NHS: Targets

Baroness Thornton Excerpts

Monday 20th December 2010 Lords Chamber

[Earl Howe]

I am sorry that the noble Lord is a sceptic on these matters. In the field of mental health care, for example, where there is a long-standing position of private sector contestability, we have seen that standards have been driven up. There is no doubt that the foundation trust model has also paved the way for higher quality in healthcare.

[Baroness Thornton]

My Lords, turning to waiting lists for accident and emergency services, which we obviously want to provide the highest possible care, I want to ask how the newly proposed scheme will improve the quality of care. For example, how will the abolition of the 19-minute response time to a 999 call that is not life threatening affect the health outcome for an elderly lady who has slipped and broken her wrist on the ice? Such a slip may not be life threatening, but the elderly lady may wait for quite some time for an ambulance and then wait considerably longer than four hours in accident and emergency. Is the waiting time not an outcome here? If the Government do not intend to introduce a new outcomes framework for two years, would the Government not be better to leave the current guarantees in place because we know that they ensure patient safety?

[Earl Howe]

My Lords, on ambulance response times, the existing eight-minute target will remain in place for category A calls. For category B calls, which are serious but not immediately life threatening, Peter Bradley, who is the national ambulance director, has been working with Professor Cooke to develop a set of 11 clinical quality indicators for the ambulance service. We are clear that those indicators will provide a much better and more rounded set of objectives than a mere 19-minute response time. Of course response times are important, but there are other things that should be focused on as well. We hope to improve standards in this way as from April next year.

NHS: Global Health

Baroness Thornton Excerpts

Monday 20th December 2010 Lords Chamber

[Baroness Thornton]

My Lords, the noble Lord, Lord Crisp, has a passion for this important issue, and I congratulate the noble Lord on initiating this debate tonight, the quality of which has proved his passion to be correct.

Good health in one country cannot be maintained if there is widespread ill health and disease in so many others. I have always felt privileged to be able to participate in debates in your Lordships’ House when such expertise and personal commitment is shown and, as so many noble Lords have said tonight, in a globalised and interdependent world, one in which disease certainly knows no boundaries, health is a global issue. The rich world has a responsibility to the developing world to support the growth of their health infrastructures and the growth of their medical education.

The nature of our responsibilities includes without doubt the need for overseas doctors to train in the UK without unacceptable barriers being placed in their way, or expense, and indeed the need for UK doctors to spend time abroad. We recognise that is a legitimate part of their qualifications, as mentioned by the noble Lord, Lord Patel, and others. It also includes the need to prepare our own UK-based doctors for the implications and effect of globalisation in our own health service and the UK population. The noble Lord is quite right—our medical training must encompass this challenge and its complexity.

The previous Government, with no small help, I suspect, from the noble Lord, Lord Crisp, produced Health is global: a UK Government strategy 2008-13 in September 2008. In it there was recognition of the fact that a healthy population is fundamental to prosperity, security and stability. It also linked the Government’s domestic and international objectives to the issue of improving global health. Could the Minister tell the House, therefore, what the Government are doing to continue this work? Has the department embraced the recommendations contained in that strategy?

We can look at the threat that global disease can pose. SARS and swine flu are two of the most dramatic examples where the world had to work together to protect itself. There is no doubt that a weakness in the healthcare in one country can put millions at risk. Nearer to home, however, in the UK, and particularly in London, we only have to think about TB and the communities most at risk. I am reminded of this by the noble Baroness, Lady Masham, who questioned me many times when I was a Minister about this.

Seventy-two per cent of UK cases of TB are among people born abroad, and about 40 per cent of cases in England are in London. It is vital, therefore, that the health service in London understands the nature of this problem, the communities at risk, and what needs to happen. The increase in migration into the UK means that UK doctors treat patients from all over the world, and medical students must be prepared for this change and understand its implications.

The report, Tomorrow’s Doctors, referred to by several noble Lords, has very wise words on these matters. It says that this is,

“leading to demands for greater cultural competency in the doctor-patient interaction”.

