, could make a significant difference to services that have had to contend with funding cuts and staffing shortages as demand has continued to rise, leaving too many vulnerable people without the right care and support.
We return to a question which was debated yesterday: the £1 billion by 2021. A number of questions remain unanswered. Can the Minister confirm that there is no actual, additional money other than the existing £8 billion that has been set aside for the NHS up to 2020, as previously announced by Her Majesty’s Treasury? Given that mental health services receive just under 10% of the total NHS budget, surely these services would actually expect to receive much of this additional money anyway, as part of the NHS settlement. Will the Minister explain how this can be expected to deliver the transformation that he and the task force say is urgently required?
In a recent Oral Question, there was the usual discussion of whether there should be a national debate about NHS funding. The Government need to get on, not just to debate it but to ensure that the NHS has enough money. Has the Minister studied the advice given by Professor Don Berwick, the Government’s safety adviser? He said, “I know of no nation that is seeking to provide healthcare at the level that western democracies can at 8% of GDP, let alone 7% or 6.7%. That may be impossible”. His advice to the Secretary of State was that it is crucial that the Government reflect on whether they have overshot on austerity. What is the Minister’s response to his own safety adviser?
Lord Prior of Brampton
My Lords, we have strayed somewhat from the subject. On the money, the Prime Minister announced an extra £1 billion in January. It is the same £1 billion and is within the £8 billion—or £10 billion—that was in the settlement in November. The Government asked Paul Farmer to set out in his report where the priorities are and where the money should be spent, and that is exactly what has happened. Interestingly, I saw Don Berwick last week. He is a very distinguished American with a lot of experience in patient safety and health improvement. There is no question: it is going to be tough. It will be very difficult to do on around 7% of GNP, but there is absolutely no doubt, from the work of the noble Lord, Lord Carter, and others, that there is a lot to go at. If it was not tough, we would not be going at it. We must take advantage of the fact that it is going to be tough by addressing some of the difficult issues which we should perhaps have addressed in the past but did not.
Health: Adult Psychiatric Care
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Lord Prior of Brampton
My Lords, that is a complicated question, or number of questions.
Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016
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Lord Hunt of Kings Heath (Lab)
My Lords, I am very grateful to the noble Lord for his careful explanation of the order. On the whole, the changes seem sensible, and I note that some of them follow the Law Commission’s recommendations. As the noble Lord will know, there has been disappointment that the Government did not bring forward a Bill or a draft Bill in relation to the whole package, and I know from our previous discussions that the Government are considering what further to do in relation to the regulation of individual health professionals. Is he able to update me on where the Government are on that?
On the detail of the order, I noted that overall the consultation outcome showed a great deal of support for the proposals, although perhaps less so in respect of the change in relation to standards for registered practices, which are no longer to be placed in legislative rules. I noted that some concerns were expressed, according to the Explanatory Memorandum,
“that removing the ‘black and white’ rules could lead to unhelpful variation for employee pharmacists in the way pharmacy owners choose to meet the standards”.
I assume that the proposal for an outcomes-based approach would ensure that there will be consistency about the standards themselves but leave more discretion for individual community pharmacies to decide how to meet them. Could the noble Lord confirm that for me?
The noble Lord made a very interesting comment at the end of his speech about the rapid change in the way community pharmacy services are provided. I certainly agree with that. I am sure he is aware that an estimated 1.6 million people visit a pharmacy every day. There is no question but that they have huge potential, not just in dispensing medicines but in many of the other services that are now available in community pharmacies, for example home delivery, compliance aids and other support to help old and frail people in particular live independently. There is also no question about the strong professional advice community pharmacies can give, particularly in relation to medicine management. We know, again, that older and frailer people in particular can be prescribed individual medicines without perhaps the GP or other doctors looking at the whole impact, whereas community pharmacies, through medicine management approaches, can have a very beneficial impact. For instance, this winter, NHS flu vaccines were available for the first time through community pharmacies. Again, that shows the benefit of recognising the professional expertise they have and of trying to ensure that they can relieve some of the load on other pressurised parts of the National Health Service.
