Care Bill [HL]
Lord Sharkey Excerpts(10 years, 10 months ago)
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Lord Sharkey
My Lords, I support the amendments in this group in the name of the noble Baroness, Lady Greengross, and I shall speak to my Amendment 86E. The noble Baroness has already spoken eloquently to her amendments and I simply wish to say that not only are they compelling but it is critically important that they become part of this Bill.
The decisions that most people make under the terms of the Bill will be some of the most important that they will ever make and it is obviously critical that people are able to make them on the basis of proper and impartial information. Many of these decisions will involve taking a view about the merits of various financial products. Many people—perhaps the overwhelming majority—will have had no experience of doing this.
There will inevitably be a high degree of uncertainty about how to choose and about the detailed implications of those choices. People will need guidance in deciding which, probably complicated, financial product to buy. This is no less true for these products than for any complex financial product, with the added emphasis that a wrong or inappropriate choice could have pretty unattractive consequences. That is why I strongly support the proposal to introduce regulated financial advice into the process, as the amendments of the noble Baroness, Lady Greengross, seek to do. Only with this kind of advice can people have some comfort that they are making the correct choices in a complex and difficult area.
My amendment in this group, Amendment 86E, also deals with the information and advice that a local authority must provide. As the Bill stands, Clause 4(3) simply says:
“In providing information and advice under this section, a local authority must in particular seek to ensure that what it provides is sufficient to enable adults”,
and so on. There are two problems here. The first is the phrase “seek to ensure” and the second is the unqualified notion of “sufficient”.
I raised the issue of sufficiency at Second Reading, when I said that there appeared to be no test for it. There is no provision in the Bill for local authorities to have a mechanism for measuring and reporting the success of their efforts in providing information or on the success of that information in achieving its objectives. My amendment is intended to address those concerns. In particular, it would remove the phrase “seek to”, so that instead of local authorities having to seek to ensure that the information they provide is sufficient, they simply must ensure that it is sufficient. The phrase “seek to” seems to me to weaken the obligation placed on local authorities quite unnecessarily. It is quite possible that any local authority could demonstrate that it was seeking to do something without actually doing very much at all. Arguably, for example, the slow and gradual implementation of a plan to provide information would fulfil the local authority’s obligation.
I am sure that that is not what the Government had in mind or what local authorities would really want to do. In that case, I see no merit in having local authorities’ obligations significantly weakened by the use of the phrase “seek to”. My amendment would remove this phrase and give the local authorities a clear, simple, plain-English duty to ensure that the specified information is sufficient for the purposes set out in the Bill. If it is possible to have a measure of sufficiency, as I believe it is, it is surely possible to ensure sufficiency rather than just seeking to ensure it. Again, in plain English—or in fairly plain English—the situation is this: we want local authorities to make the information that they must provide by virtue of subsections (1) and (2) of Clause 4 sufficient for the purposes set out in Clause 4(3)(a) and (b). We want them actually to do this, not just seek to do it.
That brings me to the notion of what “sufficient” may mean and what tests might apply. My amendment would qualify “sufficient” by inserting the word “demonstrably” before it. I can probably guess what my noble friend the Minister will say about the use of the word “demonstrably”. He will probably ask, “Demonstrable to whom?” and, “Demonstrable according to what criteria?”. The phrase “demonstrably sufficient” has a clear meaning in the context of Clause 4(3)(a) and (b). It means simply that local authorities will have to be able to show evidence that the information they provide actually does enable adults to identify matters that are or might be relevant to their personal financial position that could be affected by the system provided for in Part 1. It also means that local authorities will have to be able to show that the information they provide does enable adults to make plans for meeting needs for care and support that might arise.
Commercial organisations routinely apply this kind of test to the information they put out. It is not difficult, time-consuming or expensive to do. Doing it would have the merit of providing a real test of the meaning of sufficiency and a mechanism for reporting success in delivering it. I believe that this is what the Government and local authorities want. Using the phrase “demonstrably sufficient” provides for that.
