Francis Report: Update and Response

Debate between Earl Howe and Lord Touhig

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

I apologise to the noble Baroness. It is very important that that does not happen. This was very much a matter that Sir Robert had in his sights when preparing the report. We have a certain amount of protection for whistleblowers at the moment—the noble Lord, Lord Hunt, referred to this—and the current Government have augmented that protection, not least through the way in which we have improved the NHS constitution. But Sir Robert is clear that we need to go further and, in particular, to ensure that those whistleblowers who find their position untenable in an organisation and are obliged to leave are not thereby blacklisted by the NHS merely for having spoken up. We think that the measures Sir Robert has proposed will achieve this but, more importantly, they will ensure that there is a better form of conflict resolution, able to nip concerns in the bud at an early stage and at a local level.

[Lord Touhig (Lab)]

My Lords, I had the privilege of introducing the first whistleblower protection legislation when I served in the other place. I regret that it was not successful because the then Conservative Government opposed it. Richard Shepherd, a Conservative Member of Parliament whom I consider a good friend, was much more successful in 1998 when he introduced the Public Interest Disclosure Act, together with the support of the Labour Government. Sir Robert refers to that Act a number of times in his report. On page 9, he says:

“For a number of reasons this legislation is limited in its effectiveness … The legislation does nothing to remove the confusion that exists around the term ‘whistleblowing’ … The legislation is also limited in its applicability”.

He also refers on page 78 to suggestions that PIDA should be strengthened. I agree with him; the Act needs to be reviewed and amended. Will the Government agree to do this, because that would certainly overcome many of the problems that this report has highlighted?

[Earl Howe]

My Lords, it may be that Sir Robert’s recommendations lead to legislative proposals. At the moment, we have no view on that. We want to consult broadly to seek people’s views, not least from all parties in Parliament. If I understand Sir Robert correctly, he was keen to achieve answers to these questions that do not involve legislative change and can be achieved easily, without too much bureaucracy. However, we would certainly wish to leave the door open if legislation is needed. In fact, there is one particular measure that we will endeavour to put through in the current Parliament, as long as we have cross-party support for it.

Autism

Debate between Earl Howe and Lord Touhig

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, the answer to my noble friend’s question lies in more professionals being trained in autism and services supporting rather better the needs of children and adults with autism, and a lot of work is going on on those fronts. We are also asking local authorities to focus, in particular, on their own performance and to report back on the progress they are making on autism diagnosis, and indeed on other issues in Public Health England’s national autism self-assessment exercise. That process will draw out the shortcomings that exist in certain parts of the country.

[Lord Touhig (Lab)]

My Lords, there is evidence that some 25,000 children in England with autism have not been thoroughly diagnosed. The National Autistic Society, of which I am a vice-president, found in a survey that 34% of autistic people had to wait more than three years for a diagnosis. What are the Government doing to speed up this diagnosis and to ensure that it takes place within three months of a referral, which is the NICE recommendation?

[Earl Howe]

My Lords, part of this depends on the system working in a joined-up way between the National Health Service, local authorities and all the services upon which they depend. A great deal more training is going on, as I have mentioned. In December the Department of Health, the Association of Directors of Adult Social Services and Public Health England issued a new national autism self-assessment exercise, as I have mentioned. Much can be achieved, as we are impressing on local authorities, through low-level preventive support, and there are duties around prevention in the Care Act that local authorities now have in this area.

Meals on Wheels

Debate between Earl Howe and Lord Touhig

Monday 19th January 2015 Lords Chamber

[Lord Touhig]

To ask Her Majesty’s Government what estimate they have made of the number of elderly people who have received meals on wheels in the past year.

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

My Lords, the Health & Social Care Information Centre does not collect comprehensive data on numbers receiving meals; it only collects a subset of this group: those receiving meals as part of a formal package of care. I understand from the information centre that in 2013-14, 31,950 people received meals from councils with adult social services responsibilities as part of a formal care package. Some 29,605 were older people aged 65 or over.

