Health and Care Bill

Debate between Lord Ribeiro and Earl Howe

Committee stage
Friday 4th February 2022 Lords Chamber

[Lord Ribeiro (Con)]

My Lords, would it be possible to collect data to substantiate what my noble friend has said about the reduction in people going overseas to get organs for transplantation? Can we get some figures to be absolutely clear that the numbers are reducing and not continuing, as some of us fear?

[Earl Howe (Con)]

I expect it is possible to capture some data but, of course, there will always be cases of people going overseas who are invisible to those who collect data, and we can never guard against that.

Health and Social Care (Safety and Quality) Bill

Debate between Lord Ribeiro and Earl Howe

Friday 13th March 2015 Lords Chamber

[Lord Ribeiro]

No. The heading “harm-free care” will be changed to “reducing harm in care”.

[Earl Howe]

My Lords, before the noble Lord, Lord Turnberg, decides what to do with his amendment, I shall reinforce the explanation I gave earlier in answer to the noble Lord, Lord Warner. This clause removes the Secretary of State’s discretion around whether the requirements for registration with the Care Quality Commission should cover the safety of care. That is the approach at the moment, but the impact of the change we are making is to embed current policy and practice. As my noble friend Lord Ribeiro has helpfully explained, without this change a future Secretary of State could in theory decide not to include patient safety requirements in future regulations. The Bill ties the hands of future Secretaries of State on this important matter. It would require a change to primary legislation to alter that. That has substantive significance as well as presentational significance.

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[Earl Howe]

The noble Lord makes some very good points. The duty to share information will, we trust, ensure consistency in the sense that it will make it clear when the duty to share applies. It is clear that there is a real commitment throughout health and adult social care to overcome the cultural barriers that Dame Fiona referred to. For example, the sharing of information for the purposes of an individual’s direct care is already required as part of the professional duties of health and care professionals, and sharing for direct care purposes can be undertaken in accordance with the common-law duty of care.

The department is already working with its national partners to offer practical support to local provider and commissioner organisations on information governance and sharing. For example, the department is partner to the Information Governance Alliance, a group of national health and care organisations which has been established to provide a single authoritative source of guidance and support on information sharing. I confirm to the noble Lord that the guidance will include specific examples and will be prepared in consultation with our key stakeholders.

Turning to Amendment 6, the NHS number helps to ensure that an individual’s health and adult social care history is readily accessible when they move along their care pathway. This will improve safety and the experience of care. The adoption of the use of the NHS number as a consistent identifier has been a long-standing government objective.

It may help if I explain a little about the purpose and use of the NHS number. An individual does not need to know their NHS number to get treatment. Conversely, having an NHS number does not imply entitlement to the free use of all NHS services. The NHS number helps to confirm the identity of patients and link health records. There are some electronically based services for which an NHS number is essential and from which a patient who objects to the number being shared may not be able to benefit—for example, as the noble Baroness said, screening programmes, choose and book referrals, and electronic prescriptions in primary care. In these instances, the implications of objecting may be serious, which underlines why the decision to opt out should always be considered carefully and discussed with professionals.

That said, there is an important principle at stake here. The Government are committed to empowering the individual. In the future, it will increasingly be the citizen who determines who has access to their data, with care professionals respecting their preferences. For that reason, the Bill provides that if an individual objects, or is considered likely to object, then no duty to share information will arise under these new provisions. I hope that that is a useful explanation for the noble Baroness.

I am pleased to reassure her also that the Bill will not have any effect on the existing systems to protect victims of abuse. The Care Act 2014 sets out clear duties on adult safeguarding. Under the Act, local authorities must make inquiries, or cause others to do so, if they reasonably suspect that an adult who has needs for care and support is, or is at risk of, being abused or neglected.

Statutory guidance will provide that the early sharing of information is key to providing an effective response where there are emerging concerns. Where an adult has refused to consent to information being disclosed, practitioners must consider whether there is an overriding public interest that would justify information sharing.

There are equally robust mechanisms in place to protect children. The Department for Education has produced statutory guidance entitled Working Together to Safeguard Children, which clearly sets out that professionals should share information with local authority children’s social care where they believe that a child is at risk of abuse or neglect. It states:

“Fears about sharing information cannot be allowed to stand in the way of the need to promote the welfare and protect the safety of children”.

Existing guidance on information sharing for practitioners and managers states that if a child is suffering or is likely to suffer significant harm, professionals should share information even if consent is refused or withdrawn. The interests of the child are paramount.

I agree wholeheartedly with the sentiment behind the amendment in the name of the noble Baroness, Lady Hollins. It is critical that an individual’s communication needs are identified and shared appropriately with those responsible for providing and commissioning care and services. This Bill requires the sharing of information where this information is,

“likely to facilitate the provision to the individual of health services or adult social care in England, and … in the individual’s best interests”.

