Health: Healthcare Assistants

Baroness Thornton Excerpts

Monday 24th October 2011 Lords Chamber

[Baroness Greengross]

My Lords—

[Baroness Thornton]

My Lords, I often take my lead from the noble Baroness, Lady Masham. In an article in the Times today she said that a voluntary register was no cure. This, taken with the confusion created by, I am afraid, the noble Earl’s remarks about struck-off nurses, underlines the point at issue. I ask the Minister: is it really satisfactory that there is a chance that no one would know that a nurse was a struck-off nurse? Is it satisfactory that thousands of nursing care assistants are taking blood and carrying out procedures, but patients cannot know whether they are on a register and properly regulated? That is the problem. The noble Earl needs to think about the kind of juggernaut that is heading towards him on this one.

[Earl Howe]

No, it is not satisfactory that people should not know that a nurse has been struck off and is on the barred list. That is why it is incumbent on employers to make exactly those inquiries when taking on a new employee. As regards patients, the presence or absence of statutory regulation will not change one jot the responsibilities of employers or the responsibility of nurses to delegate appropriately on a ward or in a care home. Unsupervised, unregistered healthcare assistants should not be working without the proper authority and supervision.

Health: Obesity

Baroness Thornton Excerpts

Wednesday 19th October 2011 Lords Chamber

[Earl Howe]

My Lords, my noble friend makes what is in fact a very complex point. Many of us believe that there is a genetic element to this, and indeed the 2007 Foresight report underlined the complexity around the causes of obesity. Genetic, psychological, cultural and behavioural factors all have a part to play in it. I do not have specific advice to give my noble friend—far be it from me to do so—but there is obviously a balance to be struck between calories in and calories out.

[Baroness Thornton]

My Lords, if the Royal Society of Paediatricians, other medical organisations, Which? magazine, Jamie Oliver and many others regard the Secretary of State’s most recent obesity announcement, which presumably is based on corporate relations and the nudge theory, as, variously, “worthless”, “patronising” and “inadequate”, does the noble Earl regard this as people not understanding Mr Lansley—again—or could it be that the obesity strategy is actually not adequate and the Government need to go back to the drawing board?

[Earl Howe]

It is only inadequate if we as Government fail to work with partners as we have the ambition to do. We do have that ambition, and obviously we are disappointed by some of the reactions that have been published. However, we share the concerns expressed by Jamie Oliver and the bodies mentioned by the noble Baroness that urgent action is required to tackle obesity, and we all have a role to play in that.

Nursing: Elderly and Vulnerable Patients

Baroness Thornton Excerpts

Wednesday 19th October 2011 Lords Chamber

[Earl Howe]

The noble Baroness, with her expertise, makes a powerful point. We fully agree that there is an issue over unregistered healthcare assistants; I think the debate is around what we should do about it. We believe that the case for statutory regulation has not been made, although we would not close our minds to it. The point that the noble Baroness makes relates much more to nursing supervision, appropriate levels of delegation on a ward or in a care home, and appropriate supervision and training. That is a matter not for regulation but for nurse leaders in hospitals and care homes.

[Baroness Thornton]

My Lords, this is yet another report to add to others highlighting these issues. I think that the Minister has gone some way to explaining what change is needed, so that elderly people get treated in hospitals with the respect and dignity they deserve. However, how does he suggest that the nursing community should resist dangerous cost-cutting exercises by trusts, which are placing patient safety at risk by replacing experienced clinical staff with more junior nurses and healthcare assistants?

[Earl Howe]

We believe that patient safety is paramount and that it is a matter not just for staff on a ward but for the board of an organisation as well, to assure itself that the highest standards are being maintained. That means having proper staff ratios—ratios of staff to patients, that is—and ratios of trained and untrained staff within a ward. These are messages that we are consistently putting out.

EU: Food Labelling

Baroness Thornton Excerpts

Monday 17th October 2011 Lords Chamber

[Earl Howe]

As I hope my noble friend will allow, that is a little bit wide of the Question. I do not have an answer for her in my brief, but I will write to her.

