NHS: Hospitals

Baroness Thornton Excerpts

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

The noble Baroness is right to pull me up. If I implied that the NHS was across the board providing a lower standard of care than the private sector, I apologise because that is certainly not the case. There are some shining examples of care delivered by the NHS. However, as she will know, not all hospital trusts are as good as hers. Some give us cause for concern in a clinical sense, and they need to be challenged sometimes on the way they look at quality. That is going on at the moment with the quality, innovation, productivity and prevention programme that she will know very well.

[Baroness Thornton]

My Lords, let us get this Question back to transparency. Over a year ago, David Cameron, the Prime Minister, said:

“Greater transparency across Government is at the heart of our shared commitment to enable the public to hold politicians and public bodies to account”.

That is the point of my noble friend’s Question. I would like an assurance from the Minister that minutes and discussions are available at local and national level on the public record of meetings with private and independent healthcare providers.

[Earl Howe]

My Lords, the origin of this Question was, I believe, a freedom of information request that was replied to by my department. The background is that we have a small handful of hospitals that will struggle to achieve foundation trust status in their own right. I suggest that civil servants have to be allowed to have potentially helpful conversations with those who have experience of turning around financially challenged organisations. That is the background. We are perfectly transparent about that situation, as were the Government of which the noble Baroness was a member.

NHS: Medical Records

Baroness Thornton Excerpts

Wednesday 7th September 2011 Lords Chamber

[Earl Howe]

The noble Countess is of course correct that good patient care is about humane and sensitive treatment by the staff who serve in the National Health Service. At the same time, I think we are all clear that technology has a role to play in enhancing patient safety and improving the quality of care that the good staff of the NHS can deliver.

[Baroness Thornton]

My Lords, can I entice the Minister into being slightly more definite about when the House might see the new IT strategy which the Government keep telling us that they are about to publish? As a former Minister, I know that the answer “soon” is one that the House always looks at with some wry smiles. If we could have a more definite date, that might be helpful.

[Earl Howe]

My Lords, we plan to make an announcement towards the latter part of the autumn about the way forward for informatics, which will mean—we are clear about this—that we continue to gain more value for money from taxpayers’ investment and ensure that informatics support is fit for purpose in the modern NHS.

Southern Cross Care Homes

Baroness Thornton Excerpts

Tuesday 12th July 2011 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating the Statement. Although we had a discussion about Southern Cross two weeks ago, it is an ongoing sorry tale which seems to get worse by the day for the residents, their families and the staff of Southern Cross. I think the Minister will accept that Southern Cross’s announcement yesterday that the responsibility for managing the 752 homes will pass back to the 80 landlords who own them will almost certainly cause a vacuum that is bound to be the source of great uncertainty and anxiety among residents and their families.

I am reassured that the Government are very active on the matter, but there are questions that we need to have answered. Southern Cross is not being informative and there are things that we need to know about the situation. My questions concern what happens next and how the Government will manage this difficult situation. Can the Government publish a list of all 80 landlords? I have read in the media rumours that some landlords still have to be identified. Yesterday, it was further announced that control of 250 of the homes would be handed back to their landlords immediately. What does immediately mean? Does it mean tomorrow? What will happen? What is the process?

The House needs to know which homes those are and who is running them. Is a list available? It is certainly not available on the Southern Cross website. It is also likely that many of the landlords will have little or no experience of running care homes. For example, does the Minister have any information on the intentions of property-owning companies such as London & Regional, which owns 90 Southern Cross homes, or Prestbury, which owns 21? In the previous Statement in the House, the Minister assured the House, as he has again, that the Association of Directors of Adult Social Services is trying to support its members, who will have a key role in ensuring that the new operating companies are able to provide good quality care and that they know how to perform financial stress tests to ensure that their business models are sound. What support and assistance are the Government providing to ADASS?

I read from my press cuts that Downing Street has said that public money will be used to ensure that those in the homes can stay. Is that true and how would it be achieved? Would money be made available through local authorities? If the Government intend to provide additional resources, they will need to do so to hard-pressed local authorities if they are expected to help. What advice are the Government giving to local authorities if the property company or landlord for any of the home-owning companies is offshore?

I am reassured that new operators taking control of the homes will need to be registered with the Care Quality Commission and that plans are in place to ensure that that happens, but given the pressure on the CQC, I wonder how it will be able to achieve that within the timescales that we seem to be facing. Will the Government make more resources available to the CQC to deal with that worsening situation?

