NHS: Independent Investigation

Debate between Earl Howe and Lord Scriven

Tuesday 8th October 2024 Lords Chamber

[Earl Howe (Con)]

My Lords, I am glad we are having this debate on the report by the noble Lord, Lord Darzi, even if the tone set by the Statement—which I am sure noble Lords have read—is, as far as I am concerned, rather regrettable. It is regrettable because the noble Lord, as one would expect of that most distinguished man, has produced a thoughtful and carefully argued diagnosis and set of prescriptions for the NHS. It would have been better to treat those findings on their own terms rather than as an excuse for a highly charged political rant. Having said that, I hope that, in this House at least, we can maintain debate on a rational and civilised level.

There are indeed problems in the health service that are there for all to see and others that are less immediately visible. These problems are real and indeed require sustained remedial effort. The noble Lord, Lord Darzi, attributes them to a mixture of causes, one being inadequate central government funding. I do not expect the noble Lord to be an apologist for the previous Government, but it would have been nice if he had acknowledged more fully that, despite so-called austerity, health service funding rose in real terms in every year since 2010 and in the last five years by nearly 3% in real terms per annum. The problem, as Sir John Bell has pointed out, is not a lack of money: it is that too much of the money has been sucked, suboptimally, into acute care settings and not enough into the community. The noble Lord goes on to say that very thing. But let no one conclude from that that community funding has been neglected. The last Government oversaw the opening of 160 community diagnostic centres. As my right honourable friend said in the other place, this is the largest central cash investment in MRI and CT scanning capacity in the history of the NHS.

Is there more to be done? Yes—but the results are there and proving their worth. The NHS is currently treating 25% more people than it did in 2010. It is delivering tens of millions more out-patient appointments, diagnostic tests and procedures than it did when the coalition Government came into office. Some of the community services are being delivered by staff employed by acute trusts—the statistics tend to hide those numbers. Yes, we can talk about the need for greater productivity, but this progress—it is indeed progress—is all down to the efforts of the dedicated clinical staff across the health service on whom we all rely, and who are more in number than at any time in the service’s history.

Please do not criticise the last Government for focusing on the numbers. The imperative of planning ahead to train the right number of staff for the right care settings was amply fulfilled in the last Government’s workforce plan—a publication heralded by the NHS chief executive as

“one of the most seminal moments”

in the NHS’s history.

Can the Minister nevertheless say, despite the fact that the report is not mentioned by the noble Lord, Lord Darzi, whether the Government will embrace the workforce plan and take it forward as the NHS clearly wants and needs? Can she also say whether the Government will adopt the productivity plan announced in the last Government’s Spring Budget? That plan—again, unaccountably not mentioned in the report—would deliver the “tilt towards technology” that the noble Lord rightly advocates, with a big productivity gain to boot.

I said that the noble Lord, Lord Darzi’s report was carefully argued, but not all of it is well argued. I cannot allow his colourful statements about the 2012 Health and Social Care Act to go unchallenged. To attribute the NHS’s current difficulties and challenges in large part to that Act is, frankly, ridiculous. What that Act did was to complete the process that the noble Lord himself started, which was to ingrain quality into the commissioning and delivery of healthcare based on clearly defined standards and outcomes, meaning that providers would be competing with each other based on the quality of care and treatment that they delivered to patients.

The noble Lord, Lord Darzi, now says that we need to move away from the whole idea of competition, but I suspect he has misled himself, because he goes on to say:

“The framework of national standards … incentives and earned autonomy … needs to be reinvigorated”,


along with patient choice. What is that framework if it is not a framework of healthy competition between providers based on quality? Therefore, what role does the Minister see for competition alongside collaboration —I do not think the two are mutually exclusive—in driving up the quality of NHS care?

I have a few final questions. We are told that a 10-year plan will be produced based on the findings of the noble Lord, Lord Darzi. Whose plan will that be? Will it be the Government’s plan, and if so, how will the Government avoid what might look like a prescriptive top-down set of instructions to the health service? Does the Minister think it important that the NHS takes ownership of the plan and, if so, how will that be achieved?

In essence, the noble Lord, Lord Darzi, believes that we need to get from point A to point B—in other words, from acute settings to community settings; from tired old premises to brand new ones; et cetera. Does the Minister agree that we cannot transition from point A without first finding the money to create a functioning point B? In other words, will she and her fellow Ministers urge the Chancellor to commit to the capital expenditure necessary to achieve that?

Lastly, I quote the noble Lord, Lord Darzi:

“The vast array of good practice that already exists in the health service should be the starting point for the plan to reform it”.


Does the Minister agree with that and, if so, how does she reconcile those sentiments with the Government’s mantra—which is so discouraging to the men and women of the health service—that the NHS is “broken”?

[Lord Scriven (LD)]

My Lords, I thank the Minister for bringing the Statement to the House. You do not have to be a mastermind to realise that the NHS is straining at its seams. It is only down to the great work of the many thousands of people who work in the NHS that millions of people get great care, even though some fall between the cracks.