[Lord Touhig (Lab)]

My Lords, 220,000 fewer elderly people received meals on wheels last year than in 2010, when this Government came into office. Why?

[Earl Howe]

My Lords, as I have indicated, there are a variety of reasons for this. The data collected by the information centre include only people who receive meals in their homes as part of a council-arranged formal package. They do not include informal arrangements such as the provision of meals at day centres or via daycare, or indeed those who pay the council for their meals, as many do.

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[Earl Howe]

My Lords, local authorities’ funding through central revenue support has indeed reduced, but spending on adult social care has been relatively protected compared with nearly all other local authority services. In cash terms, councils have reported only a small reduction in money spent on adult social care since 2010, despite the tough public funding climate. It is up to the party opposite to explain where the money would come from—if it will increase local authority spending—given that the shadow Chancellor has ruled out increasing local government spending if Labour is elected at the general election.

[Lord Touhig]

Perhaps I may help the Minister. Could it be due to the fact that the average cost of a single meal has gone up 22% since this Government have been in office? How do the Government justify that?

[Earl Howe]

My Lords, local councils do not have to charge for meals; they may provide them free of charge or at subsidised rates if they want to. If they charge, they must—as is the case for any non-residential social care service—follow the statutory guidance. That guidance ensures that, where they do charge, the charge is consistent and fair.

Care Bill [HL]

Debate between Earl Howe and Lord Touhig

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

My noble friend raises an important point, and I will take her suggestion away with me. As I mentioned earlier, however, a great deal of what this Bill will deliver is, so to speak, invisible to the naked eye, because it will ensure that those with lower needs will also be catered for in some way or another. I would like to hope that, for that reason, there will be less scope for challenge. I will write to my noble friend if I can supply her with our further thinking on that important topic.

I hope that what I have said will have reassured the Committee on these important matters. This has been a well informed debate. Our continued approach to engagement and consultation on the draft regulations will obviously allow us to consider many of these issues further, and on that basis I hope that noble Lords will not press their amendments.

[Lord Touhig]

Have the Government looked at the Deloitte economic modelling, which shows that support for moderate needs actually gives a greater return on the money invested? If not, will the Minister undertake to look at it before Report stage, so that we can discuss the savings that could be achieved?

[Earl Howe]

I know that my officials have looked closely at that modelling. I have not yet had an opportunity to look at it but undertake to do so. However, in all such matters a judgment is needed as to how money is best spent. No doubt there are good arguments for the Deloitte point of view, but, as I have already outlined, we think that if one has to spend money of that order, it is better spent in the way that we propose. Nevertheless, this is a debate that we can usefully continue, and I shall be happy to do that between now and Report, and also at Report stage itself.

Autism

Debate between Earl Howe and Lord Touhig

Monday 17th June 2013 Lords Chamber

[Lord Touhig]

To ask Her Majesty’s Government what assessment they have made of the findings of the campaign by the National Autistic Society, Push for Action, launched on 14 May. I declare an interest as vice-president of the National Autistic Society.

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

My Lords, the National Autistic Society’s Push for Action campaign coincides with the Government’s review of the 2010 adult autism strategy. We are already taking forward some of the campaign’s recommendations, and we will consider others that fall to government during the review, the investigative stage of which is due to last until the end of October.

[Lord Touhig]

I must say that I am encouraged by the Minister’s words. Four years after Parliament passed the groundbreaking Autism Act, this National Autistic Society report reveals that despite some progress far too many autistic adults are missing out on everyday support. A shocking 70% of adults and their carers say they get no help from social services, and this is not always down to money. Indeed, economic modelling by Deloitte shows that every pound invested in services for autistic adults with moderate needs brings a return of £1.30. When the Government review the autism strategy, will they consider providing an innovation fund so that local councils can provide the cost-effective services that all autistic adults need and actually demand?