What can the Minister tell the House about the terms and conditions of the 44,000 employees of Southern Cross? Does the Minister know how many homes are likely to close? What is the timetable for such closures likely to be? What will happen to those residents? We know that, for the very old and very vulnerable, a move such as that can result in their death or hospitalisation. That is an extremely distressing matter.

Turning to the care home sector more generally, it would seem that although Southern Cross is definitely the most urgent, it is not alone in the sector in its struggles. The UK’s second largest care home provider, Four Seasons Healthcare, has amassed debts of £730 million that have to be repaid by September 2012. What will happen to the Lloyds properties, as this landlord is in administration? NHP, which owns 250 homes, is at a standstill with its bondholder. Indeed, my honourable friend John Speller MP, in his question in another place to the Secretary of State for Business, Innovation and Skills, pointed out that it is not just old people we are talking about here. For example, Craegmoor provides residential care services for adults with mental health problems or learning disabilities. It has 3,300 places, 174 care homes and a debt of £37.8 million. Care Principles provides similar services. It has 450 places in 17 care homes and secure hospitals; its debt is £45.77 million. Care UK runs care homes and services for the elderly. It has 3,100 places in 57 homes and a debt of £127 million.

Clearly these problems have to be addressed. I do not expect the Minister to answer questions about those homes. However, I am asking the Minister whether there is a plan and, if so, what is it? It seems to me that Southern Cross is actually the beginning of this process and solving its problems may not be sufficient.

Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011

Baroness Thornton Excerpts

Monday 11th July 2011 Lords Chamber

Moved by

[Baroness Thornton]

That this House regrets that the timetable for implementation of the Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011 (SI 2011/1256) may result in up to 4,000 more young people taking up smoking than if the original implementation date had been kept to; further regrets that the Government have not explained how they will mitigate burdens on business “while maintaining the expected public health gains”; and calls on the Government to make the health needs of young people the priority by keeping to the original timetable for implementation.

Relevant documents: 32nd Report from the Merits Committee

Baroness Thornton: My Lords, many noble Lords will be familiar with the part of the Health and Social Care Act 2009 which set in motion the regulations previously in place to enact the implementation of the display legislation to start on 1 October 2011, less than three months from today, to be in force in all shops by October 2013. The same regulations provided that small shops had an additional two years, therefore, to prepare. These regulations will not begin to come into force until April 2012 and will not be completely enforced until April 2015. This is a total delay of four years. The reason for this Motion of regret is to give the House an opportunity to discuss the reasons for such a delay and to ask what bearing the persistent lobbying by tobacco industry-funded organisations may have had on the decision that the Government have taken in this regard.

In its 32nd report, the Merits Committee raised some important points. It suggested that the House might want to seek explanation from the Minister about how the regulations could achieve the Government’s policy objectives. It pointed to the inconsistencies of the growth review, which seeks to reduce the regulatory burden on small enterprises. This might account for the delay in implementation for small shops—although I would question this anyway, and will in a moment—but it does not explain why the implementation date for larger shops is being put back. However, I accept that from today, because of the government delays, three months may not be sufficient time for large shops to prepare for this, although they have had quite a lot of notice. The Minister will need to explain the reasoning behind this decision.

The Merits Committee also called attention to the Written Statement on tobacco control issued by the Government on 9 March, in which the Government state that the take-up of smoking by young people is a particular concern. Smoking is an addiction largely taken up in childhood and adolescence and it is crucial to reduce the number of young people taking up smoking in the first place. The report went on to say that nicotine is highly addictive and that each year an estimated 320,000 young people under 16 will try tobacco for the first time and 200,000 of them will become addicted.

We are all aware of the troubling statistics which surround this issue. The Merits Committee went on to say that, taking the Government’s own baseline statistics, the 18-month delay being proposed as a result of the amended regulations may result in 4,000 young people and children becoming addicted to tobacco, with the consequent long-term health effects. I should therefore be grateful if the Minister would explain whether the Government think that this is a price worth paying for the delay in implementation.

It is worth noting that in March 2009 Norway passed a similar law, which it implemented from January 2010, allowing retailers only nine months to comply and protecting Norwegian children from tobacco marketing five years earlier than the proposals before your Lordships’ House. There is no objective evidence that the Norwegian retail trade has suffered unduly.

I understand—but I am sceptical—that the reason given for such an extended delay for small shops has clearly been the concern that the legislation might adversely affect their businesses. I am afraid I have to question this. I believe that the cynical campaign that has been mounted to delay implementation can be shown to be more for the benefit of tobacco manufacturers than for small retailers. It has become increasingly clear that what purported to be a cry of pain from thousands of small retailers was really a covert and dishonest campaign by the tobacco industry.

