NHS: Keogh Review

Debate between Lord Sutherland of Houndwood and Earl Howe

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

We are indeed looking at it very urgently at the moment in the light of the review published a few days ago by Camilla Cavendish, which focuses on exactly that issue.

[Lord Sutherland of Houndwood]

My Lords, one thing that is very positive in the Minister’s Statement, and in the way in which he responds to questions, is that he clearly understands that this is a multifaceted problem and that there is no single way in which to deal with the whole set of issues. That being said, there is, of course, a “but”. The “but” is that one element of the government response—already referred to at least twice—is the role of the future Chief Inspector of Hospitals. The view taken, and reiterated again today, is that the inspector should be within the umbrella of the CQC. For some of us, at the moment, the CQC is part of the problem. It has not solved all our problems. I share the hopes of the Government that the CQC will remove itself from its current difficulties. However, in the mean time at least—or, in my view, in the longer term—a chief inspector should have both the responsibility and the authority of reporting directly to Parliament, as does the Chief Inspector of Schools. That would be a helpful element of transparency.

[Earl Howe]

I would have agreed with the noble Lord had he made those comments 18 months or two years ago. However, the CQC has turned a very important corner. It has new leadership and has articulated new ways of working. The leadership of the CQC commands high levels of confidence in every quarter of Parliament. I am encouraged by that. However, the point that the noble Lord makes about transparency is vital. The CQC is very clear that it is not its function to gloss over poor care when it is found, nor indeed to fail to celebrate good care when that is found.

Care Bill [HL]

Debate between Lord Sutherland of Houndwood and Earl Howe

Wednesday 3rd July 2013 Lords Chamber

[Lord Sutherland of Houndwood]

Perhaps I may ask for clarification on one further point relating to complaints. Amendment 76ZZA does not propose that the CQC should handle complaints, which was the gist of the Minister’s response. Rather, it proposes that there should be a clear and transparent method of handling complaints within each trust and relevant area. The role of the CQC is to open up that window, very much in line with the Francis report, so that we can know that complaints will be handled at the appropriate level and in the appropriate way.

[Earl Howe]

I completely understand the noble Lord’s point. He will remember that in the registration requirements for providers of health or social care, the existence of a complaints system is one factor on which the CQC will need to satisfy itself. On the quality of the complaints-handling system within that provider, my answer is that it is a powerful point and an important area, but in the end it is one on which we should let the CQC decide as it develops its methodology. I do not in any way dismiss the noble Lord’s suggestion, but it is one for the CQC to take forward.

Care Bill [HL]

Debate between Lord Sutherland of Houndwood and Earl Howe

Monday 10th June 2013 Lords Chamber

[Earl Howe]

That indeed is the ambition whereby there should be consistency of standards throughout the country and people should know precisely what those standards are. The problem with this sector of the workforce is that the standards have not properly been defined until now—hence the work that Skills for Health and Skills for Care are doing. However, we will see from that work and the work of Camilla Cavendish where the gaps are and where we need to focus our attention. The noble Lord is certainly right to say that once we have these standards in place, Health Education England will be responsible for ensuring that they are properly promulgated and rolled out.

[Lord Sutherland of Houndwood]

My Lords, I thank the Minister for giving way. I appreciate his point about the responsibility of employers. They are immensely important. However, would he be prepared to extend the language of responsibility to liability, either of a fiscal, legal or right-to-practise nature? I am not asking for a detailed answer, but it would be a shift that many of us feel would be moving in the right direction.

[Earl Howe]

As a result of the Francis report, we are indeed looking at the whole question of the liability of employers in the NHS as much as anywhere else. No doubt we shall be debating those issues when we reach Part 2 of the Bill. However, I can reassure the noble Lord on that point. We have here a vital segment of our health and social care workforce. I hope that the noble Baroness, Lady Greengross—

Social Care Funding

Debate between Lord Sutherland of Houndwood and Earl Howe

Monday 11th February 2013 Lords Chamber

[Earl Howe]

My Lords, I hope that I can put the noble Lord’s mind at rest. In doing so, I thank him once again for the work he did on the Dilnot commission. It is our intention that the eligibility criteria will be introduced from April 2015—so, in advance of the Dilnot arrangements. As he well knows, that national minimum eligibility will be set to make access to care more consistent around the country. In addition, carers will have a legal right to an assessment to care for the first time. I take his point about trying to achieve cross-party consensus on social care funding.