[Earl Howe]

My Lords, we will certainly consider the idea of an innovation fund during the course of the review. We have allocated some central funding already to support the implementation of the autism strategy, for example in commissioning a range of training products from expert bodies to support local areas and professionals. I hope the noble Lord will agree that the strategy and the statutory guidance that goes with it mark a great step forward for adults with autism in England. We now need to take an honest look at how it is all working and come up with further ideas and actions as necessary.

Care Bill [HL]

Debate between Earl Howe and Lord Touhig

Tuesday 4th June 2013 Lords Chamber

[Lord Touhig]

My Lords, time and again in this House the matter of training of health professionals so that they better understand how to support and care for people with autism has been debated. Here, I should declare an interest as a vice-president of the National Autistic Society. We know that key professionals such as GPs and community care assessors still do not have a good enough understanding of autism.

Amendment 24, about which the noble Lord, Lord Rix, has spoken and to which I have added my name in support, if taken on board by the Government would at least ensure that the Secretary of State would be required to consult vulnerable people, including those with autism, their carers and groups such as the National Autistic Society, Mencap and others on matters affecting education and training that will be provided by Health Education England.

Only one in three adults with autism in this country told the National Autistic Society in a survey that in their experience social workers have a good understanding of autism. There is a well established correlation between the professionals’ understanding of autism and the degree of identification of needs among adults in that local authority area with the condition. Autism training can help ensure that adults with autism are correctly identified, and qualify for the support they need.

I recently served on the autism and aging commission, chaired by the noble Baroness, Lady Greengross. Professor Francesca Happé gave evidence about the difficulties of picking up on autistic people’s needs. She said:

“This is a group that doesn’t self-present, doesn’t come and seek services, because of their difficulties of social interaction and communication and we absolutely owe it to them to go and find out what their needs are”.

For that reason, we need well trained people to support them.

The National Autistic Society’s excellent document, Push for Action: We Need to Turn the Autism Act into Action, made a very good case. It includes a very good case study by the mother of an adult with autism. Her name is Chloe, and she says:

“We got to the point where Peter couldn’t live at home, for his own and our safety. After moving around between people he knew and staying in a B&B, eventually he got a flat but he still doesn’t get any support. Social services don’t understand autism and how it affects him. They’re not asking the right questions. They say, ‘How are you?’, and he says, ‘I’m fine’, so they come back to me and say, ‘He’s fine, he doesn’t need any help’. But of course he says he’s fine at that point because he probably is at that point”.

He does not trust them, so he says he is fine in order to make them go away because he does not believe that they understand or are able to help him.

“He had a mental capacity assessment and they asked him about managing his money. He told them that he was saving money for a motorbike but he doesn’t have any money. He can’t manage his money. He gets into all sorts of trouble”.

Chloe concludes:

“I’ve given up asking for support. Me and my husband now do everything ourselves … Now we have no expectations of what ‘services’ should be providing”.

That is just one example of the lack of trained staff having an adverse impact on the life of an autistic person and their family.

I hope the Government will ensure that autism training is included in the core curricula for doctors, nurses and other clinicians, in accordance with the commitments under the Adult Autism Strategy. It is absolutely necessary that vulnerable groups, including people with autism, are consulted about priorities for training so that decision-makers become aware of the gaps in knowledge and understanding among health professionals.

Ultimately, the Government must tackle the issue by including autism training in the core curricula for doctors, nurses and other clinicians, as they committed to do in the 2010 Adult Autism Strategy. People with a learning disability and/or autism have the right to the same quality of healthcare as those without. I believe that Amendment 24 is a good step forward in achieving that.

[Earl Howe]

My Lords, I will deal briefly with two of the amendments in this group. I will deal first with Amendment 11, which was tabled by the noble Lord, Lord Hunt. The explanation for this provision in the Bill is essentially that it is a safety net to enable an extension of HEE’s activities in future, and to ensure that this has the Secretary of State’s prior consent. HEE can carry out other activities relating to the education and training of healthcare workers, or relating to the provision of information and advice on careers in the health service. However, we believe that to avoid undue mission creep it is perhaps advisable for the Secretary of State to be content that Health Education England is branching out in new directions.