The Government have made clear in a number of publications how they value community pharmacies, so I have been puzzled by the reductions that are going to be made in the community pharmacy budget, which is the subject of an Oral Question next week. I am puzzled by the thinking behind that reduction, which I think will start in October 2016, according to a letter that the Department for Health and NHS England sent out to community pharmacies. I just wanted to ask two or three questions about this.
First, in the letter that was sent out to community pharmacists, or to their representative organisations, there was a clear implication that the Government think there are too many community pharmacies at the moment. The letter points out:
“In some parts of the country there are more pharmacies than are necessary to maintain good access. 40% of pharmacies are in a cluster where there are three or more pharmacies within ten minutes’ walk. The development of large-scale automated dispensing, such as ‘hub and spoke’ arrangements, also provides opportunities for efficiencies”.
The department is also looking at ways of online ordering, which will make it easier for the public. The letter also says it is looking at,
“steps to encourage the optimisation of prescription duration”,
which I assume means prescriptions for a lengthier period than currently.
The Pharmaceutical Services Negotiating Committee has told me that it feels that the cut in budget is incompatible with the Government’s ambitions in relation to the contribution of community pharmacy. It wants to know whether it is government policy to see a reduction in community pharmacy premises. It would be a brave Government who said that they wanted to see that, but clearly it would be helpful to know if that is a stated intention. The development of an online pharmacy service is clearly to be encouraged. The record of community pharmacy has been very good in relation to being able to adopt a digital approach. Will that be done in a way that does not bypass the actual value of the advice that pharmacists can give to individual patients, particularly about medicine management?
Finally, on the question of increasing the length of time of a prescription, we know that a lot of medicine is wasted. Often, patients give up the course before they reach the end, even though they are recommended to take the full course. I can see that making the length of a prescription longer will mean that they will need fewer visits to the community pharmacist, thereby reducing the money going to the community pharmacist. However, if it leads to a greater waste of medicine, it might be a false economy. Has the department undertaken any work on that?
Overall, the SI itself is eminently sensible, but it cannot be considered without looking at the context of where community pharmacy is going. When we debated the Health and Social Care Bill in 2012, we discussed whether community pharmacists should be represented, as of right, on the board of a CCG. The Government resisted that, but there is evidence that because community pharmacists are not around the table at CCG level, the contribution they can make is often missed when it comes to issues such as how you make a health economy work effectively together or how you can, say, reduce pressure on A&E. We may be missing a trick here in not embracing community pharmacy rather more than we have been for the past year or two.
Lord Prior of Brampton
My Lords, I had a feeling that we might stray beyond the order, and we duly have. The noble Lord raised three broad points. The first was to request an update on the Law Commission’s report into the regulators. I do not have much to say that we have not already said. We think that a lot of what was in the Law Commission’s report was absolutely right, but it was a long and fairly prescriptive approach to the matter. We are considering it and may return to it in this Parliament, but it is not a priority in the short term.
The noble Lord referred to the outcomes-based approach and raised concern about whether the standards will be consistent. The intention is that they will, but there will be more discretion in how the outcomes are achieved. We are at one on the intent that lies behind his question.
I turn to the much more difficult matter that the noble Lord raised, which does not relate directly to the order, although he is right to say that it provides some context. The first thing to say is that I agree wholeheartedly with what he said about the vital role of pharmacists not just in dispensing but in how we manage medicines, perform vaccinations and look after the old and frail. I was interested by his comment at the end about why pharmacists are not represented on the board of CCGs. When we come to debate our whole approach to community pharmacy in more detail, we will set out our views on how pharmacy should be more integrated with the delivery of health and social care. It may well be that we should revisit whether pharmacists should be on the board of CCGs. Perhaps I can take that away to think about it further.