Members of both Houses of Parliament have been contacted by three groups, each purporting to represent tobacco retailers: the Tobacco Retailers Alliance, the Association of Convenience Stores and the National Federation of Retail Newsagents. We know that the Tobacco Retailers Alliance is, in effect, a wholly owned subsidiary of the Tobacco Manufacturers’ Association. It is the most obvious kind of front group; it does not even have its own offices but operates from the Tobacco Manufacturers’ Association headquarters. At least that is clear and transparent.

The Association of Convenience Stores can claim a little more independence, and yet it, too, is beholden to manufacturers for subscriptions, sponsorship and advertising. When asked by Stephen Williams MP, the chair of the All Party Parliamentary Group on Smoking and Health, it confirmed that it receives around £100,000 a year from tobacco manufacturers. I would, however, point out that the Association of Convenience Stores has claimed that the cost of compliance would be between £2,000 and £5,000, and yet its own survey of small shops in Ireland found that the average cost of compliance was only £300.

I regret to say that the National Federation of Retail Newsagents has been much less forthcoming, seeking to conceal tobacco industry funding of its far reaching campaign against the display legislation. It recently procured, without any cost to itself, the services of a lobby firm called Hume Brophy, which telephoned and e-mailed the offices of Conservative and Liberal Democrat MPs on its behalf in the weeks before the Government were due to announce their decision on the display ban seeking their support for the repealing of the legislation. The Government are to be congratulated on resisting these blandishments.

It was discovered that Hume Brophy also acted for British American Tobacco and the company was asked whether it was funding the campaign. At first BAT denied this but, following questions at its AGM from Kevin Barron MP, it had to admit that not only had it funded the NFRN campaign against the display legislation but that it had also had meetings with Hume Brophy and the NFRN to discuss how it should be taken forward.

Once this was revealed, Hume Brophy wrote to Stephen Williams on 7 June to apologise for its involvement in such covert lobbying—it needs to be congratulated on so doing—and said that the NFRN agreed that it should write to Members of Parliament to explain. John Hume, of Hume Brophy, wrote:

“I understand that a letter to MPs will be forthcoming from the NFRN in the next couple of days”.

So far we are not aware of a single MP having received such a letter from the NFRN. In fact, it has refused to send one.

However, instead of accounting to MPs and Peers for its dubious lobbying techniques, the NFRN has attacked the Public Health Minister for attending the All-Party Parliamentary Group on Smoking and Health celebration of the 40th birthday party of Action on Smoking and Health and for presenting ASH with an award from the World Health Organisation for its work. We know of the right honourable Lady’s commitment to this issue and she is again to be congratulated on her continuing support. Frankly, rather than attacking the Public Health Minister for her commitment to reducing the harm caused by tobacco, the NFRN should do the decent thing and apologise to MPs for covertly doing the tobacco manufacturers’ dirty work.

I believe that the tobacco manufacturers have repeatedly sought to deceive parliamentarians by concealing their central role in the campaign against the display legislation. I would like the Minister’s view of this matter. Does he agree with me that this is unacceptable and does he think that it may have undermined in some way the UK’s publicly stated commitment to live up to its obligations as a party to the World Health Organisation’s Framework Convention on Tobacco Control? Indeed, the Prime Minister is on the record committing this Government to putting an end to what he has called the scandal of secret industry lobbying.

The Tobacco Control Plan for England published in March clearly states:

“The Government takes very seriously its obligation as a Party to the World Health Organisation Framework Convention on Tobacco Control”.

A full chapter is devoted to protecting public health policy from the vested interests of the tobacco industry. Is the proposed delay not a concession to exactly those vested interests and the result of a campaign by those who sell cigarettes on behalf of those who make them? Specifically, the Government have affirmed that the tobacco industry had no hand in the development of the tobacco plan, that they would publish details of any policy-related meetings with the industry by any part of government, and that they would require those engaging with the Department of Health on tobacco control to declare any links with or funding from the industry and encourage local authorities to follow that lead. In doing so, the Government are reflecting the mood across the House when during the passage of the Health Bill 2009 the noble Baroness, Lady Northover, moved an amendment to require the publishing of written guidelines on engaging with the tobacco industry. That amendment was withdrawn as the Government undertook that the Secretary of State would write to all Cabinet members reminding them of their duties under the World Health Organisation convention.

