Health: NICE

Baroness Thornton Excerpts

Wednesday 14th July 2010 Lords Chamber

[Earl Howe]

My Lords, I am sure that my noble friend will accept, as I hope I made it clear the other day, that the Government are wholly committed to improving the quality of care for people with dementia and their carers. We are standing fully behind the dementia strategy, instituted by the previous Government. That strategy contains a specific objective of improving the quality of dementia care in hospitals. I take on board what my noble friend says about the absence of adequate research in the psychosocial domain. I shall discuss that point with NICE over the next few weeks as I am aware that it is one of its concerns.

[Baroness Thornton]

My Lords, I welcome the statement that the Minister has made about keeping NICE as an independent voice. That is vital. Will the Government still support NICE in its work not just in medical research, but as regards the broader aspects of disease, social conditions, social care and so on, as mentioned by the noble Lord, Lord Alderdice? NICE has broadened its brief and has taken a much more holistic view about the conditions on which it issues guidance. Will the Government still support it in doing that?

[Earl Howe]

My Lords, as the noble Baroness will know, in 2005, the then Government charged NICE with producing public health guidance as part of its work. As we establish a more integrated and effective public health service, we will look actively at how NICE can contribute to that agenda, and, in particular, how it can contribute to integrated care provided by health and social care combined.

Health: Diet

Baroness Thornton Excerpts

Tuesday 13th July 2010 Lords Chamber

[Baroness Thornton]

They are being abolished. I declare an interest as a former unpaid trustee of the Fifteen training restaurants. Does the Minister think that it was wise of the Secretary of State to attack Jamie Oliver's school meals campaign, particularly given that he was incorrect in saying that the take-up of school meals had gone down when it had gone up? Will the Minister join the rest of the country in applauding Jamie Oliver's campaign to improve the quality and nutrition of school meals?

[Earl Howe]

My Lords, I do not know whether the noble Baroness saw my right honourable friend on television recently talking about this issue, but this is a good opportunity for me to put the record straight. He has not criticised Jamie Oliver’s work on school meals: on the contrary, he has applauded Mr Oliver and the many people who have worked very hard to improve the standard of school meals. The point that he made was that a very important initiative started by Jamie Oliver to make people more aware of what healthy eating is all about turned into a kind of prescriptive, top-down management process from Whitehall—and that is counterproductive.

NHS: White Paper

Baroness Thornton Excerpts

Monday 12th July 2010 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating the Statement made in the other place. It was certainly a help to me to read the contents of the White Paper in the Daily Telegraph and in other media outlets over the weekend. However, the coalition Government must recognise that it is far from satisfactory that Parliament should be the last place to learn about matters of such importance.

In opposition, the Conservatives promised that there would be no more pointless reorganisations. The Prime Minister gave this promise to the Royal College of Nursing last year. The coalition agreement states:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care”.

However, now it is in government, the coalition proposes the biggest structural upheaval in the NHS for 60 years —for which GPs are unprepared, which NHS staff do not want and about which patients were never asked. Inevitably, my first question to the Minister is: why have the Government broken their word on this matter? The Minister will be aware that I have never said that there was not more that could be done to make the NHS better, or indeed to give more say to patients and clinicians.

In the past two weeks, there have been two sources of independent comment on the effectiveness of today’s NHS. A couple of weeks ago, the Commonwealth Fund said that the changes Labour had made had given the NHS a fantastic rating on quality, and that it was the most efficient health service in the world. I am sure that we all welcome the report published today on the survival rates for sufferers from bowel, lung and ovarian cancer. It shows huge progress and experts have said that this is due to the waiting guarantees that Labour introduced on access to cancer specialists, so that people have their cancers diagnosed early. Of course, that is another part of the system that Andrew Lansley is now wiping away. My question is: why is this great upheaval necessary when we have a health service that is providing good care to the vast majority of people and when waiting times are as low as they have ever been? Does this policy mean that there will be a grave risk that the NHS will go backwards?

This Statement is full of “coulds” and “might bes”: it is remarkably lacking in doing words. If the coalition Government had found an appalling situation, as we did in 1997, they might have had some justification for radical solutions; but this is not the case. The White Paper and the Statement talk throughout of building on the work done by the previous Administration, which is all well and good, and which I welcome, but I am very sorry that, in our view, it has led them to the wrong conclusion.