Regarding Amendment 32A and the issue of end-of-life care, Health Education England will indeed support NHS England where it can in implementing its end-of-life care strategy, and the way that it shapes and reforms education and training.

Carers

Debate between Earl Howe and Lord Touhig

Monday 14th January 2013 Lords Chamber

[Lord Touhig]

To ask Her Majesty’s Government what is their estimate of the saving to public funds as a result of the work of unpaid carers in the United Kingdom.

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

My Lords, the Government themselves have not estimated savings to public funds as a result of unpaid carers’ contribution to care and support, although we are aware of estimates by other organisations. There is scope for debate about how best to put a financial value on this care but there can be no doubt about its huge value to those who receive care and to the wider community.

[Lord Touhig]

My Lords, I am sure that the Minister would agree that we owe a great debt to the carers of this country and, indeed, the Government recognise that because they have promised that families with a disabled child and in receipt of disability living allowance will be exempt from the housing benefit cap. However, according to the regulations, when that disabled child becomes a disabled adult, the child is considered to be a separate household from the parents who they live with. No matter that the disabled adult will perhaps need the same level of care that they received as a disabled child; the parents will then be subject to the housing benefit cap. Why?

[Earl Howe]

My Lords, the noble Lord will have to forgive me because I will need to write to him about benefits, which do not directly fall under my remit in the Department of Health. However, I can say to him that more young carers services are extending their age group to cover young adult carers, and there needs to be a proper join-up between the two. In some situations, it is true that the young adults’ needs are unmet; they can fall down the gap and not receive adequate support. A transition between children’s services and adult services should be smoother—we acknowledge that, and we are addressing this in the draft Care and Support Bill.

Autism

Debate between Earl Howe and Lord Touhig

Wednesday 5th December 2012 Lords Chamber

[Lord Touhig]

To ask Her Majesty’s Government what will be the scope of the review of the national adult autism strategy, due to take place in 2013.

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

My Lords, we are currently considering how to deliver the 2013 review of the adult autism strategy and, in particular, a range of options about how best to secure the views of service users and carers. The review, which will take place from April to October next year, is an opportunity for the Government to take stock and consider where future action is required to realise the vision of fulfilled and rewarding lives for people with autism.

[Lord Touhig]

My Lords, the National Audit Office report on the adult autism strategy said that the health service needed to improve the training of key professionals who make decisions about a person’s eligibility for benefits and services. Can the Minister confirm that the review will ensure that all government departments will implement the strategy in full, so that autistic adults around the country can access the support services that they need?

[Earl Howe]

My Lords, this matter runs across government departments. While central government can set the framework, and while it can work to remove barriers and increase awareness, which is very important, the real work—the delivery of lasting change—is for professionals, providers, voluntary organisations and, indeed, service users working together in collaboration. That effort needs to take place at a local level, which is why there is statutory guidance to prompt that action.

Health and Social Care Bill

Debate between Earl Howe and Lord Touhig

Thursday 19th January 2012 Lords Chamber

[Earl Howe]

My Lords, I understand that the noble Baroness is asking me to deliver a certain message to my right honourable friend. I am not quite sure what that message was, but if it is to do with the Health and Social Care Bill, I have to say that we need that Bill. We believe that reform of the NHS is essential if it is to be sustainable in the future. Every penny saved from this reform will be reinvested in front-line patient care. The previous Government had, as we do, an ambition to save £20 billion—the so-called Nicholson challenge—over the next three or four years. This reorganisation will enable us to contribute to that total. The modernisation will also move the NHS to a much more patient-centred system where good providers are rewarded for high-quality services. We are spending money on redundancy now to gain in the future.