This is a Motion of regret. I do not seek to overturn the revised regulations, but I would like the Minister to confirm the commitment of the Government to live up to their obligation under Article 5.3 of the World Health Organisation convention to protect their public health policy from all commercial and vested interests of the tobacco industry, and to publish without any further delay details of all policy-related meetings with the tobacco industry and its front groups by any part of Government. I beg to move.

[Lord Borrie]

My Lords, three years ago the Chief Medical Officer, Sir Liam Donaldson, said that the ban on smoking in enclosed public spaces, which began in 2007, had been a great success in terms of both compliance and improved health. There had been a considerable drop in the number of smokers. I believe that the enclosed spaces ban has indeed been a great success, and for our social environment—a benefit to the whole population.

But in the Health Act 2009 the Labour Government sought to go further and ban the display of cigarettes in shops in order particularly to give even further discouragement to underage smokers. I thought the case for such a ban on display was a thin one. It ignored the fact that in recent years the display has had to be festooned with off-putting words such as “Smoking kills”, plus hard hitting pictorial warnings. Moreover, evidence from the likes of Iceland and the Canadian provinces where displays are banned was somewhat speculative as to the effect on smoking among the young.

In the UK we seem to have given up trying to keep a balance between the rights of individuals to do something which is legal—to sell and consume tobacco and cigarettes—and society’s desire to help people give up smoking and stop children purchasing cigarettes. The Labour Government ruled that a display ban should come into effect in 2011 for large outlets, but to protect small and medium-sized enterprises to some extent from the costs of the new regulations they should be subject to a ban only from 2013. I leave aside the arguments that this distorts competition between one group of retailers and another, and it may have been justified. Now, because of the recession, the present coalition Government seek to delay the imposition of the ban a further six months for large retailers, and a further 18 months for small retailers. My noble friend Lady Thornton from the opposition Front Bench regrets these delays. I regret I cannot join her in grumbling about the modest delays that have been proposed. There are more restrictions in the offing: from campaigning groups, particularly ASH; a ban on open-air smoking—in parks and beaches, such as applies in parts of Australia—bans on smoking in cars, which would be very difficult to enforce; and, of course, banning the use of brand names, which cropped up during the discussions on the Health Act a few years ago.

There is one country in the world to which I draw the attention of the Government: Bhutan, known perhaps to many walkers on the lower levels of the Himalayas as an interesting country somewhere between India and China. I mention Bhutan because all smoking is banned there, as are all displays of cigarettes and tobacco. How far do the Government want to go in their efforts to discourage the young from smoking? It is a splendid objective, but one which sometimes ignores the other aim of allowing people their own individual choices.

--- Later in debate ---

[Baroness Thornton]

My Lords, I thank the Minister for his usual detailed and very thorough explanation. I will resist the temptation to open up the arguments we went through in detail in 2009, notwithstanding the fact that my noble friend Lord Borrie, the noble Lords, Lord Stoddart, Lord Naseby and Lord Palmer, expressed their consistent views about this matter. The noble Baroness, Lady Tyler, was right to say that the Government should take credit for the tobacco plan, and certainly Members on these Benches will support further work on tobacco control.

I thank my noble friend Lord Judd for his support. Even if he is what one might call an ultra leftist, if not an outright Trotskyite on these matters, he knows that I am in sympathy with his views. My former noble friend Lady Morgan as always had wise and considered words on this. I wish her well in her new and very important position. The noble Lord, Lord Rennard, rightly reminded us that across the House we have been working on tobacco control issues for many years, and many noble Lords have made significant contributions to that progress. My noble friend Lord Faulkner is a great friend and campaigner on these issues, and I thank him for his hard work. I agree with him that the Government should be congratulated on their plan and their commitment to tobacco control. I also thank my noble friend Lady Gale for her support. She sat behind me and supported me when I was a Minister throughout the days when we discussed these issues at length.

The Minister has offered reassurance on a number of fronts, particularly concerning the tobacco lobby. I am pleased that the coalition Government are building on the policies established by the last Government, and I do not underestimate the battles that the noble Earl, his ministerial team and his honourable friends will be fighting across Government to extend tobacco regulation. The Minister should know that he has support across the House for the battles that he and his noble and honourable friends are fighting. I welcome the banning of tobacco sales from vending machines and the review of access to tobacco, and I look forward to hearing the results of the other initiatives outlined by the noble Earl. I also welcome the promised transparency, in particular on asking about funding from the tobacco industry. The noble Earl has given us an assurance that details of the meetings will be published. Finally, I welcome his emphatic rejection of the reasons for the delay.

I thank all noble Lords for their contributions to the debate and I beg leave to withdraw the Motion.

