NHS: Walk-in Centres

Lord Mawhinney Excerpts

Tuesday 10th December 2013 Lords Chamber

[Earl Howe]

My Lords, I would not deny for a second that walk-in centres had a role in many places, and indeed the fact that so many are still open is proof of that. However, it is a mixed picture. Those centres that have closed are in many cases ones where doctors locally have perceived that, in one form or another, there is adequate provision for patients, whether through pharmacies, GP surgeries or community services of a different kind.

[Lord Mawhinney (Con)]

My Lords, how many proposals for walk-in centre closures have been advanced to public consultation over the past three years and then have not been proceeded with as a consequence of the consultation?

[Earl Howe]

My Lords, I cannot give my noble friend the answer because that is not information that we collect in the department but, as I said earlier to the noble Baroness, Lady Wheeler, we expect consultation to take place in local areas so that patients and the public at least have a chance to voice their views.

Health and Social Care Act 2012: Risk Register

Lord Mawhinney Excerpts

Wednesday 4th December 2013 Lords Chamber

[Earl Howe]

That is a helpful question. I do not believe there is a difference. As the noble Baroness rightly said, on a number of occasions the previous Government refused to disclose the risk registers, and they did so for perfectly good reasons, one of which was to enable the safe space that I referred to earlier.

[Lord Mawhinney (Con)]

My Lords, will my noble friend accept that many in your Lordships’ House will welcome this reaffirmation of the Government’s policy, particularly those who have had the privilege of being Ministers?

[Earl Howe]

My noble friend of course speaks with enormous experience of life in government, and I welcome his endorsement of the Government’s policy.

NHS: Mid Staffordshire NHS Foundation Trust

Lord Mawhinney Excerpts

Tuesday 19th November 2013 Lords Chamber

[Earl Howe]

Yes. There were no leaks. The report that the noble Baroness saw was a report on the new GP contract that we announced at the end of last week. That was legitimate reporting by the press of an element of the new contract for next year, when we want all NHS patients over the age of 75 to have a named, accountable GP. However, we are saying in this response that every patient in a hospital setting should know who their consultant is, and therefore that there should be a named responsible consultant for every hospital patient. The two issues are, therefore, related but different.

[Lord Mawhinney (Con)]

My Lords, the Statement said that the NHS has to be a moral organisation or it is nothing. I am sure that my noble friend carried the whole House with him when he said that. Therefore, the raft of changes and the new legal accountability that will come in next year are very welcome in their own right as they will bolster that concept. However, how is it that no individual or individuals have been held accountable for the tragedy and disaster at Mid Staffordshire? I know that my noble friend keeps saying, on behalf of the Government, that they do not want to encourage a blame culture, but will he explain to your Lordships’ House how we can have an accountability structure without any blame attached?

[Earl Howe]

My Lords, the trust board at Mid Staffs was ultimately responsible, and individuals on it have been replaced. That was the first step in holding the system to account. We are introducing strengthened accountability for the future, including a fit and proper persons test for directors, as well as a single-failure regime triggered by failures in care. We have also appointed a Chief Inspector of Hospitals with power to ensure that the system acts quickly to tackle unacceptable care. In a range of ways I hope that we have addressed the central point in my noble friend’s question, which is very well placed.

Ageing: Public Services and Demographic Change Committee Report

Lord Mawhinney Excerpts

Thursday 17th October 2013 Lords Chamber

[Lord Mawhinney (Con)]

My Lords, I presume to speak on behalf of all the committee colleagues of the noble Lord, Lord Filkin, by thanking him for the leadership which he gave the Select Committee and for his own knowledge and enthusiasm which drove that leadership. The five-minute advisory length of speeches will constrain committee members from dealing in any depth with the multitude of issues that we raised. No doubt that was part of the Government’s thinking when they scheduled this debate at this time.

I will restrict myself to one issue only, which came through regularly and strongly in the evidence that we were given. The report states:

“To meet the needs of our ageing population … the health and social care system needs to work well 24 hours a day, seven days a week”.

The Secretary of State told us that,

“we have to have a 24/7 NHS”.

That is good. Actually, it is vital that we have such a service, but when will we have it? We called on the Secretary of State in our report to,

“within 12 months … set out how this will be made real”.

To date, we have heard nothing. The clock is ticking in an otherwise silent room and we look to my noble friend the Minister to inject a degree of urgency in his colleagues—for I suspect that my noble friend senses that urgency even if at times he, too, is constrained from being as explicit about the issue as some of the rest of us wish to be.

