Junior Doctors: Contract

Lord Prior of Brampton Excerpts

Thursday 5th May 2016 Lords Chamber

[Baroness Symons of Vernham Dean (Lab)]

My Lords, I beg leave to ask a Question of which I have given private notice.

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

My Lords, my right honourable friend the Secretary of State for Health will write to the Academy of Medical Royal Colleges later this morning explaining that we are willing to pause the introduction of the new contract for five days from Monday should the junior doctors’ committee agree to focus discussion on the outstanding contractual issues: namely, unsocial hours and Saturday pay.

[Baroness Symons of Vernham Dean]

My Lords, I am not sure whether I am entirely happy with the Answer, but it is rather more hopeful than I was expecting and I am grateful to the Minister for it.

This dispute is of enormous importance to everybody. If there is no resolution, what will the Government do when thousands of young doctors refuse to sign contracts later this year and instead opt to become locums?

[Lord Prior of Brampton]

My Lords, given that we have the opportunity over the next five days to try to find a resolution to this dispute, it is probably not helpful now to talk about the “what ifs”. My experience of these situations is, the least said in public, the soonest mended. If the noble Baroness does not mind, I will not answer her question directly today.

[Baroness Walmsley (LD)]

Does the Minister accept that what he has said this morning, welcome thought it may be, is really rather too late? Trust is the most important element when it comes to the provision of medical services. The Secretary of State has already lost the trust not only of junior doctors but of a very large percentage of the general public. It has to be said that the BMA has also lost the trust of a certain percentage of the public. Trust is also important in political matters. We all accept the Government’s intention in their manifesto to provide more services seven days a week—of course, most junior doctors work seven days a week anyway—but does the Minister accept that imposing this contract at the end of the pause period is not the only way of achieving the Government’s objective? Further discussions with those who provide the services may very well find an even better way of providing these seven-day services to patients.

[Lord Prior of Brampton]

My Lords, I am not sure where that question ended up, to be honest. All I will say for today is that we have an opportunity over the next five days for the BMA and the Government to find a resolution to this issue. If we can, it will make the implementation of seven-day working across the NHS much easier.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Government’s approach has been cack-handed throughout the process. It would have been much better if, instead of initially rejecting this proposal and now setting out some new conditions, the Government had accepted it. Obviously, we hope the outcome will be successful and the situation will be resolved. At the end of this process, we are left with thousands of junior doctors disengaged from the service because of the circumstances of the dispute and the alarmist statements issued by the Secretary of State. Will part of the discussions look at how the junior doctors are to be brought back into the fold and given the support they so richly deserve?

[Lord Prior of Brampton]

My Lords, I think there is general recognition that many of the issues that lie behind the dispute over the contract are not actually involved in the contract itself. It is about how junior doctors are trained, valued and integrated into hospitals and the workforce. These are much broader issues than just the contract, and I assure the noble Lord that the Government are fully aware of that. Once this dispute has been settled, we can start to resolve those bigger, deeper and more fundamental issues.

[Lord Patel (CB)]

My Lords, I am surprised but delighted at the news this morning that the Department of Health has agreed to enter into discussions with the junior doctors. I hope that both sides will enter into them in the spirit of finding a resolution, rather than finding faults. I am sure that the talks will resolve the issue, because as far as I am concerned striking is not the answer. Anything that prolongs the exercise is detrimental to patient care.

[Lord Prior of Brampton]

My Lords, I wholly, 100% agree with the words of the noble Lord.

[Lord Naseby (Con)]

Is my noble friend aware that the public will greatly welcome the magnanimity of Her Majesty’s Government in willingly moving forward and having further discussions over a short period? At the same time, though—I can only speak from having talked to some of my former constituents in Northampton—the public want to know what the benefit is to both the public and the junior doctors from this new contract. Maybe the time has come to publicise, through the standby agency of the COI, in an advertisement, exactly what the benefits are to both parties.

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[Lord Prior of Brampton]

My Lords, rather than getting ahead of myself and addressing that issue, I would just say that we have five days to talk and for the Government and the BMA to try to come to an agreement. All our efforts over the next five days should be focused on that.

[Baroness Corston (Lab)]

My Lords, during the five-day process, will the Minister guarantee to revisit the department’s own equality analysis of the effect of the contract, given that it has expressly accepted that the contract discriminates against women in terms of unsocial hours and caring responsibilities but makes the amazing suggestion that this is a legitimate means of achieving a purpose? That is not fair to a profession that is becoming feminised, about which we should be pleased.

[Lord Prior of Brampton]

My Lords, I think we recognise the huge and vital role that women play. Some 60% of all medical students qualifying now are women. If we do not take care of women, we are not taking care of over half our workforce. Again, I do not think anything is to be gained from my making statements on this in public at the moment.

[Lord Wallace of Saltaire (LD)]

My Lords, does the Minister remember the EU working time directive, which a few years ago was touted as being disastrous for the training of junior doctors? It was said that it would make it completely impossible for them to be trained. Now that the Government are trying to push our junior doctors to work longer hours over more days, does that mean that all the fuss over the EU working time directive was a myth, or is this in an entirely different category?

[Lord Prior of Brampton]

No; the noble Lord has misunderstood the contract. The number of hours are coming down, not going up.

[Lord Watts (Lab)]

My Lords, the Government are pursuing a policy which is not evidence-based and is driven by dogma. Would it not be better to seek arbitration to get us out of the mess they have got us into?

[Lord Prior of Brampton]

My Lords, we now have a pause for five days. This is not dogma; we have two parties who have different views about a small part—about 10%—of the existing contract. Over the next five days we have a chance to resolve that.

[Lord Ribeiro (Con)]

My Lords, while the whole House welcomes this pause, I hope that, whatever happens, there will be an opportunity for an independent review to look at the very points that were made earlier about the lack of appreciation of and support for junior doctors. If there is one thing last week’s dispute has shown, it is that when consultants man the front door of a hospital, services are very much better. Will the Government consider having an independent review after this dispute to look at the future workforce?

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[Lord Prior of Brampton]

My Lords, my noble friend will know that Dame Sue Bailey, the president of the Academy of Medical Royal Colleges, has been asked by the Secretary of State to look at these more profound issues outside the contract, and we must do that as a matter of urgency. However, we cannot do that constructively until we resolve the current dispute.

Southern Health NHS Foundation Trust

Lord Prior of Brampton Excerpts

Tuesday 3rd May 2016 Lords Chamber

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

My Lords, with permission I shall repeat as a Statement the Answer given to an Urgent Question in another place by my right honourable friend the Minister of State for Community and Social Care on Southern Health NHS Foundation Trust. The Statement is as follows:

“The whole House was profoundly shocked by the Mazars report into the failings at Southern Health NHS Foundation Trust following the tragic death of Connor Sparrowhawk in July 2013. The first duty to patients and their loved ones is to keep them safe. This applies to all of us with a role to play in the NHS, from the front line to this House; and the Government are therefore clear that we must learn the lessons of this report for the NHS as a whole. We must ensure that the trust itself continues to be scrutinised and supported to make rapid improvements in care. If that means intervention from the regulators, they will not hesitate to take the necessary action, and we will not hesitate to back them.

Last week’s CQC report followed a focused inspection announced by the Secretary of State in December 2015. The report from the CQC set out a number of concerns, including: a lack of robust governance arrangements to investigate incidents; a lack of effective arrangements to identify, record or respond to concerns about patient safety; and a need for immediate action to address safety issues in the trust environment. The report also found that the senior management and board agendas were not driven by the need to address these issues.

I would like to set out for the House the action that NHS Improvement has taken in recent months to address the issues at the trust. NHS Improvement has been working closely with the CQC and the trust over recent months. On 24 March, NHS Improvement, which was operating as Monitor at the time, appointed an improvement director to the trust. On 14 April, following a CQC warning notice on 6 April, NHSI placed an additional condition on the trust’s licence, asking it to make urgent patient safety improvements to address the issues found by the CQC. This condition gave NHS Improvement the power to make management changes at the trust if it does not make progress on fixing the concerns raised.

On 29 April, following the resignation of the trust chair, Mike Petter, NHS Improvement announced its intention to appoint Tim Smart as the chair of the trust. As chair, Mr Smart will have responsibility for looking at the adequacy of the trust’s leadership. Given the centrality of issues of governance to the CQC’s report, I welcome the action taken by NHS Improvement. The direct appointment of a new chair by a regulator is a relatively rare step, and reflects the seriousness of the issues at the trust.

NHS Improvement will continue to monitor the situation closely in the coming weeks and months. I understand that the CQC is considering the trust’s response to its warning notice and the risks it highlighted before deciding whether to take any further enforcement action. The notice required significant improvements by 27 April. NHS Improvement is working closely with CQC and the trust, and there are monthly progress meetings between NHS Improvement and the trust.

In addition to the action we are taking on Southern Health, it is vital that we learn the wider lessons for the NHS as a whole. First, I hope the whole House can agree that it is right that we have robust, expert-led inspection from an independent CQC that provides an objective view about issues of safety and leadership, and that this is backed with action from NHS Improvement when that is required. Only by facing problems in care can we hope to solve them.

Secondly, it is vital that we ensure that we take the issue of avoidable mortality as seriously for people with learning disabilities and mental health problems as we do for other members of our society. To that end, the learning disability mortality review programme has been put in place by NHS England to ensure there is a continual cycle of learning about the causes of premature mortality in people with learning disability. In addition, the CQC will be leading a review of how all deaths are investigated, including those of people with learning disabilities or mental health needs. There can be no question that the CQC report makes for disturbing reading, and that it demands action at local and national levels. We owe our most vulnerable people care that is safe and secure, and I am determined that we do all we can to learn the lessons and make the necessary improvements in the weeks and months to come”.

My Lords, that concludes the Statement.