Care Bill [HL]
Lord Sharkey Excerpts(10 years, 12 months ago)
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Lord Sharkey
My Lords, it is a pleasure to follow the noble Baroness, Lady Donaghy. Like her, I very much welcome this Bill. It is a very good Bill and the Government are to be congratulated on bringing it forward, on responding constructively to the recommendations and observations in the Joint Committee’s excellent report on the draft Bill, and on incorporating the essence of the Dilnot report into the Bill. When it becomes law, the Bill will have the effect, among other things, of introducing certainty, stability and consistency into the provision of care. It will also create the conditions in which financial institutions can begin to write policies that will directly help in the pooling of risk, which is not the case at the moment.
The Bill deals with a very complicated subject and seeks to make fundamental changes to the current arrangements. Many of the critical components of this reform of the care system are to be left to secondary legislation and guidance. Although it is clear that many details will need to be and should be left to secondary legislation and guidance, I think that the Bill would benefit by addressing some of the key issues more directly in primary legislation.
The recent toing and froing over Section 75 of the NHS Act illustrates the point. There are some things to which the answer is not yes or no. There are things that the House may very well want to debate in a way that produces amendment. I suggest that the size of the various caps critical to this Bill are such things and would be better debated amendably than on a yes or no basis.
Dilnot noted in his report that setting the cap above £50,000,
“would not meet our criteria of fairness or sustainability”.
The proposed cap of £72,000 is greater than Dilnot’s £50,000, even allowing for inflation. I suspect that many Members will want a vigorous debate in Committee on where the trade-off between reach and affordability should lie. The same goes for the definition of eligibility in Clause 13, and for Clause 34(1), which will by regulation set out when an authority may agree to defer payment. All these things may be better discussed in the more flexible environment of primary legislation.
I will now comment on four more specific areas of the Bill. The first is communications, which is dealt with in Clause 4. The Dilnot report, which for me is a model of absolute clarity, has 10 recommendations. Two of these are about communications because Dilnot clearly views that issue as central to the success of the entire scheme. Recommendation 7 says:
“To encourage people to plan ahead for their later life we recommend that the Government invest in an awareness campaign”.
This is proactive and prospective information. Recommendation 8 says:
“The Government should develop a major new information and advice strategy to help when care needs arise”.
This is reactive and responsive information. The Bill addresses the second recommendation and not, I think, the first.
Clause 4 specifies in some detail what information must be provided by local authorities but it seems to be aimed, as Dilnot puts it, at situations “when care needs arise”. It does not seem to deal with Dilnot’s Recommendation 7, which asks for more general, wider and very much earlier awareness campaigns. Dilnot seems to be asking for a heavyweight, national publicity campaign aimed at the general population before need arises.
Furthermore, the Bill contains no provisions for defining the test for sufficiency in “sufficient” information as stipulated in Clause 4(3). It does not seem to include the requirement to provide information, for example, about how to appeal against a judgment of ineligibility. I assume that there is such a right of appeal, and a simple and quick mechanism for handling such appeals in the first instance, even though I could not spot it in the Bill.
There also appears to be no requirement in the Bill for local authorities to have a mechanism for measuring and reporting their success in providing information or the success of that information in achieving its objectives. I should be very interested in the Minister’s comments on general early-awareness campaigns; on the need to measure success in providing what the Bill calls sufficient information; and on the existence of an appeal mechanism at first instance.
The second area I wanted to speak about is eligibility. I have already said that I think that the criteria for eligibility should have been available before this debate. I also worry about a Section 75 problem in dealing with the criteria and secondary legislation. In particular, I wonder how local authorities are to be able to take a properly comprehensive view of who might be eligible. The Bill states in Clause 9:
“Where it appears to a local authority that an adult may have needs for care and support”,
and so on. That strikes me as a very passive and rather weak obligation. It does not specify any duty to be properly aware of such adults, merely to act if it appears to the authority that an adult may have such needs. We may need firmer language here. The Bill would surely benefit from obliging local authorities to take appropriate and proportionate steps to make sure that they are reasonably likely to know when an adult is in need of care and support.