Because there was no indication of timing, I put down a Parliamentary Question in July asking the Government what was the percentage of GPs providing a full weekend service. My noble friend will remember his Answer. He told me that it is all being looked at by NHS England. My heart sank because, first, I was a Minister long enough to know that when Ministers are trying to distance themselves from something difficult, they pass it on to someone else. Secondly, as my noble friend knows, I am not a great admirer of NHS England, particularly of its chief executive Sir David Nicholson—he with the wildly chequered career. He is the one who the previous Secretary of State, Mr Lansley, wanted to be wholly in charge of the NHS, rather than the Secretary of State. I know what the department thinks of Sir David. I know what the health professions and the public think of him. I maintain hope that my noble friend will be persuaded to join me and the majority, and put Sir David on a bicycle as quickly as possible.

On the other hand, the Prime Minister announced just recently that he was going to initiate a pilot study in nine areas about GP surgeries running through the weekend and providing a full service. This is very good. Well done, Prime Minister. I am not sure why there are nine areas. To be honest, as a former health Minister, I am not sure whether this policy needs to be piloted at all, but it is a step in the right direction. On the other hand, after 11 and a half years as a Minister, I have developed a marginally healthy scepticism. I was immediately reminded of that old Chinese proverb that states:

“A journey of a thousand miles starts with a single step”.

I have to say to my noble friend that I think we still have 999 miles and 1,750 yards to go. We need a full-week service.

I tabled another Parliamentary Question to my noble friend. I asked him to tell me what percentage of full social care was available at weekends. My noble friend—perhaps above all of his colleagues on the Front Bench—is too courteous and sophisticated to have given me the Answer that the words yelled out: “Nothing to do with me, guv”. We all know who has the primary responsibility for delivering social care. However, we all also know that it is to do with the Government. It is to do with providing what the Government believe people need. If it is not a matter for the Government, who is it for? While we dicker, duck and dive, there are more elderly people with frailties in mind and body, needs, deprivation, suffering and pain. All are made worse by the absence of a full seven-day-a-week service. Only government can ensure that care, support and treatment are administered effectively—I repeat, effectively—24 hours a day, seven days a week.

I have no vested interest but I have hard-won, emotionally draining experience about the importance of that to which I make reference. Near the end of her life, my mother had to spend two weekends in a local hospital because she had contracted pneumonia. Her care and treatment adversely affected her condition, even though the infection was cured. The hospital wrote a self-satisfied letter telling me how good the standard of care that it provided had been. We, the family, could not wait to get her out of the hospital and back to the residential home. In this day and age, that may sound strange because residential and nursing homes have not always had a very good reputation or appreciation—and some of them should not have, because some of the things that have happened have been horrendous. However, I want to say how grateful I am to Abbott House in Oundle for its professional, sympathetic and focused care for my mother and her well-being, despite the pressures that people are facing and the inadequacies of what the NHS made available at weekends.

Our report’s conclusion was that a radical change and an improvement in health and social care were badly needed to provide a full service. I share the view of the noble Lord, Lord Filkin: radical change will take time, and time in politics means cross-party support or radical change will never happen. Without it, the present scandal of the treatment of our elderly will grow to a point where it is not handleable by politicians who wish to act humanely. That is the size of the challenge and the size of the problem that this Government face.

NHS: Children’s Congenital Heart Services

Lord Mawhinney Excerpts

Tuesday 23rd July 2013 Lords Chamber

[Earl Howe]

My Lords, before I answer that, perhaps I may be so bold as to offer the noble Lord my congratulations on his silver wedding anniversary. I recognise why he has asked that question. It is too early to prejudge the final outcome of NHS England’s review, and I should stress that there is no preconceived result in its head. What I can say is that NHS England will need to engage with all key stakeholders throughout this review, including around any competition considerations.

[Lord Mawhinney]

My Lords, if I understood my noble friend correctly, he said that it would take until 2014 to test the process and then the review has to take place. Given the years that have been consumed in the past and that will be consumed in the future, what does my noble friend think all this is doing to the quality of service that is being provided and to the morale of those who are providing it?

[Earl Howe]

NHS England fully recognises that morale is extremely important and that it is fragile in certain locations. That is why the timescale is actually quite ambitious. Contrary to what my noble friend has said, its aim is to have a preferred approach to implementation ready by next June, which, given the scale of the task, is a major piece of work. It will of course build on the modelling and analysis that has already been done, so it is not going to be a wasted effort. In the mean time, I can reassure the House that children’s heart surgery is being delivered safely in all locations.

Medical Litigation: Impact on Medical Innovation

Lord Mawhinney Excerpts

Monday 15th July 2013 Lords Chamber

[Lord Mawhinney]

My Lords, by how much are litigation figures reduced by the intervention of mediators or arbitrators?

[Earl Howe]

I cannot give my noble friend a figure for that, but I can tell him that mediation and arbitration are increasing features in cases of this kind. We are very keen for that mechanism to grow, because the more that cases get into the hands of lawyers—I say this with great respect to noble Lords who are lawyers—the higher the bill to the NHS and the more distress there is to patients and families.