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[Baroness Tyler of Enfield (LD)]

My Lords, I, too, thank the Minister for repeating the Statement. The original Mazars report highlighted two profoundly shocking issues: the tragic and preventable death of Connor Sparrowhawk and the fact that too many unexpected deaths among those of learning disabilities and older people with mental health problems were even being investigated. Why did a full three months elapse after the Mazars report was published—and, indeed, only after a BBC investigation covered it—before Monitor finally appointed an improvement director to go in to work with the trust on urgently needed improvement? Why the delay?

Secondly, despite a series of national reports—we have just heard about the CQC report—warning notices, monitoring and progress meetings, all referred to in the Statement, nothing has been said about the precise changes that have happened or improvements that have taken place in Southern Health Trust. When can we hope to hear about specific and tangible improvements to the care provided by Southern Health Trust to some very vulnerable people?

Thirdly, it is crystal clear that new leadership needs to be in place if the trust is to retain any credibility, particularly among the people and families who use its services. Why have there been different responses to Mid Staffs and Southern Health? Both are about the neglect and death of vulnerable people in NHS care. There have been serious consequences for those in leadership positions in Mid Staffs, but not so at Southern Health. What does that say about the value placed on the lives of people with learning disabilities and older people with mental health problems?

[Lord Prior of Brampton]

My Lords, a number of serious questions have been asked. I shall make a personal observation. This trust is the result of the merger of three trusts: a mental health care trust, a community trust and a learning disabilities trust, three very complex businesses being brought together as one. They have 250 separate locations with over 1 million patient contacts every year. The risk inherent in that kind of business at this time is huge. In putting in a governance structure, we have to be very careful that we do not just draw up such structures in a boardroom or come up with strategies that cannot be implemented.

In the report, I was very struck by the fact that now there is almost a tick-box approach to the duty of candour; you tick the box to say that you have done it. Culture is usually important in this. What is the culture in the trust? That is one of the big issues that the CQC report is trying to get at. In response to the question of whether we can give guarantees about patient safety: this is inherently a very risky activity. Putting in strong governance structures is very important, but much will depend on the culture within the trust.

I turn to some of the particular points. I, too, was struck by the fact that there were still problems with ligature points in some of the facilities, as had been pointed out by the CQC some time ago. I was struck by the fact that the epilepsy protocol for those being bathed or showered had not yet been approved two and half years after Connor Sparrowhawk’s death. Clearly, there were very significant problems at the trust. On the question of where accountability and responsibility lie, the chairman has resigned. The principal job over the next three or so months will be assessing the capability of the executive management. That seems the right way to approach this.

It is always tempting to call for a public inquiry; I understand that temptation. We have an independent regulator, the CQC. The inspection team was led by mental health professionals and is fully transparent. We now have to give the trust the chance to respond to the CQC’s report and watch for serious improvements.

The noble Baroness asks if there have been any improvements. There are some illustrations and examples in the CQC report of where there have been some improvements, but putting in a new governance structure, changing the whole culture about raising concerns about those kinds of issues, will not happen overnight. Of course, I appreciate that for Connor Sparrowhawk’s family this happened two and a half years ago, and one must never lose sight of that.

A question was asked about NHS Improvement. It put in an improvement director. These people do not grow on trees. If we are honest about the NHS, we are very short of highly qualified and highly skilled senior management, and it sometimes takes time to find the right people.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, the history of people with learning disabilities and mental health problems and the institutions in which they live goes back a long way. Many appalling situations have taken place, and I do not want to belittle this deplorable situation. However, did the report also identify areas of very good-quality care and professional standards? The danger is that vilifying an institution—and even going on to a public inquiry, which prolongs the agony even further—does not give it the opportunity to build on its strengths and provide the quality of care that the hundreds of people working there wish to provide and wish to be proud of doing.

[Lord Prior of Brampton]

I am grateful to my noble friend for those comments. There are many examples in the CQC report of good care. In one of the domains that the CQC inspects, which is caring, it is clear that the vast majority of people who work for Southern Health are deeply caring, committed people. We have to be careful. I am afraid it is a question of the curate’s egg; the report is good in parts. I go back to what I said originally: an organisation this big is incredibly difficult to manage. That is one of the learnings that we need to take from this. The temptation to merge organisations to get centralised cost reduction, or whatever, is very tempting but leads to serious issues around governance.

[Baroness Masham of Ilton (CB)]

My Lords, where does Healthwatch come in? Should there not be far more openness and participation by the public to stop such things from happening? It is all very well having management, but one wants caring people from the community who will speak out on behalf of these people.

[Lord Prior of Brampton]

My Lords, this goes back to the culture of the trust. It is important that members of the public or Healthwatch have a right to go in and visit facilities, and that they are welcomed there, but that they do not go native at the same time—that they are truly independent, looking at it from the patients’ perspective. Healthwatch has an important part to play, and the relationship that it has locally with the CQC inspection team is very important.

[Lord Foulkes of Cumnock (Lab)]

My Lords, I am slightly perplexed. Why is it that, once again, it is only because an Urgent Question was tabled and agreed by the Speaker that Parliament knows all the details and is able to hold the Government to account? If, as the Minister says, the Government are so concerned about it, why did they not volunteer a Statement?

[Lord Prior of Brampton]

My Lords, the CQC report is in the public domain, as are all the CQC reports. To be honest with your Lordships, I am not technically sufficiently aware of the procedures of the House to know why it did not automatically come to the House but, as I say, I am here today.

Mental Health Services

Lord Prior of Brampton Excerpts

Thursday 28th April 2016 Lords Chamber

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment has been undertaken of the likely impact on the quality of mental health care of removing mental health quality premium measures from NHS England’s Quality Premium Guidance for 2016-17.

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

My Lords, the quality premium for 2016-17 enables clinical commissioning groups to choose three local priorities, including from a menu of 17 mental health indicators. Given that mental health is still part of the scheme, NHS England has not assessed the effect of removing it. The Government have invested more than ever in mental health. Spending is estimated to have increased to £11.7 billion, and in January we announced almost £1 billion of extra investment.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for his Answer, but I confess that I am left genuinely perplexed by the decision to drop the national level financial incentive for commissioners locally to improve mental health care. The four national measures account for 70% of the quality premium, which is worth up to £217 million. Relegating mental health to the very long list of 80 indicators from which local commissioners can choose only three seems no substitute. How does that downgrading of mental health in the quality premium scheme square with the Government’s oft-repeated commitment to ensure equality between physical and mental health?

[Lord Prior of Brampton]

My Lords, this year NHS England has chosen primary care, cancer and antibiotic prescribing to be the three key parts of the national quality scheme but, as the noble Baroness has said, 30% is determined locally, of which 17 indicators are related to mental health. NHS England proposes to include a mental health indicator in its national scheme in 2017-18. The point about the national schemes is to provide incentives and they will change from one year to another. If they are the same every year, they will cease to be incentives.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will know that the general record on mental health has been very poor over the past few years. We are far away from parity of esteem; indeed the National Audit Office has commented on this. There is widespread concern within the circles involved in mental health services that, despite what Ministers say, the NHS itself and NHS England are not committed to parity of esteem. Leaving mental health out of the national priorities sends a signal to the NHS that, despite what Ministers say, in the end it is not important. I wonder whether the Government would reconsider this issue and give new instructions to NHS England on it.

[Lord Prior of Brampton]

My Lords, I find it hard to believe that anyone can think that mental health is not a key priority for this Government, given that we have promised to spend another £1.4 billion on children and young people’s mental health and a further £1 billion a year on adult mental health, along with accepting the findings of the Farmer report in full. I assure the House that mental health remains an absolute priority for the Government.

[Lord Watts (Lab)]

My Lords, quite frankly, our experience is that a crisis is taking place, especially in children’s mental health services. Has the Minister visited these centres to see whether that money is being delivered? Our experience is that it is not.

[Lord Prior of Brampton]

I think there is a general recognition that mental health has been the Cinderella service of the NHS for generations and that, within that, mental health provision for children and young people has been a Cinderella service within the Cinderella service. We are putting a great deal of resource into it. Yes, I have visited a number of mental health care trusts. We all know at first hand that the service is highly underfunded, which is why we have committed to spend this extra money on it over the next five years.

[Lord Harrison (Lab)]

My Lords, is not the underlying problem for the health service that we simply do not have the quantum of money and resources available to deal with the many challenges, of which mental health is one? The Minister will well know that diabetes, which is threatening to explode out of all recognition, is one of the others. We need more resources.

[Lord Prior of Brampton]

It is partly a question of resource, although I point out to the noble Lord that the country that spends the most money on healthcare and has the worst results is America. It is not just a question of resource. It is how we spend it as well as the amount of money.

[Lord Crisp (CB)]

I am sure that the Minister well understands that people working in mental health see this as a very negative signal, given all that has been said before. Will he answer two questions, please? First, what would he say to people working in mental health to reassure them that the Government are still giving this level of priority to mental health? Secondly, as he has already said, these quality premiums are intended to incentivise quality. What impact does he think removing mental health from the national priorities —the national quality premium—will have on quality in mental health?

[Lord Prior of Brampton]

What I would say to people in the NHS is that the Government are committed to spending a lot more money—more money than has ever been spent before on mental health—so we are putting our money where our mouth is. We are the Government who signed up, with the Liberal Democrats, to putting parity of esteem in law in the 2012 Act, and we are absolutely committed to doing that. There is no ground for thinking that we are deprioritising mental health. The quality premium that NHS England uses to focus the attention of CCGs will change every year. It had mental health in it last year; it had other issues in it this year; and I hope that it will have mental health in it next year.

[Baroness Brinton (LD)]

Parity of esteem has a very specific meaning and it is good news that some extra money has been coming into mental health services but, until mental health is a real priority and there is equal funding, particularly to take pressure off the acute sector, there remains a problem. Can the Minister please confirm that mental health will continue to benefit from additional funding next year, given the priorities set out in the mental health five-year forward view? It would be really reassuring to the House to know that at least there was continuing additional funding available.