The Bill is also silent on the time that a local authority may take between becoming aware that an adult may be in need, making an assessment, determining eligibility and providing the service. It is clear that we need national standards of service here. I assume that requirements will be written into guidance, but I would welcome the Minister’s assurance on that.
The third area that I want to address is the question of direct payments. The Joint Committee was quite right to propose that we should not be too restrictive about the use of direct payments, and I was glad that the Government agreed to that in their response and to see no unreasonable restrictions in the Bill. However, the problem is likely not to be abuse but accidental mismanagement and complications arising from it. It seems highly likely that some who ask for and are allowed direct payment may find the subsequent commissioning and managing of the services that they need stressful, complex and burdensome. It may be a very good idea if the local authorities have an obligation to provide friendly oversight of and help with the management of direct payment services, at least in the first months of their existence. It would be a great pity if the valuable ability of people to specify and obtain what they need was allowed to suffer from bureaucratic, management or legal difficulties due to inexperience, misunderstanding or contractual unsuitability.
The fourth and final area on which I should like to touch briefly is funding. As many other noble Lords have said, to make all that work, the funding needs to be sufficient. In particular, the Dilnot cap needs to be set at the optimum level to balance reach and affordability. We will want to examine the assertions made in the impact assessment carefully in Committee. I hope that the impact assessment’s calculations turn out to be accurate on examination and when we are in possession of all the details to be contained in secondary legislation.
I note, for example, that the Joint Committee states in Recommendation 5:
“The introduction of a capped cost scheme, which will result in many more people being assessed and entitled to a personal budget, is likely to lead to an increase in disputes and legal challenges. We are not confident that Ministers have yet fully thought through the implications for local authorities of these changes”.
Rather worryingly, there does not seem to be any financial provision for that in the impact assessment.
I end by repeating what I said at the beginning. Notwithstanding my four areas of concern and my feeling that the balance here between primary and secondary legislation is not quite right, I believe that this is a very good Bill. I believe that, with proper funding, it will lead to a clear and genuine improvement in the provision of care, and I congratulate the Government on introducing it.
Food: Fast Food
Lord Sharkey Excerpts(11 years, 1 month ago)
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Lord Sharkey
To ask Her Majesty’s Government what is their assessment of the effectiveness of the Responsibility Deal for Calorie Reduction in achieving significant product reformulation in food sold by fast food operators.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the responsibility deal’s calorie-reduction pledge challenges businesses, including fast food companies, to take action to help people eat fewer calories. This includes product reformulation. Responsibility deal partners report annually on the progress that they have made against their pledges. Annual updates for 2012-13 will be published on the responsibility deal website in summer 2013.
Lord Sharkey
My Lords, the plain fact is that not a single fast food operator has signed up to the calorie-reduction pledge. I asked McDonald’s why and it said that it was because of concerns about the lack of clarity and vagueness in some of the Government’s definitions. If the calorie-reduction pledge does not work with fast food operators, how else can we make certain that they reduce calories in the 5.5 billion meals they serve every year in the UK?
Earl Howe
In fact, my Lords, 32 businesses have signed up to the pledge to help people consume fewer calories, which is a responsibility deal priority. They include seven of our major retailers and some of the nation’s biggest food manufacturers, as well as Subway, which is a fast food company—so we do have one. It is a deliberately wide-ranging pledge, allowing companies and their customers to reduce calories through a broad range of actions. I say to my noble friend, however, that we will have fast food companies very much in our sights over the coming months.
Children: Obesity
Lord Sharkey Excerpts(11 years, 3 months ago)
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Lord Sharkey
To ask Her Majesty’s Government what assessment they have made of the factors contributing to the rise in childhood obesity.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, obesity is a complex issue, and there are many factors that contribute to children becoming obese. We are committed to tackling obesity in children. Our call to action on obesity sets out the actions that everyone needs to take. For our part we will continue investing in the Change4Life programme, the national child measurement programme, and the School Games.