An individual’s particular communication needs would be a good example of such information. This will be made clear in guidance.

The concerns that the amendment seeks to address reflect those Mencap has recently raised with the Department of Health. I am pleased to say that my officials have had constructive discussions with Mencap and we welcome its offer to help shape the guidance. Mencap welcomes the Bill as it has the potential not only to improve information sharing between health and social care, especially for people with a learning disability, but also has, in its words, the potential to “save lives”. I would add that, provided the patient or his or her attorney have consented to its inclusion, any information from a GP record that can be coded can be included on a summary care record. Work is already under way to expand the summary care record inclusion data set to include specific communication needs items.

[Lord Ribeiro]

My Lords, I thank the Minister for clarifying the issues around the consistent identifier. It is interesting that the use of the consistent identifier and the sharing of information was welcomed at Second Reading by the noble Lords, Lord Turnberg, Lord Willis of Knaresborough and Lord Hunt of Kings Heath. The noble Lord, Lord Hunt, confirmed that the Opposition were very supportive of sharing a patient’s information, which, as he said, was,

“clearly in the best interests of their patients”.—[Official Report, 6/2/15; col. 961.]

That slides me very easily and comfortably into Amendment 5 and the question of best interests, which, again, has been addressed. I must confess that I have always used, and continue to use, the term “best interest” without assuming that this can be used only about those without mental capacity, as defined by the Mental Capacity Act 2005. It is my understanding that in these clauses the phrase “best interests” assumes its general meaning and provides a relevant person with a duty to act in the individual’s best interest when providing information for direct patient care. That is my understanding of the term.

As regards Amendment 6, patient control and choice about how their information is used is the subject of wider government policy. I believe that what needs to be done in that respect has already been illustrated. It is about empowerment of the individual and giving them control over their own information. I also welcome the intervention of the noble Baroness, Lady Hollins, in highlighting a key piece of information in patient care. Her description of a patient who died after surgery for want of the right word when asked a question—the patient answered incorrectly, which led to a fatal outcome—was truly revealing. In my experience, it is critical that if an individual has particular communication needs, those who provide care or treatment should know about them beforehand.

I am confident that the requirements to share information in support of direct care in the Bill already encompass communication needs. The Minister commented that Mencap has sought reassurances that health professionals should become more aware of the ways in which people can communicate their health and care needs. I am sure that, from his statement earlier, work on this will take place to ensure that those concerns are met. With those comments, I hope the noble Baroness will be happy to withdraw her amendment.

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[Earl Howe]

My Lords, I very much hope that I can allay the concerns of both noble Baronesses and the noble Lord. In its report, the Law Commission recommended a consistent main objective for professional regulators and the PSA around patient safety. It also recommended two subsidiary objectives: maintaining confidence in the profession and proper professional standards and conduct. The Law Commission’s report describes this proposal as restating the existing legislative position that public protection is the regulators’ main objective. The Government’s view is that public protection is sufficiently important that it should be expressly adopted in the legislation.

The noble Baroness, Lady Pitkeathley, asked whether public confidence might conflict with public health, safety and well-being. In the example of the Professional Standards Authority identifying a poorly performing regulator, it is clear that the interests of public protection and public health, safety and well-being would require the PSA to take action. In this example, any argument that the objective of promoting and maintaining public confidence in the professions would require the PSA to conceal poor performance would clearly run counter to public protection. The objective of promoting and maintaining public confidence in the professions does not mean that the PSA or the regulatory bodies should be promoting the reputation of the professions generally. Rather, it is about taking action where there is a risk that confidence in the profession as a whole is undermined to the extent that it may deter people from seeking the treatment or care that they need and impact on public protection. This example highlights the fact that while the objectives are all linked to public protection, in practice they may not always necessarily be relevant, or relevant to the same extent in particular cases. It is not a case of one objective overriding another or preventing it being considered but ensuring that they are pursued only where they are relevant to public protection.

The Bill does not prioritise or weight one element of public protection over another. It is for the PSA to determine how it applies those elements in carrying out its functions in relation to the regulators and considering the issues of the case. My view is that health, safety and well-being will always be relevant to public protection when the PSA is carrying out its functions in relation to the regulators. It will be for the PSA to determine how to apply the objectives appropriately.

The noble Baroness asked whether the objective to promote and maintain public confidence might inadvertently lead the regulators to be less transparent in highlighting bad practice. Equally, that might lead to regulatory committees and panels punishing professionals who do not pose any threat to the public. If the actions of a doctor appear likely to reduce confidence in the medical profession and influence the decision of individuals as to whether to seek medical help at all, it may be right to take action. However, panels and committees will be asked to reach their own objective judgment as to whether particular acts or omissions would affect public confidence if no action were taken. A subjective view, uncritically influenced by public opinion or the media, would be an unacceptable basis for a decision.