I do not want to be taken down the route of the number of pharmacists, because we are out to consultation at the moment. It is a fact that 46% of pharmacists are located in very close geographic proximity to each other. That is one reason why we have been looking at the structure of delivery of community pharmacy. On the one hand, we absolutely recognise that in rural areas we must have community pharmacies close by, and we want them to be much more integrated with healthcare delivery; on the other, there must be a question mark about the structure of community pharmacy. The number of outlets has grown from 9,000 to 11,500 in the past seven or eight years, which is a huge increase. Much of that increase has come from people setting up shop in very close proximity to existing pharmacies. It is right that we look at the whole delivery of healthcare by pharmacies, and it will be interesting to see what emerges from the current consultation.
Alcohol Strategy (EUC Report)
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Lord Hunt of Kings Heath (Lab)
My Lords, I, too, congratulate the noble Baroness on the way in which she introduced the report and on the report itself. We have had a very balanced debate. I suppose we are seeking to embrace the enjoyability of alcohol in moderation, alongside a recognition that for many people it causes misery and degradation. To get the policy right will always involve a balance, and one that we do not get right every time. For instance, looking back, the extension to 24-hour licensing was done with the best of intentions. If I recall correctly, it tried to encourage what we thought to be a responsible, continental style of drinking. I am not sure whether it has altogether been successful in that regard.
The report itself is excellent, because it has assembled a great deal of hard evidence about the scale of alcohol use and some of the problems that arise from it. I particularly took the point that not only does Europe have the highest per capita alcohol consumption in the world, but we know that the UK has high consumption itself. We also know, as the committee points out, that there are huge variations in society. The noble Baroness, Lady Murphy, may well be right about the statistics coming through on young people and the reasons for that. We should be cautious about reading too much into that at the moment.
I very much took on board the evidence given to the committee by the Chief Constable of Northamptonshire about the impact of alcohol on domestic abuse. He estimated that alcohol was a factor in a third of all domestic abuse. The Home Office official, Mr Greaves, pointed to the Crime Survey for England and Wales which estimated that in 49% of violent incidents,
“the victim believed the perpetrator to be under the influence of alcohol”.
There is also the more general issue of anti-social behaviour. My honourable friend Jessica Phillips caused a certain degree of controversy a couple of weeks ago, when she compared what happens in Broad Street in Birmingham every Friday night with the very serious incidents in Germany. She has been criticised for that but she is certainly right that Broad Street on a Friday or Saturday night is not a very pleasant place to be, the problem being that it is also where Symphony Hall and the Rep are, so it is difficult to avoid. Frankly, for many people the atmosphere and disorder that come from alcohol are frightening. I know that the Government are seeking to give greater powers and flexibility to local authorities to try to ensure that licensing is more appropriate. However, the Minister will know that local authorities are torn between, in a sense, public order and wanting young people to come and spend money in their cities. That is a conundrum and a very big problem.
We come to the issue of the European strategy. The report from the noble Baroness, Lady Prashar, says that Europe has a limited competence in health. Successive Governments have wanted to keep that competence limited. Certainly, from our point of view that was because we wanted to make sure that changes in European directives and legislation would not impact on the way we run our National Health Service. The current debate about TTIP shows some of the dynamics of concerns about how, say, that potential trade agreement between Europe and North America might impact on the way we run the NHS. I certainly support the continued limited competence in health on the part of the EU, which needs to concern itself with a lot of other issues at the moment.
However, I also take the point made by the committee that there is a case for EU action which can supplement and add value to the activities of national governance. In their response, the Government say that they agree with that. Can the Minister give me any indication that the Government really do sign up to that, so that they will support some European-wide action where that truly can add value to how we want to take forward policy on alcohol in this country?
My noble friend Lord Brooke made some very telling points about the Chancellor of the Exchequer and inconsistencies in his approach to these issues. He might have mentioned the swingeing cutbacks in public health budgets that have taken place at the same time as the decision that the Chancellor announced. I hope that the Minister will say something about taxation and consistency. As regards the strength of cider, 8% or 9% is a shocking figure. We are entitled to ask the Government to look again at the requirement for consistency. I would also like to ask the Minister about minimum pricing. The Government are keeping this under review. Of course, Governments keep everything under review. But I would like to hear a little more about the Government’s current thinking on pricing, because clearly many people think that we should use pricing as a way to reduce consumption.