[Baroness Thornton]

My Lords, I congratulate the noble Baroness, Lady Oppenheim-Barnes, on her Question but I have to say that I think her target should not be the EU but actually her own Government. If you put “food labelling” into a search engine, you will get hundreds of different versions of how food can be labelled. It feels like we are going backwards because of the flexibility that the Government have sought through the EU regulations. What part have the Government’s relationships with the corporate sector played in this matter, and, indeed, if food labelling is going to become more confusing, will that not count against the drive to have good and well balanced diets?

[Earl Howe]

My Lords, as the noble Baroness will know, there are various points of view from various sectors of industry about what constitutes the best and most helpful form of food labelling. As a matter of fact, that has lain at the heart of the difficulty in reaching agreement in Europe, because there are so many divergent views around this. It is quite true that we do have very strongly held views—not least by the Food Standards Agency—about the value of traffic lights. We have equally strong views, held by certain sectors of industry, on the GDA model. As I said earlier in answer to the noble Baroness, Lady Howarth, it would be desirable to have consistency, but we are not there yet. We will continue to work at that objective.

Health: Charities

Baroness Thornton Excerpts

Wednesday 12th October 2011 Lords Chamber

[Earl Howe]

The noble Baroness makes a good point and I shall ensure that it is passed on to my right honourable friend at the Treasury. She will understand of course that I cannot give her a categorical answer at this point.

[Baroness Thornton]

Will the Minister confirm that the Department of Health has a strategy for encouraging and supporting charities, social enterprises and mutuals, both as patient and carer advocates and as providers of healthcare? In addition, would the Minister care to say how that policy might be enacted by the proposed commissioning structures in light of, for example, the failure of Surrey Community Health—a local and qualified social enterprise—to win a very large contract, losing it to Richard Branson’s Virgin Healthcare?

[Earl Howe]

I agree with the noble Baroness that it is important we do not lose vital local services that achieve high-quality outcomes. We shall be working with PCTs, therefore, in the transition to the new arrangements between the NHS Commissioning Board and clinical commissioning groups as they develop, to ensure that the sector’s contribution to improved public health and social care is fully recognised. In the end, however, she will appreciate from our preceding debate that these matters will continue to be determined at a local rather than a national level—and it is quite right that they should be—because centrally we are not aware of local circumstances in the detail that we should be.

Health and Social Care Bill

Baroness Thornton Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Thornton]

My Lords, along with everyone in the House, I thank the Minister for his most competent and coherent introduction to the Health and Social Care Bill 2011. The Labour Benches have a great team dedicated to working on this Bill. It includes my noble friends Lord Hunt, Lord Beecham, Lady Royall and Lady Wheeler; our new Whip, my noble friend Lord Collins, who recently retired as the general secretary of the Labour Party and joins us as our junior member of the health team; and, of course, a galaxy of experience behind us.

I became so desperate to see this legislation that I even got involved with the Localism Bill in the summer, so desperate was I to be doing something. Long awaited, the delayed Bill we are considering today is in its fourth version so far. Indeed, it may not be the last. The first was definitely the Conservative version. It was prepared before the election based on the ideology of markets and regulation. It is now a much more complex Bill but the core intent remains the same. This Bill, with its 303 clauses and 24 schedules, creates a framework that will fundamentally change the nature of the NHS. It will change the NHS from a health system into a competitive market. It will turn patients into consumers and patient choice into shopping. Most crucially, it will turn our healthcare into a traded commodity.

Therefore, I start with a fundamental and simple point. People did not expect, did not vote for and do not want these changes. The Government were not elected to do this. They do not have the electorate’s mandate. I know we will hear arguments about whether or not this Bill is a mere continuation of the work of my former Government. I assure noble Lords from the outset that this is a specious argument, which I urge them to put aside. Our reforms were in our manifesto. They helped to improve and strengthen the NHS. They most certainly were not this Bill.