Today, the NHS is not on its knees. We saved it by investment and commitment to its values. A period of stability is needed so that energy can be focused on the financial challenges ahead and to do that it needs a confident and motivated staff to continue the development of the many services that we initiated; for example, specialist trauma services; the reconfiguration that has been necessary to deliver stroke services; the co-ordination of partnerships to make the best use of expertise for diabetic care at local level; and the investment in and the building of special expertise for kidney dialysis so that more people can look after themselves at home.

What will happen to all those services which require regional and local strategies and—a matter close to the heart of many in this House—how will the many hundreds of GP practices in London cope with the way in which TB manifests itself and spreads in London? A pan-London strategy is needed. How will a bottom-up service cope? It would be unsurprising if people conclude that this White Paper and the proposals that it contains are ideologically driven. That is why there is a betrayal of the promises that were given by the coalition. With that betrayal one also has to take a second glance at the patient voice mantra that we hear from the Secretary of State. We have to question whether that is a convenient cover for a concerted attempt to change completely the way in which healthcare is delivered in this country and is part and parcel of the determination of the Conservative Party to shrink the state. It is best to be honest about such matters and I ask the other partner in the coalition to say whether that is its view too.

Many will believe that this is tantamount to the privatisation of the commissioning function of the NHS. Will there be any restrictions on the use of the private sector to support GPs? Added to that, the Government are bringing in a series of market reforms for hospitals. The Secretary of State has previously admitted that his plans would allow hospitals to go bust. Can he confirm that if a foundation trust got into financial difficulty he would step in to protect it, or would he allow it to fail? Even more important, if all the NHS delivery is done through foundation trusts, what will that mean for patients?

Frankly, I do not believe it is good enough to conduct a huge experiment on an organisation that is delivering for its patients an improving service. The staff of the NHS do not need years of uncertainty about the future of their organisation and their jobs. The NHS needs confident, motivated staff, but today the noble Earl has opened up uncertainty for the 1.3 million people who work for it.

Let us turn to accountability for £80 billion of public expenditure. I ask the noble Earl to confirm that the Treasury also had something to say about accountability in this respect. GP practices are mostly small enterprises; they are small businesses. If, for example, another network of small businesses, such as the Federation of Newsagents, was about to be handed £80 billion of public money from the Treasury and told to spend it how it liked, I suggest there might be some small concern. We support a strong role for GPs but we have to question the wisdom of wiping away oversight and the handing over of £80 billion of public money to GPs, whether they are ready or not.

We are not alone in our concerns about this. Michael Dixon, chair of the NHS Alliance, says that only about 5 per cent of GPs are ready to take over commissioning responsibility. So what will happen to the other 95 per cent? Sir David Nicholson has judged that even the best GP practice-based commissioners are only about a three out of 10 in terms of the quality of their commissioning and that is not good enough to give them £80 billion of public money to spend. So what sound evidence does the noble Earl have that 100 per cent of GPs are ready, willing and able to commission services for the entire population?

The Statement talked of rewarding commissioners who hit outcomes. Does that mean yet more money for GPs and, if so, how much?

How many jobs do the Government expect to be lost, and how much money have they put aside for redundancy costs? What guarantees can the Minister give the House that people will not simply be paid off by the NHS to be re-employed, doing the same job, by someone else? Crucially, where is the public accountability and the accountability to Parliament? The Patients’ Association has said that nothing can replace the accountability of the ballot box. I absolutely agree, and I invite the noble Earl to join me in that support.

How will GPs be held to account for the £80 billion of public money for which they will be responsible? Chris Ham of the King’s Fund has questioned whether the independent NHS board, the world's biggest quango, will be able to hold more than 500 GP consortia to account in an effective fashion. What does it mean for the accountability to Parliament if the Government go ahead and set up the NHS board? An annual report is not sufficient. Those of us who work with a lot of voluntary organisations in the health sector know that they will not think that that is sufficient. MPs at the other end of the building will really think that that is not sufficient when they want to raise questions asked by their constituents.

[The Earl of Onslow]

My Lords, the noble Baroness has spoken for nine minutes. I thought, and it has been my experience in 30 or 40-odd years in this House, that you are supposed to ask questions concisely, not to make a 10-minute speech—because I see that she has some more pages to read.