I would like to come on to the issue of public health. I have been very impressed with the work of Public Health England in the last two or three years. Its work is evidence-based and the body has been forthright. I hope that the Government will continue to listen to Public Health England’s recommendations in this area. Regarding the impact of the reduction in the public health budget to local authorities, to what extent does the Minister think that Public Health England and the Government have a role in that context to chivvy local government to take seriously its responsibilities in the area of alcohol? That is one area where you can see that almost all the services of a local authority can have an impact. You can also see the tensions within a local authority because, on the one hand, encouraging more licensed premises—and encouraging more people to use them—will have a positive impact on its income and jobs; on the other hand, it has all the problems that arise from anti-social behaviour. Therefore, local authorities have a major role to play in public health responsibility. It is not good enough simply to leave it to local authorities. The Government and PHE need to be rather more proactive in encouraging local authorities to treat this seriously and as a priority.
Finally, I come back to the point raised by the noble Baroness, Lady Murphy. Recently, we saw the publication of advisory alcohol limits. I do not think that this is an easy issue. However, does the Minister think it advisable to publish limits that are so low that just about everybody will simply disregard them? I am sure that Ministers had debates with the Chief Medical Officer about this. I am not being critical but what will be the eventual outcome? Clearly, there is an element in the public health movement which wants to move to a no-alcohol position—not perhaps prohibition because we have all seen the consequences of that—and is itching to go down the route of eventually saying, “No, you should not drink alcohol at all”. I understand that and am sympathetic to the public health movement, but there is a terrible danger that if you say to young men that the limit is 14 units—that is, four or five drinks a week—it will just be laughed at and disregarded. I am not sure whether nudge policy comes to mind. However, this does not seem to me very nudgy; rather, it seems very nanny. As part of taking forward a general strategy on alcohol, perhaps the Government need to think again about the psychology of alcohol and what really would influence behaviour.
Allied Health Professionals: Training
Lord Hunt of Kings Heath Excerpts(8 years, 3 months ago)
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Lord Prior of Brampton
My Lords, Health Education England is proposing a net increase of 334 places in 2016-17 and we expect a growth in overall numbers of nurses and AHPs from 2017 onwards as a result of moving on to the standard student loan system.
Lord Hunt of Kings Heath (Lab)
My Lords, will the Minister clarify that? He says that there is to be a net increase, but he will know that in relation to some specialties there is actually to be a reduction next year. This is a shambles. The Government have announced an increase in figures by 2020, but next year we are going to see an actual reduction in some of those places. What is going on?
Lord Prior of Brampton
My Lords, as I said, overall there is a small net increase of 334. That is largely for paramedics, where HEE believes that there is a more serious shortage than for other allied health professions. As I said, we have seen a significant increase in AHPs of more than 16% over the last five years and we expect that growth to continue after 2017.
Junior Doctors
Lord Hunt of Kings Heath Excerpts(8 years, 3 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the Minister for repeating the Answer given in the other place. Clearly, the current situation is very worrying and we all want a speedy resolution of it, but I have three quick points to put to the Minister. First, he will know that imposing a contract which the overwhelming majority of junior doctors oppose risks industrial action further than that to which he has referred tonight, and more anger among NHS staff at a time when morale is low. If a new contract cannot be agreed, will he now rule out imposing one?
Secondly, the Minister knows that much of the angst among junior doctors has been caused by the Health Secretary’s repeated attempts to conflate reform of the junior doctor contract with the issue of a seven-day NHS. Will the Minister tell the House, for the record, which hospital chief executives have told the Government that the junior doctor contract is a barrier to seven-day service working? Will he tell me why this Health Secretary has gone out of his way to pick a fight with the very people who are already working across seven days?
The Minister is very well acquainted with the NHS and, indeed, with the views of junior doctors, with whom I know he keeps in very close touch. Does he not consider it absolutely appalling that these hugely important people, on whom the health service is going to depend for the next 20 or 30 years, have been so upset by the Health Secretary’s approach that they feel such estrangement from the NHS? Does he not think that the Government need to completely reset this process and what they have been saying about junior doctors and seven-day working, to get a proper resolution of this dispute?