This Bill was not mentioned in anyone’s manifesto; nor was it in the coalition agreement. As for the democratic mandate mentioned by the Minister, top-down reorganisation, which is what the Prime Minister said, does not seem to be a mandate. One can scour the manifestos of the Conservative Party and the Liberal Democrat Party, and the coalition agreement, for anything that suggests a fundamental change to the powers of the Secretary of State for Health. Nothing suggested wholesale dismantling of the structures of the NHS; nothing about the biggest quango in the world being created, the NHS Commissioning Board; nothing about the intention to allow £60 billion of taxpayers’ money to be spent by GPs, originally on their own and now through clinical commissioning; nothing about the creation of a huge bureaucratic economic regulator, the new Monitor; and nothing about many other parts of this Bill, some of which is good and some less so. There is no mandate for this Bill. That is a serious constitutional issue for this House, which is signalled to us by, for example, the Constitution Committee report.

In the context of the most draconian changes for 60 years, the least we could have expected was a raft of analysis and evidence that would form a convincing and arguable case for the direct benefits of these changes to patients. If the evidence exists—I would say that it does not—it has manifestly failed to convince those who work in our NHS, those who study our NHS and certainly those who use it: so, no mandate, no evidence and no support. In addition to that, there has been one of the worst impact assessments that most experts have ever seen, showing no cost benefits. I suggest that this is not much of a basis for a change programme, which, to quote David Nicholson, is so large that it can be seen from space.

It is a sad day for this House and for Parliament that we are being urged to expedite this Bill. As informed commentators keep telling us, the state of disorganisation in the NHS is past the point of no return. Indeed, the Minister circulated a letter minutes before this debate started in which the last paragraph points to and emphasises the need for us to get on with this rather than the need for us to scrutinise this Bill.

There has been a breathtaking disregard for the democratic process. The reforms are being implemented in such a way that there is now paralysis, uncertainty and lack of leadership in the system. This has been inflicted on the NHS by this Government. Is it too late for a fresh look? I do not think so. I urge noble Lords not to be panicked, bullied or browbeaten. Our job is to scrutinise and improve this Bill, because it is certainly the most significant legislation that we are going to see in the whole of this Parliament.

On these Benches, we take this responsibility very seriously—indeed, I think that all noble Lords feel this responsibility—because we must not fail. All eyes are on us. If the Bill proceeds into Committee, these Benches will not delay this Bill in its passage through the House. I have promised the Minister this. In return, the Government must make as much time available as noble Lords need to give this huge and complex Bill the scrutiny that it deserves. The public and the NHS would not understand if we did anything less.

I pay tribute to the noble Baroness, Lady Williams, and others, such as Evan Harris, for their steadfast campaign and I hope that we can work together to improve this Bill. I promise that these Benches will be here to support sensible amendments to this Bill from wherever they come and I hope that noble Lords will do the same.

Perhaps I might gently remind my Liberal Democrat friends that for many years the NHS has been a toxic political issue for the Conservative Party and it never was for them. In fact, the Liberal Party was in at the birth of the NHS: you were part of its genesis. I would just ask: why would you put that legacy and that history in such jeopardy? As for the Conservative Party, people wanted to believe David Cameron when he promised before the election to protect the NHS. He promised to guarantee a real rise in funding and to stop top-down NHS reorganisation. I put it to noble Lords that every one of his promises is now being broken.

At a time of austerity, the NHS needs co-operation, collaboration and integration, not experiments with the extension of competition. So we are keen to scrutinise this Bill: we support the greater involvement of clinicians in commissioning; we support the devolvement of public health to local authorities with the right safeguards and financial support, and independence at a national level; and we support the creation of health and well-being boards and local accountability. We believe that the Bill needs to enhance the patient’s voice because we think that that is very inadequate at the moment. We believe that accountability and transparency need to be addressed from top to bottom of this Bill.

