NHS: Management Consultants

Lord Laming Excerpts

Monday 13th February 2012 Lords Chamber

[Earl Howe]

My Lords, I received notice of this Question just over an hour ago so I do not have precise figures about McKinsey. What I can say is that whereas the previous Administration in 2008-09 spent £100 million in the Department of Health on consultancy, my department has spent under £10 million on consultancy this year—very considerably less.

I read the article in the press this weekend which probably prompted the noble Baroness’s Question. I think we need to be careful before casting doubt on the integrity of public servants—and, indeed, of McKinsey. The article referred to Monitor. Those at Monitor are bound by very strict rules and procedures to ensure transparency and openness in all their dealings and to avoid any possible conflicts of interest. They follow those rules and procedures to the letter.

[Lord Laming]

My Lords, does the noble Earl take from this important Question the significance of having in place a robust implementation strategy should the Bill become law, because translating the aspirations of the Bill into day-by-day practice will be a considerable challenge? Can he assure the House that that will be attended to in the proper way?

[Earl Howe]

Yes, I can. The reform of the NHS is a major project. Frankly, it would be irresponsible if the Government were not to commission expert professional advice in undertaking a project of this kind. Consultancy, if used judiciously, can be highly cost-effective. I assure the noble Lord that the implementation of the Health and Social Care Bill is occupying our minds night and day and, so far, I am pleased to report that it is going well.

Health and Social Care Bill

Lord Laming Excerpts

Wednesday 8th February 2012 Lords Chamber

[Lord Laming]

My Lords, may I briefly add my thanks to the Minister and the Constitution Committee? Its second report was particularly helpful. To follow the point made by the noble Baroness, Lady Williams, it is right to see Amendment 5 in the context of some coherence over how this accountability will work, not just at ministerial level but at board level. There will be further amendments. At this stage, suffice to say that the Constitution Committee looked at these matters in the broadest possible way to ensure that—whether in terms of autonomy or commissioning—there would be a coherence to the way in which accountability would continue to be established in the National Health Service; and, in particular, that those responsible for commissioning and other important work follow through their tasks in relation to ministerial accountability to Parliament.

The second report of the Constitution Committee was a model of how such matters can be dealt with coherently, succinctly and very clearly. We are indebted to the Minister for giving us the opportunity to consider that more carefully; and to the Committee for its work, which took us forward enormously and has brought us to where we are today. I am grateful and I support the amendment.

[Baroness Pitkeathley]

My Lords, far be it from me to cast a pall over the House of Lords at its best. I join others in being glad about the consensus and in congratulating the Constitution Committee. I also congratulate the Convenor on the part that he played in getting the consensus. It is a privilege to follow him.

I join the noble Baroness, Lady Williams, in hoping that the consensus can continue but I have to remind the House of how the Bill is viewed out there. It is deeply unpopular with many of the people who will be required to make it work. They will make it work because that is what the workforce of the health service does and always has done in the most difficult of situations. However, it is looking to us to make those difficulties as few as we possibly can. Therefore, in congratulating ourselves on reaching where we have on this issue, let us remember the task before us.

Health: Pathfinders

Lord Laming Excerpts

Thursday 12th January 2012 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. I think everybody agrees that integrating services, however one defines that—although the common denominator is surely from the point of view of the patient—is a good thing. We do not wish to lose sight of the lessons that have been learnt so effectively in the places mentioned by my noble friend. It is true that other areas have yet to catch up. We recognise that, and the focus over the next 12 months will be very much on sharing the lessons that have been learnt by the pathfinders that we know are working well.

[Lord Laming]

Does the Minister agree that the success of this scheme depends a great deal on the facilities within the health service becoming much more community orientated and much more available to people in the community? It is not either social services or the health service. Both have to play their part. What are the Government doing to achieve that?

[Earl Howe]

I do recognise that. It gave rise to the fairly famous quote by Sir David Nicholson, the chief executive of the NHS, who went down to Torbay to see the work being done there. He came away saying:

“I have seen the future and the future is Torbay”.

There was good reason for him to say that because Torbay has established close relationships between social workers, district nurses, therapists and allied health professionals through a single point of contact so that intermediate care services are delivered effectively, thus avoiding the need for patients to be admitted to hospital.