The Darzi report is a very good medical history and it gives a diagnosis, but we all know that the treatment plan is going to be the important point if we are to deal with a reformed, new and productive NHS. There are some welcome themes in the report that are not new. Those who know the previous Darzi report will see have seen some of them before: prevention; moving resources from hospital care to primary and community care; dealing with the wider determinants of health; improvements in and parity for mental health; and a bigger role for public health.

I understand that the Minister will answer many questions by saying that we need to wait for the 10-year treatment plan, and probably the Budget, before such specific questions can be answered, but I have a few general questions for the Minister, to get at least a sense of the direction that the Government wish to take.

Is it the Government’s intention to restore the public health grant back its 2014 levels? Are there any general views about looking at changing the structure of public health, nationally or locally? On capital, what is the Government’s thinking about the general theme of allocation to hospital and non-hospital services, and how will this be managed and monitored? On data, what is the Government’s thinking on the workforce plan, particularly when there is a huge imbalance when it comes to digital and data between the private sector and skills within the NHS? That is not to say that there are not some good skills within the NHS, but there is clearly an imbalance.

Welcome as it is that the report talks about moving resources from hospital to non-hospital settings, I was a manager in the health service in the early 1990s and I know that this has been said since at least the 1970s. What are the Government going to do to be able to move resources from sunk costs in the acute sector into other sectors? What mechanisms will be put in place? How will this be monitored? More importantly, who will be held accountable for making sure that it actually happens? How will the new neighbourhood approach affect the existing workforce plan? If a new health service is anticipated, what will the effect be on the workforce plan and the implications for capital allocation?

We all want to see a productive and effective healthcare system that improves peoples’ health and independence, but that cannot be brought about if we do not have a strong, effective, well-funded social care system. I do not understand why social care has been kicked down to the next Parliament, or how we are going to solve the health and well-being of the population without that being done. If the major reforms of social care are in the next Parliament, what steps are the Government going to take in this Parliament to deal with the social care crisis?

I look forward to the Minister’s answers, but, more importantly, to the 10-year treatment plan’s arrival in the next few months.

Infected Blood Inquiry

Debate between Earl Howe and Lord Scriven

Tuesday 30th July 2024 Lords Chamber

[Earl Howe (Con)]

My Lords, this is a welcome Statement and I thank the Minister for repeating it. During the passage of the legislation that underpins the creation of the infected blood compensation scheme, one thing that I am very glad that we all agreed on across the House was that we should not let party politics interfere with our collective aim of reaching a fair and workable set of legal provisions in response to Sir Brian Langstaff’s recommendations. It is therefore particularly welcome to see that collegiate spirit continuing under the newly appointed ministerial team, and I thank them for that.

The debate that took place last Friday in the other place served to clarify a number of important questions arising from the Statement and I do not therefore propose to dwell on matters that have already been covered. The main areas that I would like to touch on relate in one way or another to the projected timetable for delivering compensation and justice in all its forms. It is excellent to hear that the recent period of election purdah did not prevent the further interim payments of £210,000 being made to beneficiaries of the infected blood support schemes living with infections, as was promised by the previous Government.

However, the other promise that we made was to put in place as soon as possible arrangements to make an interim payment of £100,000 to the estates of deceased people who were infected with contaminated blood or blood products and whose deaths have not yet been recognised. To fulfil that promise, it is clearly necessary, as the Statement indicated, to reach consensus between the devolved Administrations and the Government in Westminster, as well as those in charge of the existing support schemes, on how exactly those arrangements should be implemented. Can the Minister say how those discussions are progressing? Is she confident that, when applications for those payments open in October, they will open across the United Kingdom, as opposed to just a part or parts of the United Kingdom?

Secondly, the Statement made it clear that the regulations to establish the scheme would be made on 24 August, which, as the Act provides, is exactly three months after Royal Assent. How will that work, procedurally and legally? One risk that we identified when the Victims and Prisoners Bill was being debated was that a three-month deadline for making regulations might be too rigid if the Summer Recess, and/or an election campaign, meant that the regulations would have to be made at a time when Parliament was not sitting. Our solution was to create the Infected Blood Compensation Authority in shadow form, with a view to timing Royal Assent for a date some time in July, when we judged that the risk of a parliamentary recess or Prorogation interfering with the making of regulations would be reduced. Because of reservations expressed by Labour shadow Ministers, it was not possible to build any flexibility into the statute to allow for those risks, which, as things have turned out, may be seen as unfortunate, because Royal Assent had to happen as soon as the general election was announced. Can the Minister clarify what the legal effect will be of the regulations being made when Parliament is not sitting? At what point will the Infected Blood Compensation Authority be legally in being?