Turning to the term “well-being”, the BMA has raised concerns with my ministerial colleague Dr Dan Poulter about how it would be interpreted by fitness to practise panels and committees. Well-being has been a long-standing and established feature of the legislation for three of the regulators. It encompasses those aspects of a professional’s role that may have an impact on individual patients but not directly impact on their health or safety. Dignity, compassion and respect are all important in delivering care, and it would not be right to disregard them.

It will be for the regulators to formulate and issue guidance for fitness to practise panels on interpreting and applying the objectives in practice, including the term well-being. The legislation makes clear that those objectives are considered only under the umbrella of public protection.

My officials will draw the regulators’ attention to those concerns should the overarching objective become law. That is in order to inform any guidance that will be needed to implement both this Bill and the secondary legislation for the GMC.

The noble Baroness, Lady Finlay, also asked about how we view the definition of “public” in the Bill. It of course includes patients and service users, as well as other parts of the collective public. I hope that that reassures the noble Baroness that the objectives in relation to well-being and public confidence will not be pursued outside the regulators’ objective to protect the public.

[Lord Ribeiro]

In following the Minister, perhaps I may deal, first, with “well-being”. At paragraph 3.20, the Law Commission’s report states:

“We disagree with the criticism of ‘well-being’. This term has already been incorporated without difficulty into the main duties or objectives of many of the regulators”.

Within that context, it feels strongly that that term cannot be misinterpreted.

The Bill introduces consistent objectives for the PSA and the regulators based on the proposals of the Law Commission’s review last year. Most of the professional regulators have some form of main objective. Although they are not consistently expressed they are generally to protect, promote and maintain the health and safety of the public. It is the health aspect with which the noble Baroness, Lady Pitkeathley, was particularly concerned at Second Reading. I think that that concern has been allayed today.

It is clear that public protection—by “public” I of course include patients—is sufficiently important that it should be adopted expressly in legislation. Defining public protection in terms of these three elements to be pursued by the regulators and the PSA as their overarching objective enables public protection to be considered in its fullest sense. That should give comfort and reassurance to the noble Baronesses who have spoken. With that, I hope that the noble Baroness will agree to withdraw the amendment.

Alcohol-related Disease

Debate between Lord Ribeiro and Earl Howe

Wednesday 17th December 2014 Lords Chamber

[Earl Howe]

My Lords, increasingly, GPs are being made aware of the need to upskill in this area. Of course, it is not just GPs but local authorities who have responsibilities in the arena of public health to make sure that excessive drinking is discouraged. I can write to the noble Lord with the precise details of the GP training that I am aware of.

[Lord Ribeiro (Con)]

My Lords, does my noble friend agree with Professor Roger Williams, author of the Lancet commission report on liver disease, that with more than 1 million admissions per year due to alcohol-related conditions, and the developing tsunami of obesity cases, many of whom will present with non-alcoholic fatty liver disease, services will be seriously stretched in the future? What efforts are going to be made to try to stem this tide?

[Earl Howe]

My noble friend is right. I am afraid that the figures for hospital admissions over the past 12 years make gloomy reading. Admissions relating to alcohol-related illness have more than doubled. We welcome the recent falls in alcohol consumption that we are witnessing, and the falls in alcohol-related deaths, but we should not be complacent—and we are not. Harms such as liver disease, as well as social impacts such as crime and domestic violence linked to alcohol, remain much too high, and Public Health England is giving priority to alcohol issues from this year, particularly through support to local authorities.

NHS: Funding

Debate between Lord Ribeiro and Earl Howe

Monday 17th November 2014 Lords Chamber

[Earl Howe]

My Lords, tackling health inequalities is one of the major tasks facing NHS England. It is built not only into its mandate but into legislation, and we expect NHS England to address it at every level—both in the acute area and in the community. It is of course up to local commissioners to prioritise their funding, but we expect to see over the next few years a shift from care in the acute sector to care in the community, both to prevent acute admissions and to ensure that people stay healthy for longer in their own homes.

[Lord Ribeiro (Con)]

My Lords, the 2004 GP contract, which was introduced by the party opposite, forced GPs to come off on-call rotas at night and at weekends, thus removing them from out-of-hours services. The impact of this on our emergency departments has been quite dramatic. Will my noble friend confirm that the introduction of the Better Care Fund will go a long way not only to integrate these services between primary and secondary care but to remove pressure on our A&E services in the acute sector?

