NHS: Out-of-Hours Services

Lord Laming Excerpts

Monday 29th July 2013 Lords Chamber

[Earl Howe]

My Lords, the NHS 111 service is not unsafe—it is a safe service. In the vast majority of the country it has been provided very well for patients. We were confident that the service could be provided well, and so it has proved. The isolated cases where the service has fallen short are highly regrettable, but there is no issue about the quality of NHS Direct’s provision of NHS 111. I am afraid the issue there is that it got its sums wrong and cannot provide the service economically.

[Lord Laming]

The noble Earl will recall that in his response last week on the pressure on accident and emergency services, he referred to the change that had taken place in the GP contract that relieved them of the opportunity of being on call. Are the Government going to renegotiate the GP contract? If not, is there a possibility of placing a primary care service in every accident and emergency unit in the country?

[Earl Howe]

My Lords, we are straying a little from the Question before us, but I understand the relevance of the noble Lord’s point to the urgent care pathway generally. We are obviously looking very carefully at the GP contract. I cannot tell him at the moment how far negotiations have reached, because we are only at the start of the process. However, his point about primary care services in A&E departments is well made, and many A&E departments do indeed provide that to ensure safe triage of patients on arrival.

Health and Social Care

Lord Laming Excerpts

Wednesday 5th June 2013 Lords Chamber

[Earl Howe]

There are a number of indicators in the NHS Outcomes Framework and, indeed, in the public health outcomes framework and the adult social care outcomes framework relating to the vulnerable elderly groups in our population. I shall need to write to the noble Lady with a specific answer to her question. However, her question is extremely pertinent to the issues that have been very high profile recently, the resolution of which depend, in part, on ensuring that we can avoid unplanned admissions to hospital and keep people securely in their own homes.

[Lord Laming]

My Lords, will the Minister assure the House that when the separate inspectorates are established they will reinforce integrated working rather than operate in separate identities?

[Earl Howe]

I can indeed, and I can do so with confidence because the three chief inspectors that we propose to create—one of whom, the Chief Inspector of Hospitals, has already been appointed—will be working as part of the Care Quality Commission. They will be senior employees of the CQC and their job will certainly be to align the methodology that they use to assess good and poor care.

NHS: GP Services

Lord Laming Excerpts

Tuesday 21st May 2013 Lords Chamber

[Earl Howe]

My Lords, I think that the GP contract is but one element of a more complicated picture. It is not the only issue or, indeed, is it the only solution. It is true that access to out-of-hours care in some parts of England is simply not good enough. We are not saying that family doctors should necessarily go back to being on call in the evenings and at weekends. They work hard and have families, and they need a life too, but we must take a serious look at how out-of-hours NHS care is provided. My right honourable friend the Secretary of State will be talking to GP leaders about how we can do that over the coming weeks.

[Lord Laming]

My Lords, the noble Earl has indicated that there is a need to look again at the availability of community-based services. Hospital-based services are available seven days a week but community ones for much less, and that includes social care services. While not wanting staff to work all hours, is it not possible to move towards a situation where the services will be available at all hours while we protect staff working time?

[Earl Howe]

The noble Lord, Lord Laming, has summed up the situation extremely well. I am sure he knows that Sir Bruce Keogh, the NHS medical director, is currently looking at how NHS services across the piece can be provided seven days a week in a much fuller way than they are at the moment. Access to GPs out of hours is part of that wider consideration and NHS England is working with the royal colleges and professional organisations to develop a set of standards that will apply to seven-day services. Some trusts are already thinking about treating patients at weekends for non-urgent operations and procedures. We want to encourage that trend.

NHS: 111 Telephone Service

Lord Laming Excerpts

Monday 13th May 2013 Lords Chamber

[Earl Howe]

On the issue of A&E, there is no doubt that the NHS has been under very heavy pressure over the past few weeks. I am pleased to say that over the past two weeks the NHS as a whole has met the 95% standard, but obviously that statistic masks difficulties that are still being experienced in particular locations. The challenge now is to ensure that we are ready for next winter, and all the work that is now being done in NHS England, by clinical commissioning groups and within providers is designed to ensure that we are much readier for the pressures to come.

[Lord Laming]

My Lords, does the Minister accept that, although we refer to “primary care services”, they are not primary in that they are available for the shortest number of hours per week of any part of the health service? Unless things change dramatically, it is inevitable that accident and emergency will be seen as the first point of call for more and more people, especially in out of office hours.

[Earl Howe]

I take the noble Lord’s point. That is why the 111 service has been created; there is no doubt that there was a very confusing landscape in which people did not know who to call out of hours, and they did not necessarily have the telephone number of the out of hours provider in their area. The 111 service is designed to simplify all that, and across the vast bulk of England people are getting a good, if not fantastic, service. Unfortunately, in two areas of the country, the south-east and the south-west, we are still seeing problems arising, and those are being gripped.

Care Quality Commission

Lord Laming Excerpts

Thursday 14th March 2013 Lords Chamber

[Earl Howe]

The noble Baroness is right to focus on that issue. There are a number of things that we can do. We will shortly introduce new minimum standards to improve training for care staff, which will help in that regard. We aim to double the number of apprentices in care services by 2017 because there is clearly a workforce imperative here. We are proposing to expand the current care ambassador scheme, which promotes a positive image of the sector. That again will assist in recruitment. We are also launching an online tool to support recruitment and provide information about working in care and support, all of which is designed to address workforce concerns and concerns around skills.