As for funding in the existing system, in the last spending review we made, as he knows, an additional £7.2 billion over four years available for care and support. Since then, we have provided local authorities with an additional half a billion pounds. We believe the challenge creates an opportunity for local authorities to innovate and to explore new ways of working better to meet the needs of their local populations and to optimise the use of the resources that they have. Many local authorities are already innovating, and we are committed to supporting them to deliver further service improvements.

[Lord Sutherland of Houndwood]

My Lords, I am pleased to welcome the Government’s Statement today. This has been a long time in the waiting, not simply from this coalition Government, who have done well to get this far, but from previous Governments. There has been prevarication for more than 10 years, and it is about time we got started. We have now started. As has been said, this is a first step on the way. There are many steps to be taken thereafter, and a great deal of discussion and, if possible, cross-party consensus would be useful.

Will the Minister confirm that an adequate length of time will be made available for that, not simply a Question for Short Debate, in the near future? Secondly, will he confirm that it would be open to any Government, perhaps his own Government, to look again at the financial thresholds that they are setting in this Statement as and when, as we all hope, the economy improves?

[Earl Howe]

I am grateful to the noble Lord, Lord Sutherland, and pay tribute to his work over many years in this field and in the royal commission some years ago. I will convey his wishes to my noble friend and other members of the usual channels. I agree that it would be unsatisfactory to have an unduly short debate on a complex and important subject.

As regards the thresholds, I hope I can reassure him. It is our intention, as I mentioned, to introduce clauses into the care and support Bill when it reaches Parliament that would embody the essence of the Dilnot proposals but to leave it to regulations to set the relevant numbers for the cap and the means test, for example, so that it would be a relatively easy matter for a future Government, if they so wished in brighter economic circumstances, to change those figures if they felt that that was the right thing to do.

Social Care: Funding

Debate between Lord Sutherland of Houndwood and Earl Howe

Monday 21st January 2013 Lords Chamber

[Earl Howe]

Yes, my Lords, my noble and learned friend is right. The Dilnot proposals focus primarily on social care although there are always knock-on effects for the health service. In theory, it will be possible for us to produce clauses covering the Dilnot proposals for scrutiny by the Joint Committee but I am not in a position to give that undertaking at present.

[Lord Sutherland of Houndwood]

My Lords, I welcome the announcement that has been made and I hope that it will please more of us than seems to be the case at the moment. We shall see. Does the Minister agree that the effectiveness of the Dilnot proposals for a cap depends on adequate insurance products being available to cover pre-care costs or costs that arise before that cap is reached? If so, have the Government had any discussions with the insurance industry or are any planned?

[Earl Howe]

My department is engaging actively with the financial services sector for the very reasons that the noble Lord suggests. As I have said, care needs are very difficult to predict and care costs can be open-ended in the current social care system. At the moment, that makes financial products very expensive to buy and difficult to develop. There are many reasons why people do not consider financial products for their care at present, including a lack of awareness that they have to pay. We very much hope that the introduction of a Dilnot-type solution to this problem will encourage the financial services sector to develop these products and we believe that that will happen.

Social Care: Sustainable Funding

Debate between Lord Sutherland of Houndwood and Earl Howe

Tuesday 17th July 2012 Lords Chamber

[Earl Howe]

My Lords, we look forward to a continuation of the constructive cross-party talks that have taken place. We have been clear that we accept the principles of the Dilnot recommendations, including financial protection through capped costs and an extended means test. They are the right basis for any new funding model. That sets out, if you like, our high-level view on what a new funding system should look like, but there will be many questions to answer—such as on the level of the cap and whether the funding system should be voluntary, universal or opt-in—before we can make any firm decisions. It is right that we take time to work through this, including engaging with stakeholders to make sure that any reform is the right one. That means that the next spending review is the appropriate time to take those decisions.