That is quite right. It continues:

“Medical students have to be prepared carefully for this change, with curricula exposing them to an understanding of why migration happens and specific migrant health issues as well as how to treat a broad range of diseases not routinely seen in the UK”.

Can the Minister say, therefore, whether TB and other conditions and their management are adequately included in the training of doctors in the UK? Indeed, would the forthcoming change of the Health Education Board mentioned in the document referred to by the noble Lord, Lord Jay, which will be an issue for the House in months to come, encompass the proposal made by the noble Lord, Lord Crisp, and other noble Lords today?

Hospices and Palliative Care Services

Baroness Thornton Excerpts

Wednesday 15th December 2010 Lords Chamber

[Baroness Thornton]

My Lords, I congratulate the noble Viscount, Lord Bridgeman, on securing this short but important debate, which has had many very pertinent contributions. The goal of palliative care is to prevent and relieve suffering and improve quality of life for people with serious and complex illnesses. End-of-life care affects all of us; it is everybody’s business and, as such, must be a central focus of any health, social care and housing reform agenda.

Much of the recent progress in end-of-life care was enabled by its inclusion as one of only eight high-level priorities in the NHS Next Stage Review, which the previous Government brought forward. Indeed, we made end-of-life care a priority; we made a commitment to it and, significantly, we increased funding to hospices. The key challenge facing the Government now is to ensure that end-of-life care continues to be one of the top few high-level organisational priorities at each stage of the forthcoming reforms. The proposals in the White Paper published this summer did not reflect the importance of end-of-life care sufficiently to guard against it being subsumed by other higher profile priorities. That is not just my opinion; it is also the opinion of the Palliative Care Association.

I have glanced at the results of the consultation published today and have yet to find the words “end-of-life strategy”. It may be in the operation strategy document, which is my weekend reading. I echo my noble friend Lord Faulkner in his concern about how the new GP commissioning will deliver palliative care. I suspect that many organisations that have campaigned for end-of-life care so successfully in recent years will be concerned about what comes next. Diluting recognition of end-of-life care as a discrete, high-level priority risks undermining the progress made, and I suggest devalues end-of-life care as a government priority. I should be grateful for the Minister’s comments on this and his reassurance. Surely, if the Government intend to drive cultural change in the NHS, as they say they do, it is essential that they reflect the whole journey of a person’s care throughout their life to their death and into bereavement care for their family and friends. The Minister needs to address some serious worries and concerns raised during this debate.

Autism

Baroness Thornton Excerpts

Tuesday 7th December 2010 Lords Chamber

[Earl Howe]

My Lords, the statutory guidance that already exists—it has been revised in light of the response to the consultation—makes it explicitly clear that in addition to general autism awareness-raising training for staff, local areas should develop or provide specialist training for those in key roles who have a direct impact on access to services for adults with autism, such as GPs, community care assessors and commissioners and service planners.

[Baroness Thornton]

My Lords, I congratulate the Minister on continuing to make progress in this matter. As he will know, commissioning for autism services requires expert knowledge and, as my noble friend said, a recent National Audit Office survey found that 80 per cent of GPs said that they needed more training in autism awareness. Can the Minister outline whether any progress is being made to change that situation because, if it applies to GPs, it probably applies to other health workers? Is the Minister also supportive of the call from the National Autistic Society for NICE guidelines and for the inclusion of autism as one of the future quality standards currently under consideration by the National Quality Board?

[Earl Howe]

My Lords, we cannot mandate to NICE what quality standards are produced. However, the case for developing a quality standard for autism will be considered as part of work to commission a comprehensive library of such standards from NICE in line with our plans in the White Paper. NICE is already developing clinical guidelines on diagnostic pathways for autism, including one for children and young people with autism. That is scheduled to be published in September next year. On training, I cannot really add much to what I have already said to the noble Lord, Lord Low, but it is very high on the agenda.