[Lord Prior of Brampton]

I assure the House that, on the funding that the Government have agreed for children’s and young people’s mental health and adult mental health—in the light of the Prime Minister’s announcement in January, but particularly in the light of Paul Farmer’s report that came out six weeks ago —we are fully committed to meeting those obligations.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I do not think that the House in any way doubts the Minister’s personal commitment to additional expenditure on mental health. However, he will be aware if he has been listening to questions in this House over the past few weeks that the issue of mental health provision has come up, for example, on the Question of children caught up in separation yesterday, and in relation to asylum seekers and the prison population. One of the key resources in short supply is mental health practitioners. What are the Government doing to encourage more people coming into the health professions to regard mental health practice as a priority for their careers, not just a government priority?

[Lord Prior of Brampton]

The noble Baroness makes an interesting point. There are no short-term fixes for workforce issues. It is generally recognised that there is a shortage of people choosing psychiatry when they come through their foundation year 2 as junior doctors. We are concerned about that. There has been a significant increase in the counsellors used for delivering IAPT courses, but we are cognisant of the fact that we have to keep a very close eye on that.

Health: Hepatitis C

Lord Prior of Brampton Excerpts

Thursday 28th April 2016 Lords Chamber

[Baroness Featherstone]

To ask Her Majesty’s Government whether the funding for the new interferon-free Hepatitis C treatment will come from the National Health Service or HM Treasury.

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

My Lords, the funding for interferon-free hepatitis C treatment will be provided by NHS England, via its allocation from HM Treasury, as with all NHS treatments.

[Baroness Featherstone (LD)]

I thank the Minister for his Answer. I declare an interest in as much as my nephew was a haemophiliac, who died having been infected with hepatitis C. Today, I seek an assurance from the Minister that none of the £125 million—an inadequate sum—that has been promised to survivors, or families of those who were likewise infected, is used to pay for the new interferon treatment, which is a 99% cure licensed by the NHS. I want his assurance that none of that money will be used for enhanced payment and that all of it will go to support survivors or those who have been bereaved.

[Lord Prior of Brampton]

My Lords, I do not think I can answer that question as I do not fully understand it. Perhaps I could meet the noble Baroness outside the Chamber. All I can say is that NHS England is funding the new interferon-free treatments in accordance with the NICE technology appraisals, and is prioritising people on the basis of unmet need. I think the modelling assumption shows that 10,000 people will receive the new treatment in the coming year. I cannot answer the specifics of the noble Baroness’s question but I will follow it up outside, if I can.

[Lord Patel (CB)]

My Lords, an estimated 220,000 individuals in the United Kingdom are chronically infected with hepatitis C virus. Deaths among the under-60s from end-stage liver disease and liver cancers due to the virus have doubled over the last decade. We have in the interferon-free treatment a drug that is effective in successfully treating the disease, as it reduces the viral load in 98% of patients treated to virtually zero in the whole spectrum of genome of hepatitis C virus. Therefore, it is an effective preventive drug for developing end-stage disease. It has the potential to eradicate the disease in the population. In that scenario, why would we treat only 10,000 patients per year, as the guidance says, for the next two years and not treat every patient who is a chronic carrier of hepatitis C virus?

[Lord Prior of Brampton]

My Lords, there is clearly a budgetary constraint. The noble Lord mentioned 220,000 people—I thought it was slightly less than that—and this drug costs many tens of thousands of pounds per treatment. Clearly, however much we would like to treat 220,000 people, it is just not feasible to do so. That is why we have NICE, which has produced its appraisals and said that, using its modelling, the number of people who need to be treated in the coming year is likely to be between 7,000 and 10,000, rising to 15,000 by 2021. However, I agree with the noble Lord that this interferon-free treatment is a massive improvement on previous treatments, with a very high cure rate.

[Lord Hunt of Kings Heath (Lab)]

My Lords, this is a wonderful treatment, but what has happened is blatant rationing. The Minister says that it is down to money, but something has long puzzled me. The Government reached a five-year agreement with the pharmaceutical industry that any additional costs over a baseline plus inflation would be refunded by the industry and, every quarter, his department gets back millions of pounds from the drugs industry. So can he tell me why arbitrary limits are being placed at local level on the provision of new drugs? What is happening to that rebate money? Is it in fact going back to the Treasury and not the NHS? It is quite unnecessary for there to be this rationing.

[Lord Prior of Brampton]

I feel almost as if we are living on a different planet—of course there are going to be budgetary constraints. Some of these new drugs are hugely expensive. We have a good scheme—the PPRS scheme that the noble Lord referred to—which enables us to get rebates from big pharma, but some of these new drugs are extremely expensive. I cannot say what the exact cost is of this interferon-free treatment for hepatitis C, but I can tell the House that it is many tens of thousands of pounds for a treatment. There are 220,000 people who could benefit from this treatment, according to the noble Lord, Lord Patel—that means many billions of pounds. If we spend many billions on this particular drug, there are many billions that we will not be able to spend on mental health or in other parts of the NHS.

[Lord Mancroft (Con)]

My Lords, can my noble friend be kind enough to tell the House what the 200,000 people who will not receive treatment this year are expected to do, how long they are expected to wait for treatment and—bearing in mind that most or many of them will develop cirrhosis and liver cancer and go on to die—how much it will cost the taxpayer and the National Health Service to care for and treat each patient through to death? How much less is it than the cost of providing treatment today?

[Lord Prior of Brampton]

My Lords, there are many people who suffer from hepatitis C who are asymptomatic and do not know that they have hepatitis C, so I do not know if the figure of 220,000 is true or not. But people with it can have treatment using the drug interferon—which is an extremely unpleasant treatment that can take up to a year and has some very horrible side effects. This new drug is, in many ways, a miracle drug. It is a fantastic drug, but it is incredibly expensive. We have to accept that, not just for hepatitis C but for many cancer treatments, there are going to be some drugs that are too expensive to spend on huge numbers of people.

[Baroness Walmsley (LD)]

My Lords, if there are budgetary constraints, surely those victims who were infected by state action should have priority. Is the Minister aware that there are many Welsh patients who were infected with contaminated blood in English hospitals and are now being used in a game of pass the parcel between the UK Government and the Welsh Government? Can he say what was agreed at the meeting on 24 March between his officials and officials of the Welsh Government? Patients in Wales have not been able to get an answer from the acting Chief Medical Officer of the Welsh Government on this. Perhaps he could write to me.

[Lord Prior of Brampton]

My Lords, this new drug for hepatitis C is made available on the basis of clinical need, not the route of infection. There is a consultation going on about whether a special fund might be established for those who have received infected blood. I cannot answer specifically on the issue of the Welsh people but I will write to the noble Baroness on that matter.

[Lord Kakkar (CB)]

My Lords, I declare an interest as chairman of UCLPartners and Business Ambassador for Healthcare and Life Sciences. What progress has been made on the accelerated access review, which is supposed to be able to address some of these important issues with regard to the adoption of innovation into routine practice in the NHS?

[Lord Prior of Brampton]

The noble Lord makes a very good point. Of course, we hope that the accelerated access review will lower the cost of some of these drugs by shortening the time it takes to approve new drugs. We hope that the accelerated access review will report within a couple of months.

Healthwatch England

Lord Prior of Brampton Excerpts

Tuesday 26th April 2016 Lords Chamber

[Lord Harris of Haringey]

To ask Her Majesty’s Government why, when advertising the post of Chair of Healthwatch England, the Department of Health stipulated that the successful candidate would require private sector experience, and why the governance arrangements for Healthwatch England have been changed so that its Chief Executive is subordinate to the Chief Executive of the Care Quality Commission.

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

My Lords, the chair appointment was open to applicants from all backgrounds. Public appointments benefit from a diverse mix of skills, experience and backgrounds. In some cases, private sector experience may be sought to bring a different perspective that adds real value to the work of the board or committee. The Healthwatch England CEO has always been a CQC employee and this will not change. They will also continue to be responsible for delivering the committee’s priorities.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the Minister for his Answer. However, it is a fact that when the post of the chair of Healthwatch England was advertised, it specifically—I think in the first line, virtually—said that the Government were particularly seeking somebody with private sector experience. Why was that given preference over and above somebody with, perhaps, a background in consumer representation? The CQC chief executive had a direct line of accountability to the Secretary of State. That has now changed. Perhaps the noble Lord can tell us why he thinks his right honourable friend the Secretary of State for Health has acquired a reputation for not wanting to hear contrary views about the state of the health service.

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[Lord Prior of Brampton]

My Lords, I should make it clear that the advert said that someone with a private sector background was desirable, not essential. No one else on the committee of Healthwatch England has a private sector background, so to have that kind of mix would seem common sense to me. Maybe it is particularly the case in that role, following someone such as Anna Bradley, who is very much a champion of consumers. Having that sort of championship of consumers on the board of Healthwatch England is important. With regard to the line of responsibility of the chair of the CQC, she is still ultimately appointed by the Secretary of State for Health.

[Baroness Walmsley (LD)]

My Lords, what precisely is it that somebody with a private sector background could bring to this organisation that somebody without a public or voluntary sector background would not bring? Should not the criteria be much more about understanding how best to undertake public engagement and an ability to shape services that reflect public priorities and concerns? Does this Question not raise a more general one about the politicisation of public appointments?

[Lord Prior of Brampton]

I disagree. I had a private sector background when I became chairman of the CQC, I might add, so perhaps I am slightly biased in this regard. Having a mix of people from all different backgrounds, whether private, public or voluntary sector, is a very good thing.

[Lord Lansley (Con)]

My Lords, would my noble friend the Minister agree with me, as one who was responsible for the creation of Healthwatch, that there is a powerful rationale for its close working relationship with the CQC? The CQC needs to listen to the patient voice in the exercise of its responsibilities, and Healthwatch benefits significantly from being able to trigger action by the CQC where it finds that things are going wrong.

[Lord Prior of Brampton]

I agree with my noble friend. Healthwatch has two principal roles: first, to gather intelligence locally, which it can then feed into the CQC and its inspections; and secondly to be the strong voice of patients at a national level.