In addition, we believe there are matters concerning mental health, children’s safety and well-being, training and workforce planning, research and many other issues that will be raised by noble Lords across this House, which will need plenty of time in which to be debated and given the scrutiny that they deserve.

The wider context of this, of course, is the need for the NHS to deliver the Nicholson challenge and find the £20 billion of efficiency savings. We on these Benches believe that that is a priority and is enough in itself. Our concerns with this Bill are many and serious but the core of the Bill around regulation and the failure regime did not receive proper scrutiny in the other place. Indeed, the failure regime received no scrutiny whatever because it was introduced too late. We will be seeking major changes to Part 3, which we regard as dangerous as well as unnecessarily complex, bureaucratic and expensive. We do not support making our NHS into a regulated market, as advocated by some. Whatever the merits of competition and quasi-markets—we will hear a lot about these during the course of the Bill—they cannot be the basis for the delivery of healthcare. Indeed, there is a role for regulation, but the role and nature of the regulator has to be a lot clearer than it is in this Bill at the moment. I am giving noble Lords a very rapid summary of our major concerns and the areas of the Bill which we think need attention.

I now wish to address the procedural and constitutional challenges posed by the Bill. I would like to be very clear to the House: my right honourable friend Andy Burnham made a serious offer to the Secretary of State over the weekend. He asked the Government to withdraw the Bill and committed Labour to co-operating with the Government to implement the clinical commissioning agenda using existing powers, and doing it as quickly as possible. I repeat that offer to the Minister now. However, frankly the omens do not look good.

My party will support the amendment of my noble friend Lord Rea not to proceed any further with the Bill. We invite all those who love their NHS to join us. We do this with a heavy heart because it is this House’s job to scrutinise and improve legislation. However, we believe we have no option because there is no doubt that there is an overwhelming call for us to stop the Bill from the royal colleges, the professions, doctors, nurses, thousands of health workers, patients and, indeed, non-patients. However, there is an alternative before us today, and we think this offers a way forward if the Bill is not withdrawn or stopped. It is an alternative offered by the amendment in the name of the noble Lord, Lord Owen. The idea that we can have double the scrutiny going on at the same time is very attractive. We believe that it will expedite the process of scrutiny and we urge the Minister to accept this proposal. We know from previous experience that issues referred to a Select Committee help the House enormously in taking decisions.

Why did 100 noble Lords want to speak in this debate? Why did the noble Lord, Lord Owen, feel moved to put a significant amount of his time over the summer into working out a constructive way to maximise the scrutiny of the Bill? Why has the noble Baroness, Lady Williams, spent an enormous amount of her time since the spring trying to work out a way forward for the Bill? Why have dozens of noble Lords attended seminars and briefings since March better to understand this Bill? Why do we think thousands of people have written letters and sent e-mails to Peers across the House expressing their concern about the future of the NHS? Indeed, I pay tribute to the GPs, clinicians, nurses, midwives, physios and other ancillary therapists, mental health workers, care workers, trade unions, patient groups and health charities for the time and attention they have given to the detail in the Bill. The majority still do not like it. All of this has happened because our NHS is precious to every family and every person in the land, whether or not we use it. Everyone knows that whatever happens to them, wherever they are and however serious it may be, they can get healthcare. This is possible because we pay for it together and it is part of the social fabric of our nation. The NHS, in Bagehot’s terms, has a dignified as well as an efficient side and a specific role in the psyche of the nation as a symbolic guarantor of fundamental decencies. Any prospective reformer would have to respect those. I suggest that Andrew Lansley has not done so.

Our NHS was built on the principles of co-operation and integration as a genuinely national system with a properly accountable Secretary of State answerable to Parliament—a system working for the benefit of patients. This is where I end because the only real test of these reforms is their impact on patients. We are good in this House at hearing patients’ experiences and acting on them. We will have to listen very carefully indeed in the coming months. There is huge expertise in this House: medical, legal, organisational, charitable, and, often the most important, a great deal of common sense and practical experience. We will need to bring every bit of this wealth of talent to bear on this Health and Social Care Bill. I look forward to working with noble Lords across the House and with the Minister in the coming months.