[Baroness Thornton]

We are the Opposition, and the only Opposition here. I have asked five or six questions so far and I have more.

That leads us to look at the bureaucracy involved in the proposals. The White Paper has managed to unite progressive views in opposition to it with the unlikely figure of Melanie Phillips of the Daily Mail. She wrote:

“Oh dear. The last thing that's needed right now is yet another massive reorganisation, which may well incur even greater costs … it could mean yet more paperwork - and that GPs would be likely to demand more money for the additional responsibilities”.

Well, quite.

In my experience, PCTs are staffed with decent, hard-working public servants who care greatly about the NHS and its patients. How does the Minister think that they felt when they read the quote from a senior Department of Health source—I apologise to the House for the language—who anonymously briefed the Health Service Journal this week, and said:

“PCTs are screwed. If you’ve got shares in PCTs I think you should sell”.

Is that any way to treat staff who have served the NHS loyally? What does the Minister think about bureaucracy. The Government may find that what they think of as bureaucracy is the system for accounting for the expenditure of public money. Can the Minister tell me precisely how the replacement of 130 PCTs by more than 500 GP practices and consortia will reduce bureaucracy and paperwork?

The White Paper represents a roll of the dice that puts the NHS at risk in a giant political experiment with no consultation, no piloting and no evidence. The sadness is that the Government are taking an £80 billion gamble with the great success story that our NHS is today. Of course we welcome positive change and benefits for patients. We saved this NHS. At a stroke, this Government are removing public accountability, demoralising NHS staff at a time when we need them. For patients, it opens the door to a new era of postcode prescribing which will vary from street to street. We know that the streets and the patients who will suffer most are those whom we on this side of the House are determined to defend. We will be challenging the proposals along those lines.

Health: Spending Cuts

Baroness Thornton Excerpts

Wednesday 30th June 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness is right to draw attention to this issue, of which I am very conscious. Where we have commissioning, it is important that the population base for a given condition is sufficient for that commissioning organisation to contend with. With regard to specialised conditions, I am working hard to ensure that the model we propose will take them fully into account.

[Baroness Thornton]

My Lords, Hamish Meldrum from the BMA said:

“We urge the government and NHS organisations to focus on those areas where they can truly eliminate waste and achieve genuine efficiency savings rather than adopt a ‘slash-and-burn’ approach to health care with arbitrary cuts and poorly thought-through policies”.

For example, I understand that there is a 50 per cent cut in the communications budget of the Department of Health. Does this include public health information programmes, and are they being dropped? Will they include programmes on smoking cessation, stroke, obesity and various other public health issues? I would have thought that those would have been a priority for this coalition Government.

[Earl Howe]

My Lords, public health is indeed a priority for the coalition Government. However, we are subject to a government-wide constraint on marketing and communications expenditure. That means that every programme of communication or marketing has to be justified by the evidence that it will do some good. That is a good and proper control. It does not mean that we will stop all spending, but we have to justify what we do.

Health: Stroke Treatment

Baroness Thornton Excerpts

Wednesday 30th June 2010 Lords Chamber

[Baroness Thornton]

My Lords, I start by thanking the noble Lord, Lord Rodgers, for bringing forward this debate. It is almost exactly a year since we had a debate in your Lordships’ House in which the noble Lord mentioned stroke and, indeed, his questions were answered by me. I do not expect that the noble Lord imagined that he would be addressing his questions to a Minister who, one year on, is now his noble friend. I hope that the noble Lord, Lord Rodgers, is not going to let up on his consistent holding of the Government to account for what is going to happen to stroke services and the stroke strategy.

It is not often that I do this, but I intend now to quote myself from 25 June last year. In that debate, I said:

“The noble Lord, Lord Rodgers, raised the issue of stroke, as did several other noble Lords including the noble Lord, Lord Walton of Detchant”—

whose debate it indeed was. I continued:

“He was right to point out that we have a new national framework for stroke and we are endeavouring to give it the right kind of emphasis and prioritisation that stroke requires. I can confirm that the 10-year plan is on track, that the stroke strategy acknowledges that the networks are of great benefit and that all the stroke services in England now fall within one of the 28 networks. The work of the stroke improvement programme, including the networks, will be evaluated over the next year, after which future work plans will be considered”.—[Official Report, 25/6/09; col. 1750.]