Health and Social Care Bill

Lord Laming Excerpts

Wednesday 21st December 2011 Lords Chamber

[Lord Alderdice]

My Lords, Christmas time, like some of the other festivals in the year, is of great importance for many reasons, not least the opportunity for us to spend a little bit more time with our families and friends than is usual during the normal period of our work. They also provide markers during the year which remind us and enable us to say a word of thanks to those who work with us and serve us so extraordinarily well in your Lordships' House. We are enormously fortunate in that regard, as we all know.

There are some people who come to us at an early point in their career for a relatively short time—interns and young people who come to work here for a little while who then go off with their knowledge and experience and do other valuable and worthwhile things. Indeed, my noble friend Lady Williams and I were just talking about how pleasant it is to see some of these young people continuing on to do absolutely marvellous things for their community and their country. We have been fortunate that they have started with us. Others, as has already been noted by the noble Lord, Lord Bassam of Brighton, come at a later point in their career, perhaps having served Queen and country in various parts of the world. They come here as doorkeepers, attendants and in other jobs to provide us with order and security, comfort and great courtesy.

However, there are others who come to us through other organisations, and I particularly want to mention those from the Metropolitan Police. It is sadly the case, but it is the case, that we owe our security to them, and it is important for us to acknowledge that that continues and sadly in the upcoming year will undoubtedly continue to be a requirement for us, and we are grateful to them.

There are others who come to us at an early point in their career and spend much of their life working here with us. Some of them are in hospitality, some are in the clerking community and some are in the clerical and administrative community. They provide extraordinary stability for your Lordships' House, and an institutional memory which is itself of enormous importance, although I know that a number of noble Lords also provide some of that. Some stay with us for a very long time, and it is important that we acknowledge them. One in particular, Christine Bolton, has just completed 40 years of service to your Lordships' House. I think that merits particular mention. She is universally and very affectionately known as Chris. She joined your Lordships’ House as a clerical officer on 1 November 1971. For many years, she was on the staff of the Journal Office and was an early user of what in those days was known as new technology—first, using a database on a mainframe computer and then using word-processing software on eight-inch floppy disks. I think that a few of your Lordships still remember those kinds of things.

Chris is now in the Legislation Office where she has become the cornerstone of our procedures for handling private legislation. For myself and our office, when recently one of our colleagues was ill and special arrangements had to be made for a replacement, we should like to acknowledge how helpful, courteous and gracious she was. It was not just a matter of Chris doing the job and doing it properly but she did it with grace and courtesy, which is one of the reasons why she has become so affectionately known throughout your Lordships’ House. She is not alone and many others serve your Lordships’ House in this way but today is an opportunity to pay particular tribute to her.

We will now, I trust, take a break even from some of those letters to which the noble Lord, Lord Hunt of Kings Heath, referred. I trust that all noble Lords will travel safely home to the various parts of our United Kingdom, or to other places if they are fortunate enough to go away, and will have a good rest, relaxation, time with friends and families, and thorough recuperation because I fear that not only the duties within your Lordships’ House but the challenges that come from outside in 2012 may be substantial and significant. We would do well to be ready for them.

[Lord Laming]

My Lords, I think evidence of the effectiveness of the usual channels is that we have reached this point in the calendar at the same time as we have reached the completion of the long Committee stage of the Health and Social Care Bill. This Bill has received the kind of scrutiny for which this House should take great credit. It is in keeping with the function of this House that we scrutinise these Bills with great care. This Bill has certainly received great scrutiny in Committee. I certainly associate myself with the comments of congratulation that have been addressed to the Front Bench and to the others who have played such a big part in the Bill. There is of course much yet to be done.

Mention of one Bill does not exclude in any way the work that has been done on the other Bills that have come before your Lordships’ House. Each of the Bills that we have had, or still have, before us has an enormous importance to our fellow citizens. Potentially, they affect the lives of us all and all citizens of this country. Therefore, it is important that the House continues to fulfil its responsibilities with the care that I certainly admire greatly.

In that process, we are enormously assisted by some outstanding staff. The staff in this House not only help the work to be conducted in a most efficient manner, but they behave always with great commitment, courtesy and support for all that we do. This has been a difficult period because the Bills have been so demanding that it has meant a number of late nights, some of which have become early mornings. As has already been said so well, the House is remarkably well served by its staff. We find it difficult to convey words fully to express our gratitude to them and we are indeed fortunate.