Lord Prior of Brampton
My Lords, the noble Lord said he had three questions; I think there were only two questions there, which is unusual, if I may say so. We do not want to impose a contract. We want the BMA to come back and continue the talks and we still hope that that will happen. Clearly, imposing a contract is not what we ever wanted to do when this whole process started. As was said in the Statement, the Secretary of State’s door is open and we hope that we can resolve these difficult issues in a negotiated, consensual way.
On the noble Lord’s second question, he rightly said that this is an appalling situation, but actually I describe it more as a tragedy. Let me quote from a trainee doctor:
“I feel undermined and not valued at work and I have seen how this flagging morale among colleagues has caused more than ever to leave the profession. It is a hard job that takes dedication and stamina to continue. But as we are criticised and treated as ‘cogs in a wheel’ rather than as individual professionals, I think we will see ever increasing numbers of people leaving this profession”.
That was in 2005, after the contract came in. The issues facing the junior doctors go back a long way. It is not just about plain time on Saturdays or this particular contract but about how we value, reward, train and trust junior doctors. That is the issue we must come to when the current dispute is resolved.
Opticians Act 1989
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Lord Hunt of Kings Heath (Lab)
My Lords, it has been a riveting debate and noble Lords have expressed a very clear view, although the Minister will be aware that we have had written submissions that express very different views, which are potentially bound up with financial interests. So we are all looking forward to the adjudication that the Minister will, I hope, give us in a few minutes.
I start with a point about innovation and adoption, because I know that the Minister is concerned about this. On the face of it, here we have an innovative UK-based company doing very well abroad but not in this country because of this dreadful healthcare issue of slowness to adopt. I know that eyes are precious and, clearly, in the end, a precautionary principle must be applied. However, I worry that, one way or another, the healthcare establishment is putting barriers in the way of what appears to be a really innovative company. I hope the Minister will pick up that argument.
From the documentation, it is clear that the paper by Dr Charman is an important one. The question I put to the Minister is whether he is satisfied that the GOC and its standards committee actually discussed that paper appropriately. I have seen annexe 4 of the paper we have been sent: notes of the standards committee discussion. This does not seem to be a scientific examination of the report by Dr Charman. Rather, it looks like—how can I put it kindly?—a group of prejudices looking for an argument to put across. It comes across as a very paternalistic approach. First of all, it makes the statement that the market for this product in this country was,
“not thought to be significant”.
Of course it is not significant at the moment, because it is not allowed to develop. Having been sent these adjustable spectacles—although I was not brave enough, as the noble Lord, Lord Newby, was, to wear them—I know that they are clearly very easy to use and to adjust.
The second argument, which was raised by the noble Lord, Lord Newby, is about the developing world issue. The third argument, which I find puzzling, is the statement that:
“It was not clear what benefit the product would bring”.
It is patently clear what benefit the product would bring to the public. The final point, and one that really interests me, is point 12:
“The Committee raised the fact that it has been documented in the academic literature that ‘self-adjustment’ by patients is very subjective”.
Well, “subjective” is a word I would use to kindly describe the paper by the standards committee.
The noble Lord knows that one has to be cautious here. The noble Baroness, Lady Walmsley, is right: perhaps a way through is to ask an independent adjudicator to look into this. The situation is clearly unsatisfactory and it does not look as though the GOC response has been rigorous enough.
I hesitate to move on to the issue of regulation, but we did debate the General Dental Council two weeks ago. I have been in correspondence with dentists and the GDC, and it seems to me that they are still in denial about the criticisms made of them by the PSA. On the one hand, we see huge improvement in regulators, and I pay tribute to the GMC and the work that has been done there. But on the other hand, there seem to be question marks about how some of these professional regulators operate. I suggest to the Minister that the PSA, which I have great confidence in, be asked to look at this matter, particularly the governance arrangements within the GOC. That might warrant careful examination.