There is no question that the Labour Government took the issue of stroke very seriously, for all the reasons that have been eloquently described by noble Lords today. I think particularly of the very fair summary of the history of this issue which the noble Lord, Lord Rodgers, gave.

I suppose, then, that my first questions to the Minister are: has the review been finished, what is its outcome and what are the government plans for taking forward the strategy? Indeed, will the coalition Government be following the stroke strategy, or will they be junking it to start all over again in a year’s time? Personally, I would counsel against such a course of action, given the widespread support that the strategy has across a whole range of medical and voluntary organisations and, indeed, the involvement of many of those organisations in the creation and continued monitoring of the strategy.

However, there are some worrying signs, to which other noble Lords have already referred. On the recent decision by the coalition Government, on 10 June, to remove ring-fencing conditions from the £15 million 2010-11 revenue grant to local authorities for implementing the stroke strategy, I can only quote the excellent briefing, for which I am very grateful, from the Stroke Association. It says that in its opinion this,

“makes the risk of cuts to current support service levels even more pronounced and in need of urgent attention”.

I agree with it and would really like to know how the strategy will now be delivered at local level.

The NAO and the PAC, which noble Lords have also mentioned, recognise the risk posed to improvements in the longer-term stroke strategy services by the end of additional funding for the implementation of the national stroke strategy after 2010-11 and the current financial pressures facing the NHS and local authorities. Under these circumstances, we need a commitment from the department that these improvements will continue in the long run. Indeed, as has already been mentioned, the PAC makes a number of key recommendations on how the department can sustain and improve further the standards of service for all stroke patients across the whole care pathway, and asks for reports on progress in areas within 12 months. I agree with that and would like to hear a commitment from the Minister to that course of action. Indeed, when we were in government we regarded the work of the PAC as extremely important in helping us to deliver the stroke strategy.

However, I am alarmed at the current risks to services. The NAO report shows that 76 per cent of local authorities surveyed have used the Department of Health’s ring-fenced funding to develop services with the Stroke Association. As mentioned by my noble friend Lady Pitkeathley, the number of contracts with local authorities to provide information and support has increased from 164 in 2005 to 268 in 2009. It seems that, at current levels, one in every two patients is able to access them. Around half the local authorities have also used the funding to establish their own dedicated stroke-related jobs, such as stroke care co-ordinators, stroke-specific social workers and occupational therapists, and a quarter have used some of the grant to fund breaks for carers.

We know that there is also still an unmet need. It would seem that, at the moment, an estimated 50 to 60 services around the country could be under threat of not having their contracts renewed. This is a very serious issue. Some local authorities have already put recruitment on hold for vacant positions. I am concerned that the message being sent from the department is that this is no longer a priority for local authorities. How will the coalition Government re-establish the priority that we gave stroke, and how will they re-establish those networks that have been so important in improving the treatment of stroke across the country and for the future?

I have several other questions which the Government need to address. They relate to the issue of funding at local level. Do the Government have plans to monitor and evaluate the use of the ring-fenced funds to ensure that they continue to be a priority? Does the Minister feel that the premature ending of ring-fencing sends the message that I have already outlined—that this is no longer a priority? What on earth will they do about that? The Stroke Association and the voluntary sector have a right to be very concerned.

The Minister would expect me also to refer to FAST. The previous Government invested £10 million between 2008 and 2010 in awareness-raising activity around strokes, centred on the highly visible Act FAST campaign, which I demonstrated to your Lordships’ House twice last year. The PAC report describes this campaign as “excellent” and concluded that it,

“had improved public awareness of stroke and the responsiveness of ambulance and hospital staff”.

Given that the mantra we keep hearing is that the Government want an evidence base for the decisions that they take, I hope they will take on board the NAO’s public survey, which gives the evidence that this campaign has worked. Will the Minister confirm that the funding allocated for the continuation of the excellent Act FAST campaign will be spent? What plans does the department have to continue funding the excellent campaign to improve awareness of stroke over the medium to long term?