Health: Passive Smoking

Baroness Thornton Excerpts

Tuesday 30th November 2010 Lords Chamber

[Earl Howe]

My Lords, we have no plans to legislate further for banning smoking in cars. As she will know, when a car is used as a workplace smoking is illegal, but when a car is being used privately that is a different matter. We do not intend to legislate.

On messages in schools, we know that youngsters are concerned about parental smoking. In fact, the younger the child, the more concerned the child tends to be. Schools are encouraged to include advice on smoking in the PSHE curriculum.

[Baroness Thornton]

My Lords, following the successful implementation of the smoking ban in all workplaces and public places in July 2007, which was opposed by many in the party opposite, will the Minister undertake—

[Baroness O'Cathain]

No.

[Baroness Thornton]

I except the noble Baroness, Lady O’Cathain, from that.

Will the Minister undertake to ensure that, under the proposals for GP commissioning, NHS smoking cessation services will continue to be effectively commissioned and funded and that nicotine products will continue to be prescribed?

[Earl Howe]

My Lords, the noble Baroness, Lady Thornton, is wrong. The Conservative Party did not oppose the second-hand smoke provisions. We did not oppose them in principle; we supported the Government. We opposed some of the detail, but that is a different thing.

On smoking cessation, there is no doubt that local stop-smoking services are effective and are available free of charge in communities across the country. Evidence shows that the most effective way of stopping smoking is with local stop-smoking services because smokers get behavioural support as well as effective medicines and treatments on the NHS.

Public Health

Baroness Thornton Excerpts

Tuesday 30th November 2010 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating the Statement, which as we know was well trailed on the “Andrew Marr Show” on Sunday and on the “Today” programme this morning. There are some things that we would like to welcome and support in the Statement, and there are some that we think are a cause for concern. My overall impression is slight disappointment at the insubstantial nature of this Statement. Much of it is common sense and much of it picks up where the previous Government left off, but the Government have had quite some time to think about and to decide on the direction for public health. I believe that this White Paper is short on strategy. Therefore, I look forward to more substance as we move forward.

I think that we would agree that local authorities have an important role to play in the delivery of the public health agenda. Presumably, the new public health service will take on some of the responsibilities of the Health Protection Agency. I have to say to the noble Earl that I wonder why it was necessary to announce the abolition of the HPA, except to make a political point, which is disappointing, when a new agency is being created. The appointment of the new directors of public health will be very important in this programme of delivering a public health agenda. For them to be effective, they will need to be independent. How do the Government intend to ensure that directors of public health in local authorities have the necessary independence and power to deliver an agenda, which sometimes a local authority may not want to hear and may find expensive to deliver?

I am disappointed at the cheap gibes in the Statement, which I can only assume were the idea of the Minister’s bosses—that the nanny state ruled during the Labour years and that Mr Lansley’s “nudge-nudge” public health strategy will be more effective. We need to get past that sort of name calling. The evidence shows that by taking a lead, as Labour did, in the diagnosis of public health issues based on evidence and in taking some of the big decisions on, for example, smoking, exercise and diet—the noble Earl has not ruled out that this Government might need to do that too—we provided a good framework for people to take responsibility for their health and to start to change their habits. I hope that this Government will continue to support families where it is needed.

I do not think that nudging would have got us the ban on smoking in the workplace. “Nudge” will not replace the brilliantly successful schools sports programme. I am not sure that nudge will deliver the national screening programme mentioned in the Statement. I am certainly sure that nudge will not deliver healthy meals in schools or fruit for schoolchildren. So I am sceptical about the nudge part of this Statement.

However, we can all agree that factors such as unemployment, education, environment and equality are important determinants of health. The Statement is correct in saying:

“Unhealthy behaviours, like drinking too much, smoking … are … rooted in poor aspiration, adverse peer pressure and low self-esteem”.

As Marmot puts it, and as the noble Earl has said, they are the “causes of the causes”. That is absolutely correct.