Finally, is the Minister satisfied that the PSA has enough powers of intervention? From what I have seen in relation to the GDC, I am not entirely sure that it has. This is an important issue in itself, but it also raises questions about regulation and the way it is undertaken. Having read the GOC paper, I have doubts about how rigorously that body approaches its task.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, I thank the noble Lord, Lord Newby, for bringing this subject, which is a new one for me, to our attention. I tried on a pair of adjustable-focus glasses a few days ago, and they are easy to use. The noble Lord is wearing some this evening, and although they may not be as fashionable as some pairs of glasses, I can see that they are perfectly serviceable.
It is odd for us on this side of the House—it is certainly odd for me—to find ourselves painted into the position of being against choice, competition and deregulation, which are now being advocated from the Liberal Democrat Benches. I do not normally associate them with that particular role. Instinctively I am a deregulator, and to be honest, many of the arguments that noble Lords have made resonate strongly with me. Clearly there is a huge vested interest at stake. Whether that is being improperly used in this case I do not know—but one can see that there will always be a strong voice for the status quo.
I should also pay tribute to the company for its work in Rwanda, which is clearly very important. Equally impressive, in many ways, is its breaking into the Japanese and American markets—no easy feat for a small private company. I take on board the words of the noble Lord, Lord Hunt, about how often we hear about companies finding it easier to break into overseas markets than into our own market. It is deeply frustrating, when we produce so many highly innovative products such as this one.
As for an independent review, perhaps we can come back to that question later. I rather like the thought, but although the role of the PSA was brought up in the context of the GDC, I am not sure what powers it has in such areas. That may be worth exploring. Unfortunately, however, I am going to disappoint the noble Lord, Lord Newby—but perhaps not wholly. We shall see when we get to the end. I shall put the other side of the argument, if I can—but in doing that I do not want to imply that the arguments we have heard are not powerful: they are. I know that my right honourable friend in the other House, Oliver Letwin, back when the Deregulation Bill was going through, would have instinctively been very positive towards the arguments that noble Lords are making.
As noble Lords are aware, in order to do what the noble Lord asks it would be necessary to amend the Opticians Act to remove requirements relating to the sale and supply of optical appliances. Clearly this is something we would do only after very careful consideration, and if we were confident that the proposal could stand parliamentary scrutiny. So if we were to take this forward at all, an independent review of some kind would be a requirement.
In the UK the sale of optical appliances is governed by the Opticians Act, which requires spectacles and contact lenses to be dispensed to a prescription issued by a registered optometrist or medical practitioner following a sight test. We are probably all aware of the exception that has been made. In response to the noble Lord, Lord Stoneham, I should say at this point that I will reread—or rather, read for the first time—the 1989 review, where similar arguments were put forward against the exception for reading glasses.
The Opticians Act does allow reading spectacles to be sold over the counter to adults with age-related sight loss. However, this exception has very limited criteria. The reading glasses must have the same power in both lenses, the power of the lenses must be in the range between 0 and 4 dioptres, and the glasses must be for reading purposes only. The General Optical Council is responsible for regulating the sale of glasses in the UK.
I am aware that Adlens has been in discussion with the GOC about its proposal that over the counter sale of its adjustable-focus glasses be allowed. As noble Lords know, in considering this issue the GOC sought the views of its standards committee, asking for its views on any benefits that adjustable-focus spectacles might bring, and any adverse effects that these products might have on the public’s health and safety. I am not aware of the extent to which it took into account the Charman report, which the noble Lord, Lord Hunt, mentioned. That is something that we should look into.
The standards committee raised a number of concerns, including concern about the safety of the product and the possibility that the product might not meet legal standards for driving.
Lord Hunt of Kings Heath
The point is that although the note we have says that the standards committee was provided with the independent report, it is not clear what it actually did with the report. It does not look as if the committee went through it in detail and considered the arguments—but that might just reflect the way in which the note was taken.
Lord Prior of Brampton
We have often been provided with reports, but that does not necessarily mean that we have read them and given them our full attention. I will ask that question.