[Earl Howe]

I agree with my noble friend that the primary purpose of the Better Care Fund is clearly to make care better, but it is also a major step forward in making our health and care services more sustainable, and moving to a preventive model that delivers care closer to home and keeps people healthy in the community. GPs have a major part to play in this and I am encouraged by the extent to which they are now engaging in the task of addressing the BCF.

National Health Service: Hospital Beds

Debate between Lord Ribeiro and Earl Howe

Wednesday 11th June 2014 Lords Chamber

[Lord Ribeiro (Con)]

Would my noble friend like to ask the noble Lord, Lord Kennedy of Southwark, how funding is undertaken in Germany? German hospitals are funded on the basis of length of stay. In this country, we have demonstrated that we can get patients home much more quickly, particularly after surgery, with the use of day case surgery. Furthermore, Sweden has fewer beds than we do.

[Earl Howe]

My noble friend makes the case very eloquently that it is very difficult to compare different health systems. We should pay credit to the NHS for performing very efficiently and effectively in the face of rising demand over recent years.

Health: Folic Acid Fortification

Debate between Lord Ribeiro and Earl Howe

Wednesday 2nd April 2014 Lords Chamber

[Earl Howe]

My Lords, we will announce a decision by Easter. I am aware, as the noble Lord is, of the impatience that many people have shown about this matter. However, it is right that the Government balance both the risks and the benefits of a policy that would see the mandatory fortification of a staple food. I think that that is a responsible course to take.

[Lord Ribeiro (Con)]

My Lords, is my noble friend convinced that the evidence for introducing folic acid into white bread flour is irrefutable, given the fact that successive Governments have tried to introduce fluoride into water for all of us but have failed to do so?

[Earl Howe]

My Lords, there are risks associated with the fortification of flour with folic acid. That was pointed out by the scientific committee and was why its recommendation was conditional on certain things taking place. As it pointed out, there is a potential for significant numbers of the population to be pushed above the guideline upper limit for folic acid. We have to take those issues seriously in reaching a balanced decision.

Food and Soft Drink Industry: Sugar

Debate between Lord Ribeiro and Earl Howe

Tuesday 11th February 2014 Lords Chamber

[Earl Howe]

My Lords, tackling obesity calls for action by the widest possible range of partners, including the food industry but also including schools. That is what we are trying to do through the responsibility deal. Our National Child Measurement Programme, the School Food Plan, the School Games and the money that we are putting into school sports funding—£150 million a year—all contribute to the joint effort across government to influence the way in which calories are consumed by children. I have encouraging news on that front, which is that the level of child obesity is now the lowest that it has been since 1998, so we are moving in the right direction.

[Lord Ribeiro (Con)]

My Lords, I congratulate the noble Earl on leading on the successful amendment in this House which led to the vote going through the other place yesterday on smoking in cars. Can he further protect children by tackling the issues around obesity? What are the Government doing to encourage the soft drinks industry to take action on calorie reduction as part of the responsibility deal?

[Earl Howe]

My Lords, I think that the compliment should be paid to my noble friend Lord Ribeiro for the part that he played in bringing about the amendment on smoking in cars. A number of soft drinks companies have taken action to reduce calorie content in their drinks. Coca-Cola has reformulated its Sprite product. AG Barr pledged to reduce the average calorific content in its portfolio of drinks. I have mentioned Sainsbury’s and Tesco’s actions on their own brands. Premier Foods has reformulated various products and reduced sugar in those. Therefore, we are making headway and I think that the responsibility deal is proving its worth.

Mesothelioma

Debate between Lord Ribeiro and Earl Howe

Thursday 5th December 2013 Lords Chamber

[Earl Howe]

I am sure that the noble Lord wants to take advantage of this opportunity to raise that particular issue, but it is a rather different one from the Question posed by the noble Lord, Lord Alton. However, I will take his question away and ensure that a letter is sent to him in response.

[Lord Ribeiro (Con)]

My Lords, the Government are to be congratulated on introducing the Cancer Drugs Fund, but how do they anticipate that the vital research which needs to be done into mesothelioma will continue to be funded without legislation to compel those insurance companies which so far have not stepped up to the plate to make a contribution?

[Earl Howe]

My Lords, as my noble friend will be aware, four insurance companies have stepped up to the plate with funding of £3 million, which admittedly is nearing its end, but I do not think that we can belittle that contribution. My noble friend may be interested to know that the MRC and the NIHR together spent more than £2.2 million on mesothelioma research in 2012-13, which is a larger sum than for many other disease areas. I say again that the issue is not the lack of funding because the research funding in both the MRC and the NIHR has been protected. What is lacking are suitable proposals.