I am proud to have been part of the Government who transformed the treatment of stroke in this country. We made the National Stroke Strategy a priority and gave additional funding to strategic health authorities for its implementation. We ensured strong leadership at a national level with a national clinical director for stroke and the new NHS Stroke Improvement Programme. Progress was aided by the inclusion of implementation of the National Stroke Strategy of the NHS operating framework as a tier-1 “must do” national requirement. I am pleased that the tier-1 status continues to be there in the revised operating framework that this Government have just published. I hope that that is not just for this year, but for the duration of the strategy. Is that the case?

We know that the best way to reduce the human and economic cost of stroke is through prevention. I put it on record that I remain to be convinced that the coalition Government are taking seriously their commitment to issues of public health. The prevention of stroke is key to the whole of the Government’s public health drive. Smoking cessation, obesity campaigns and swimming are all linked to how we prevent stroke in the future. How will the Government’s work to prevent stroke happen in the current financial climate and given the freeze in advertising? Having a policy which just says that we are going to prevent stroke by doing the following things, but are cutting the budget that allows us to communicate that, makes it not at all a useful commitment. It is meaningless. It is important that we hear what the Minister has to say on that.

Finally, what does the moratorium on reconfigurations mean for stroke services? Following consultation, Healthcare for London planned to introduce eight hyper-acute stroke units, all of which it hoped would be up and running by April 2011. However, I have to ask, what is the future for these centres? The Secretary of State has said:

“I am fulfilling the pledge I made before the election to put an end to the imposition of top-down reconfigurations in the NHS … As part of this, I want NHS London to lead the way in working with GP commissioners in their reconfiguration of NHS services. A top-down, one-size fits all approach will be replaced with the devolution of responsibility”.

We have heard this many times before. However, this has potentially extremely serious implications for stroke services in London, which are beginning to deliver an absolutely excellent first-rate service which is saving the lives of Londoners. As someone who lives in London during the working week, I would like to know what would happen to me now if I had a stroke. Would I end up at one of these centres or have they now been reconfigured out of existence? I suggest that we probably need to keep a very vigilant eye on the future of stroke services.

[Lord Clinton-Davis]

I apologise for speaking in the gap. I did not know whether I could be here. However, it would be remiss if I were not to mention the debt that some stroke sufferers owe to the authorities of this place. I am one of them.

Health: Primary and Community Care

Baroness Thornton Excerpts

Thursday 24th June 2010 Lords Chamber

[Baroness Thornton]

My Lords, this is an interesting subject for debate, as the debate has proved. Learning the lessons of the past 10 years at the moment when great change is about to be unleashed on the whole way in which healthcare is delivered in the UK seems appropriate, and I congratulate the noble Lord, Lord Mawson, on his usual entrepreneurship in the timing of this debate and the passion that he brings to the issues of innovation in providing public services—in this case, healthcare—as well as his hopes for less bureaucracy, less political change but not, I hope, less accountability. The noble Lord has been making this kind of wonderful speech for as long as I have known him. Rightly, he blames bureaucracy and politicians in his passion to roll out the models that he knows so well and that work so well. As he knows, I have a great commitment to social enterprise and entrepreneurship, but I think that he needs to give some credit where it is due about the progress of the past 10 years.

I remind the House that some progress has been made. I should like to look at two issues—the LIFT programme and the development of social enterprise in the past 10 years. The LIFT programme, delivered through community health partnership, is there to create, invest in and deliver innovative ways in which to improve health and local authority services. I know that the noble Lord, Lord Mawson, is familiar with the LIFT programme and has tales to tell about the difficulties of this bit of the bureaucracy. But it is there to deliver and provide clean, modern, purpose-built premises for health and local authority services in England. The reason why the programme is so important is because 90 per cent of patient contact with the NHS occurs in general practice. The research shows that primary care in the inner cities, where healthcare need is the greatest, may have suffered from a disproportionately high number of substandard premises in primary healthcare. That is why we instituted the LIFT programme. We knew that the condition and functionality of existing primary care estate was variable, with current facilities not meeting patients’ expectations and quality and access often being below an acceptable standard—and, therefore, service development sometimes very severely hampered by the limitations of the premises.

As a Government, we made an investment in primary and social healthcare facilities. We made it a priority in inner-city areas. It was clear to us that new buildings were required to provide people with modern, integrated primary care services. When we came to power, there is no doubt that the creation of new facilities was fragmented and piecemeal. Developments tended to be small scale and focused on more affluent areas; they tended not to integrate social care at all. The landscape has been transformed in the past 10 years. If I add to this the review done by my noble friend Lord Darzi, it is clear that we have made some progress.