I disagree with this Statement where it puts forward a cross-government initiative; that is, joined-up government. The noble Earl needs to explain how throwing somewhere between 400,000 and 500,000 people on the dole will help their self-esteem and their family’s prospects. He would need to explain the joined-up bit of the Government that led his right honourable friend the Secretary of State for Education to get rid of the successful school sports scheme that got our nation’s children playing sport. Ditto housing benefit cuts, which may put some families’ homes at risk or move them away from where they can earn a living. That is not going to provide the right environment. Finally, we have the abolition of the education maintenance allowance, which has allowed thousands of children from low-income families to stay on at school after 16. If, as Marmot says, life chances and opportunities are an important part of people’s well-being and health, how can the Minister explain the contribution of this initiative to public health?

I want to turn to the regulation of tobacco. This House has debated this issue at length and over quite some time, and by several large majorities it supported the introduction of point-of-sale tobacco regulation and the banning of tobacco products in vending machines. Just this morning, on the “Today” programme, the Secretary of State confirmed that he accepted the evidence that the visibility of cigarettes is a factor that leads to the initiation of smoking. He also mentioned the issue of plain packaging and the Government’s intention to consult on this. We all know that such a consultation will take years and that any action to put tobacco into plain packaging, following on from such a consultation, will take years to come into force. This cannot and should not be seen as an alternative to the legislation to ban tobacco displays. The display legislation is on the statute book. It will protect this generation of children from brightly coloured displays in shops. I should like to ask the Minister this: will cigarettes no longer be on display in supermarkets from October next year? Further, if the Government intend to consult on plain packaging, how long will the consultation take, who will run it and how much will it cost?

I have two or three more questions for the Minister. I warmly welcome the Government’s intention to invest in Sure Start children’s centres and in more health visitors. I also support the development of health protection plans and screening programmes, but I have to ask the Minister: is this nudge or is this target? How are the Government going to decide whether enough people are being screened, because that aim needs a target rather than a nudge? The ring-fencing of public health budgets is going to be a challenge. How will the Government decide what is going to be included in those budgets and what will be excluded? Moreover, how are they going to stop hard-pressed local authorities from raiding them? That will indeed be a challenge. We support the Government in doing this, but we will need to address how it will be possible to deliver that ring-fencing.

Finally, I certainly welcome the greater use of voluntary and community organisations. We worked with many organisations in different health fields, and that is exactly right. However, the funding and support for these organisations needs to be maintained.

Health: Academic Health Partnerships

Baroness Thornton Excerpts

Monday 29th November 2010 Lords Chamber

[Baroness Thornton]

My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Finlay, on drawing this important matter to the attention of the House. As has so often happened in the past, the noble Earl and I are usually, or probably, the least qualified people to answer this debate, given the quality of the contributions that have been made this evening. I particularly thank my noble friend Baroness Donaghy for her thoughtful contribution.

Evidence from around the world demonstrates the profound role played by world-class research and teaching in driving innovation in healthcare. Academic health science centres are designed to maximise clinical and academic synergies by ensuring that clinical research and teaching staff work in concert to unified plans that transcend the separate structures of their respective clinical and academic institutions. In 2007 a review of healthcare in London led my noble friend Lord Darzi in a framework for action to recommend the creation of a number of academic health partnerships. In October 2007 Imperial College Healthcare became the first to be established in the UK when Imperial College London’s faculty of medicine merged with the Hammersmith Hospital and St Mary’s Hospital NHS trusts. I know that several more—mentioned by other noble Lords—have subsequently been established, notably Cambridge University Health Partners, King’s Health Partners, Manchester Academic Health Science Centre, UCL Partners, Barts and The London NHS Trust.

We can be proud of the achievements of these innovative partnerships and the benefits that they have brought in their own areas to the cities that they are in and across the world. The engines of clinical innovation— for example, at Barts and The London—will be 70 new clinical academic units, clusters of closely related specialties or sub-specialities working to a single plan for clinical care research and teaching. For example, guests from all over the world flew to London the week before last for the opening of a new cardiovascular biomedical research unit at the Royal Brompton Hospital. The BRU is a joint initiative between the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London and puts the partnership at the forefront of international research into the most challenging heart conditions. It is funded by the National Institute for Health Research.