Tobacco: Packaging

Debate between Lord Ribeiro and Earl Howe

Thursday 28th November 2013 Lords Chamber

[Earl Howe]

My noble friend makes a very important point. She is, of course, right that the tobacco companies protect their commercial position with great vigour. We will indeed keep an exceedingly close eye on the actions of the tobacco industry and, should we decide to introduce regulations, we will do all we can to ensure that they are watertight.

[Lord Ribeiro (Con)]

My noble friend should be congratulated on his leadership in taking forward this proposal on plain packaging. He will be aware that I have introduced a Bill on banning smoking in cars where children are present. I recognise the difficulties that that presents for the Government, but after this three-month period of consultation, if the recommendations of Sir Cyril Chantler, who, I agree, is a very highly respected clinician, are accepted by the Government and legislation is introduced, I hope that that will give an impetus to the Government to think again about the importance of banning smoking in cars where children are present.

[Earl Howe]

I pay tribute to my noble friend for his championing of this cause. I am sure that the main reason people smoke in cars is that they do not understand how harmful second-hand smoke can be for children. Of course we would like to see smoking in cars carrying children eradicated entirely but, at present, we are not convinced that legislation presents the most effective or proportionate approach. Rather than create new offences, we prefer to promote and encourage positive behaviour change, and there is emerging evidence that we are succeeding on that score.

NHS: EU Legislation

Debate between Lord Ribeiro and Earl Howe

Monday 21st October 2013 Lords Chamber

[Earl Howe]

My Lords, it is the impact on our health service that we want the Royal College of Surgeons to look at specifically. In the coalition agreement, we committed to limiting the application of the working time directive in the UK, including in the NHS. Nobody wants to go back to the bad old days of tired doctors, but it is important for the working time directive to have more flexibility for a health service that operates on a 24-hour basis. Increased flexibility for the NHS would allow it to take account of local needs and practices, while at the same time ensuring the health and safety of the workforce. We stand prepared to work with partners in Europe to that end. I believe there is strong support in the NHS for this.

[Lord Ribeiro (Con)]

My Lords, I thank my noble friend for acknowledging the role that the president of the Royal College of Surgeons is playing to ensure that the European working time directive is not having an adverse impact on patient care. In the United States, the duty hours that surgeons work are limited to 80, although flexibility has been introduced into their working so that trainees nearing independent practice can work more flexibly and for more hours. As 80% of surgical trainees currently work more than 48 hours a week, is it not time that we applied some flexibility to the European working time directive?

[Earl Howe]

My noble friend speaks, as always, with great authority on these matters. The independent review is by clinicians and of clinicians, looking specifically at the issues associated with the implementation of the directive. It means that any issues that are identified and can be acted on without needing to change the law—which was one of the points underlying my noble friend’s question—could lead to swift and effective action. In addition, my noble friend might like to know that the review will be looking at how the directive interacts with the junior doctors’ contract. It is intended to provide a sensible front-line view of doctors’ working hours.

Health: Cancer

Debate between Lord Ribeiro and Earl Howe

Monday 20th May 2013 Lords Chamber

[Lord Ribeiro]

My Lords, we have 11 cancer registries in the United Kingdom and Public Health England is due to merge eight of the English cancer registries with the National Cancer Intelligence Network this year. The United States and Sweden have national registries, and the benefit of that is that they are able to establish not only the diagnosis and causation but also the impact of treatment on patients and provide much more information to improve the quality of outcomes for patients. Is it not time that we had a national registry, mindful that independence for Scotland may put this at some risk?

[Earl Howe]

My noble friend raises a very important issue. I agree that it is important to draw together as much information as we can about causes of death from across the country. However, I am advised that the question of whether a cancer-related death can be attributed to the underlying disease or to the treatment cannot be answered comprehensively from information collected as part of the death certification process or the cancer registration process or, indeed, a combination of both. However, as I hope my previous answer indicated, I am sure that this is a developing science.

NHS: Out of Hours Service

Debate between Lord Ribeiro and Earl Howe

Tuesday 26th March 2013 Lords Chamber

[Earl Howe]

My Lords, of course, the results from the Patients Association report are a matter for concern. We are absolutely committed to improving access to GPs and, from 1 April, responsibility for making sure that that happens will pass to the NHS Commissioning Board. We have outlined a clear set of objectives around patients’ experience of local primary care services in the mandate to the board; we have launched marketing campaigns in each of the new NHS 111 areas, which we are confident will facilitate better access to out-of-hours care; and we will publish information regularly, so that patients can see how their practice is performing and feed back to their practice when it is not performing.

[Lord Ribeiro]

My Lords, at a time when nurses are being urged to wash their patients, is it not time that the GP contract was renegotiated so that GPs can be responsible for the out-of-hours care of their patients and, in doing so, perhaps relieve the pressure on our A&E departments?