I was going through the standards committee’s concerns. Another was that individuals may incorrectly self-adjust, causing a danger to the public when driving. Another was that the sale of these products may distract the public from having regular eye examinations. That is an issue that needs consideration. I appreciate that the noble Lord may not be convinced by the arguments put forward by the GOC’s standards committee, but we would be foolish not to take into consideration its professional view—the precautionary view that the noble Lord, Lord Hunt, mentioned. We have to give that due weight.
I understand that one of the original intentions behind the development of these glasses was to bring accessible vision correction to the developing world, particularly to areas where there was little or no affordable eye care. In the UK we are lucky enough to have no barriers to accessing sight tests and optical appliances which correct refractive errors. The NHS provides free sight tests to children, older people, those with or at risk of eye disease, and people on low incomes. In addition, help with the cost of glasses is available to children and people on low incomes.
It is already the case that self-adjustable glasses can be supplied by a registered medical practitioner or optometrist if they would benefit patients in particular circumstances. I do not think that we should downplay the important role of optometrists in carrying out sight tests. Optometrists are healthcare specialists trained to examine the eyes to detect defects of vision, signs of injury and ocular diseases, as well as problems with general health. Anyone who has had a sight test in recent years will know how much more is done these days than would have been done four or five years ago. Optometrists also offer valuable clinical advice, in addition to prescribing glasses and contact lenses.
One of the concerns raised by the standards committee was that members of the public might be discouraged from attending for regular sight tests. I appreciate that noble Lords do not agree with this argument, given that the availability of ready readers has not had such an impact. However, ready readers have a minimal prescription power and are for reading only.
Drugs
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Lord Hunt of Kings Heath (Lab)
My Lords, I warmly endorse the comments of the noble Baroness, Lady Walmsley, and welcome my noble friend’s introduction to this very disturbing and important debate. We have all studied the ONS figures and noble Lords have already referred to the fact that the mortality rate from drug use has been recorded as the highest ever. My noble friend referred to how deaths involving heroin and/or morphine between 2012 and 2014 increased by almost two-thirds, while other figures from the ONS also show increases. It would be fair to ask the Government what their current analysis is of the reasons for that.
My noble friend has said that he is concerned that a change in government policy, because they felt that too many people were, as he put it, “parked on methadone”, has seen the introduction of an incentivised programme essentially to encourage drug users to complete their treatment more quickly and achieve abstinence. However, that has brought with it some perverse consequences. One thing it shows is that there are always risks in trying to incentivise clinical behaviour through some kind of payment or lack of payment, so we need to be very careful. What risk assessment was undertaken of the impact of this change, because it is important not only in itself but in relation to the future direction of government policy?
My noble friend asked two specific questions: whether the Minister will agree to set up an investigation into the causes of these drug-related and mental health deaths in order to see how many had been given a dual diagnosis and, as I have mentioned, a risk assessment of the decision to bring in, as he called it, a payment-by-results approach to discouraging the use of methadone. He asked for another risk/impact assessment of the overall current strategy, and I must say that I very much endorse his recommendations.
My understanding is that Public Health England is investigating the trends around drug misuse deaths. I have looked at its recent publication, but what I could not find was any reference to the issue raised by my noble friend—the policy change to payment by results. In the light of this debate, is PHE investigating that specific issue? Will PHE, which is after all a part of the Department of Health, explore that area?
My noble friend and the noble Baroness, Lady Walmsley, also talked about the issue of drug treatment funding and the role of local authorities. I was interested to see the NICE guidance, or at least the local government briefing it produced in May 2014, which provides a lot of good advice for local authorities. I know that advice to local government from NICE is not at all mandatory in the way in which a technology appraisal might be for the NHS, but what is the Minister’s analysis of how far local authorities are following that guidance? Do the Government or NICE itself have any responsibility at all to make sure that local authorities are doing the right thing here?
One then comes to the issue of funding. On Monday, the noble Lord again referred to the amount of additional money put into the health service. He will know that around half has come from other pockets of Department of Health expenditure, including of course the public health budget. Clearly, the concern is that there will be an impact on those services where we depend on local authorities for funding under a public health banner. Again, what assessment has his department made of the impact of the reduction in funding for public health on the kind of community services that are so much more important?