[Baroness Wall of New Barnet (Lab)]

My Lords, is the Minister satisfied with the support that Healthwatch gets, both physically and financially? In many areas it is struggling, particularly now that it has had to stand off and be independent. With all the changes going on, is there a view on whether it is effective because of the way it is being dealt with?

[Lord Prior of Brampton]

My Lords, that is a good question. The truth is that Healthwatch is good in parts. Some local Healthwatches are extremely good and some are quite weak. Part of the rationale for the restructuring that the noble Lord, Lord Harris, raised in his Question is to save central overhead costs, which means that there will be more money available to Healthwatch England to do its core job locally.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, is this not just another attempt to bring the private sector into patient representation—just another example of the Government trying to place their business friends everywhere? The new guidelines on ministerial appointments give the Minister three bites of the cherry: to be able to suggest names; to meet some of the candidates before shortlisting to make recommendations to the panel; and then to have the final say. That is completely different from previous practice. If we really are to have an open process, should we not have the Minister involved only at the end, when the panel has made the decision?

[Lord Prior of Brampton]

I honestly do not think that the noble Baroness is correct. I really do not feel that this process has been politicised in the slightest. It is interesting that the chief executive of NHS England and the new chief operating officer were both previous special advisers to a Labour Government, so it is pretty hard to say that we are politicising appointments in the NHS.

[Baroness Hussein-Ece (LD)]

My Lords, I do not think the Minister has sufficiently explained why the patients’ voice, the chairman of Healthwatch, or, indeed, the chief executive should remain subordinate to the chief executive of the Care Quality Commission. Surely the patients’ voice should be a strong, independent voice and not subordinate.

[Lord Prior of Brampton]

I had the privilege of working with Anna Bradley when she was chair of Healthwatch England. I put on public record that she was an outstanding chairman. I do not think any changes have happened that will mean that that role will be in any way diminished.

[Lord Whitty (Lab)]

My Lords, is the Minister confident that the lines of responsibility of the chief executive of Healthwatch are compatible with the very clear assurances that his noble friend, the noble Earl, Lord Howe, gave to this House about the independence of Healthwatch during the passage of the Health and Social Care Act 2012? The House was very anxious about it and I feel that this is against the spirit of those assurances.

[Lord Prior of Brampton]

My Lords, the critical question is whether the CQC is independent. It is most important that the regulator is independent. So long as Healthwatch can help the CQC carry out its role as an independent regulator, surely that is the really important question we should be asking.

Health: Treatment Rationing

Lord Prior of Brampton Excerpts

Tuesday 26th April 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what is their response to the Royal College of Surgeons report showing that Clinical Commissioning Groups are rationing treatments by the use of restrictions on routine surgery for patients who smoke or who are overweight or clinically obese.

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

My Lords, we would not support CCGs imposing arbitrary restrictions on patients. However, there are often sound clinical reasons for encouraging patients to lose weight or stop smoking—for example, to get the best clinical benefit from joint replacement surgery. CCGs should support patients to reduce their tobacco usage or reduce their weight and signpost them to the appropriate services. It is for CCGs to ensure that their local commissioning priorities use resources in the best interests of their patients.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Lord for that Answer because it is clear that these blanket bans are nothing more than crude rationing and cause great distress to patients. Will he issue instructions to CCGs that they are not to embark on these kinds of blanket bans? Does he agree that the programmes to support weight management and smoking cessation should be part of the treatment programme rather than be used as a barrier to treatment?

[Lord Prior of Brampton]

Yes, my Lords. The noble Lord has quoted almost verbatim from the recommendations of the Royal College of Surgeons report, which I have in front of me. I agree with him completely.

[Lord Patel (CB)]

My Lords, does the Minister agree that CCGs should be obliged to publish their evidence base for their policies? If he does not, will he say why not? Further, what recourse does a patient have to challenge their CCG when they do not receive surgical treatment because of the latter’s policies?

[Lord Prior of Brampton]

My Lords, the noble Lord will be aware of the Atlas of Variation, which encompasses a new programme, Right Care; it looks at variations in medical and surgical practice across different populations and tries to spot unwarranted variation. That is the best way to identify where different CCGs are not delivering the kind of care that we would expect. In view of what we have just said, I am tempted to say that where an individual does not get the treatment he expects, he should complain to his local Healthwatch. That would be one way to do it but every hospital has a PALS and he could always write to his MP. There are lots of ways in which individuals can raise concerns if they wish to do so.

[Lord Ribeiro (Con)]

As a surgeon, I had cause to cancel or delay operations on patients who were obese or were smokers, but those decisions were based on clinical grounds from the knowledge I had of the individual patient. Clinical commissioning groups can give guidance but they should not provide diktats. What assurance will the Minister give that clinical decisions will be left to those who have the best interests of the patient at heart and who know their patients?

--- Later in debate ---

[Lord Prior of Brampton]

The noble Lord has encapsulated well the recommendation of the report of the Royal College of Surgeons, which is that all decisions about individual patients should be taken on clinical grounds as they affect the particular patient.

[Lord Rennard (LD)]

My Lords, does the Minister accept that the reduction in expenditure on public health of £200 million a year may make it harder to reduce the prevalence of tobacco smoking and obesity, and that in these circumstances patients referred to smoking cessation courses or weight management courses may find it more difficult to get the support they need? In those circumstances, they may need more guidance and support on how to challenge the decisions of CCGs, if they are being discriminated against unfairly and in breach of national guidelines.

[Lord Prior of Brampton]

My Lords, the success that this country has had on smoking reduction has been pretty exceptional. The strategy on obesity that the Government will announce soon will mark a new priority in addressing the problems of obesity. I do not think there is any evidence to suggest that the reductions to which the noble Lord referred are having any discernible impact on the number of people receiving support on smoking cessation and obesity reduction before surgery.

[Lord McFall of Alcluith (Lab)]

My Lords, selective dorsal rhizotomy, the spinal injuries operation for young people with cerebral palsy, has been not only restricted but withdrawn in both England and Scotland. Numerous paediatric neurosurgeons have given testimony to the near-miraculous benefits of such surgery, which transforms the lives of young people who were previously thought to be wheelchair-bound for their lifetime to one of mobility and independent walking. Therefore, will the Government reconsider this decision, write to me and put a copy in the Library so that this issue is transparent and young people who need this surgery, and whose families are desperate for it, can have the same chance as everybody else in the National Health Service?

[Lord Prior of Brampton]

My Lords, I cannot answer the noble Lord’s question now, but I agree to his request to write to him and will place a copy of my letter in the Library.

[Lord Robathan (Con)]

Does the Minister not agree that everybody in this country must know that smoking and being overweight are bad for them? Does he not think that individuals should be encouraged to take greater personal responsibility for their health, rather than less?

[Lord Prior of Brampton]

There is clearly a balance between the obligations of individuals to take responsibility for themselves and the obligation of society to help people to do so. Getting that balance right has characterised the success we have had in reducing smoking in this country and which I hope we will have in reducing obesity as well.

[Viscount Ridley (Con)]

My Lords, in relation to the reduction in smoking, last week the Government published an impact assessment of the European Union tobacco products directive, which comes into force on 20 May. Does the Minister agree with the estimate by London Economics that aspects of that directive, including the ban on vaping liquids of 20 milligrams per millilitre or more, could increase deaths across Europe by 105,000 people?

[Lord Prior of Brampton]

My Lords, I am not able to answer that question, as I do not have the facts at my fingertips. However, I will investigate it and write to the noble Viscount.

[Lord Hunt of Kings Heath]

My Lords, the Minister said that the obesity strategy would be coming out soon. What is his interpretation of “soon”?

[Lord Prior of Brampton]

Before long, my Lords.

[Baroness Finlay of Llandaff (CB)]

What action does the Minister intend to take against clinical commissioning groups which are commissioning services based on arbitrary, discriminatory decisions rather than on evidence?

[Lord Prior of Brampton]

My Lords, the whole purpose of local commissioning groups was that they would be guided and directed by local clinicians. They must be allowed to set their own local priorities. It would not be right for me to direct local commissioning groups how to behave.

Junior Doctors: Industrial Action

Lord Prior of Brampton Excerpts

Monday 25th April 2016 Lords Chamber

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

My Lords, with the leave of the House, I will now repeat a Statement made in the other place by my right honourable friend the Secretary of State for Health on seven-day health services and junior doctors’ industrial actions. The Statement is as follows:

“Mr Speaker, we have many choices in life but one thing over which we have no control is the day of the week when we get ill. That is why the first line on the first page of this Government’s manifesto said that if elected, we would deliver a seven-day NHS so that we can promise NHS patients the same quality care every day of the week. We know from countless studies that there is a weekend effect showing higher mortality rates for people admitted to hospital at weekends. The British public know it too and today we reaffirm that no trade union has a right to veto a manifesto promise voted for by the British people. We are proud of our NHS as one of our greatest institutions but we must turn that pride into actions. A seven-day service will help us turn the NHS into one of the safest, highest-quality healthcare systems in the world.

This week, the BMA has called on junior doctors to withdraw emergency care for the first time ever. I will update the House on the extensive measures being taken up and down the country to try to keep patients safe but, before I do that, I wish to appeal directly to all junior doctors not to withdraw emergency cover, which will create particular risks for A&Es, maternity units and intensive care units. I understand the frustration which many junior doctors feel: that because of pressures on the NHS front line, they are not always able to give patients the highest quality of care they would like to. I understand that some doctors may disagree with the Government over our seven-day NHS plans, and particularly on the introduction of a new contract. I also understand that doctors work incredibly hard, including at weekends, and that strong feelings exist on the single remaining disagreement of substance—Saturday premium pay. But the new contract offers junior doctors who work frequently at weekends more Saturday premium pay than nurses, paramedics, the assistants who work in their own operating theatres, police officers, firefighters and nearly every other worker in the public and private sectors.