[Earl Howe]

Increasingly, this is likely to happen, because our changes to the GP contract this year are bound to make sure that GPs think more about long-term integrated care for their patients. The recommendations from NICE underpinned the new arrangements in the GP contract, and my noble friend is absolutely right that that has to remain very squarely in the sights of all GPs.

NHS: Research and Development

Debate between Lord Ribeiro and Earl Howe

Monday 17th December 2012 Lords Chamber

[Earl Howe]

I agree with the noble Lord. The Government are providing a record £800 million over five years for NIHR biomedical research centres and units as from April of this year. The centres are based within the most outstanding NHS and university partnerships in the country; they are leaders in scientific translation; and they will play an integral part in the life sciences strategy which the Government published last year.

[Lord Ribeiro]

My Lords, may I declare an interest as a surgeon and say that surgical research attracts less than 2% of the total funding that goes into research? There may be those in this House who feel that surgeons just cut and do not actually do an awful lot of laboratory work, but the truth is that research is an integral part of surgery. We are there to bring translational research from the lab to the patient and to produce results, particularly in the field of cancer. I would therefore be grateful if my noble friend could assure me that there will be much greater emphasis on providing support for surgery?

[Earl Howe]

I agree with my noble friend about the importance of surgical research. The NIHR funds extensive research in surgery across a wide range of funding streams. The most recent estimate of its spend on directly funded research relating to surgery was £7.3 million, but that is a rather historic figure which goes back to 2009-10. In February this year, the NIHR issued a call for research on the evaluation of technology-driven implanted or implantable medical devices and decisions will be made on that next March. Twenty million pounds has been invested in the NIHR Surgical Reconstruction and Microbiology Research Centre, which is an initiative between my department, the Ministry of Defence, the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. I hope that my noble friend will agree that that is a positive development.

NHS: Women Doctors

Debate between Lord Ribeiro and Earl Howe

Tuesday 6th November 2012 Lords Chamber

[Earl Howe]

My Lords, there is no evidence that there is a problem with female recruitment into the health service. Indeed, the male-to-female gender balance over the past few years has decreased from 1.83:1 in 2001 to 1.25:1 in 2011. However, I recognise that we should not be complacent. Even with the increased participation of women in medicine, we appreciate that more can be done to improve the selection of senior doctors into senior positions.

[Lord Ribeiro]

My Lords, I declare an interest as a member of the committee chaired by the noble Baroness, Lady Deech. In 1998, I introduced the first job-sharing scheme for female trainees in London and Essex. This involved two girls who both had children and managed to complete their training before the 48-hour week was introduced. What efforts are the Government making to encourage job-sharing and less than full-time training?

[Earl Howe]

My Lords, the Government fully support flexible working. We encourage organisations to take account of the recommendation made by the noble Baroness, Lady Deech, on that subject and adopt working arrangements that are amenable both to doctors who are parents and doctors who are carers.

NHS: Definition of Exceptional Case

Debate between Lord Ribeiro and Earl Howe

Monday 2nd July 2012 Lords Chamber

[Earl Howe]

My Lords, I hasten to reassure the noble Baroness that I have every sympathy with the individual in question, and I was aware of this particular case. The chief executive of the NHS will shortly be writing to her clinical tutor to suggest a possible way forward. However, I should put on record my view that the commissioner is acting reasonably in insisting that its decision on exceptionality should depend solely on the clinical need of the patient, and not on any broader social factors. If there is now good clinical evidence to support the use of this particular treatment, commissioners should be considering whether to make it available to all patients with similar clinical needs, and not just to a few individuals.

[Lord Ribeiro]

Is my noble friend aware that the pancreatic unit at Leicester is not able to do any islet cell transplantation operations because the PCT refuses to fund them? The excuses used to justify not funding these operations are that these may be “procedures of limited value” and “experimental surgery”. There are, in fact, four clinical units throughout the UK doing islet cell transplantation, with good records and good outcomes. I want to know whether the PCTs are not funding these operations in order to present a clean sheet to the incoming CCGs in April 2013, or whether there is another reason.

[Earl Howe]

My Lords, no, that is not the reason. My noble friend is quite right that this treatment has been around for a little while. However, it is not yet in mainstream practice. It is expensive, it is not routinely available in the NHS, and indeed NICE has published interventional procedure guidance which concludes that it,

“shows some short term efficacy, although most patients require insulin therapy in the long term”.

That does not seem to me to be a resounding endorsement of this treatment.