[Lord Laming]

My Lords, will the noble Earl assure the House that the Government, when considering the report referred to by the noble Baroness, Lady Wheeler, will look at it in the context of another report published today by a House of Lords committee chaired by the noble Lord, Lord Filkin? Together, these reports pose one of the greatest challenges to our society, and it is very important that the Government take these matters as seriously as possible, for the benefit of us all.

[Earl Howe]

I quite agree with the noble Lord. He will know that we have an Oral Question next week on the report published today by the noble Lord, Lord Filkin.

NHS: Clinical Commissioning Groups

Lord Laming Excerpts

Wednesday 16th January 2013 Lords Chamber

[Earl Howe]

I am very grateful to my noble friend. I have meetings from time to time with the chairman of the NHS Commissioning Board, as does my right honourable friend the Secretary of State. I also meet regularly with the chief executive of the Commissioning Board. It is important that there is that interaction between Ministers and the board if there is to be proper accountability.

[Lord Laming]

Will the Minister say whether poverty was the only element that was removed and, if so, why was this singled out?

[Earl Howe]

Poverty was not removed. As I hope I have outlined, there are various criteria reflecting deprivation which are most certainly relevant to the fair allocation of resources. Age is clearly another factor, because it would be difficult to envisage an allocation formula that did not take it into account; it is the key factor in determining an individual’s need for healthcare. That is not to say that other factors such as deprivation should not continue to be considered.

Department of Health: Budget

Lord Laming Excerpts

Thursday 6th December 2012 Lords Chamber

[Earl Howe]

My noble friend makes an extremely important point. He will know that the Government have made it clear that mental health problems should be treated as seriously as physical health problems. That commitment has now been made explicit in the Health and Social Care Act 2012. As he mentioned, the Government’s mandate to the NHS Commissioning Board explicitly recognises the importance of putting mental health on a par with physical health. It tasks the NHS Commissioning Board with developing a collaborative programme of action to achieve that and it will be held to account accordingly.

[Lord Laming]

My Lords, does the Department of Health and its Ministers monitor the number of people who today are in hospital and whose treatment is being completed, but who are there because alternative arrangements have not been made for them?

[Earl Howe]

Yes, my Lords. As the noble Lord will know, the problem of delayed transfers of care is not new. We have seen a drop in delayed transfers in terms of the number of days but there has been a levelling off in recent years. However, it is up to the NHS and social care services to collaborate to ensure that proper and appropriate community services are available to patients when they are discharged from hospital. That planning process begins the moment the patient enters hospital.

Social Care: Apprenticeships

Lord Laming Excerpts

Thursday 29th November 2012 Lords Chamber

[Earl Howe]

My Lords, a great deal of work is going on, not least in the field of leadership. As I have mentioned, the National Institute for Clinical Excellence, soon to be the National Institute for Health and Clinical Excellence, will be issuing quality standards in this area. Skills for Care is also working to refine and improve the standards that social workers need to adhere to—and, of course, social workers as opposed to social care apprentices are statutorily regulated.

[Lord Laming]

My Lords, the noble Earl and the House will have been shocked by a number of recent reports about the exploitation of the vulnerability of people who are receiving social care, either in institutions or in their own homes. Can the noble Earl assure the House that the Government will do everything they can to ensure clear managerial accountability for the quality of care that is delivered, and will ask the inspectorates to make sure that they will do what they can to assess the quality in the different parts of social care services?

Winterbourne View

Lord Laming Excerpts

Tuesday 30th October 2012 Lords Chamber

[Lord Laming]

My Lords, the Minister has made it plain that it has been the Government’s position for some time that people with learning disabilities should be enabled to live with local personalised services, supported in the community. The fact that some former residents of Winterbourne are now living with their families is an indication that this policy has been implemented all too slowly. There are too many units like that around the country. Will the Minister tell the House what levers are being employed to speed up this policy so that people have a range of local services designed to meet their personal needs?

[Earl Howe]

My Lords, I am absolutely in agreement with the noble Lord, Lord Laming, that it is really important that people are held to account for making change happen. We have indicated what we think that change should be, and that is why we have developed a concordat with key partners to get them to commit to the actions they will take. We also plan to strengthen the learning disability programme board, in particular to make sure that key delivery partners—such as the NHS Commissioning Board, the CQC, ADAS and the Local Government Association—are core members. The board will review progress on implementing the action set out in the final departmental report and the concordat. We have tried to address the issue that the noble Lord homed-in on—which is speed of action—but the core of his point was that there are too many people currently in specialist in-patient learning disability services, including assessment and treatment units, and that they are staying there for too long. This is often due to crises which are preventable or which can be managed if people are given the right support in their own homes and in community settings. That is the agenda that faces us.

Mental Health Act

Lord Laming Excerpts

Monday 29th October 2012 Lords Chamber

[Lord Laming]

We are all grateful for the way in which this matter has been handled, and particularly pleased that it will not result in any fundamental change in mental health legislation. I come to this from a point of ignorance, so I hope that the Minister will excuse what seems an innocent question. Does this mean that the future emergency legislation that will come to the House is aimed at deeming that the practitioners who dealt with these cases are now licensed to deal with them, or does it mean that the patients have been deemed to be appropriately assessed?

[Earl Howe]

The question that the noble Lord, Lord Laming, asks is not a naive one at all—it is a very important one. The draft legislation that has been prepared is very narrowly drawn and its effect will be to ratify retrospectively those decisions taken by the panels that assess doctors for approval and treat those decisions by the panel as if they had been lawfully made. So it does not apply directly to patients but to the approval of the clinicians involved.