None of this can take place without echoing a concern around mental health issues more generally. We all signed up to parity of esteem. The Government have said that they are committed. I believe that they have issued instructions to clinical commissioning groups about mental health service funding, but word reaches us that the reality is somewhat different. My noble friend Lord Patel has raised an important, difficult specific point. It cannot be divorced from overall considerations about mental health policy. If one considers the four-hour A&E target that is not being met, we know that a lot of people who are coming to A&E one way and another have mental health issues. I cannot help wondering whether for CCGs to reduce funding to mental health services has not been counterproductive in terms of the pressure that it has put on other parts of the system. I accept that my noble friend has raised a specific, serious point. If the Government cannot answer the exact point today, I hope that they will agree to some kind of review so that we see the outcome.
NHS: Trust Finances
Lord Hunt of Kings Heath Excerpts(8 years, 3 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, I thank the noble Lord for repeating the Answer to the Urgent Question in the other place. If ever the inadequacy of the 2012 Act needed illuminating, the Minister has certainly done that today. The reality is that we have two separate regulators giving exactly opposite instructions to NHS trusts. The CQC tells hospitals that they are unsafe and should increase their clinical staff—I do not believe that one single report by the CQC has not said that they need to increase their clinical staff. On the other hand, Monitor and the NHS TDA tell hospitals to cut staff.
Like me, the Minister has been chairman of an NHS foundation trust. What on earth are the chairman and board meant to do when they receive this conflicting advice from the regulators, all dressed up in gobbledegook and ambiguity to cover the regulators against the nonsense they are coming out with? What does the Minister say to the King’s Fund? On Saturday, it said that, three years on from the report into Mid Staffs,
“which emphasises that safe staffing was the key to maintaining quality of care, the financial meltdown in the NHS … means that the policy is being abandoned for hospitals that have run out of money”.
The Minister said that the settlement secured by the Department of Health in the spending review would sort out the financial pressures that hospitals are under. I know nobody actively serving on the front line of the NHS who believes that there is any chance whatever of that happening over the next five years. Monitor and the TDA have written to every hospital asking them to take urgent steps to regain control of their budgets, including headcount reductions. Was the Minister or the Secretary of State aware that that letter had been sent? Did it receive ministerial approval?
Finally, on the question of the £8 billion that the NHS was meant to have asked for, I point out to the Minister that the NHS did not ask for it; it was the NHS Commissioning Board, which is not the NHS. Again, I know of nobody of any repute in the NHS who thought that £8 billion was anywhere near enough. Would the Minister confirm that even the NHS Commissioning Board in its Five Year Forward View said that the £22 billion required in efficiency savings would be a huge stretch? Can he confirm the £5 billion identified by my noble friend Lord Carter? There seems to be a big gap between that £5 billion and the £22 billion.
National Health Service: Nurses
Lord Hunt of Kings Heath Excerpts(8 years, 3 months ago)
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Lord Prior of Brampton
My Lords, we are still consulting on the details of this scheme, but I assure the noble Baroness that the loan scheme will be available for mature students doing their second degree as it is for those doing their first degree.
Lord Hunt of Kings Heath (Lab)
My Lords, last night in the education regulations debate, the noble Baroness, Lady Evans, said from the Dispatch Box that last year the cap on applications for nursing students meant that 37,000 applications were rejected, yet today the Minister quoted the figure of 10,000 extra places by 2020, which I take to mean 2,000 places a year. What about the other 35,000 a year who are presumably rejected for a nursing place? If there are ways of getting rid of the cap, why on earth are the Government not allowing many more nurses to be trained? Is it actually because they have cut the budget of Health Education England which would have to finance the placements of those student nurses in NHS trusts?
Lord Prior of Brampton
My Lords, I think the noble Lord is wrong in what he says, but I will double check. I believe that there will be an additional 10,000 placements per year, but I will check that afterwards. That is not until 2021 because the new scheme will not come into place until August 2017, which means that the first students will come out of the new scheme in 2020. We are estimating that there will be 10,000 in that year.