I shall mention some of these outcomes and particularly draw them to the attention of the noble Lord, Lord Mawson. He said that he was tired of words and no delivery. Well, there has been a huge amount of delivery—in fact, £2.2 billion worth of delivery of new schemes. I take for example the centre at Church Road, Manor Park in Newham, which the noble Lord may be familiar with. It brought together three GP practices and contains district nursing as well as health visitors, dentistry, pharmacy and many diagnostic services. Then there is the Thurnscoe primary care centre in Barnsley, which has, among other things, eight GPs and traditional primary care services; it is able to do blood tests, ultrasound scans and minor procedures, which means shorter hospital waiting times. It also includes an ICT training suite, a GP training room, an audiology clinic, a podiatry clinic, district nursing and physiotherapy.

The one that I like best is the Kenton Resource Centre in Newcastle, which was built on the site of an old clinic on Hillsview Avenue. It has a new health facility, including the relocated GP practice, but it also includes community health professionals, Newcastle City Council and voluntary services, a local customer centre, which provides housing and benefit advice, a Newcastle City Council library, which serves three neighbouring districts, and a Northumbria Police office for local beat officers.

I could go on. In fact, the most recent centre was opened last week in Dudley—the new multimillion-pound state-of-the-art Brierley Hill centre. Therefore, I think that we can say that we have been delivering local community centres in the last 10 years, but I ask the Minister what the fate of the programme will be. How will it fare in the reconfiguration of the NHS that we are told is on its way?

Let us turn to social enterprise. I declare an interest as a serial offender in social enterprise. I have spoken many times in your Lordships’ House about the development of social enterprise and I have sponsored things such as the community interest companies Bill. I think that it is worth saying for the record that social enterprise is a business whose objectives are primarily social and whose profits are reinvested back into its services for the community, with no financial commitments to shareholders or owners—it is free to use its surplus income to invest in its operations to make them as efficient and effective as possible. Well known social enterprises include Turning Point, the Eden Project and the Big Issue.

The Department of Health has been promoting social enterprises through the initiatives that the Labour Government took, as we saw the advantages of them for patients and service users. We instituted the right to request as part of our broader vision for the NHS. I know that the first phase of the right to request has been enacted and I think that the second phase is about to be enacted, but I should like confirmation of that from the Minister. I should like to know what will happen to the social enterprise investment fund and to the right to request.

I should specifically like to know from the Minister what will happen to contracting, although he may not be able to give me an answer right now. The Labour Government made a commitment through the department that, when a social enterprise had been established in the health service, had gone through the right to request and was contracting for services, that enterprise would have a three-year or possibly a five-year contract, which would be guaranteed once it had gone through the whole process. Will that continue under the new regime? If the Government are serious about developing social enterprises to deliver primary healthcare and other services within the health service, a contract of three to five years will be vital for those businesses.

The noble Lord, Lord Mawson, talked about the Bromley by Bow Centre, which is a tremendous achievement. I should like to mention the Big Life centres. The Big Life is based in Manchester. It grew out of the Big Issue and works with people completely cut off from health, housing and employment services. There are now eight or 10 centres providing holistic services to the communities in which they are based. The Kath Locke Centre combines the best in conventional NHS healthcare with complementary therapies. It is well built and a good place to relax, and is extremely well used by its local community.

The Big Life Group issued a manifesto for the last general election, which I commend to the Minister. It states:

“We believe, developing a market in the NHS has really only meant opening up to large private sector companies and has largely missed the opportunity to bring in innovation through the social enterprise sector”.

I do not agree completely with that: it may be as unfair as some of the comments made by the noble Lord, Lord Mawson. However, the Big Life Group may have a point. We as a Government did not succeed as much as I wish we had. The challenge is now there for the coalition Government. If they are serious about having an innovative marketplace, they must address the issues raised by organisations like the Bromley by Bow Centre and the Big Life Group.

I agree with the noble Lord, Lord Mawson, that the department must encourage more entrepreneurship. Like him, I have been frustrated by slow progress across the piece. As the founding chair of the Social Enterprise Coalition some 10 years ago, I think we should blow our own trumpet. Where there was one Bromley by Bow, there are now many. Social enterprise was mentioned in every party manifesto, and is now part of the coalition Government's programme. We have made great progress. However, there are still huge challenges.

