Care Bill [HL]

Debate between Lord MacKenzie of Culkein and Earl Howe

Monday 21st October 2013 Lords Chamber

[Lord MacKenzie of Culkein (Lab)]

My Lords, I also support both amendments. It seems to me, as a nurse, to be a self-evident proposition that having safe staffing levels and the correct skill mix, taking into account dependency and acuity, is the right thing do. Anyone who has listened to the debates in this House on various Bills dealing with health and social care over the past few months knows that it is an enormously complicated issue. However, we must bring it back to this level of patient safety and the duty of providers to provide safe staffing levels and the correct skill mix. If that is not done, all the other things we talk about will be in vain and we will end up with more reports, more inquiries and more problems.

As has already been said, it is incumbent on Governments to take account of all these things: the Francis report, the review into Winterbourne View and some of the recommendations in the excellent report produced a few months ago by the noble Lord, Lord Willis. It is vital that we get this right. At a time when financial pressures will force authorities to look at diluting the numbers of trained nursing staff and trained staff in the community and replacing them with healthcare assistants or support workers with hugely varied levels of training and experience, it is absolutely right that we get the correct level. As has already been said, both of these amendments can only add to the Bill and take nothing away from it.

[Earl Howe]

My Lords, I hope that I can give noble Lords considerable reassurance on the Government’s position on these important issues. It is almost axiomatic that safe, high-quality care is dependent on people and that right-staffing, in terms of numbers and skills, is vital for good care. The importance of having the right staff with the right skills and in the right numbers is central to the delivery of high-quality care. Where staff are stretched because they are too few in number, corners will be cut, with inevitable adverse consequences for patient care. Equally, where staff do not have the right skills to carry out their tasks, the quality of care will suffer.

Patient safety is the first priority, and safe staffing levels really matter. The quality of care provided to patients is ultimately the responsibility of the leadership of provider organisations. It is their responsibility to ensure that they have the right staff with the right skills in the right place at the right time in order to provide high-quality care. In the final analysis, it is for hospitals themselves to decide how many nurses they employ, and they are the best placed to do that. Nursing leaders have been clear that hospitals should determine and publish staffing details and the evidence to show that staff numbers are right for the care needs of the patients that they look after.

Although local providers are best placed to do this based on local need, we expect them to look to authoritative guidance and evidence-based tools and learn from best practice to deliver cost-effective and safe care. We recognise that there is a need for national action to ensure that local organisations meet those expectations. As a result of the national nursing and midwifery strategy and vision published in 2012, Compassion in Practice, a considerable amount of work is going on across England to ensure that providers use evidence-based tools, using acuity and dependency measures to set staffing levels, and for boards to publish these staffing levels on a regular basis.

I want to explain what we are now doing to build on that work. First, the Chief Nursing Officer, supported by the National Quality Board, is developing guidance for the system, including a set of expectations, to support provider organisations in securing the appropriate staffing capacity and capability for nursing, midwifery and care. This guidance is being developed with the intention of ensuring safe patient care and that patient outcomes are not compromised. It will include expectations on transparency and publication of information on staffing.

This guidance is being developed jointly by the statutory organisations responsible for quality across the NHS, which are brought together as part of the National Quality Board and which include the Care Quality Commission, Monitor, the NHS Trust Development Authority and NHS England. It will be published next month. I can therefore only agree with the intention behind the amendment that providers need to be open and transparent about their staffing numbers. The positive news is that action is already in place to ensure that this happens.

Health: Flu Vaccine Research

Debate between Lord MacKenzie of Culkein and Earl Howe

Wednesday 23rd November 2011 Lords Chamber

[Earl Howe]

My Lords, the difficulty with advertising is that there is no evidence either way as to whether an advertising campaign has an impact on vaccine uptake, although there is no doubt that it has an impact on vaccine awareness. Without a marketing campaign last year, it was notable that the flu vaccine uptake was very similar to that achieved in previous years. We believe that the best way to access those who are at risk is through GPs. We know that from surveys that ask patients what has prompted them to get vaccination.

[Lord MacKenzie of Culkein]

My Lords, has the Minister seen reports in the nursing press that student nurses are being denied the influenza vaccine, despite advice to the contrary from the Chief Medical Officer? Can he comment on that and see whether something can be done about it?

[Earl Howe]

My Lords, although student nurses are not technically employees, as the noble Lord will know, they will be working for a particular NHS trust, with that trust’s patients, and it is therefore the trust’s responsibility to consider the safety of the student nurse and indeed the patients that they care for. If student nurses are going to be carrying out front-line work, particularly with vulnerable patients, then the trust should follow the advice we have issued on healthcare workers generally.

NHS: Hinchingbrooke Hospital

Debate between Lord MacKenzie of Culkein and Earl Howe

Thursday 10th November 2011 Lords Chamber

[Earl Howe]

The accumulated deficit is approximately £39 million; part of the arrangement specifies that Circle will work towards paying off that deficit over the 10 years of the contract.

[Lord MacKenzie of Culkein]

I understood the chief executive officer of Circle Health Ltd to say on television this morning that his organisation was a social enterprise on the Waitrose model. My understanding of Waitrose is that all employees are partners and that profits are either paid back to the partners or reinvested in the company. Is that the situation with Circle Health Ltd?

[Earl Howe]

My advice is that Circle is part-owned by its employees; more than 50 per cent is owned by them. The remaining share of the ownership is by private sector investors.

Health and Social Care Bill

Debate between Lord MacKenzie of Culkein and Earl Howe

Wednesday 9th November 2011 Lords Chamber

[Earl Howe]

They will be employed by local authorities. It is too soon to say to the noble Lord what the pay grade of those people will be, but clearly they will be very senior officers within the local authority. Yes, strictly speaking, if there is freedom to set pay locally, there could be some variations around the country, but I would envisage that the pay grade of directors of public health will gravitate towards a certain figure, whatever that may be.

[Lord MacKenzie of Culkein]

The Minister spoke about the value of the pay review body being independent, but I was not clear whether he saw a future for that body. Could he clarify that first?

[Earl Howe]

My Lords, we value the pay review bodies, and there are no plans to disturb them at the moment. I sought to indicate that we continue to look at how pay arrangements are best structured. The pay review bodies do an extremely valuable job at present, as they have done for many years.