Abortion

Lord Mawhinney Excerpts

Thursday 6th June 2013 Lords Chamber

[Earl Howe]

My Lords, I am aware of all the initiatives mentioned by the noble Lord. The issue of the sex selection of foetuses is, of course, extremely serious. However, as I mentioned in my earlier Answer, following extensive investigation and analysis we do not believe that there is any evidence that this is happening in the UK. That is the prime reason why we do not agree with the noble Lord that measures should be put in place to collect data regularly on the sex of the aborted foetus. Were we to do that it would require changes to legislation. It would also require changes to clinical practice, and it has ethical implications. I hope the noble Lord will understand that we have thought about this very carefully.

[Lord Mawhinney]

Will my noble friend tell us how many prosecutions have taken place in the last year for terminations that fell outside the Act?

[Earl Howe]

I am not aware of any prosecutions in the last 12 months. The Crown Prosecution Service reviewed the evidence of the pre-signing of HSA1 forms and decided not to take further action against some individuals, but other investigations are continuing.

NHS: GP Services

Lord Mawhinney Excerpts

Tuesday 21st May 2013 Lords Chamber

[Earl Howe]

My Lords, I certainly did not mean to mislead the House and if I have done so in any way I apologise. The summary given by the noble Lord is broadly right. Under the old general medical services contract, GPs had a 24-hour responsibility for their patients, although most GPs delegated responsibility to GP co-operatives or commercial providers. At the beginning of 2004, as I recall, only a small proportion of GPs actually provided out-of-hours services themselves. However, 24-hour responsibility continued to be unpopular with GPs as they felt it was discriminatory, which is why the contract was renegotiated at that time. It has brought about a growth in GP co-ops, with more use of telephone triage and more patients offered emergency consultation with a primary care centre. But that has resulted in fewer home visits and I think that point in particular is one that is exercising many people.

[Lord Mawhinney]

My Lords, does my noble friend understand that while he is telling the truth in saying that the contract is only one of a number of aspects that have to be addressed, the problem is that Ministers have said that so frequently from this Dispatch Box and the one in the other Chamber that it is now in danger of being understood as a reason why Ministers will not tackle contract issues? If my noble friend and his colleagues would start by addressing the contract issues, they would be doing us all a great favour. He would thereby be creating a lot more credibility when the other issues, which have to be addressed simultaneously, are turned to.

[Earl Howe]

My Lords, my noble friend makes an extremely important point. He may know that my right honourable friend the Secretary of State is very concerned to look carefully at the current contract to make sure that it does not include too many perverse incentives to tie GPs’ time up too much. If we can work towards a contract with the agreement of the profession that enables GPs to take a more holistic look at their patients’ health and adopt a more preventative approach, which I think everybody agrees is desirable, that is thoroughly to be wished for. However, this is work in progress.

NHS: 111 Telephone Service

Lord Mawhinney Excerpts

Monday 13th May 2013 Lords Chamber

[Earl Howe]

My Lords, the University of Sheffield did work for the department reporting on the first four NHS 111 pilots. That showed that 92% of patients were satisfied with the service and that 93% felt that the advice given was helpful. It also found that, overall, the service was meeting its objective of getting people to the right place first time. On that basis, it was considered safe to go ahead with a rollout. Unfortunately, in particular areas of the country, the resources deployed to meet the demand have not been accurately assessed, but I stress that that is in a minority of locations.

[Lord Mawhinney]

My Lords, does my noble friend accept that if the Government were to take firm action and turn back the clock to require general practitioners to provide seven days a week, 24 hours a day comprehensive and efficient service, demands on 111 would greatly decrease?

[Earl Howe]

My noble friend, with his experience, is very wise on these matters. I think it would be quite difficult to turn the clock back completely, but I take his point. There is enormous scope for GPs to contribute to the drive to keep elderly, frail people in particular out of hospital. Too many people are landing up in hospital with chronic diseases who should never have been allowed to get there.

UK: Ageing Population

Lord Mawhinney Excerpts

Tuesday 19th March 2013 Lords Chamber

[Earl Howe]

My Lords, we know that to adapt and respond to future need, the health and care system needs to change. The conclusions of the noble Lord’s report correlated in many ways with our own analysis in this respect. The challenges that the report sets out create an opportunity for the NHS and local authorities to innovate and explore new ways of working together to meet the needs of their local populations better and to optimise the use of resources, which is of course critical. We think the NHS and local authorities are best placed to understand the opportunities that exist in their areas, and we are committed to supporting them in that regard.

[Lord Mawhinney]

My Lords, will my noble friend undertake to intercede with the usual channels so that your Lordships’ House can have an early and full debate on the report from the Select Committee on Public Service and Demographic Change, given the highly significant consequences that would flow if the committee, of which I was a member, even got it half right?

[Earl Howe]

My Lords, I can say to my noble friend that I will certainly do that, because this is a very important report. I thank not only the noble Lord, Lord Filkin, but all members of the committee, who worked extremely hard to prepare a very well thought out set of conclusions.