I have some questions for the Minister. It seems that in two years’ time, £60 billion of NHS funding might be funded through local commissioning, as the noble Lord, Lord Crisp, mentioned. What will happen to these schemes and programmes if this reconfiguration of the NHS is going to be so profound? How will the Bromley by Bows and the Big Life centres be developed under those circumstances? How will this entrepreneurship be taken into account in the new commissioning scheme? The noble Baroness, Lady Finlay, made a valid and wise point: the rush to change might jeopardise what has already been achieved through partnership and innovation. I agree with the noble Lord, Lord Crisp, that we do not want to lose some wonderful examples of PCT innovation in the forthcoming reorganisation. How will the coalition Government build on the platform that we created—or do they intend to dismantle the platform, with all the risks that go with that?

NHS: Patient Targets

Baroness Thornton Excerpts

Wednesday 23rd June 2010 Lords Chamber

Asked By

[Baroness Thornton]

To ask Her Majesty’s Government how they will ensure that patients will be seen in reasonable time by doctors and other primary care professionals following the publication of the revised NHS operating framework which removes NHS patient targets.

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

My Lords, the revised NHS operating framework stops central performance management of process targets that have limited justification. The NHS must be free to manage services at a local level, and will be accountable to the patients and the public it serves. To ensure this, we shall continue to collect data measuring access. Incentives for timely access such as through the quality outcomes framework, the NHS constitution and the contractual regime remain in place.

[Baroness Thornton]

I thank the noble Earl for that Answer. He will recall that in 1992 his Government launched their Patient’s Charter, in which the pledges for patients included:

“to be guaranteed admission for treatment by a specific date, no later than two years from the day when the consultant places the patient on a waiting list”.

I might add that his Government did not achieve that. I take it that the coalition Government’s objective is not that, but the House might like to know what they think is a reasonable waiting time. We got it down to 18 weeks. What does the noble Earl think it should be?

[Earl Howe]

My Lords, it is right for me to make clear that the previous Government achieved a great deal in bringing down waiting times—there is no doubt that that was a major worry for patients—and they are to be commended for that. The noble Baroness is concerned that we do not let the situation slip, and I fully share that concern. As I have indicated in brief terms, two main issues will prevent it happening. The first is that the legal duty on commissioners to commission services that comply with operational standards around the 18-week referral time still applies. The second is the NHS constitution, which contains the right to access services within minimum waiting times, as she knows. Those patient rights within the constitution have not been diluted.

Health: Cancer

Baroness Thornton Excerpts

Monday 21st June 2010 Lords Chamber

[Earl Howe]

The noble Baroness is quite right, which is why in the NHS there is such an emphasis on speed of referral when a GP first suspects that cancer may be present in a patient. This is an area to which we are very alive, and I hope that we will be able to make further announcements about it in due course.

[Baroness Thornton]

Does the Minister accept that new cancer treatments such as PDT have benefited both from crucial investment by the Government and from partnership with leading cancer research charities? Is he prepared to guarantee that this crucial research will continue to be funded by the Government so that more deaths from cancer can be prevented in the future?

[Earl Howe]

The noble Baroness is quite right. This is a partnership effort, and she may know that a systematic review of PDT has been undertaken as part of the Health Technology Assessment programme, which is an element of the National Institute for Health Research. The final report on that will be published in August, but the institute has already identified that there are not enough high-quality research studies in this area. We know from experts in the field that there are at least three or four areas where further research should be prioritised.

Health: Government Spending

Baroness Thornton Excerpts

Monday 14th June 2010 Lords Chamber

Asked By

[Baroness Thornton]

To ask Her Majesty’s Government which health agencies and arm’s-length bodies will be affected by cuts in government spending.

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

My Lords, the Government are committed to reducing bureaucracy and improving efficiency. By streamlining and simplifying the infrastructure, we can ensure that clinicians focus on what really matters: delivering the best possible health outcomes for patients. All non-front-line organisations will be expected to operate efficiently and contribute to the Government’s commitment to reduce central administration spending by one third. That is why we are reviewing how best to organise the national infrastructure. The review will report in due course.