Motion withdrawn.

NHS: University Health Centres

Baroness Thornton Excerpts

Monday 4th July 2011 Lords Chamber

[Earl Howe]

My Lords, naturally, before preparing myself for this Question, I looked carefully into the way in which university practices are funded. The advice I received is that there is no reason to be concerned on that front. Many university GP practices are funded quite generously. Where they can lose out is over the quality and outcomes framework, which is targeted mainly at elderly patients with long-term chronic conditions, so it is not surprising that university campus practices do not earn the extra money that they could. Nevertheless, we believe that there is no case for making an exception for university practices in the way that they are funded.

[Baroness Thornton]

My Lords, I congratulate the noble Baroness on getting her head around the system of weighting for payments to GPs for their patients. It contains such gems as,

“An overall weighted listsize for the PCO is generated as the sum of Practice Weighted Listsizes for all Practices in the PCO, and this PCO Weighted Listsize is used together with the PCO Weighted Population”.

I will not go on, but I congratulate the noble Baroness. Given the mental health problems that students often face, is the Minister confident that the system of weighting takes proper account of that medical issue, which is certainly more prevalent than the chronic conditions that he mentioned in a community general practice?

[Earl Howe]

My Lords, the characteristics of each GP practice will naturally vary according to the patient population. Although a practice situated on a university campus may have higher numbers of patients who require mental health advice and support, there may well be fewer patients in need of other services. I am not aware that there is a particular issue of underfunding of university practices in relation to the mental health burden. As the noble Baroness will know, the QOF was adjusted in 2008 with a two-year time delay, so university practices have had a chance to adjust and prepare for the change.

Health: Stroke Care

Baroness Thornton Excerpts

Monday 4th July 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is quite right in all that he says. I would just point out that the official statistics are rather historic and it is important that we take stock when the revised figures are before us in some months’ time. As regards how best practice will be driven when the health service reforms are in place, I would repeat my earlier comments about the ability of the NHS commissioning board to drive forward higher quality, informed by the new quality standard produced by NICE. More particularly I think we can do a lot through the tariff. At the moment, best practice tariffs are starting to play a role in encouraging and driving best practice at hospital level.

[Baroness Thornton]

My Lords, tomorrow is the 63rd birthday of the NHS. Would the Government give the NHS the birthday present of eliminating local differences in stroke services by implementing the recommendations in the stroke strategy? In that way, when we all break into song next year when the NHS is 64 years old, we will actually have achieved something very important.

[Earl Howe]

It is very appropriate that the noble Baroness should remind the House of the NHS’s 63rd birthday. I can think of few better presents than that which the noble Baroness has outlined. I can say only that the efforts within my department, and indeed throughout the NHS, continue unabated to ensure that stroke patients are treated to the highest possible standards and that unacceptable variations are eliminated.

Reform of Social Care

Baroness Thornton Excerpts

Monday 4th July 2011 Lords Chamber

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

My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:

“Mr Speaker, with permission, I wish to make a Statement on the reform of social care. This coalition Government have from the outset recognised that reform of the care and support system is needed to provide people with more choice and control, and to reduce the insecurity faced by individuals, carers and their families. By 2026, the number of people over 85 years old is projected to double. Age is the principal determinant of need for health and for care services. It is estimated that in 20 years’ time, 1.7 million more people will have a potential care need than do today.

People often do not think about how they might meet those costs in later life. They assume that social care will be provided free for all at the point of need, but since the establishment of the welfare state this has never been the case. Currently people with more than £23,250 in assets, often including their home, face meeting the whole cost of care themselves. The cost of care can vary considerably and it is hard for people to predict what costs they may face. The average 65 year-old today will face lifetime care costs of £35,000. However, as the Commission on the Funding of Care and Support notes, costs are widely distributed: one in four will have no care costs, but one in four will face care costs over £50,000 and one in 10 over £100,000.

The lack of understanding of how the system works and the uncertainty about costs means that it is difficult for people to prepare to meet potential care costs and there are currently few financial products available to help them. This means that paying for care can come as a shock to many families and can have a severe impact on their financial security.

Change is essential. That is why we took immediate action by establishing the Commission on the Funding of Care and Support last July. It was tasked with making recommendations on how to achieve an affordable and sustainable funding system for care and support for all adults in England. In response to its initial advice, we allocated an additional £2 billion a year by 2014-15 in the spending review to support the delivery of social care as a bridge to reform. This represents a total of £7.2 billion extra support for social care over the next four years, including an unprecedented transfer of funds from the NHS to support social care services that will also benefit health.