Regrettably, over the course of this pay dispute 150,000 sick and vulnerable people have seen their care disrupted. The public will rightly question whether this is appropriate or proportionate action by professionals whose patients depend upon them. Taking strike action is a choice. If they will not listen to the Health Secretary, I urge them to listen to some of the country’s most experienced doctors. Professor Sir Bruce Keogh, Professor Dame Sally Davies and the former Labour Health Minister Lord Darzi have all urged doctors to consider the damage both to patients and the reputation of the medical profession that this will cause.

Let me also address today some of the other concerns that have been raised by junior doctors. First, there is concern that a seven-day NHS might spread resources too thinly. This Government’s financial commitment to the NHS has already seen a like-for-like increase of 10,700 more hospital nurses and 10,100 more doctors. This is following last year’s spending review which, despite the pressure on national finances, committed the Government to a £10 billion real-terms increase in the annual NHS budget by 2020. So while it is true that pressures on the NHS will continue to increase on the back of an ageing population, we are not saying that the current workforce will have to bear all the strain of delivering a seven-day service, even though they must of course play their part.

Secondly, there is concern that the Government may want to see all NHS services operating seven days. Let me be clear: our plans are not about elective care but about improving the consistency of urgent and emergency care at weekends and evenings. To do this, the Academy of Medical Royal Colleges has prioritised four key clinical standards that need to be met. These include: making sure that patients are seen by a senior decision-maker no more than 14 hours after arrival at hospital; the seven-day availability of diagnostic tests with a one-hour turnaround for the most critically ill patients; 24-hour access to consultant-directed interventions, such as interventional radiology or endoscopy; and twice-daily reviews of patients in high-dependency areas such as intensive care units. Around one-quarter of the country will be covered by trusts meeting these standards from next April, rising to the whole country by 2020.

Thirdly, there is concern that proper seven-day services need support services for doctors at the weekends and evenings, as much as doctors themselves. Less than half of hospitals are currently meeting the standard on weekend diagnostic services, meaning that patients needing urgent or emergency tests on a Saturday or Sunday, such as urgent ultrasounds for gallstones or diagnostics for acute heart failure, face extra hours in hospital at weekends or even days of anxiety waiting for weekday tests. Our new standards will change this, with senior clinician-directed diagnostic tests available seven days a week for all hospitals by 2020.

Finally, there is a legitimate concern that a seven-day NHS needs to apply to services offered outside hospitals if we are properly to reduce pressure on struggling A&E departments. So, as announced last week, this Government’s seven-day NHS will also see transformed services through our GPs.

We are committing an extra £2.4 billion a year for GP services by 2020-21, meaning that spending will rise from £9.6 billion last year to over £12 billion by 2021—a 14% percent real-terms increase. Thanks to this significant investment, patients will see a genuine transformation in how general practice services operate in England. By 2020 everyone should have easier and more convenient access to GP services, including at evenings and weekends. We will not be asking all GP practices to open at weekends to deliver this commitment, but instead using networks of practices to make sure people can get an evening or weekend appointment nearby, even if not at their regular practice. We have committed to recruiting an additional 5,000 doctors to work in general practice to help meet this commitment and we will support GPs in this transformation by harnessing technology to reduce bureaucratic burdens.

Returning to the strikes, the impact of the next two days will be unprecedented, with over 110,000 outpatient appointments and over 12,500 operations cancelled. However, the NHS has made exhaustive preparations to try to make sure patients remain safe, and I want to thank those people in NHS England, NHS Improvement and every trust in the country, who have been working incredibly hard over this weekend to that effect.

I have chaired a number of contingency planning meetings, bringing together the operational response across the entirety of the NHS and social care. From this, NHS England has worked with every trust to ensure that it has plans in place to provide safe care, with particular focus on its emergency departments, maternity units, cardiac arrest teams and mental health crisis teams. As part of their duties for civil contingency preparedness, trusts also have major incident plans in place which are ready to be enacted if required. NHS England has also asked GP practices and other primary care providers in some areas to extend their opening hours so patients can continue to get the important but non-emergency care, such as follow-ups and assessments, they need.

Finally, we have set up a dedicated strike page on the NHS website to provide as much information as possible to the public during this strike action on local alternatives to hospital care, where these alternatives are and when they are open. This website is now live and can be reached at www.nhs.uk/strike. The NHS 111 system will also work as normal during the strike and has been provided with additional staff to cope with the expected increased demand. We would encourage people who are concerned that they may need urgent care to visit this website and call 111 in advance of showing up at their local A&E.

The NHS is busting a gut to keep the public safe. However, we should not lose sight of the underlying reason for this dispute: namely, this Government’s determination to be the first country in the world to offer a proper patient-focused, seven-day health service. To help deliver this, the NHS will this year receive the sixth biggest funding increase in its history. However, it is not just about money, as we know from the mistakes of previous Governments of all colours. It is also about taking the tough and difficult decisions necessary to make sure that we really do turn our NHS into the safest, highest-quality healthcare system in the world. This Government will not duck that challenge, and I commend this Statement to the House.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, instead of reeling off the litany of justifications and figures that we have just heard, is it not really time for the Secretary of State to put aside his pride, stop being pig-headed and listen to people in the national interest? He is clearly not listening to the junior doctors but will he not now listen to the sensible compromise proposal from other parties, including my own, which, I point out, does not undermine the Government’s objectives in the long term?

There are two big differences between the euphemistic “gradual introduction” that he is proposing and the pilot projects proposed by other parties. The first is that of course a pilot scheme can be independently evaluated. If the Secretary of State is so confident that this scheme will not damage patients or doctors, why is he afraid of proper evaluation? The proper and safe implementation of the new contract is surely worth a very small delay. Secondly, a pilot would mean that all junior doctors evaluated in a hospital would be on the same contract, whereas piecemeal introduction, which he is proposing, could mean that two doctors working side by side in the same department were on totally different contracts. Does the Minister not agree that this would be deeply divisive, as well as very difficult practically?

I am also very concerned about the idea of consultants manning A&E departments this week. While I am grateful to them for being willing to step forward in the interests of patient safety, I am concerned that it might work in the opposite direction in their own departments. Who will take the difficult decisions in, for example, cardiology or vascular medicine when urgent cases come up and the consultant is setting somebody’s broken finger in A&E? Has the Minister thought about that?

Should not the Secretary of State consider his position? Is he really the right person to solve this dispute? Patient safety, not the future of his own job, should be his prime consideration. This week, that will be at risk—website or no website.

[Lord Prior of Brampton]

My Lords, I am personally massively sympathetic to the concerns expressed to me by many junior doctors over the last three or four months, and in fact over the last 12 or 13 years. For family and personal reasons, too, I feel hugely in sympathy with the situation in which they find themselves. There is no doubt that the training of junior doctors is wholly inadequate. Their placements are short term and they move from one rota to another, with many rotas unfilled. There is a lack of teamwork now that the old firm has gone and nothing has replaced it. There is also a lack of leadership and mentorship for juniors.

When I compare the training and TLC that junior doctors get with that received by those going into accounting, law, big corporates, investment banking or other areas like that, I think that the lot of the junior doctor is not a good one. I remember reading a paper, probably 10 years ago, by Dame Carol Black when she was president of the Royal College of Physicians. She talked about the deprofessionalisation of the profession, and that really will come to pass if we are not careful. So I am hugely in sympathy with many of these issues and I have particular sympathy for women—especially young women with families and so on.

But let us be honest about this. That is not what this contractual dispute is about. Those are the big issues but this dispute is about pay on Saturdays. That is the issue that the contract fell down on. The noble Lord and the noble Baroness opposite talked about a pilot—but are we really talking about piloting a different Saturday pay structure? Everything else was agreed between the BMA and Sir David Dalton. To be honest, it is disingenuous to say that we could pilot something like that. Fundamentally, this is about pay, and I think that the junior doctors have got it wrong when they go on strike and withdraw emergency cover over an issue related to premium pay on Saturdays. It is simply not a big enough issue to cross the threshold of withdrawing emergency cover. They must recognise that. There will be a time to address the more fundamental issues affecting the training of junior doctors, and they must be addressed for the sake of the profession, of patients and of hospitals—but, sadly, that is not the issue that we are confronting today.

Two other important issues were raised. In answer to the noble Baroness, not all cardiologists and cardiac surgeons are rushing off to an A&E department. They will cover urgent and emergency cases in their own specialties as well.

Although in a way it is not for debate today, the noble Lord, Lord Hunt, raised the very fundamental, long-term problem of whether there are the resources within the system to deliver the ambitions that we all have for a world-class health service. Maybe today is not the time to answer that: we should probably focus on the matter in hand.

[Lord Campbell-Savours (Lab)]

My Lords, perhaps I might ask two very brief questions. First, I recognise the undertaking that the Conservative Party gave in its manifesto, but were the BMA—or the junior doctors, more widely—consulted prior to the general election on their views on seven-day working? That is quite a simple question. If they were, what was their response in that consultation? Secondly, following the Written Questions that I tabled recently on information that the Government might hold on the position of junior doctors, why do the Government not keep statistics on doctors’ resignations from the National Health Service and on the emigration of doctors who cede their posts in the United Kingdom to take up posts overseas? Why are those vital statistics not available, particularly when we are going into this very difficult period?

[Lord Prior of Brampton]

My Lords, first, the need for a seven-day service has been recognised by the medical profession for a number of years. I remember reading the Future Hospital report four or five years ago in which the Royal College of Physicians talked about a seven-day service. Of course, it was the academy of the royal colleges that produced the 10 clinical standards that underpin a seven-day service. The issue is not whether or not there should be a seven-day service; the more serious issue that has been raised is whether we have the resources to deliver a seven-day service. We argue that we are putting enough resources into the NHS to do that. So I think that the principle of a seven-day service, certainly for urgent and emergency care, if not for elective care, is well accepted by the medical profession.