[Lord Sutherland of Houndwood]

My Lords—

Care and Support

Debate between Lord Sutherland of Houndwood and Earl Howe

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

I agree with my noble friend. Only last week, I talked to people at the Norwich and Norfolk University Hospital who emphasised that very point. Very often, the absence of packages of care that are tailored to the needs of the individual results in delayed discharge from hospital and often a deterioration in the condition of the patient. That helps no one. There is therefore a burning need for commissioners, providers and those providing care in the community to work together to define appropriate packages. I fully agree with my noble friend that those who have had strokes are particularly in need of the kind of packages that can best assist them when they move back into their own homes. This is an area that is crying out for further work. We hope that it will flow from the creation of clinical commissioning groups and health and well-being boards at a local level.

[Lord Sutherland of Houndwood]

My Lords, I am very happy to welcome the ministerial Statement as one of the first distant tweets of a swallow, perhaps announcing some hope of spring. However, as we all know this year, summer does not inevitably follow spring. I do not take the view that the glass is half-empty; I take the view that it is currently about 20% full. The real question is about how you put the other 80% in. That has to do with money—there are no two ways about it. Until that is confronted, I will not be convinced that the Government or—even more so—the Treasury understand the scale of the issues facing us. Demography has been announcing them for 15 or 20 years and they will get more and more urgent. There is a requirement not just for an incremental change but for a reassessment of priorities, as the Statement suggested.

One suggestion in the Statement is the importance of the integration of care. I thoroughly agree with that but have a question for the Minister. Can he reassure us that it will at least be considered that the integration of care be followed by the integration of budgets between health and social care? Many of us believe that that is one element that has to be put in place. I would not want it ruled out as an issue.

Southern Cross Care Homes

Debate between Lord Sutherland of Houndwood and Earl Howe

Tuesday 12th July 2011 Lords Chamber

[Earl Howe]

I think the noble Lord and I are at one in wanting to see diversity of provision. The restructuring that I suspect we are likely to see emerge from this will result in just that, as a matter of fact. It appears that Southern Cross is to be split into a number of smaller enterprises, and that in itself should, we hope, lead not only to a more diverse arrangement but a more secure one. However, I do not take issue with the thrust of the noble Lord’s remarks at all.

On the issue of the ownership of some of these care homes, our concern as Ministers is not so much where the shareholdings lie as on whether that in itself has implications for the quality of the care that residents receive. I am not aware that that has been a factor. As long as the ownership of these care homes is legal and we are not seeing tax evasion as opposed to tax avoidance, to an extent it is not an issue for the Government. But it is something that is likely to be examined quite closely as the restructuring takes place.

[Lord Sutherland of Houndwood]

My Lords, I welcome the way in which the Minister’s Statement has given reassurance to those in care homes and their families. It is immensely important that we continue to do that. There is, however, a further area of reassurance that I hope the Minister will be able to say something about. We have reassured staff through TUPE that perhaps there is some protection for their terms and conditions, but speculation in the press today suggests that the cost of care in these homes might rise significantly because of a period of underinvestment. I hope that we can at least monitor any such rises to ensure that they are gradual rather than sudden and therefore financially debilitating.

[Earl Howe]

My Lords, the noble Lord, Lord Sutherland, makes a very good point. The advice I have been given is that during the restructuring process, the cost of care should not be a factor. While local authorities may have to revise their budgets, that should not result in disruption for residents.

NHS: Reform

Debate between Lord Sutherland of Houndwood and Earl Howe

Monday 6th June 2011 Lords Chamber

[Earl Howe]

My Lords, the criticisms that my noble friend has received have no doubt been considered under the umbrella of the NHS Future Forum. I can tell him only that I have personally received many expressions of support for the key principles that we have outlined.

[Lord Sutherland of Houndwood]

My Lords, the NHS makes a considerable contribution to the health of patients through its participation in major research projects, working with drugs companies and those concerned to improve the quality of care in hospitals and outside. What protection is there for this continuing?

[Earl Howe]

The Bill states that the prospective NHS commissioning board will have a duty to promote research and continuous improvement in the quality of care. As the noble Lord will know, that duty will be underpinned by the role of NICE, which will be tasked with producing quality standards that are informed by the latest innovations coming through from the research agenda.