Since then we have taken forward wider reform. In November last year, we published our vision for adult social care setting out our commitment to a more responsive and personalised care and support system that empowers individuals and communities, including the objective that all those who wish it should have access to a personal social care budget by 2013, and in May, the Law Commission published its report, after three years of work, on how to deliver a modernised statute for adult social care. Making sense of the current confused tangle of legislation to deliver a social care statute will allow individuals, carers, families and local authorities more clearly to understand when care and support will be provided.

Andrew Dilnot’s report comes at the same time as the final report from the palliative care funding review, which I received last week. Tom Hughes-Hallett and Sir Alan Craft have made an excellent start in looking at this complex and challenging issue. We want to see integrated, responsive, high-quality health and care services for those at the end of life. We will now consider the review team's proposals in detail before consulting stakeholders on the way forward later this summer. We will also consider how best to undertake substantial piloting, as recommended in the report, in order to gather information on how best to deliver palliative services.

We are also responding to events at Southern Cross, which have caused concern to residents in Southern Cross care homes and their relatives and families. We welcome the fact that Southern Cross, the landlords and the lenders are working hard to come up with a plan to stabilise the ownership and operation of the care homes. We have also been clear that we would take action to make sure there was proper oversight of the market in social care. That is why, through the Health and Social Care Bill, we are seeking powers to extend to social care the financial regulatory regime we are putting in place in the NHS, if we decide it is needed, as part of wider reform.

A central component of those reforms will be the long-term funding of care and support. Over the past 12 months, Andrew Dilnot, the chair of the Commission on the Funding of Care and Support, together with the noble Lord, Lord Warner, and Dame Jo Williams have engaged extensively with many different stakeholders. They brought fresh insight and impetus to this most challenging area of public policy. We welcome the excellent work of the commission and its final report. I would like to thank Andrew Dilnot, the noble Lord, Lord Warner, and Dame Jo Williams for the work they have undertaken. It is an immensely valuable contribution to meeting the long-term challenge of an ageing population.

The report argues that people are unable to protect themselves against the risk of high care costs, leaving people fearful and uncertain about the future. The commission’s central proposal is therefore a cap on the care costs that people face over their lifetime of between £25,000 and £50,000; it recommends £35,000. Under the commission’s proposals, people who cannot afford to make their personal contribution would continue to receive means-tested support, but it proposes that the threshold for getting state help with residential care costs would rise from £23,250 to £100,000. People would make some contribution to their general living costs in residential care, but this should be limited to between £7,000 and £10,000.

The commission also proposes: standardised national eligibility for care, increasing consistency across the country; universal access to a deferred payments scheme for means-tested contributions; improvements in information and advice; improved assessments for carers and better alignment between social care and the wider care and support system; and to consider changing the means test in domiciliary care to include housing assets. It makes recommendations about how, as a society, we will organise and fund social care. We will now take forward consideration of the commission’s recommendations as a priority.

The commission recognises that implementing its reforms would have significant costs that the Government will need to consider against other funding priorities and calls on constrained resources. In the current public spending environment, we have to consider carefully the additional costs to the taxpayer of the commission’s proposals against other funding priorities. Within the commission’s recommendations, it presents a range of options, including on the level of a cap and the contribution people make to living costs in residential care, which could help us to manage the system and its costs. That is why we intend to engage with stakeholders on these issues, including on the trade-offs involved.

Reform in this area will need to meet a number of tests, including: whether proposals would promote closer integration of health and social care; whether proposals would promote increased personalisation, choice and quality; whether proposals would support greater prevention and early intervention; whether a viable insurance market and a more diverse and responsive care market would be established as a result of the proposals; the level of consensus that additional resources should be targeted on a capped costs scheme for social care; and what a fair and appropriate method of financing the additional costs would be.

The Government have set out a broad agenda for reform in social care. We want to see care that is personalised, that offers people choice in how their care needs are met, that supports carers, that is supported by a diverse and flourishing market of providers and a skilled workforce who can provide care and support with compassion and imagination, and that offers people the assurances they expect of high-quality care and protection against poor standards and abuse. Andrew Dilnot’s report was never intended to address all these questions, but it forms a vital part of that wider agenda.

To take it forward, we will work with stakeholders in the autumn, using Andrew Dilnot’s report as the basis for engagement as a key part of a broader picture. This engagement will look at the fundamental questions for reform in social care: improving quality, developing and assuring the care market, integration with the NHS and wider services, and personalisation. As part of that we want to hear stakeholders’ views on the priorities for action from the commission’s report and how we should assess these proposals, including in relation to other priorities for improvement in the system. As the right honourable Member the Shadow Health Secretary and I have discussed, we will also engage directly with the Official Opposition in order to seek consensus on the future of long-term care funding.