Interestingly, on the point about the number of people leaving—the resignations that the noble Lord referred to—I was pretty horrified to hear about the son of someone on the noble Lord’s Benches who had left the NHS to go to work in America two years ago, I think. He described a pretty torrid time working in the NHS as a junior doctor. To cap it all, when he went, there was no exit interview. No one was really concerned or knew that he had gone. That is just another illustration of the fact that we have not sufficiently respected or valued junior doctors in the NHS.

[Lord Birt (CB)]

My Lords, I wholly support the Government’s objective of seven-day working in every part, eventually, of the health service. However, I observe that the Government are trying to achieve these objectives, as the noble Lord, Lord Hunt, has just said, in a very economically adverse climate where health spend per head is in decline, in a country where the population is expanding very rapidly, and where we see significant bottlenecks right across the system. All of us can see how important junior doctors are to the system. I do not know how many of your Lordships saw the excellent BBC series on junior doctors a year or so ago set at the Royal Liverpool Hospital, in which their importance to the system and dedication was simply remarkable. We would all, I am sure, stand behind that. They should not be threatening to withdraw their labour, but it is amazing that a group of such dedicated workers can even consider doing such an inappropriate thing—they are not natural strikers. The question I put to the Minister is this: as I said, the Government’s objective is correct, but should they not move towards it with greater stealth in the context of moving towards a health service that is again appropriately funded?

[Lord Prior of Brampton]

My Lords, I echo the sentiments of the noble Lord. I recognise the vocational commitment of junior doctors and that they are not natural strikers. It is a tragedy that we have got into this situation. There are no winners in this dispute and only one absolutely clear loser: the thousands of patients who are now suffering. The noble Lord asked whether we could have got here with greater stealth. These discussions have been going on for three years. We have had one independent review done by the DDRB and a number of independent assessments of the impact on mortality of not working at weekends. The Government are putting £10 billion of new money into the health service over the next five years, which was asked for by the NHS. In the NHS there will always be a lack of resources: demand will always exceed supply in a system where there is no price mechanism. That is an issue that all Ministers have lived with in the NHS since 1948. However, I echo his views: it is tragic that we find ourselves in this position with junior doctors. They are not natural strikers.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, is it not unworthy to describe the Secretary of State for Health as being anything other than unequivocally committed to improving patient safety in the NHS? Consistently and throughout his time as Secretary of State, this has been a priority of his with total dedication, and I much regret that anybody should question that. However, is it not equally deplorable that junior doctors, who are respected and loved by the public and are on a step on their career towards consultant posts, should take an action that will undermine the respect and confidence in which doctors have long been held? My noble friend rightly pointed out the many issues concerned with junior doctor training, but extra money for working on a Saturday, which junior doctors have always had to do, as have those in many other professions, is not the reason now to jeopardise their reputation among the public.

[Lord Prior of Brampton]

I can confirm both those points. If the Secretary of State for Health was to fall under a bus tomorrow and somebody was writing his obituary, it is “patient safety” that would be written on his tombstone. That is the one big issue that he has consistently fought for ever since the problems at Mid Staffordshire were uncovered three years ago. Patient safety is his guiding star as Secretary of State for Health. I agree with my noble friend that it is tragic to see thousands of highly committed, highly intelligent and otherwise sensible young people going out on strike.

[Lord Beecham (Lab)]

My Lords, I am sure that there are many in your Lordships’ House, and perhaps people outside it, who rather regret that the noble Lord himself is not Secretary of State for Health as opposed to the present incumbent of the office. He has shown great sensitivity about this issue and, indeed, all others, and is widely respected here. However, is it not unfortunate that the Statement made this afternoon is somewhat disingenuous? It refers, for example, to the high mortality rates for people admitted to hospital at weekends—something which has been disputed in the sense that, to the extent that it exists, it is not necessarily connected to the issue of a seven-day service but rather a function of the emergency situation that many people face which is why they are admitted to hospital at that time.

Is it not equally somewhat disingenuous to refer to the recently announced further investment in the NHS as something that is directed at the issue which is the cause of the dispute? As has already been pointed out, the service has been denied comparable funding to that in previous years and is in a very serious condition up and down the country. I hope that the Minister can persuade the Secretary of State that it would not be a futile exercise, as he has perhaps suggested today, to accept the suggestion made by the group of four people from different backgrounds, including a former Conservative Health Minister who was also a doctor, to have a discussion about trialling the new scheme? As is so often the case in this House in other contexts, decisions appear to have been made without any proper assessment of the potential outcome. In this case, there is a very serious potential outcome both for the service and for patients. Will the Minister speak again to the Secretary of State to reflect the view, which I suspect is fairly widely shared, that the Secretary of State is making a mistake in not acting on the suggestion that has been made?

[Lord Prior of Brampton]

On mortality rates at weekends, the noble Lord is absolutely right that there has been confusion about the difference between the terms “excess mortality” and “avoidable mortality”—the two are clearly very different. However, having said that, I think it is widely recognised that the lack of senior cover and diagnostic support, particularly at weekends, is not at all satisfactory. Certainly Bruce Keogh and others have looked at this—I think that there have been six very detailed studies looking at mortality at weekends. The fact that there is a higher level of mortality than you would expect is ground for providing greater support at weekends. As for the suggestion that there should be a pilot scheme to study the contract, I tried to answer that in my response to his noble friend and I have nothing else to add to that.

[Lord Patel (CB)]

My Lords, what will happen tomorrow and the day after is unprecedented in the history of the NHS: junior doctors will withdraw their services from emergency care. Despite some of my own family disagreeing with me, I, as a doctor, could never have contemplated taking that action. But the junior doctors today do feel hard done by for many reasons, which the Minister has stated, about how they and their training are valued—and that is an issue that we need to address. I am not allowed to make a speech today, and I will not, so let me come to the crucial point. The Minister said that the crucial issue is that of Saturday pay. It cannot be impossible for both sides to agree to sit down to break this deadlock and discuss these pay issues. Otherwise, where are we going to go? We have to find a solution. On the one hand, the junior doctors are saying, “Do not impose the contract on us”, and on the other hand, the Secretary of State is saying, “I have to impose the contract because you won’t agree with my pay conditions”. There has to be a solution. What solution does the Minister think we might have?

[Lord Prior of Brampton]

My Lords, we have discussed this issue outside the Chamber. Although one must never give up hope, I find it hard at the moment to see how a negotiated, agreed solution might be found. We have had three years of negotiations; we have had 75 meetings. We came within a hair’s breadth of a solution, with the Government making concessions around how much of Saturday should attract premium pay, but we were unable to do the deal. Sir David Dalton, a very distinguished, well-respected chief executive of Salford Royal, led those negotiations and his advice to us afterwards was that he could not find a way through it. His advice then was that we had no choice but to impose the contract. None of us wanted to impose the contract; we all wanted to find a solution. But with the current BMA executive we found that impossible. Much as I regret it, as things stand this evening, I do not see a solution.

[Lord Ribeiro (Con)]

My Lords, as a junior doctor in 1975, I went on strike, so I can understand why junior doctors might feel the way they do. The difference between 1975 and now is that we did not withdraw emergency cover. That is the point we should concentrate on, because I fear that, on Tuesday and Wednesday, people will be denied care irrespective of the cover provided by consultants and we will see some deaths occurring. When they do, the blame will fall squarely on both parties, which is most unfortunate. Something needs to be done. It is late and, as the noble Lord, Lord Patel, said, we are talking about a sticking point over Saturday. Surely we could agree that emergency care starts at 1 pm with premium pay. Perhaps that would be both sides meeting in the middle.

When this is all over—I regret that I think that tomorrow’s strike will go ahead—may I please ask that we have an independent inquiry and review? This is about the sustainability of a workforce that does not use junior doctors at the front door to deal with all the work. We need a workforce that will put senior decision-making at the front door of a hospital so that the juniors can have more time to be supervised and trained.

[Lord Prior of Brampton]

My Lords, I completely agree with that. When the dust has settled, we have to take a wholly new and independent look at how junior doctors are trained. As the noble Lord will know, Sue Bailey, chair of the Academy of Medical Royal Colleges, has been asked to look at this, but I do not think it is possible to do that sensibly while the dispute is ongoing. We need the full co-operation of junior doctors in that review. I would personally welcome an independent assessment of the way we train junior doctors once this dispute has been settled. I share my noble friend’s views entirely: it would be wonderful if the junior doctors would agree to provide emergency cover on Tuesday and Wednesday this week. But it is now 8.15 pm on Monday and time is rapidly running out.

[Lord Elystan-Morgan (CB)]

My Lords, the High Court will adjudicate in the first week of June on whether the Secretary of State ever had the authority to dictate to the junior doctors. There are different views on that question, but it does not really matter if the judgment goes against the junior doctors; the question is whether it is politic, sensible and proper in all the circumstances for the Minister to proceed by way of diktat. I urgently ask the House to consider these words; they are not mine but those of Sir David Nicholson, who up to two years ago, as your Lordships will remember, was the head of the NHS in England. They are addressed directly to the Secretary of State:

“Our future consultants, leaders and chief executives will forever remember you win by the exercise of power and imposition a catastrophe for the NHS”.

[Lord Prior of Brampton]

My Lords, as I have said, this is not a place where we ever wanted to be. Imposition was absolutely a last resort and I again try to assure the House that it was arrived at only after three years of negotiation, an independent review by the DDRB and countless meetings. It was felt that, after all that time had elapsed, we had no choice but to impose the contract.

[The Earl of Caithness (Con)]

My Lords, I declare an interest as one of those who have suffered as a result of the doctors’ strike. My appointment on 9 March was postponed until tomorrow—that was a seven-week delay; I do not know when the next appointment will be—but many people are in a much more serious condition than me. Can my noble friend tell the House what the knock-on effect will be? The Statement referred to 110,000 patients who were due to be seen at the time of the last doctors’ strike, who were scheduled to come in for this doctors’ strike and who will now be delayed yet again and clog up the system.