There appear to be three legs to the AHSC stool. For it to work properly it needs excellent education, excellent healthcare and excellent research. It also needs time. This is not a five-year project; this is a 15 to 20-year shift in the development of excellence and innovation in these areas. My understanding is that the funding of the academic health science centres is a mixture of MRC, DBIS and NIHR. Under the current structure, SHAs and PCTs have delegated responsibility to administer research funding. In addition to his powers to conduct or assist research, the Secretary of State has a duty under Section 258 of the 2006 Act to ensure that facilities are made available for universities with medical or dentist schools in connection with clinical teaching and the research connected with clinical medicine or clinical dentistry. This duty is delegated to the strategic health authorities and PCTs under the regulations.

Therefore, my first question to the Minister—echoed around the House—is unsurprisingly: how will this particular aspect be delivered and funding allocated under the new NHS structure? Who will undertake these duties with the demise of the strategic health authorities and PCTs? Linked to that, we need to ask about workforce planning. As many noble Lords have mentioned, clinical academics need to be fed through to these bodies. How will that happen?

The British Medical Association has recommended consideration of the roles of networks, health innovation and education clusters and the National Institute for Health Research and how these will fit into the Government’s overall plans. Can the noble Earl assure the House that the funding for the National Institute for Health Research is, indeed, safe?

On the necessity for ensuring excellence in education, we also need to look at the implications of the Browne review of university funding because we need to know how the leg that concerns teaching and universities will be affected. Presumably the cutbacks in the funding of higher education will have an impact on AHSCs in relationships with universities as they collaborate with them. There is the potential for a double whammy here, both in costs to individual students and, indeed, in the cutbacks that universities are to suffer as a result of the CSR settlement. Like other noble Lords, I welcome the fact that research has been protected under the CSR, but it seems to me that at least two legs of this stool are looking a bit dodgy. I invite the Minister to tell the House how the Government intend to support the future of these partnerships in the long term.

Medical Profession (Responsible Officers) Regulations 2010

Baroness Thornton Excerpts

Tuesday 23rd November 2010 Lords Chamber

Moved by

[Baroness Thornton]

As an amendment to the above Motion, at end to insert “but this House regrets that the draft regulations may imperfectly achieve the policy objective of the introduction of a revalidation scheme in light of the Government’s proposed changes to the NHS administrative structure which will affect the operation of the revalidation scheme in general, and these regulations in particular”.

[Baroness Thornton]

My Lords, as the Minister quite rightly suspects, it was a combination of the report of the Merits of Statutory Instruments Committee on 7 October and my concerns that some aspects of the statutory instrument as drafted need further explanation that caused me to put down this amendment to the Motion this evening. I think it is important to say from the outset that as one of the Ministers who guided the Health and Social Care Act 2008 through your Lordships' House with my noble friend Lord Darzi, I am very pleased that this Government are showing determination to push ahead with this agenda because at the heart of this legislation are patient safety and ensuring that all clinical professionals deliver high quality, effective and safe care to their patients.

I fully appreciate that responsible officers are integral to improving care, and the development of their role seeks to raise the already high standards of the overwhelming majority of professionals, but their job is to identify and swiftly deal with the small number of staff who are not able to meet those standards. The public, professionals and the NHS have a right to be assured that licensed doctors are fit to practice.

I have absolutely no desire to delay the important matter of implementing this legislation. However, I think that it is important that the secondary legislation does the job that the original legislation intended. The report by the Merits Committee raises some important questions in this regard, as do some of the important bodies whose membership will, as it were, be on the receiving end of the instruments.

I think that the regulations do a very good job of describing the duties of the responsible officer and, indeed, the connection between responsible officers and designated bodies and medical practitioners, and this leads me to my first set of questions. Part 1 of the schedule contains a list of designated bodies that includes at least two organisations that the Government intend to abolish: strategic health authorities and primary care trusts. I join the Merits Committee in its recommendation that the House seeks clarification on how the Government's proposed changes to the NHS structure will affect the revalidation scheme in general and these regulations in particular.