Health: Breast Cancer

Baroness Thornton Excerpts

Monday 3rd October 2011 Lords Chamber

[Earl Howe]

My noble friend makes an extremely important point. That is why we need a body such as NICE, the National Institute for Health and Clinical Excellence, to advise the health service on what treatments represent cost-effective value for money. The tendency of drugs to impose considerable cost on the NHS is very great, as he points out. It is important that clinicians focus on those drugs that really do the best for patients. I am aware that a number of drugs are currently being assessed by NICE with regard to breast cancer.

[Baroness Thornton]

My Lords, I apologise for my conference throat—it is all the cheering I did last week. The Government published a strategy for cancer in January 2011 and set a target of improving cancer survival rates, so that by 2014-15 an extra 5,000 lives will be saved each year. What progress has been made towards meeting the target that was expressed in Improving Outcomes: A Strategy for Cancer and saving those extra 5,000 lives a year?

[Earl Howe]

My Lords, there are broadly three ways in which we can attain that target. The main way is through early diagnosis—in particular, by making sure that women are aware of the signs and symptoms that could indicate breast cancer—but also by improving access to screening and to radiotherapy, which has already been covered in the question from the noble Baroness, Lady Morgan. To support the NHS to achieve earlier diagnosis of cancer, the strategy has been backed by over £450 million over the next four years. That is part of over £750 million additional funding for cancer over the spending review period.

NHS Future Forum

Baroness Thornton Excerpts

Thursday 15th September 2011 Lords Chamber

[Baroness Thornton]

My Lords, I am very pleased that my noble friend Lady Wheeler has put this Motion before the House today. The timing is perfect: we are within a few weeks of the long awaited Second Reading of the Health and Social Care Bill; and we are within a few days of the party conferences, at at least two of which, my own and that of the Liberal Democrats, the threats to and future of the NHS will be near the top of the agenda for our members. What happens at the Conservative Party conference is probably as much of a mystery to the Minister as to the rest of us. However, we do know from announcements made by the Prime Minister from one of his holidays this summer that he thinks that it is “job done” as a result of the work of the Future Forum, and that the Government's proposals now have widespread support from staff and patients. I could not help but wonder at what point the Prime Minister made this announcement and what particular beverage he might have been enjoying at the time.

However, as I said in your Lordships' House when the Future Forum was established, as well as when it reported, it is a political fix by the Prime Minister and his Liberal Democrat deputy. One of them had realised that his Secretary of State was not a safe pair of hands and had succeeded in uniting the whole medical profession—patients and patient groups—against his proposals; the other had just had a disastrous set of election results, lost a referendum and received a good kicking from his members at the Liberal Democrat spring conference in March. The noble Baroness, Lady Williams, described the reforms at that time as privatisation by stealth and said that they amounted to a plan to dismantle one of the most efficient public services of any in Europe.

Of course, I do not hold the Future Forum responsible for its genesis. I accept that all its members have acted in good faith and worked hard in the service of the public. I also accept that they did broadly a good job within their remit. However, it has to be said that the whole of this Bill is topsy-turvy. Instead of consultation, pre-legislative scrutiny and a draft Bill, and a legislative process followed by implementation, we have implementation speeding ahead and an initial consultation on a White Paper whose responses, it has to be said, were largely ignored by the Secretary of State when they did not accord with his plans. Indeed, that evidence included a large number of “buts” and raised many issues. Many organisations thought that the White Paper contained some very risky proposals.

Then a Bill arrived without the evidence base that the noble Earl has always said should be present before legislating. There has been no pre-legislative scrutiny. Frankly, if ever a Bill would have benefited from a Joint Committee of both Houses, this is it.