We will then set out our response to the Law Commission and to the Dilnot Commission in the spring, with full proposals for reform of adult social care in a White Paper and a progress report on funding reform. It remains our intention to legislate to this effect at the earliest opportunity. The care of the elderly and vulnerable adults is a key priority for reform under this Government, and I commend this Statement to the House”.

My Lords, that concludes the Statement.

[Baroness Thornton]

First, my Lords, I thank the Minister for repeating the Statement today. It is difficult to imagine a more important issue for us to consider. Care of the elderly and vulnerable is probably the most difficult and intractable problem facing our society. It is one that we have to resolve; we cannot afford to let it go on and on unresolved. We can all agree about this.

It should be a cause for celebration and pride that one in five of us alive in Britain today will now live to be 100, and that our children can expect to spend one-third of their lives in retirement. Instead, thousands and thousands of us approach old age in fear—fear that we will need care that will not be there or will not be good enough, fear that our savings will be wiped out by an open-ended cost, fear that we cannot protect our families from this cost, and fear of becoming a burden or being left alone. That is why we on these Benches welcome the Dilnot report and the Statement.

These proposals contain many important elements that were in the plans that we set out when we were in government in our care White Paper prior to the general election. I join the Minister in congratulating Mr Andrew Dilnot and his colleagues, my noble friend Lord Warner and Dame Jo Williams on the excellent job that they have done. I know that many of the organisations concerned with this issue—Age UK, the Alzheimer’s Society, Care UK and others—have been very impressed by the way in which the commission has carried out its tasks, but they are now, quite rightly, very keen to ensure that the momentum created by this excellent report is not lost. Many noble Lords will have seen the letter, signed by 32 of these organisations, pleading with us not to pass up this opportunity. I welcome the Minister’s confirmation that detailed and important involvement of stakeholders will continue.

I am very impressed with the way in which all the members of the commission have seen it as their mission to explain to the widest possible audience what lies behind their recommendations and why they have reached the conclusions that they have. I know that my noble friend Lord Warner has been in major media contact since the early hours of this morning; many of us will have been treated to the masterclass from Andrew Dilnot on the “Today” programme.

In response to the report my right honourable friend Ed Miliband, the leader of the Labour Party, has said on behalf of the Labour Party that we would be willing to put aside our party’s pre-election proposals in order to try to find a solution. I invite the Minister to agree with me that it is just as well that politicians sometimes ignore the cynicism and negativity of commentators, such as Mr Nick Robinson of the BBC, who I heard recently, and show an understanding of the importance of reaching a national consensus on these matters. We will all need to show the kind of determination that my right honourable friend the leader of the Labour Party is showing. Will the Minister comment on suggestions in the media, including from members of the Conservative Party, that suggest that the Treasury is already lining up to kill these proposals? I hope that this is not the case and that the tweet today quoting Stephen Dorrell as saying that the Government must show willingness to find the money for Dilnot’s long-term care overhaul is more accurate.

The last thing Britain needs is for Andrew Dilnot’s proposals to be put into the long grass, or even the medium-cut grass. This is a once-in-a-lifetime opportunity that we must address. It is what the Government do with it now that counts. My right honourable friend the leader of the Labour Party has made a big offer to the Prime Minister to put politics aside and to work to see a better long-term system of social care put in place for elderly and disabled people in our country. We on this side are willing to talk to and work with the Government and all other parties to do so, because we know that any system of care must give all of us the long-term confidence to know what will be on offer for us and our families. It requires the Prime Minister to give a lead, because agreeing an affordable and sustainable system involves important parts of government beyond the reach of the Health Secretary. It requires the Prime Minister to give a guarantee that the Government will not kick Mr Dilnot’s recommendations into the long grass, because the system needs urgent and lasting reform. Will the Minister give us that guarantee today? If the Government are serious, we in the Labour Party are serious. If the Government are serious, we need to hear what the plan is going to be as we move forward.

Mr Dilnot recommends a White Paper by December this year, but this already seems to have slipped to the spring. Will the Minister say which is it? Will he also tell the House when we can expect a draft Bill—are the Government aiming for this to be in the next Queen’s Speech? In the absence of the noble Baroness, Lady Campbell of Surbiton, will the Minister confirm that the Government welcome and will take forward recommendation 6 on the portability of care assessments? Will the Government be supporting her Private Member’s Bill on this? Does he agree that cross-party talks are required and that the Prime Minister should give this lead? How and when will this start?