Since the 2008 Act, the UK Revalidation Programme Board—hosted by the GMC, which I thank for its briefing and comment on this matter—has been rolling out the reform in phased stages, including a number of pilot exercises which aim to produce a well informed and robust system. Can the Minister tell the House how the changes that have been proposed will affect the pilots and their results? For example, the published guidance says that the responsible officers themselves will be assessed by the responsible officer in the strategic health authority, so what will happen now? How will the Government overcome this problem? I anticipate that we can expect some further orders and, if so, when and will they too be piloted? If nothing exists in the structure of the newly reformed NHS between groups of commissioning doctors at local level and the NHS Board at national level who or what will perform this function?

At the time of the original legislation, we had considerable discussion about the GMC and its role in this matter and about not conflating its particular and important role as the independent regulator for doctors in the UK or, indeed, creating conflicts of interest. At the moment, it seems to me that the only body that would appear to have a structure between the very local GP consortia and the national board is the GMC. What is the Minister’s view of this? How will revalidation work under those circumstances?

I thank the Minister for forwarding to me the letter that his honourable colleague Anne Milton sent to members of the Delegated Legislation Committee in another place. In this letter, she addressed the changes of architecture to the NHS. However, I am afraid that I did not find her explanation very comforting. She says:

“The Government’s proposed changes to the structure of the NHS set out in the White Paper ‘Equity and Excellence: Liberating the NHS’, in particular the abolition of PCTs and SHAs, will not affect the majority of organisations designated under Regulations, including NHS and independent hospitals. These organisations need to start putting the systems in place that support doctors, and provide the information that demonstrates the quality of care they provide. Without this, there is a danger that doctors will be inadequately supported for the introduction of medical revalidation in 2012. I believe that the medical leadership and stability provided by having responsible officers in place will also be important during this period of change”.

Well, quite: the two bodies that can provide that leadership are being abolished.

I turn now to concerns that have been expressed by professional organisations, which particularly led the Merits Committee to say that,

“these regulations are drawn to the special attention of the House on the grounds that they imperfectly achieve the policy objective”.

When I was a Minister, I would have regarded that as the parliamentary equivalent of being put on the naughty step and given a detention at the same time. I think that the Minister needs to give some thought to this matter and to put his responses on the record.

The British Medical Association has said that the laying of the order is “premature”. Although I am not one for delaying these matters, the Minister needs to address its concerns. The Royal College of Surgeons has expressed disappointment that many of its concerns were not addressed in the regulation. It raised the issue of potential conflicts of interest to arise from the installation of responsible officers with simultaneous corporate board responsibilities—for example, medical directors.

The RCS seems to think that such officers might be torn between trust obligations and the professional role of the responsible officer. I am sure that the Minister will be familiar with the examples that these organisations have raised. How do the Government intend to avoid the revalidation recommendations becoming the tools of managers and trust management agendas, rather than matters relating to the compliance of GMC and Royal College standards? Will the Minister confirm that it is the responsible officer’s responsibility to examine the doctor’s clinical ability and professional conduct, not his contribution to the meeting of trust budgets or targets? On this matter the regulations appear to be silent. Perhaps the Minister will expand. The RCS has expressed particular concern about the failure to incorporate whole practice appraisal in these provisions. I think that the Minister needs to give the House an explanation and reassurance about the need for the comprehensive protection to which patients are entitled.

On indemnity, will the Minister confirm how the Government will approach the issue of the potential increase in contributions for medical directors who take on the role of the responsible officer?

Finally, the GMC has expressed concern about appeals and that there is a significant omission of local appeals systems. The GMC fitness to practise processes should not be both the first and the last resort for appeal. There should be a viable appeals structure that flows up to fitness to practise. The British Medical Association says that in some organisations progress has been slow in demonstrating the capability to pull together the necessary data to actualise the new system. It says that appraisal has been patchy and disjointed in many organisations, and that that is quite aside from getting around to supporting any appeals system that may arise. I have raised several issues and I suspect that other noble Lords will seek clarification on the various other issues. I look forward to the Minister’s response.