A number of members of the staff of the House work behind the scenes and we never see them, but they are extremely important to all that we do. It falls to me to have the pleasure to refer to two members of staff, Esther Roake and Nelly Parker. Over the years they have been employed to clean the collection of books in the Library. They have done this with great commitment and enthusiasm. They begin their task in the Library, going from shelf to shelf, removing every book and dusting it, cleaning the shelf and then putting the books back, and when they have cleaned all the books in the Library, they move into the collections in the corridors and other byways of the building. Remarkably, at the end of the process they are ready to start again because by the time they reach the end, the books on the Library shelves need to be dusted again. They have done this task for many years with, as I have said, great commitment and enthusiasm and, amazingly, they both claim not once to have opened any of the books. They say the reason for that is that they do not have time to do so, unlike us. They have been very cheerful members of our staff, and Esther always had a generous supply of sweets in her pocket that she would share with those who stopped for a friendly chat along the way. We pay tribute to these two members of staff, who have now retired.

We also offer our warmest thanks to all the staff who work behind the scenes for everything they do. On behalf of the Cross-Bench group, I wish everyone a happy Christmas and offer all good wishes for 2012.

[Baroness Anelay of St Johns]

My Lords, I wish all the staff and all Members of this House a very happy and peaceful Christmas.

NHS: Hinchingbrooke Hospital

Lord Laming Excerpts

Thursday 10th November 2011 Lords Chamber

[Earl Howe]

My Lords, there was extensive consultation, but the important point for my noble friend to understand is that this was a locally led process. Ministers—and, for that matter, civil servants in the department—were not involved in the decision process. The decision was made by the strategic health authority board and the recommendation then came to Ministers. However, I can tell my noble friend that support for this decision has been very widespread, not least among the medical community in the area.

[Lord Laming]

My Lords, will this hospital continue to provide the same range of facilities as it does now? I understand that it does not provide A&E, for example, but will it be given the freedom to reduce the range of services in the future or will it have to carry on with the same services that it provides now?

Hospitals and Care Homes: Hydration

Lord Laming Excerpts

Monday 7th November 2011 Lords Chamber

[Earl Howe]

My noble friend raises a very good idea. I have heard of similar ideas in different trusts, all designed to meet the same objective. The key point my noble friend makes is that patients who may be malnourished when they enter hospital or have difficulty feeding or accessing drink for themselves should have their condition assessed straightaway so that the nursing care is there for them when they need it.

[Lord Laming]

Could the Minister assure the House that the Government will do everything possible to increase the number of unannounced inspections, both in hospital and in care homes, to make sure that these basic and very important matters are being properly attended to?

[Earl Howe]

My Lords, since the publication of the CQC summary inspection report, my right honourable friend the Secretary of State has requested a further 500 inspections of dignity and nutrition in care homes and 50 further visits to hospitals, which will start in the new year.

Health and Social Care Bill

Lord Laming Excerpts

Wednesday 2nd November 2011 Lords Chamber

[Baroness Thornton]

In the spirit of co-operation across the House it might be useful if I outline the position of these Benches, too. During the past few days I have said to anybody who would listen to me that this is the position in which I thought we probably ought to end up. Those who have been sitting with me on the Long Table can bear testament to that. The reason I added my name to the amendment of the noble Baroness, Lady Williams, is because I feel strongly that that is the right way forward. I am very pleased to hear that the noble Baroness has not resiled from her position on that. I have talked to several lawyers and consider that the amendment in the name of the noble and learned Lord, Lord Mackay, may address political issues but does not fully address the legal issues concerning the responsibility of the Secretary of State.

I have what I can assure noble Lords is a sparkling 10-minute speech, but I do not intend to make it now. However, I may save it for a later occasion. I think this is a good solution if other noble Lords agree with it. I look for an assurance from the Minister about how the discussions on this matter should proceed. We have a record on this Bill of cross-House discussions involving all the people with an interest and expertise in matters relating to it. In that spirit, I wish these amendments to be withdrawn so that not only our lawyers but our medical experts, and, indeed, the Constitution Committee, can be persuaded to have another go at this issue. Towards Christmas we may find a solution that suits us all. If not, I may instead have to make my 12-minute sparkling speech on Report. I hope that the House will feel that this is a good way forward.