Lord Sharkey
My Lords, one-third of our children are already obese, and the fact is that cheap fast food can be a major contributor to obesity. The Government’s responsibility deal for calorie reduction has signed up 31 companies, which have promised to reformulate their products to make them less fattening. However, according to the Department of Health’s website, not one of these signatories is a fast-food operator. Does this not suggest a failure of the voluntary approach and that we need regulation, as the BMA says, to make food companies play their proper part in reducing obesity?
Earl Howe
My Lords, I am grateful to my noble friend. In fact, the responsibility deal has led to a number of very important gains and benefits, not least from food companies: food retailers as well as food manufacturers. Calorie labelling, for example, has expanded rapidly in out-of-home settings; we now have labelling in around 9,000 outlets across the country, which is to be welcomed. As my noble friend said, 31 companies, some of them household names, have signed up to the responsibility deal calorie reduction pledge. However, this is an area that we continue to work on, and I think my noble friend’s comments are well placed.
Health: Cancer
Lord Sharkey Excerpts(11 years, 4 months ago)
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Earl Howe
My Lords, via the Medical Research Council we are supporting a study to assess the effectiveness of a new test called the Mcm5 protein test to see if it can help to diagnose cancer of the pancreas, bile duct and gall bladder. I am also aware of a number of other research projects that my department is funding in the field of pancreatic cancer and I would be happy to write to the noble Lord with the details.
Lord Sharkey
My Lords, where you live will dramatically affect your chances of surviving pancreatic cancer. In south-west London the one-year survival rate is 22% while in north Trent it is 11%. Do we know why this is? What are we getting right in south-west London but not in north Trent?
Earl Howe
My noble friend is absolutely right to raise the point. To support the NHS in tackling regional variations in cancer survival rates, we are providing data to providers and commissioners that allow them to benchmark their services and outcomes against one another and to identify where improvements need to be made. Surgical resection is currently the best curative intervention for pancreatic cancer, and through the National Cancer Intelligence Network we have already made available data collections on the survival rates and surgical resection rates across a range of cancers, including pancreatic cancer.
NHS: Clinical Networks
Lord Sharkey Excerpts(11 years, 5 months ago)
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Lord Sharkey
My Lords, I declare an interest as a lay member of a cancer network lung cancer group. I know the Minister is aware that our survival scores for lung cancer need improvement and that early diagnosis is the key to that improvement. In the light of that, what steps are being taken to make absolutely certain that any reduction in the number, staff or funding of cancer networks does not damage the efforts to improve early diagnosis?
Earl Howe
My Lords, I am grateful to my noble friend. As regards cancer, it is important to look at what the Government are doing across the piece. As the noble Lord may recall, the cancer strategy that we published a while ago is backed by more than £450 million of investment. This is specifically to target earlier diagnosis of cancer; to give GPs increased access to diagnostic tests; to allow for the increased testing and treatment costs in secondary care; to support campaigns; and so on. That is a large sum of money and it is committed.
NHS: Women Doctors
Lord Sharkey Excerpts(11 years, 6 months ago)
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Lord Sharkey
Does the Minister agree that monitoring the number of women in leadership roles in the NHS from consultant upwards will be a marker of appropriate career progression?
Earl Howe
Yes, indeed, my Lords. The noble Baroness, Lady Deech, raised that in her report as an action point. It can be done at a trust level or at a higher level in the health service. But it is certainly important to monitor—I understand that the term is “credentialing” —the skill sets of those doctors, who may move out of the health service and want to move back in again, so that jobs can be found for them more easily.
Diabetes
Lord Sharkey Excerpts(11 years, 10 months ago)
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Lord Sharkey
To ask Her Majesty’s Government what data they have on, or what best estimate they can give of, the extent to which the consumption of sugar will contribute to the substantial increase predicted in the incidence of diabetes in England and Wales.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government currently cannot provide an estimate of the extent to which sugar intake will lead to future incidence of diabetes in England and Wales, because, on balance, there is no clear evidence that sugar intake alone specifically causes diabetes. Obesity increases the risk of type 2 diabetes. The habitual consumption of calories in excess of needs for a healthy body weight results in weight gain, irrespective of whether these are from sugar or fat.