[Lord Touhig]

My Lords, will the Minister tell us whether the report in this morning’s Guardian that the NHS regulator is proposing that a hospital should be credit-rated is correct? If it is correct, why are the Government pursuing this commercialisation of our hospitals? They are not supermarkets; they are places of care.

[Earl Howe]

My Lords, I have not seen that report, but clearly there is concern, following Southern Cross, as to whether difficulties such as those should be predictable in some way. I am sure that a lot of thought is being devoted to trying to avert such crises in the future. I will look at that report and write to the noble Lord with any comments.

NHS Reform

Debate between Earl Howe and Lord Touhig

Monday 4th April 2011 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. In answer to his first question, it is likely that the period of listening and engagement will extend through the Easter Recess and beyond. The precise duration of the intermission has not been fixed yet because much will depend on the volume of feedback that we receive. While I have not spoken to the usual channels about this, I am still working on the premise that your Lordships’ House will receive the Bill prior to the Summer Recess. I believe that, if the House agrees, we can thereby reach the Bill’s conclusion within a reasonable space of time. That will enable us to adhere to the current timetable for the implementation of our proposals. But that statement does come with what I might call a health warning because we are clear that we want to listen to the opinions of everybody who counts in this, and it could be that the period of reflection may extend into the late spring. But no doubt I will be able to enlighten him further in due course.

My noble friend mentioned the democratic input at health and well-being board level. This is one of the issues that we will want to receive opinions about because I know there has been disquiet on this front. He knows that his party was instrumental in building into our plans the democratic element of health and well-being boards and the fact that they should be situated at local authority level. That was a very positive contribution made by the Liberal Democrat Party which has, by and large, been widely accepted. If there are ways we can bolster that democratic accountability without cutting through the core principles that we have articulated for decision-making in the health service, then we are willing to look at them.

[Lord Touhig]

My Lords, the Minister said that the NHS was in a healthy financial position and that the Government intend to increase NHS spending by £11.5 billion over the life of this Parliament. Yet, in the last financial year, the NHS had an underspend of £5.5 billion and the forecast this year is a further underspend of another billion. The Chancellor has said that he intends not to hand this money over to the NHS but to keep it in the Treasury. The Nuffield Trust says that this is a retrospective cut in health spending. Does the Minister agree?

[Earl Howe]

My Lords, the noble Lord needs to bear in mind that the forecast surplus for 2010-11 represents a very small proportion of the department’s budget. It is greatly to the credit of the health service and the department that they have managed to come in on the right side of the line and by a margin that, in the scheme of things, is not significant. I say that without being at all blasé about the figure of £1.4 billion. I suggest to the noble Lord that that represents good financial management. Yes, the money that represents the surplus cannot be carried forward into the subsequent year but that is not the same thing as saying that providers, for example foundation trusts, may not use their carry-forward balances. That is still possible at provider level. I hope, on reflection, that the noble Lord will not think too badly of the way the service has been run in the past few months.

Health: Sickle-Cell Disease

Debate between Earl Howe and Lord Touhig

Monday 14th March 2011 Lords Chamber

[Earl Howe]

I am sure my noble friend’s suggestion is a very good one. I do not think that the practice of carrying identification is by any means universal, but is it perhaps one that could be commended to the relevant patient groups.

[Lord Touhig]

One in 10 children diagnosed with sickle-cell disease will suffer a stroke. Unfortunately, a number will die. Those who do not will go on to have further strokes leading to disabilities and cognitive loss. The Minister talked about a screening programme. Do the Government have in mind any plans to get greater public awareness of sickle-cell disease by a public education programme right across the board among all groups in society?

Health: Care and Compassion?

Debate between Earl Howe and Lord Touhig

Thursday 3rd March 2011 Lords Chamber

[Lord Touhig]

To ask Her Majesty’s Government what action they plan to take in response to the Parliamentary and Health Service Ombudsman’s report Care and Compassion?.