[Lord Prior of Brampton]

My Lords, there is an important distinction to be made around withdrawal of emergency cover. I can of course sympathise with the tens of thousands of patients who have been badly inconvenienced—that is bad enough—but when you withdraw emergency cover, people can die. It will be surprising if there are not some severe outcomes from what is happening tomorrow. Tens of thousands of people have been severely inconvenienced; tens of thousands of people have had their treatment disrupted, but the real tragedy will be when people lose their lives.

[Baroness Cumberlege (Con)]

My Lords, I thank the Minister for setting out some of the difficulties that junior doctors face. I declare an interest: I run a company which trains a lot of junior doctors. Ten years ago I did the work on professionalism for Dame Carol Black and we produced our report, Doctors in Society. We said that professionalism is signified by the values, behaviours and relationships that underpin the trust the public have in doctors.

On Wednesday of last week I made a statement—I was asked to give a lecture—and I threw down a gauntlet to the Royal College of Physicians and said that it was 10 years since we did that work; would it not now consider redoing it? I am delighted to say that it has accepted that and I hope my noble friend will support it.

Medicine is a much-respected profession and withdrawing care from those in extremis is an erosion of professionalism. It is also an erosion of trust that the public have in doctors. I hope this strike will be resolved as soon as possible and that, at least, we can get on to see the issues that the Minister has mentioned and address them through the royal college and the academy.

[Lord Prior of Brampton (Con)]

My Lords, time is up so I shall be very brief. I am delighted that the Royal College of Physicians is going to redo its work on professionalism. My noble friend is right that the real damage could be a long-lasting damage to the public’s trust in the profession. However, I am sure it will be rebuilt in time.

Wheelchair Users

Lord Prior of Brampton Excerpts

Thursday 21st April 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether they will introduce uniform standards and a national tariff payment in order to achieve high-quality outcomes for wheelchair users.

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

My Lords, NHS England is developing a national dataset to ensure transparency about the quality of services in order to drive improvement. NHS England and NHS Improvement are actively working with the sector to define the currencies and reference costs that will enable national tariffs to be set.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord will know that the wheelchair alliance, chaired by the noble Baroness, Lady Grey-Thompson, has shown that we have, essentially, a set of dysfunctional local wheelchair services with variations in access, standards and waiting times. The noble Lord has referred to a national specification but the reality is that, unless he can ensure that it is mandated at local level we will not get high-quality, consistent services. Will Ministers be prepared to meet the wheelchair alliance to discuss how we can get uniform, high-quality standards at local level?

[Lord Prior of Brampton]

The noble Lord is right: the variation in wheelchair standards around the country is wholly unacceptable. The truth is that we do not know the level of this variation because we have never collected the data before. The data are now collected and, of course, I can answer yes to his question. In fact, my honourable friend in the other place is making an announcement on 18 May, I think, about the support we are going to provide to local CCGs over wheelchair provision. I am sure that I can speak for him and say that he will be delighted to meet the wheelchair alliance.

[Baroness Gardner of Parkes (Con)]

My Lords, is the Minister aware of problems encountered with London buses? I declare an interest in that my daughter has used a wheelchair for many years, although just recently she has made a marvellous improvement after being given an electric impulse and has been able to walk for the first time for 30 years. Bus ramps have been broken by wheelchairs that are too heavy. She has done a lot of work to ensure that wheelchair manufacturers produce wheelchairs with a marked vehicle weight that will not damage buses. Therefore, there is a need for more uniformity in higher standards.

[Lord Prior of Brampton]

I totally agree with my noble friend that there is an absolute need for greater uniformity and standardisation. The level of variation around the country is wholly unacceptable.

[Baroness Brinton (LD)]

My Lords, the NHS guidance on the website to people seeking a powered wheelchair says:

“Each service will have a strict criteria of eligibility. Usually the NHS services do not provide powered wheelchairs … for outdoor use only”.

Some areas, including mine, say that this means you get one only if you need to use it inside your own house. This does not mean independent living. When will the criteria be changed to ensure that if a powered wheelchair is needed for work purposes it will be provided?

[Lord Prior of Brampton]

As the noble Baroness knows, the criteria are local at the moment. The point of collecting the data and developing a tariff, which takes into account assessment, the equipment and repair and maintenance, is to have local commissioning against the national standard.

[Baroness Grey-Thompson (CB)]

My Lords, I declare an interest as chair of the national Wheelchair Leadership Alliance. Does the Minister recognise that not getting this service right is increasing the burden on the NHS? The cost of fixing a pressure sore alone is about £150,000, whereas providing the right cushion costs £400, so by improving wheelchair services we can save the NHS money rather than costing it money.

[Lord Prior of Brampton]

The noble Baroness is absolutely right. Getting the wheelchairs fitted properly and making the right assessments can save the NHS a fortune. It is outrageous that we have not tackled this before. The tragedy of the NHS is that if you do not have a tariff or target, you do not get the money. We are developing a tariff. The charter developed last year by the wheelchair alliance is an outstanding document.

[Lord Faulkner of Worcester (Lab)]

My Lords, can the Minister indicate how much progress his honourable friend the Minister for Disabled People has made in persuading Britain’s sports governing bodies, particularly the football authorities, to make sure that all their stadia comply with the accessibility guidelines, which are of course of particular importance to wheelchair users? I declare an interest as a vice-president of the Level Playing Field charity.

[Lord Prior of Brampton]

My Lords, I am afraid that I cannot answer that question as I do not know the answer. If it is all right to do so, I will write to the noble Lord and place the answer in the Library.

[Baroness Masham of Ilton (CB)]

My Lords, I declare an interest as president of the Spinal Injuries Association. Is the Minister aware of the very complex needs of some people who break their necks, are completely paralysed and operate a wheelchair by pushing the back of their head or by their mouth? Will he assure the House that the specialist hospital units are able to advise CCGs on this issue?

[Lord Prior of Brampton]

The noble Baroness raises a very important point. I will do what I can to ensure that we retain that specialist knowledge that can be provided to local CCGs.

NHS: New Junior Doctor Contract

Lord Prior of Brampton Excerpts

Monday 18th April 2016 Lords Chamber

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

My Lords, with the leave of the House, I shall repeat as a Statement the response to an Urgent Question given in the other place by my right honourable friend the Secretary of State for Health on junior doctors’ contracts. The Statement is as follows.

“Mr Speaker, this House has been updated regularly on all developments relating to the junior doctors’ contract, and there has been no change whatever in the Government’s position since my statement to the House in February. I refer members to my Statement in Hansard on 11 February and to answers to Parliamentary Questions from my ministerial colleagues on 3 March, which set out the position very clearly. Nevertheless, I am happy to reiterate those statements to the honourable lady.

The Government have been concerned for some time about higher mortality rates at weekends in our hospitals, which is one of the reasons why we pledged a seven-day NHS in our manifesto. We have been discussing how to achieve this through contract reform with the BMA for over three years without success. In January, I asked Sir David Dalton, the highly respected chief executive of Salford Royal, to lead the negotiating team for the Government as a final attempt to resolve outstanding issues. He had some success, with agreement reached in 90% of areas.

However, despite having agreed in writing in November to negotiate on Saturday pay, and despite many concessions from the Government on this issue, the BMA went back on that agreement to negotiate, leading Sir David to conclude that,

“there was no realistic prospect of a negotiated outcome”.

He therefore asked me to end the uncertainty for the service by proceeding with the introduction of a new contract without further delay. That is what I agreed to, and what we will be doing. It will start with foundation year 1s from this August and will proceed with a phased implementation for other trainees as their current contracts expire, through rotation to other NHS organisations. Let me be very clear: it has never been the Government’s plan to insist on changes to existing contracts, but only to offer new contracts as people change employer as they progress through training. This is something the Secretary of State with NHS organisations as employers are entitled to do, according even to the BMA’s own legal advice.

National Health Service foundation trusts are technically able to determine terms and conditions, including pay, for the staff they employ. However, the reality within the NHS is that we have a long tradition of collective bargaining, so in practice trusts opt to use national contracts. Health Education England has made it clear that a single national approach is essential to safeguard the delivery of medical training, and that implementation of the national contract will be a key criterion in deciding its financial investment in training posts. As the Secretary of State is entitled to do, I have approved the terms of the national contract.

This Government have a mandate from the electorate to introduce a seven-day NHS, and there will be no retreat from reforms that save lives and improve patient care. Modern contracts for trainee doctors are an essential part of that programme, and it is a matter of great regret that obstructive behaviour from the BMA has made it impossible to achieve that through a negotiated outcome”.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the Minister for repeating the Answer given in the other place, which I have listened very carefully to. It now seems abundantly clear that the Secretary of State does not have the power in law to impose a new contract on junior doctors. The problem is that the Secretary of State’s various Statements over the last few months could not be interpreted in any way other than that he thought he had the power and he was going to impose a contract. The significance of this is that the junior doctors took him at his word. The importance of that is that the Junior Doctors Committee of the BMA took the unprecedented decision to escalate industrial action on the back of his apparent decision to impose the new contract when talks collapsed.

The noble Lord, Lord Prior, knows that I have absolutely no argument with the development of fully comprehensive seven-day services in the NHS. However, the tragedy is that the very group of staff on whom so much is now dependent for clinical out-of-hours care—the junior doctors—has become utterly disenchanted with the way this has been handled. We have reached a very serious situation, and I very much fear for the future of the NHS and what is happening. I just say to the noble Lord that surely, even now, the Government need to find a way through. Interestingly, in the response, which has come from Ministers in the other place, there is a recognition of the benefit of collective bargaining. Is it not time to give collective bargaining another go?