[Baroness Finlay of Llandaff]

My Lords, we all know the sad history of this, through Shipman, which has led us to where we are today. I do not want to block these reforms because they will improve medicine for patients and for clinicians. But there are some questions which need to be sorted out urgently. One question is the role of the responsible officer in relation to doctors in primary care, particularly with the reorganisation.

In his opening remarks, the Minister spoke about trusts, but I would suggest that hospital practice is very much the easy end of it. The difficulty is where will doctors in primary care sit? How will the responsible officer work in relation to them? Where will academics sit and who will be the responsible officer, because there is sometimes a conflict, as has been pointed out, between academic priorities and the clinical priorities of a trust where that doctor may have an honorary contract? Even more, what about locums? What about the doctors who are constantly moving around? How will they be captured in the system? How will they be adequately and appropriately revalidated? Even with what used to be called 360 degree appraisal—that is, getting opinions from a lot of people—with locums there is a real danger that they will only spot their friends to fill out the forms because they may have had lots of contacts. Those concerns may never be sufficiently in the system to be raised before such a doctor moves on.

There is also a difficulty for those who raise problems. It may be that the doctor who is seen as the sand in the shoe of the trust, the difficult person, is raising real concerns about the way in which management is conducted, which is impeding good patient care. We know that one of the biggest problems is attitude. Often, the biggest problem encountered is not about the ins and outs of technique, because you can retrain on that quite quickly, but is about someone’s attitude. Someone who is whistleblowing, someone who works in the same organisation—I hate to use the term “whistleblowing”, because it is a sad reflection of the NHS as it is today that that term is around—and raises concerns should not in any way potentially be penalised for doing so. We would just go backwards and not forwards if that is the case.

Given that the majority of doctors are doing a really good job and are very flexible and going through changes, the system that comes in must not be too onerous. It must not be just a tick-box exercise. It has to be subtle enough to pick up real issues around performance and attitude. It has to pick up qualitative feedback, so that a bad attitude is detected, including a bad attitude towards patients.

As regards the responsible officer, I am afraid to say that I am sufficiently old-fashioned to think that I would prefer the minimum time after qualification to be a bit longer. It is not until someone has been practising for about 15 years that they really have accrued enough wisdom to be able to take on what will be a very onerous and potentially important role in relation to their colleagues. We need them to have a degree of wisdom. The appeals system is absolutely crucial if this is to work well and fairly. I hope that the Minister will give us a full reply in his response.

We also must be clear that the system will not pick up another Shipman. This is a clinical system and not a criminal justice system, so no one should be fooled into thinking that it will. Dame Janet Smith pointed out two things. First, the most important information about patient safety is doctors watching other doctors. They have to be able to raise concerns easily. Secondly, a good clinical governance system is a system in which questions can be raised at an earlier stage and more readily. So it is the whole system of the NHS with good clinical governance that will make this work. I hope no one thinks that just having responsible officers putting in appraisals will do the job because that will be a wallpapering exercise.

However, my main concern relates to primary care and to financial conflicts. In a privately managed organisation there may well be a conflict between what is actually in the patient’s best interest and what is being put forward as the protocol in that managed care programme. It may well be that the doctor is working in the patient’s best interests, but not in those of the organisation. Again, there has to be a degree of neutrality among the responsible officers. I hope that the Minister will be able to give replies to all these concerns, and like other noble Lords, I look forward to his response.

--- Later in debate ---

[Earl Howe]

My Lords, the answer to the first question of the noble Baroness, about career breaks and so on, is yes, the regulations allow for that. In answer to her second question, we are not specifying that responsible officers have to be medical directors. As she knows, we are leaving it up to the organisations to decide that. Therefore, she can be reassured on her other questions.