[Lord Laming]

My Lords, it is clear that around the whole House it is felt that the constitutional position of the Secretary of State is of immense importance. The House must give careful thought to that issue in order that we get it right, because the National Health Service is important to every citizen, as we heard earlier during our consideration of a Question. What the health service stands for, how it carries out its responsibilities and where responsibility and accountability rests are of great importance.

The House is indebted to all those Members who have put their names to the amendments. They are thoughtful amendments that represent the best interests and work of this House. It is a great credit to those who have put their names to the amendments that they are happy to consider withdrawing them today, because it is important that the House should not take precipitous action, that we accept the thoughtful response from the Minister and that we give plenty of time and opportunity to try to resolve this. There is actually a shared commitment around the House, and I therefore have every confidence that the House will reach agreement. I very much hope that noble Lords who have tabled these amendments will accept this opportunity to meet with the noble Earl and resolve this matter before the next stage of the Bill.

Winterbourne View

Lord Laming Excerpts

Wednesday 8th June 2011 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend. My understanding is that all patients at Winterbourne View have been regularly reviewed by a multidisciplinary clinical team in the past six months on behalf of the primary care trust that commissioned their care, and most of them in the past three months. I am sure she is right to say that those who have conducted such reviews should examine their processes and my understanding is that that is exactly what will happen.

We have endorsed the CQC’s proposal to launch a programme of risk-based and random unannounced inspections of a sample of the 150 hospitals providing care for people with learning disabilities. They will work in conjunction with local government improvement and development, ADAS, Mencap and with experts with experience of this programme. The spirit of my noble friend’s question is amply addressed in the programme.

[Lord Laming]

Will the Minister encourage the Government to reinforce messages about managerial accountability wherever vulnerable people are being cared for and about the fact that the greater the degree of vulnerability, the greater that accountability must be held by the managers of the service?

[Earl Howe]

The noble Lord is quite right. There has clearly been a serious failing in management here. We are looking at that urgently and, no doubt, important lessons will be learnt. All agencies have acted immediately on being alerted to the situation by the “Panorama” team and, as I have mentioned, appropriate inquiries are under way.

Health: Multiple Sclerosis

Lord Laming Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

The noble Baroness makes a very important point, and she is right. I will have to check whether the guide refers to that issue. I would be surprised if it did not. However, the central point that she makes is quite correct. The key to this, as so often, is good communication between those providing care at every stage of the care pathway. Sometimes, unfortunately, that breaks down.

[Lord Laming]

Can the Minister tell the House what means the Department of Health has for monitoring the reductions in these multidisciplinary teams to which he has referred? There is evidence, at a local level, of quite serious reductions at present.

[Earl Howe]

The problem is that, historically, there has been no requirement to publish information on the number of multiple sclerosis nurses. The NHS Information Centre for health and social care extracts data from the electronic staff record and quality-assures the data prior to publication in the non-medical workforce census. The qualified nursing, midwifery and health visiting staff group is broken down only by area of work, so it is quite difficult to keep a handle on this.

Homelessness: Tuberculosis

Lord Laming Excerpts

Tuesday 1st March 2011 Lords Chamber

[Earl Howe]

My Lords, I was very interested to hear about the noble Baroness’s experiences in the north-east and I would like to hear more. The points that she raises lie behind our intention in the Health and Social Care Bill to make GP consortia responsible not just for the patients on the GP lists but for all the population in the local area. The health and well-being boards, which we propose should be set up at local authority level, will bring together all the relevant stakeholders to look at how the health needs of an area can best be met and prioritised.

[Lord Laming]

My Lords, this is a group of our fellow citizens who are particularly vulnerable and can so easily be lost in the system. At a time when there is considerable pressure on budgets, will the noble Lord use whatever good offices he can to ensure that this remains a priority in all the public services and is not seen as a soft option?

[Earl Howe]

My Lords, the short answer to the noble Lord’s question is yes. We have committed to ring-fence the public health budget and I think that there is no better earnest of our intentions for public health than that.