Tobacco: Control

Debate between Lord Ribeiro and Earl Howe

Tuesday 19th June 2012 Lords Chamber

[Earl Howe]

My Lords, if we are successful in our strategy to reduce smoking rates significantly, an inevitable consequence will be that, over time, less and less tobacco will be sold. It is smoking that we aim to reduce, which will have consequences for the sale of tobacco products. For the good of public health we are trying to arrive at a point where there is no smoking in this country, and that would mean no retail sales of smoking tobacco. Hence I fully support the remarks of my right honourable friend the Secretary of State.

[Lord Ribeiro]

My Lords, I am grateful to my noble friend for acknowledging the harm and damage that smoking does. Can he assure the House that the Government are equally determined to ensure that smoking will not have an adverse effect on children and children’s health in the future?

[Earl Howe]

The need to reduce and, we hope, eliminate the uptake of smoking by young people is one of our top priorities. I would like to thank my noble friend for his Private Member’s Bill, which will certainly enable this issue to benefit from a wide airing. We would all like to see smoking in cars with children eradicated—the health of people can be harmed by second-hand smoke. The key question for us at the moment is what is the most appropriate and workable way of protecting children from second-hand smoking. No doubt we will debate that matter when we come to my noble friend’s Bill.

Health and Social Care Bill

Debate between Lord Ribeiro and Earl Howe

Tuesday 13th March 2012 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend Lord Ribeiro for tabling these amendments, which address the important issue of ensuring that patients have consistent access to appropriate and cost-effective drugs, whether a service is commissioned by the NHS or by local authorities.

As the House will know, NICE’s technology appraisals provide important recommendations on the clinical and cost-effective use of medicines and other technologies in the NHS. The funding direction that applies to recommendations in NICE technology appraisals has helped to ensure equity of access to NICE-recommended drugs and treatments wherever patients live in England.

While technology appraisals are perhaps most commonly associated with specialist drugs or interventions used or initiated in NHS secondary care, they also make important recommendations about drugs and interventions for use in other care settings, including preventive interventions. In future, these are likely to fall within the scope of local authority commissioning responsibilities for public health. My noble friend mentioned the example of Champix. He is right: technology appraisals could address drugs to aid smoking cessation and treatments to tackle substance misuse.

I agree with my noble friend that extending a funding mandate to NICE-appraised drugs or treatments commissioned by local authorities would bring important benefits. It would guarantee patients access to appropriate and cost-effective drugs, whether a service was commissioned by the NHS or by local authorities. In doing so, it would protect patients’ existing rights as set out in the handbook to the NHS constitution, to which he rightly made reference. I am very pleased that I am able to support these amendments and I hope that your Lordships will feel able to support them as well.

[Lord Ribeiro]

My Lords, I thank my noble friend the Minister for accepting the amendments. I thank also the noble Lord, Lord Beecham, for his kind words.

Tobacco

Debate between Lord Ribeiro and Earl Howe

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, yes, the vested interests of the tobacco companies are well recognised. The Department of Health is careful to ensure that the Government’s obligations under the framework convention are met, including the treaty obligation to protect public health policies from the vested interests that he referred to. For example, I hasten to reassure him that the tobacco industry was not involved in the development of the Government’s tobacco control plan, which was published last year.

[Lord Ribeiro]

Can my noble friend outline what steps the Government are taking to reduce the promotional impact of tobacco packaging, particularly that which is targeted at vulnerable young girls?

[Earl Howe]

My Lords, we shall shortly be announcing a consultation on the subject of plain packaging for tobacco. We wish to hear views from all interested parties on that subject.

Smoking

Debate between Lord Ribeiro and Earl Howe

Thursday 8th September 2011 Lords Chamber

[Lord Ribeiro]

To ask Her Majesty’s Government whether they will introduce legislation to stop adults smoking in cars when children are present.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, exposure to second-hand smoke is hazardous, especially to children’s health. Since smoke-free legislation was introduced in England in 2007, evidence shows that the number of children being exposed to second-hand smoke has continued to fall. However, some children are still exposed in the home and in family cars. We want to encourage people to create family environments free from second-hand smoke. The Government are proposing a range of voluntary measures that we believe can achieve more, more quickly, than legislation.

[Lord Ribeiro]

My Lords, I thank the Minister for his considered response. The evidence of damage to children from passive smoking is well documented. Thirty jurisdictions in Canada, Australia and the United States have banned smoking in cars when children are present. In Canada, exposure to smoking in cars fell by one-third to one-half in some provinces over a six-year period. Is my noble friend aware that the concentration of smoke in the back of a car is considerably greater than that in the front, even if the driver’s window is open? Is he prepared to follow the example of the Welsh Assembly and introduce legislation if efforts to change behaviour fail?