Then, halfway through its Commons stages, there was an unprecedented pause and a listening exercise, which should have taken place at the outset. We have the Future Forum. This body, which has made many recommendations about amendments to the Bill, has no authority other than being appointed by the Prime Minister. The people making recommendations and active in public life on a much smaller scale than this, with much less responsibility than the Future Forum, are subject, as are all of who have been governors of schools, to completing a register of interests. None of the Future Forum has done so. That is not a satisfactory or businesslike way to proceed with creating public policy and taking it forward into legislation.

Yesterday, I wrote to the noble Earl about Future Forum mark 2 and what influence its deliberations might have on the progress of the Health and Social Care Bill in your Lordships' House. I look forward to an answer to that. I have asked whether we will have a pause and whether we will be seeing amendments resulting from the Future Forum's deliberations.

I now turn to what the Future Forum has already said and I will use the Liberal Democrat’s aspirations for the Future Forum and what it should bring into the Bill as my guide. We know that the Prime Minister thinks that the Future Forum has done the trick, but what of his deputy, Mr Clegg? Mr Clegg had 13 red lines. On this side of the House, we believe that seven of those have failed and six have fallen short, as my noble friend Lady Wheeler has said. I think that his score card stands at C plus, but my noble friends behind me think that that is probably too generous.

I am grateful to my noble friend Lady Wheeler for reminding the House that our duty in this House is to the NHS and the nation. It is our duty not to suspend our critical faculties when we look at the Bill. We believed that this was a deeply flawed Bill from the outset, but at least it was coherent. We now think that it is immensely more complex and bureaucratic. Ultimately, it will be more expensive for the taxpayer. That was mentioned by my noble friends in different ways.

Much has been said already about the Secretary of State’s powers in the Bill. I suspect that that issue will test the House’s powers of understanding and literacy, as my noble friend said. I also suspect that some of our lawyers will probably engage with it as well, so I will not refer to that in my remarks today. I want to look at some of the other issues that the Future Forum has tackled.

On more democratically accountable commissioning, we have to say that that has failed. The relevant clauses of the Bill do not yet contain elected members or councillors on commissioning consortia, while health and well-being boards are able only to give their opinions to consortia. Consortia are under no obligation to abide by that opinion. The call for a much greater degree of coterminosity between local authorities and commissioning areas was mentioned by my noble friend Lady Pitkeathley. Practice lists do not bear any relation to local authority boundaries, by and large, so they are not a reliable solution to this problem.

A call for no decision about the spending of NHS funds to be made in private and without proper consultation, as can take place by the proposed consortia, has failed. As my noble friends have said, consortia will not be as transparent as PCTs currently are because they do not have to abide by the Nolan principles on public life and the public meetings legislation. It is left up to them to decide what business to conduct in private and not in public. That is unsatisfactory and we are talking about billions of pounds of public spending. We have failed there.

Then there was the call for the complete ruling out of any competition based on price to prevent loss-leading corporate providers undercutting NHS tariffs and to ensure that healthcare providers compete on the quality of care. There is no doubt that something has been achieved here. However, there will continue to be a number of NHS services not covered by the tariff with greater competition from private providers. That means that price competition for those services has not been ruled out. So that has failed.

We need to turn to cherry picking, which could destabilise and undermine existing NHS services relied on for emergencies and complex cases. We have failed completely on that point. The Government’s amendments addressing cherry picking require only that a provider be transparent in how it chooses its patients. It says nothing about preventing providers picking the easiest and most profitable patients. Furthermore, picking patents is only one part of cherry picking. Private providers will also be able to pick the easiest and most profitable types of treatment to provide—elective surgery, for example—while leaving the NHS to do the expensive loss-making treatments such as emergency inpatient care. Nothing in the government amendments prevents that and therefore risks destabilising those NHS services.