Next, one of the key reassurances that I gave when taking the Bill through was around the need to listen to the victims. We envisaged involving the infected blood community directly in two ways: first, in setting the final shape of the compensation scheme and, secondly, in assisting Sir Robert Francis as interim chair of the authority in ensuring that the scheme, when up and running, was implemented fairly and with the full benefit of input from those whose lives have been directly affected by this calamity. As regards the former, it is good news that Sir Robert Francis completed his engagement exercise last month and that he will be publishing the outcome in advance of 24 August. As regards the latter, can the Minister reassure the House that it is still the intention for the infected blood community to be represented in the compensation authority through its committees and subcommittees? If so, is work proceeding now to give effect to that intention?

Could I next ask the Minister to confirm a point that I know is still a matter of anxiety for the infected blood community? It is a question that concerns those currently in receipt of support payments. As the responsible Minister, I gave the House an assurance that no one will be worse off under the final compensation scheme than they would have been under existing support schemes, and that an additional top-up payment would be made to anyone assessed as being entitled to less money than would otherwise have been payable via the infected blood support schemes. In other words, I promised that those people who have a legitimate expectation of receiving a certain sum of money from support payments over their lifetime will have that expectation honoured. Can the Minister confirm the assurance that I gave? Following on from that, can the Minister clarify for me whether what are now classed as ex gratia payments under the support schemes are now in effect to be rebadged as compensation?

I shall touch also on a further concern within the infected blood community, relating to access to necessary treatment. Victims have told me that parts of the NHS have been slow to recognise the moral and clinical urgency of treating those whose illness, or multiple illnesses in some cases, stems directly from receiving infected blood or blood products. Will the Minister ask her colleague in the Department of Health and Social Care to look into this and report to the House on how any difficulties of this sort might best be remedied? The Republic of Ireland issues a special card to those registered as having been infected by contaminated blood or blood products, so that there is no argument when someone presents themselves to the GP or the hospital. Is that an idea that could be considered here?

While on the subject of treatment, can the Minister say whether everything is on track in NHS England and the devolved Administrations to roll out the bespoke psychological support service for those infected and affected by the infected blood disaster?

Finally, the Statement is right to pick up Sir Brian Langstaff’s finding that there is a culture of institutional defensiveness that can too often rear its head in areas of the public sector. The Government have stated their intention to bring forward a statutory duty of candour to address that issue—and, indeed, this was a proposal that we debated at some length during the passage of the Victims and Prisoners Bill. It is an idea that has obvious appeal and no doubt the Government will bring forward legislation in due course when they are ready to do so. However, I said, during our debate, that it is an idea that merits a reasonably long run being taken at it before it is set in legislative stone—and I repeat that view today, because I do not in fact think that a duty of candour is of itself a magic bullet that is capable of changing what is often an ingrained culture.

The duty of candour that we have already in the NHS has not prevented some very serious and high-profile disasters arising out of poor care, or even criminal behaviour. Similarly, we already have the Civil Service code, which mandates honesty and transparency but has not, alas, prevented the kinds of cover-ups and dishonesty in departments of government that Sir Brian Langstaff has highlighted. So, finally, will any proposals to introduce statutory duty of candour for the public sector as a whole be preceded by extensive and thorough engagement with all those parts of the public sector to which the duty is intended to apply?

[Lord Scriven (LD)]

My Lords, I welcome the Minister to her place and wish her well in the role she is undertaking. We on these Benches also welcome this Statement and commit to a collaborative cross-party approach to this very important issue.

Victims of the infected blood scandal and their families have been waiting for decades to see justice. Tragically, as we know, thousands have died without ever having received compensation. The report of the inquiry into the scandal, chaired by Sir Brian Langstaff, laid bare the suffering inflicted, the cover-ups and the systematic failures of individuals and of the British state as a whole. Not only did individuals and the state fail to help these victims, but in many cases people were lied to, treated with contempt and dismissed outright. It is good to hear updates on progress, but victims have waited far too long and there are still some gaps.

I want to follow up on the comments by the noble Earl, Lord Howe, about the treatment and some dismissive approaches by the NHS. Rather than just having a card, now that patient records are electronic would it be possible to put an automatic flag in them so that the onus is on the service and not the individual to make sure that timely treatment is given by the NHS?

An infected blood compensation authority will be set up, but what framework is being set for a light-touch approach to those seeking compensation? We have seen that compensation schemes, such as for Horizon, can be complex and difficult for those who have been affected to navigate. What framework are the Minister and the Government asking the compensation authority to undertake that will make it as light-touch as possible but with appropriate probity in place?

Another problem with the Government’s proposals for compensation is that only infected victims and bereaved partners are entitled to the autonomy award. This is being used as a catch-all to cover, for example, clinical trials and the loss of the right to have children. Affected parents cannot claim this £50,000 award, but it is the only measure that looks to compensate for the financial outlay of supporting the child or children of the deceased and their partners over many years.

Another issue with the autonomy award is that it does not recognise infected and affected partners whose pregnancies have been terminated as a result of links to their blood infection. Does the Minister not agree that there is a good case for the autonomy award to be extended to specific affected individuals who can prove injury? I look forward to the Minister’s answers.