[Earl Howe]

My noble friend speaks with great authority on this subject, and I find little to disagree with in anything that he has said. He is absolutely right that children are particularly vulnerable to the harms of second-hand smoke: more than 300,000 children in the UK present passive smoking-related illnesses to their GP every year. We have to take this matter seriously, and we are. However, despite the evidence my noble friend cites from Canada, it is still early days to judge how effective that legislation has been, over and above voluntary measures. The second issue that poses problems is enforcement. However, we continue to look at these questions very closely.

NHS: Clinical Excellence Awards

Debate between Lord Ribeiro and Earl Howe

Monday 27th June 2011 Lords Chamber

[Earl Howe]

My Lords, in building the NHS that we all want for the future, we need to continue to recognise and reward those individuals who give outstanding patient care and who contribute in a notable way to clinical academic excellence. At the same time, we need to ensure that the system in place to do that is effective, affordable and in line with other public sector reform. It is those questions that the Doctors’ and Dentists’ Review Body is considering at the moment.

[Lord Ribeiro]

Does the Minister agree with the Academy of Medical Royal Colleges, the Academy of Medical Sciences and others that clinical excellence awards make an important contribution to the quality and excellence of care in the National Health Service? How will the replacement of these awards by one-off non-pensionable awards, like the proposed surgeon of the year prize, improve standards?

[Earl Howe]

My Lords, as I have just said, we believe that financial rewards, in the form of clinical excellence awards, should remain. It is just a question of how that system is designed. We have not said that non-financial recognition should take the place of financial awards. They would operate alongside financial awards; they would not in any way supplant them. However, we think that there is a role for perhaps more imaginative thinking in areas like speciality-based awards or departmental or division-based awards, for example, or indeed ad hoc recognition for outstanding clinical leadership. The DDRB is looking at these questions too.

NHS: Consultation on Reform

Debate between Lord Ribeiro and Earl Howe

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

My Lords, I am aware of that concern. This matter has occupied the minds of Ministers. I say to those who are serving in the NHS day by day and, indeed, to the pathfinder consortia and the early implementer local authorities that they should continue with the work that they are doing because it is from them that we most wish to hear about the practical lessons that our proposals may point to. It is, I am sure, an unsettling time for them but we hope that after this period of reflection we can continue with the passage of the Bill with proper momentum.

[Lord Ribeiro]

Does the Minister agree with me that the principles referred to earlier underpin the NHS reforms? These principles are supported by the coalition Government and follow on from the same reforms that were introduced by the previous Government. I would like him to acknowledge that these principles should be reaffirmed in any response to the listening exercise.

[Earl Howe]

My noble friend is quite right: the principles that underpin the Bill and—I emphasise this—the principles that have always underpinned the National Health Service, are not going to change. He is right that the approach that we are adopting is in many senses an evolutionary one, following on from initiatives taken by the previous Government. I am grateful to him for pointing that out and I am sure that this will be a feature of the government response that we shall publish in due course.

NHS Reform

Debate between Lord Ribeiro and Earl Howe

Monday 4th April 2011 Lords Chamber

[Lord Ribeiro]

My Lords, I thank my noble friend for repeating the Statement. The health reforms are necessary because they address the complexity and cost of medical care, which are growing daily as our population also grows. Our elderly population is growing simply because of the improvements in healthcare over the past few years. Here I acknowledge the unprecedented funding provided by the previous Government to stimulate the health service in its development. This Government have agreed to enhance that funding.

The noble Lord, Lord Darzi, signalled a change from process management to service delivery based on quality. This Government have accepted the challenge to pursue a quality agenda, knowing that, although quality care is costly, at the end of the day—particularly in my speciality, surgery—there is no question that good quality care, particularly the use of minimally invasive surgery, leads to early discharges of patients and better outcomes. I hope that this principle of quality is something that the Government will pursue. Is it my noble friend’s intention that the emphasis in health reforms should remain on quality outcomes being the bedrock of the reforms?

[Earl Howe]

I can reassure my noble friend Lord Ribeiro instantly on that. He will know, I am sure, that the acronym that was coined by the previous Government, QIPP, which stands for “quality, innovation, prevention and productivity”, is symbolic of a whole series of workstreams not just in the Department of Health but throughout the health service to ensure that quality is maintained and enhanced in the service. Unless we deliver higher quality to patients, the service will not be sustainable. Some people say that higher quality care costs more money but, as my noble friend will know from his own craft speciality, the better the care that you deliver the less costly it often is because care that is delivered in a substandard way often results in unintended consequences, such as patients returning to hospital with complications. We need to drive safe care and right care in the system.

Many of the levers that we have to improve quality are not in the Health and Social Care Bill at all—for example, the need to roll out the information agenda, without which there can be little transparency of quality. Those activities are being pursued with energy and drive in my department.