There was a call for government commissioning to be in full compliance with the Human Rights Act and freedom of information laws. The Liberal Democrats were particularly concerned that freedom of information should be extended throughout the Bill. That has not happened. It is an important priority for our discussions when we look at the Bill. Billions of pounds’ worth of public money and millions of people's treatment are at stake.

We also had a call for ensuring that health and well-being boards are a strong voice for accountable local people in setting the strategic direction for co-ordinating the provision of health and social care services. There is a failure there. Consortia are under absolutely no obligation to abide by the views of health and well-being boards. So we go on. I will leave the failure regime, which was introduced at such a late stage, for our attention in a few weeks’ time.

I am so pleased that there are Members in both Houses of all parties and across this House who are turning their attention to the actuality of the Bill and its applicability. I highly commend the noble Baroness, Lady Williams, and other Liberal Democrat Members—noble, honourable and plain activist—who have not swallowed the line that now all is well with the Health and Social Care Bill. I know how difficult it can be to find yourself at odds with your leadership, your party and your own Government. I have been there many times over the past 30 years. But in this case, our first duty is to the NHS, its patients and those who work in the NHS. We must proceed by not looking at theoretical structures and esoteric arguments. We must look outside the Chamber and hear the clinicians and patient groups and let them be the guide to what happens to the NHS in the future.

NHS: Cost-effectiveness

Baroness Thornton Excerpts

Monday 12th September 2011 Lords Chamber

Asked By

[Baroness Thornton]

To ask Her Majesty’s Government whether the Department of Health will draw attention to the recent report in the Journal of the Royal Society of Medicine on the cost-effectiveness of the National Health Service.

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

My Lords, the department welcomes the report to which the noble Baroness refers, and recognises the significant gains in health achieved by the National Health Service since 1979. However, its evidence is limited and does not support broad generalisations on NHS cost-effectiveness. The NHS can still make major improvements to the health of the nation and must continue to respond to pressures from an ageing population, new technology and rising patient expectations.

[Baroness Thornton]

My Lords, I thank the Minister for that Answer. The Government seek to justify the hugely risky reforms of the NHS by saying that our NHS is not fit for purpose in a variety of ways, including not being cost-effective. We all know that improvements can be made—there is no doubt about that at all—but how does the Minister reconcile that with yet another authoritative report in the Royal Society of Medicine journal which says, among other things, that in terms of cost-effectiveness—that is, economic input versus clinical output—the UK NHS is one of the most cost-effective in the world, particularly in reducing mortality rates, and that among other systems, the US healthcare system is one of the least cost-effective?

[Earl Howe]

My Lords, I must point out one thing about this report: it does not make any claims for how cost-effective our health system was at any given point in time. What it does is measure the improvement in mortality over a period and then assess the cost-effectiveness of that improvement, which is a very different thing. Yes, the NHS has made great strides in improving mortality rates, but that is the only metric that the report deals with. It completely ignores other measures of quality. It is also completely silent about anything that happened after 2005, so recent years are not covered.

Smoking

Baroness Thornton Excerpts

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

The noble Baroness is right. We believe that the Government’s commitment around the introduction of tobacco display legislation strikes the right balance. We have amended the implementation dates. Displays will come to an end in large shops on 6 April next year, and in small shops on 6 April 2015.

[Baroness Thornton]

My Lords, my Government and this Government should be proud that today there are more than 2.5 million fewer smokers in England than there were in 1998. The noble Lord, Lord Ribeiro, points to the challenge of how to make certain behaviours unacceptable. Does the Minister believe that the Government’s nudge policy will work here? Will the Government invest in a public information campaign aimed at substantially and permanently changing public behaviour in this respect?

[Earl Howe]

My Lords, we are going to publish a tobacco marketing plan later this year which will lay out precisely what we propose to do at a local level. It is our intention to support local efforts to raise awareness and use the insights that we know about from behavioural science to influence positive changes in behaviour, including around the social norms of not smoking when children are present. Voluntary local initiatives are already working. There is a very good example of that in Lincolnshire at the moment. We want to roll out more programmes like that.