[Baroness Thornton]

I thank the Minister for that Answer. Notwithstanding the Government’s proposed intention to create the biggest quango of all in the NHS board, what can the Human Tissue Authority and the Human Fertilisation and Embryology Authority expect from the bonfire of the quangos? Will it be a third of their work, for example? I choose those two because the Minister and many noble Lords in this House were closely involved in considering the legislation that led to the creation of those two important bodies.

[Earl Howe]

My Lords, the focus of the exercise that is going on at the moment is, on the one hand, to look at value for money and, on the other, to look at how best we can deliver quality. Therefore, the review will consider which functions should be carried out at a national or arm’s-length level, which could be stopped with no detriment to the delivery of front-line services and which could be undertaken elsewhere in the system or, indeed, left to the market. So there is no target as regards getting rid of a certain number of bodies. The point of view from which we come is that of functions.

Mid Staffordshire NHS Foundation Trust

Baroness Thornton Excerpts

Wednesday 9th June 2010 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating this important Statement. The Secretary of State promised to establish a public inquiry to examine the Mid Staffordshire Foundation Trust as late as February when he was in opposition and my right honourable friend Andy Burnham made a Statement on this matter in another place and announced the findings of the Francis report.

The staff, management and board of the Mid Staffordshire Foundation Trust have worked hard to turn round this foundation hospital and to re-establish good relations with their local community. They now find themselves back on the front page for failures that occurred three or four years ago, which have already been the subject of three inquiries. Therefore, my first question to the Minister is, how do the Government intend to support the staff and management of Mid Staffs during the coming public inquiry? I agree with the noble Earl—it is important to put this on record—that we should acknowledge the work that the current chief executive and chairman have undertaken in the past year or so to turn round this hospital, which has met with a large measure of success. I hope that the Government will support them in the coming months.

There have now been three reports into the terrible events at the Mid Staffordshire hospital. Professor Sir George Alberti published a review of the hospital’s progress in emergency care, and Dr David Colin-Thomé published a report on how the commissioning and performance management system failed to expose what was happening in the hospital. The independent inquiry by Robert Francis QC was then established in July 2009. That report is 800 pages long, and I think the noble Earl will agree that it reflects with accuracy the terrible catalogue of failure of care of patients and their families, the comprehensive failure of the management and the failure of the foundation board. As my right honourable friend in another place said, our job in government then was to hold a mirror up to the NHS, which is why we commissioned the Francis report in July and brought forward the further proposals and terms of reference for a further inquiry. Therefore, of course the new inquiry has our full support, as has anything in the Statement that, for example, strengthens and supports whistleblowers in the NHS.

My next question is: how much account will be taken of the previous reports, conducted as they were by very distinguished medical and legal professionals? Can the Minister explain in what way the questions or terms of reference of the new inquiry will differ from the draft terms of reference which my right honourable friend agreed before the election? How long will this inquiry take and how much will it cost? Indeed, what has happened to the many recommendations made in the Francis report in February, which were accepted in full by the then Government? Will they continue to be implemented while this inquiry is ongoing?

Where I think that the Statement is disappointing and perhaps even dangerous is in the reference to targets. It seems to me that the noble Earl is in danger of prejudging the findings of the public inquiry in his undertaking to get rid of targets. The Conservatives have made it clear that they have an ideological opposition to targets, and they have used what happened at the Mid Staffordshire NHS Foundation Trust as their main example of why the four-hour target in accident and emergency is bad. We can have a discussion about that target. We think it is about national standards and that it is a tool for improvement. We also think it is about patient safety—indeed, it has huge support from patients and health staff, including doctors. What we know about Mid Staffordshire is that staffing fell to dangerously low levels. We know that it was not following the national guidance on targets and that it had a stupid staffing policy, which meant that it did not have enough nurses. We also know that the board and management completely failed to address these matters.

What will the Government do if the public inquiry finds that it was these gross failures at every level that were the problem and not the targets? It would be very unfortunate if this inquiry were used by the Government to justify their commitment to that ideology. Does the Minister agree that there needs to be a balance here? Surely the public inquiry needs to address with an open mind these isolated and awful events in this hospital, and then other hospitals and the NHS can learn the lessons from that. If that is the aim, the Government will have our full support.