[Lord Prior of Brampton]

My Lords, the noble Lord has raised two substantial points. The first is the difference between introduction and imposition. The fact is that, in the context of the NHS, where there is really only one offer, the difference between introduction and imposition is very small. Technically, it is true that individual employers are responsible for its imposition, but in reality, as the noble Lord will know from all his years in the Department of Health, the Secretary of State has considerable powers in this matter. I do not think the noble Lord would want all trusts to cut their own deals locally—there has to be an actual contract. It is true that when the legislation for foundation trusts was brought forward by the noble Lord’s Government a few years ago, they were given the power to negotiate their terms and conditions locally but, with the exceptions of, I think, Southend and possibly Guy’s and St Thomas’, they have chosen to stick with the national contract.

On the noble Lord’s last point about a way through, there are no winners from this dispute. The patients are very clear losers, and it is tragic that we have got to the situation that we have. The threshold for withdrawing emergency cover from hospitals needs to be a lot higher than the one the junior doctors are adopting on this occasion.

[Baroness Walmsley (LD)]

My Lords, this Statement comes at a time when the latest figures for A&E performance are the worst ever—1% lower, we were told last week, than the figure for January, which was the previous worst ever. The staff are very close to exhaustion. Thirty-five per cent of the doctors in this country were born abroad—the highest level in the OECD. With this very long-running dispute, many junior doctors are now saying that they are going to go abroad, and the Government have not told us whether they will increase the number of places for trainee doctors to try to compensate for that. We, and the doctors themselves, really need to know.

I would also like the BMA to tell us what percentage of its members now want to strike, because I think that it has given us old figures. However, if the Government want a seven-day NHS, this is absolutely the wrong time to target the junior doctors. They need to do some proper negotiation and not hold the sword of Damocles over the heads of some of the most important public servants we have.

[Lord Prior of Brampton]

My Lords, the noble Baroness talks about a proper negotiation. This negotiation has gone on for three years and there have been 75 meetings about this contract. It is hard to know what a proper negotiation is when you have that number of meetings over that period of time. The junior doctors may not recognise this but the Government feel that 73 different concessions were made during that period. In many ways this has gone on for too long, and that is why, when Sir David Dalton got involved towards the end of the contract negotiations, his advice was, “You’ve got to settle this”. We cannot go on and on negotiating and discussing these matters.

On the other point that the noble Baroness raised, the pressure on our emergency services is huge at the moment. She is right that the A&E performance in January was very poor, but it is simply the case that demand on our A&E departments is huge.

[Lord Elystan-Morgan (CB)]

My Lords, is not the reality of the situation that for many months the Secretary of State has used the language of coercion rather than compromise? It is abundantly clear that he never had the statutory authority to impose such a contract of service on the doctors. At what point was he first advised that he had no such authority?

[Lord Prior of Brampton]

I do not think that the Secretary of State has been under any misapprehension about his powers in this matter. The BMA, on behalf of the junior doctors, is judicially reviewing his powers, but those powers are clearly set out in Section 1 of the 2006 Act. It is our position that he has always had those powers, but we expect that to go to a judicial review on 8 and 9 June.

[Lord Myners (CB)]

My Lords, does the Minister commend the Government’s handling of this matter to private sector employers?

[Lord Prior of Brampton]

I think that all good employers recognise that having the trust and confidence of their staff is fundamental. No employer, government or private, would wish to have the outcome we have in this situation. As I said earlier, there are absolutely no winners from this dispute, and the Government regret as much as anybody that we have come to this particular pass.

[Lord Winston (Lab)]

Does the noble Lord agree—I am sure he does—that the great majority of junior hospital doctors, whatever the situation, are deeply altruistic people and remain so? They see this strike as part of that altruism, as is very clear from talking to them, and I am sure the Minister would agree about that. Does he not feel that one risk is the long-term damage not just to the health service but as regards people who are thinking of coming into the health service in the future? The young people whom I see in universities and even in schools are now asking me, “Should I actually be doing medicine?”. Does the noble Lord agree that some kind of compromise at this stage would be better, as it might well save money, rather than cause more anguish and more money to be spent in the long term?

[Lord Prior of Brampton]

My Lords, I certainly agree that some of the best and finest young people in Britain go into medicine. It is a wonderful vocation—I use the word “vocation” advisedly. We have had three years of trying to come to a compromise and there comes a point in any negotiation when you have to draw stumps, although it is very unfortunate and very sad when that happens. Over that three-year period there were opportunities for both sides to come to an agreement and it is tragic that we did not do so, but I feel that after three years the Secretary of State had little option but to accept the advice of Sir David Dalton.

[Baroness Donaghy (Lab)]

My Lords, as a former chair of ACAS, I admit that I have never heard ACAS say, “We have reached the end of negotiations”, although that may be one individual’s view. Sometimes negotiations take a very long time and a lot of patience. If these negotiations have been done in the context of 99% of the population thinking that this contract could be imposed and then, all of a sudden, as we have heard this afternoon, it cannot be imposed, I wonder whether that climate has affected the negotiations. Perhaps ACAS can be brought back in to see whether it can bring about a settlement.

[Lord Prior of Brampton]

The noble Baroness will know that ACAS was involved earlier on in the negotiations, and it was under the auspices of ACAS that Sir David Dalton did his negotiations. I just repeat what I said before: theoretically you can go on with these negotiations in perpetuity. There was a huge desire on the part of the Government to settle this dispute and, as I said, we deeply regret that we were unable to do so.

[Lord King of Bridgwater (Con)]

My Lords, the Statement referred to Sir David Dalton—

Psychiatric Units: Child and Adolescent Patients

Lord Prior of Brampton Excerpts

Wednesday 13th April 2016 Lords Chamber

[Lord Harris of Haringey]

To ask Her Majesty’s Government what assessment they have made of the number of deaths amongst child and adolescent patients in psychiatric units, in the light of the investigation conducted by the charity Inquest.

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

My Lords, every death of a young person in in-patient psychiatric settings is a tragedy. It is essential that each case is fully investigated and lessons learned. Four children have died in in-patient child and adolescent mental health services since NHS England came into existence in 2013. The Minister of State for Care Services plans to meet Inquest to consider what more can be done.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the noble Lord for that response. It is obviously at odds with the comments made by his honourable friend the Minister of State, who told “Panorama” that the department simply did not know how many young people had died in psychiatric care. Does the noble Lord accept that he and his ministerial colleagues have a duty of care under Article 2 of the European Convention on Human Rights towards those in their care in psychiatric units? If so, as he said he was in favour of the principle of all those deaths being adequately investigated, will he ensure that in future there is a requirement on psychiatric units to report on premature deaths of all patients and that they are independently investigated by a body separate from the psychiatric unit concerned? He and I have discussed that in the past in his previous incarnation as chair of the Care Quality Commission.

[Lord Prior of Brampton]

My honourable friend Alistair Burt, the Minister for Care Services, and I accept that the lack of clear knowledge on how many deaths there have been in psychiatric care settings is not satisfactory or acceptable. I think the difference from the figure of nine in the “Panorama” programme is partly because the figure of four is from 2013 whereas the figure of nine probably goes back to 2010. Nevertheless, it is essential that we clear that up and get those facts straight. Alistair Burt has agreed to meet Inquest to do so.

As far as investigating these awful tragedies when they happen and learning from them, where someone is detained under the Mental Health Act and a suicide happens there is a requirement to inform the CQC, as the noble Lord will know. For example, where a child is not detained under the Mental Health Act, there is no such requirement. We are looking at this very thoroughly and when my honourable friend in the other place has completed his work I will write to the noble Lord with our findings.

[Lord Patel of Bradford (Lab)]

My Lords, I want to carry on the discussion about admission to psychiatric hospitals. During the passage through this House of the 2007 mental health legislation, we identified that more than 350 children were placed inappropriately on adult psychiatric wards every year. One assumes that, almost 10 years on, that figure should have dramatically dropped and we should not see children placed on adult psychiatric wards. Can the Minister shed any light on whether we know how many children are still placed on adult psychiatric wards and what is being done to stop that happening?

[Lord Prior of Brampton]

My Lords, I think the figure for children on adult psychiatric wards is 391. It is far too high. It was described in the “Panorama” programme as the Cinderella service of a Cinderella service. What has come to light in the work done by the Sunday Times, “Panorama” and Norman Lamb in the other House is that we have a very serious problem here. It is not going to be solved overnight. The Government have committed to spend £1.4 billion over this Parliament to improve child and adolescent mental health care, but we have a long way to go.

[The Lord Bishop of St Albans]

My Lords, part of the answer to this difficult problem must be to ensure that we get the very best mental health care for young people at the earliest stage possible. I notice that earlier this week a report was published by the think tank CentreForum pointing out that mental health providers turned away 23% of the referrals of under-18s made to them. That includes illnesses such as anorexia, and sometimes young people are turned away because at that stage they have an insufficiently low BMI to justify being treated, despite the evidence that early diagnosis and treatment produce the best results. In the light of that, can the Minister reassure the House that Her Majesty’s Government are keeping under review the criteria by which people are able to access these mental health services, to ensure that we get the best outcomes?

[Lord Prior of Brampton]

My Lords, there is no question but that early intervention is critical. There is a huge amount of unmet need. I expect that everyone in this House will know someone who has a child who has suffered from mental health problems, whether anorexia, self-harm or other aspects of mental ill health. It is a complete disaster, and for anyone who watched that “Panorama” programme it will have been brought very close to home. What the right reverend Prelate says is absolutely right. As I said in answer to the earlier question, we have a long way to go.

[Baroness Tyler of Enfield (LD)]

My Lords, the recent research highlighted on the “Panorama” programme also highlighted the deeply disturbing fact that there is no single body responsible for collecting, analysing and recording these data. What plans do the Government have to ensure that this information is centrally collected and publicised?

[Lord Prior of Brampton]

If I may, I will write to the noble Baroness on this matter. For me, the two profound issues in that “Panorama” were, first, that the parents of that poor girl, Sara Green, had to travel for over five hours to visit her in the in-patient setting that she was in; and, secondly, that she was found to be ready for discharge after three months in that setting but it was six months later when she took her life in the home, because there was no community resource in place closer to her home. The whole thing is a tragedy, but those two aspects in particular were very disturbing.