[Baroness Thornton]

My Lords, I thank all noble Lords for contributing to this debate, particularly the noble Baroness, Lady Finlay, the noble Lord, Lord Colwyn, and my noble friend Lord Rea. I also thank the Minister for his comprehensive answer. Noble Lords will have heard me say from the outset that I did not intend to delay the implementation of the regulations. However, noble Lords should also acknowledge that if we ignored the reservations expressed by the Merits Committee and various medical organisations, and did not to pay heed to what they had to say about this, we would not be carrying out our duty of scrutiny. I thought that the most important thing was to get on record the answers to the very questions that we have raised.

I thank the Minister for his usual comprehensive and competent answer, which helpfully addressed many concerns. The abolition of PCTs and strategic health authorities is on the “wait and see” bit of this agenda. We can take it that the Department of Health has not yet worked out what it is going to do. I take some comfort from the fact that this, like much else, is in the melting pot of what is becoming the NHS at the moment; it is work in progress. With that and with thanks, again, to the Minister, I beg leave to withdraw the amendment to the Motion.

Amendment to the Motion withdrawn.

Health: Chronic Obstructive Pulmonary Disease

Baroness Thornton Excerpts

Wednesday 17th November 2010 Lords Chamber

Asked By

[Baroness Thornton]

To ask Her Majesty’s Government when they will implement the National Clinical Strategy for Chronic Obstructive Pulmonary Disease.

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

My Lords, the reforms set out in Equity and excellence: Liberating the NHS will ensure that the NHS focuses on improving outcomes for patients. As a result, we are looking at the role and nature of clinical strategies within the reformed NHS to ensure that they reflect this focus.

Today is World COPD Day. I can assure the House that we are committed to improving outcomes for those who suffer from COPD and from asthma. We will make further announcements shortly.

[Baroness Thornton]

I join the Minister in welcoming World COPD Day, which draws attention to this incurable, degenerative lung condition. However, I am disappointed that he has not thought fit to use today to adopt the COPD strategy, which was left up and ready, as it were, when the previous Government left office. Apart from anything else, I wonder whether he is aware that the British Lung Foundation’s research shows that up to 80 per cent of GPs cannot tell the difference between asthma and COPD. That is a very serious issue for prescribing. The adoption of the COPD strategy would bring systematic training and awareness-raising of this condition.

[Earl Howe]

My Lords, as I indicated in my Answer, the reform programme that we have outlined is intended to ensure that all parts of the system work more effectively in improving health outcomes. That has to include COPD. We have to ensure that everything that we do fits into the proposed new architecture of the NHS. In the mean time, we will continue to work with key organisations and with clinical leads for COPD and asthma to make sure that change happens. I know that a great deal of activity is in hand across the NHS to improve outcomes for patients with COPD and asthma as a result of the good work undertaken so far.

Department of Health: Arm’s-length Bodies

Baroness Thornton Excerpts

Tuesday 16th November 2010 Lords Chamber

[Earl Howe]

My Lords, my noble friend makes a good point. We need to distinguish between posts that are administrative in nature, where we will see considerable reductions, as I have mentioned, and posts that relate to clinical activities. There is obviously a clear case for the latter posts to be advertised and filled where necessary.

[Baroness Thornton]

Will the Minister explain to the House why the Human Tissue Authority and the Human Fertilisation and Embryology Authority have been included in the Public Bodies Bill when some 28 other NDPBs—I apologise to the House for that—were listed on 14 October in the announcement made about quangos? Will the Minister also explain whether an impact assessment has been done on any or all of these bodies, and when we might see the results of that? How many people does he expect will be made redundant, and at what cost?

[Earl Howe]

My Lords, the impact assessment will be published as soon as we know the size and shape of the costs involved. As I mentioned in my original Answer, we do not know that at the moment because we do not know about natural wastage, the grades of the people who will have to leave, and so on. The main reason why those two bodies have been included in the Bill is that our proposals, when we finalise them, will be very simple. As I have outlined, they will involve reparcelling the current functions of the bodies in different directions. That is not a difficult thing to do: it can be done very easily by secondary legislation.