Lord Sharkey
My Lords, by 2050, on current trends, at least half of adults and a quarter of children are predicted to be obese, which will cause a huge epidemic of diabetes. Many experts agree that the excessive consumption of sugar is a factor in obesity and in diabetes. In fact, US scientists have concluded that sugar consumption levels are now so harmful that sugar should be controlled and taxed in the same way as alcohol and tobacco. Will the Minister give urgent consideration to taxing sugar in processed foods to help avert an imminent public health disaster?
Earl Howe
My Lords, we keep the question of taxation under review in the light of emerging international evidence on its impact. That will include looking at the experience of the recently introduced tax on saturated fat in Denmark and what effect it has had on diet and health. With any fiscal measure, there is always a risk of unintended consequences, so we would have to look at this particularly carefully.
NHS: Public Information and Advice
Lord Sharkey Excerpts(11 years, 11 months ago)
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Lord Sharkey
To ask Her Majesty’s Government whether they plan to review, after an appropriate interval, the comparative performances of public health information and advice campaigns under (1) the new, and (2) the former, NHS architectures; and, if so, when and whether the findings of that review will be made public.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the department continuously reviews the performance of its public health information and advice campaigns. Our investment in campaigns reflects evidence of their effectiveness. Summaries of campaign research are published online as part of our freedom of information publication scheme. Publication typically occurs six months to a year after receipt of the final research report. As evaluation is ongoing, we have no plans to review the impact of campaigns against specific changes to NHS architecture.
Lord Sharkey
I thank the Minister for that Answer. He will be aware that the country faces an epidemic of obesity, with predictions that nearly a half of all adults could be obese by 2030. He will also know that changing childhood eating habits is the key to addressing this problem. What long-term plans do the Government have for information and advice campaigns aimed at influencing childhood eating habits?
Earl Howe
My Lords, my noble friend is absolutely correct to highlight the importance of preventing obesity, particularly obesity in the young. He will be reassured to know that the Change4Life Campaign, which we have continued from the previous Government, will include this as a major focus into the future.
Health: Pancreatic Cancer
Lord Sharkey Excerpts(12 years ago)
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Lord Sharkey
My Lords, in preparing for this debate, three things struck me with a special force; the first was that 25 per cent of pancreatic cancer patients experience symptoms up to 12 months prior to diagnosis; the second was that nearly 30 per cent of pancreatic cancer patients visited their GP five or more times before diagnosis; the third was the alarming fact that the disease attracts less than 1 per cent of overall cancer research funding. With regard to the first and second areas, this seems to me to suggest very strongly indeed the need for better information to be made available both to the doctor and to the patient. Will the Minister give urgent consideration to putting in place quickly a pilot campaign whose objectives are to increase awareness among both patients and doctors of the possible symptoms of this disease? I know that the Government have done that very successfully for bowel cancer.
The third area is the question of the very low level of research funding for the disease. I realise that it is not a simple matter to increase the funding for one particular disease, no matter how pressing the case may be. In many ways this is because there is an analogue of the market mechanism in operation when it comes to the allocation of research funds. That is not a criticism of what happens in a general sense; I point out only that relying on the normal processes of allocating research funding is unlikely to result in much of an increase for the rarer types of cancer, such as pancreatic cancer, in any reasonable timeframe.
That is why I ask the Minister to see if there is any way of bypassing or supplementing the normal process of funding allocation and to see if there is any way of directly intervening to generate a substantial and urgent increase in funding. I realise that this is not easy, and it is consistent with the Government’s commitment to improve the treatment of cancer in the UK and bringing our survival rates up to those enjoyed by many advanced countries.
I, too, thank the noble Lord, Lord Aberdare, for giving us the opportunity to debate this vital issue. I hope that the Minister may be able to give sympathetic consideration to the proposals that I have put forward.