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

My Lords, the department has asked the Care Quality Commission to conduct a series of unannounced inspections on NHS trusts, and will report on its findings. The department wrote to NHS chairs on 15 February to raise awareness of this report and to ask them to assure themselves that their own organisations were up to standard. Similarly, the chief nursing officer also raised the report findings at her February meeting with strategic health authority directors of nursing.

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[Lord Touhig]

I thank the Minister for his Answer, which is very helpful. We in this country are blessed with a National Health Service staffed by very dedicated and committed people but, as this report highlights, there are instances of neglect and a lack of care for the elderly. The best way to prevent cases like the 10 listed here happening again is to ensure that everyone in the National Health Service, if possible, reads the report. It is available online at www.ombudsman.org.uk, but can the Government find ways to help to distribute the report so that everyone working in the health service can read it?

[Earl Howe]

My Lords, I understand and applaud the noble Lord’s reason for making that suggestion. I will overlook the issue of cost, but I am not sure that his idea would necessarily have the desired impact. What is needed here is for local leaders to take charge. That is why the chief executive wrote to every chairman and chairwoman in the NHS asking them to share the report with every member of their board, so that they can examine the services in their particular organisation and assure themselves that these situations are not happening on their watch. Nevertheless, I am certain that boards around the country will wish to take heed of the noble Lord’s suggestion.

Autism

Debate between Earl Howe and Lord Touhig

Tuesday 7th December 2010 Lords Chamber

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

My Lords, yes, I believe that the planning guidance will be effective in delivering the strategy for adults with autism. This guidance has been developed with advice from health and social care professionals, people with autism and their carers and the voluntary groups representing them. Only by such a transparent, mutual approach can we achieve the vision that the Government have set out for adults with autism: fulfilling and rewarding lives within a society that accepts and understands them.

[Lord Touhig]

I thank the Minister for that reply. I am sure he agrees that, when planning services, it is important to know what services are needed and how many people need them. I do not know whether the Minister is aware of the National Audit Office report which has revealed that 80 per cent of councils have no idea how many people with autistic spectrum disorders live in their areas. Will the Minister therefore agree to meet our colleague, the noble Baroness, Lady Browning, myself and members of the National Autistic Society to discuss ways in which we can ensure that local authorities meet their statutory duties towards people with autism?

[Earl Howe]

My Lords, I should be very happy to meet the noble Lord to discuss those issues. Although we do not have definitive figures for the number of people with autism in England, we have commissioned a study into the prevalence of autism among adults to inform strategic planning at central and local levels to benefit adults with autism as they access public services. We have commissioned that study from the University of Leicester and it is due to report by March 2011.

Disabled People: Dementia

Debate between Earl Howe and Lord Touhig

Monday 11th October 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness is right. The national dementia strategy quite rightly recognises the need to improve the quality of care for people with dementia in hospital and that is identified in the new implementation plan as one of the key priorities for action. Of course, the main priority has to be to avoid admitting dementia patients to hospital in the first place, if possible. We should admit them only when it is strictly necessary and we should discharge them at the earliest opportunity. We have set priority areas for all hospitals to take urgent action, including appointing a senior member of staff to improve the quality of care for people with dementia and to look after the training of staff in hospitals.

[Lord Touhig]

My Lords, between a half and two-thirds of people with dementia never receive a formal diagnosis. That could be improved if GP practices, the mental health services and the royal colleges were to develop dementia care pathways. That was a recommendation by the Public Accounts Committee in the other place in 2008. What progress has been made in developing those pathways?

[Earl Howe]

My Lords, progress is being made thanks to the quality standard published by NICE in the summer on dementia care. That will underpin the outcomes framework that we shall look for in the care of dementia patients. He is absolutely right in what he says: two-thirds of people with dementia never receive a diagnosis in the first place; the UK is in the bottom third of countries in Europe for diagnosis and treatment of dementia patients; and GPs do not feel adequately trained in this area. So there is a lot of work to do.