Finally, I know the Minister agrees that there is a need for the House to have an opportunity to have a more thoroughgoing debate about this matter, the report and its recommendations. I hope that we can also join forces in trying to secure that opportunity.

NHS: Health Improvements

Baroness Thornton Excerpts

Wednesday 29th June 2011 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government how they will ensure that the NHS delivers strategic health improvements requiring levels of technology and expertise appropriate to regions or cities with large populations.

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

My Lords, our commissioning proposals will establish a national NHS commissioning board providing oversight of commissioning in the NHS and directly commissioning some services, including specialised services, where it makes sense to commission for larger populations. The NHS commissioning board will have a sub-national presence and local commissioning will be undertaken by clinical commissioning groups. The NHS commissioning board will have a duty to promote integrated services for patients, both within the NHS and between other local services.

--- Later in debate ---

[Baroness Thornton]

I thank the Minister for that Answer, as far as it goes. The successful reorganisation of stroke services in London, which has saved many lives, was led by clinicians, as it should have been, but the commissioning and its delivery were in fact only brought about by NHS London, the ability of the strategic health authority to manage the PCTs and through great collaboration with the providers. Apart from the providers, all of these bodies are being dismantled and abolished as we speak. In the new system, how precisely would similar improvements be brought about? Who would take the lead and who would ensure their delivery?

[Earl Howe]

My Lords, where it is deemed appropriate to commission a service at scale but below the level of the NHS commissioning board, as I described in my original Answer, it will be open to clinical commissioning groups either to establish a lead group to take control of the commissioning and to agree budgets and pathways or for clinical commissioning groups to collaborate jointly. The advantage of the system that we are proposing is its flexibility. Depending on population size and the needs of an area, commissioning can be done at several levels.

NHS: Clinical Excellence Awards

Baroness Thornton Excerpts

Monday 27th June 2011 Lords Chamber

[Earl Howe]

My Lords, as I have just said, we believe that financial rewards, in the form of clinical excellence awards, should remain. It is just a question of how that system is designed. We have not said that non-financial recognition should take the place of financial awards. They would operate alongside financial awards; they would not in any way supplant them. However, we think that there is a role for perhaps more imaginative thinking in areas like speciality-based awards or departmental or division-based awards, for example, or indeed ad hoc recognition for outstanding clinical leadership. The DDRB is looking at these questions too.

[Baroness Thornton]

My Lords, I commend the noble Lords, Lord Walton and Lord Ribeiro, on doing a really admirable job as the shop stewards for distinguished clinicians—and quite right, too—but I would point out that innovation and excellence cuts across all NHS staff, including nurses, midwives and therapists, who often introduce wonderful innovation at their level. Could the Minister tell us what incentives are in place in the system that recognises that excellence as well?

[Earl Howe]

The noble Baroness is absolutely right. We do need to incentivise all staff, both clinical and non-clinical in the NHS, to innovate. We can do that in a variety of ways. She will know that the noble Lord, Lord Darzi, proposed a number of ways of doing this, including innovation prizes and innovation funds, which are extremely popular. We also can incentivise through the tariff. As she will know, we have protected the research budget, which in the long term will serve us well in driving through innovation in the NHS.

Drugs: Prescribed Drug Addiction and Withdrawal

Baroness Thornton Excerpts

Thursday 23rd June 2011 Lords Chamber

[Earl Howe]

My Lords, my noble friend will know that we have set aside a very considerable sum of money over the spending review period to expand the availability of talking therapies. I entirely agree that it is an important avenue of treatment.

[Baroness Thornton]

Following on from the noble Earl’s supplementary question on how to ensure that good practice becomes standard practice, how will that sit with the dismantling of strategic health authorities, PCTs and other levers that might be used to ensure progress? Who or which organisations in the proposed restructuring of the NHS will be able to ensure that patients who have an addiction to prescription drugs receive the support that they desperately need? I agree with the noble Earl that this is an emergency; it is not the first time that we have discussed this on the Floor of the House.

[Earl Howe]

My Lords, the responsibility for commissioning these services in future will lie with local authorities, supported by Public Health England. The noble Baroness will be aware that it is our proposal to ring-fence the public health budget. Local authorities will be informed by the joint strategic needs assessment that they carry out and will work in partnership with local delivery organisations and with local GPs, who, as I have mentioned, will be even better informed than they are at the moment thanks to the Royal College guidance.