NHS: Staff

Baroness Donaghy Excerpts

Thursday 30th November 2017 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, what a great privilege it is to follow the noble Baroness, Lady Emerton, and what a champion she has been for nurses, midwives and the health service. I think that the House will have another opportunity to pay tribute to her work but I am so pleased that she was able to participate in this debate.

I also thank my noble friend Lord Clark of Windermere for initiating this important debate. It is important because it is about the future welfare of about 1.3 million people in the NHS—let alone the people in their care—and they are all on the Agenda for Change pay system. But this is part of a wider context, which is important to remind ourselves of. The health service needs a higher ratio of spending as a percentage of GDP if we are to match the standards of other advanced nations, notwithstanding the extra resources required to care for our ageing population. The total UK health spending—including public and private expenditure—was 9.8% of national income in 2015 according to the Institute for Fiscal Studies. Although that was in line with the EU-15 average, it was below the levels of the United States at 16.9%, Japan at 11.2%, Germany at 11.1%, and France at 11%. Health spending has increased since 2009-10 but at an historically slow rate—1.4% a year. Also, it should be remembered that cuts in other departments, particularly local government, were disproportionately severe and have acted as a major obstacle to progress on social care. We must bear in mind that the average increase over the previous 60 years was 4.1% per year.

The second, larger bit of the context is that all the government reassurances about supporting the values of the NHS should be taken together with the appalling Health and Social Care Act. This was a top-down piece of legislation which created even more bureaucracy in the health service. It has not dealt with social care at all and many of today’s problems can be laid at its door.

In the 1960s I spent a couple of summers working as a ward orderly at Warwick Hospital, so I have been a health service worker—admittedly in a very different era and on a pretty low wage. I would march up and down the ward in a full-length cow gown—I am sure the noble Baroness, Lady Emerton, will remember the cow gowns—pulling a trolley full of urine bottles. I thought I was the bee’s knees.

For many years I was also a non-executive director at King’s College Hospital foundation trust. I chaired a considerable number of consultant appointment panels and was impressed by the calibre of the applicants, and the amount of training, study and moving around the country at frequent intervals that our system seems to require. I was also impressed by their internationalism. From whatever country they came, they had worked and conducted research in a different country from their birthplace. We are extremely fortunate to have people who are pathfinding in different forms of medicine and different methods of healthcare. The shortages in emergency medicine, psychiatry and general practice are extremely worrying and mean that some of our population may receive suboptimal care. What practical steps are the Government taking to address these shortages and maintain the internationalism of our consultants?

I will mention nursing briefly, not because nurses are not vital and recruitment and retention are not reaching crisis point, but because many other speakers, not least the noble Baroness, Lady Emerton, have far more expertise than I do. My former union, UNISON, is asking the Government to legislate for safe staffing levels so that acceptable nurse-to-patient ratios improve recruitment and encourage nurses to stay in the profession. UNISON’s annual survey in April this year showed that wards are now so understaffed that nurses cannot ensure safe, dignified and compassionate care. Half of respondents had to work through their breaks to make up for the lack of colleagues and 41% worked more than their contracted hours. This is leading to exhaustion and burnout.

UNISON has no confidence that the Government can deliver on their commitment to triple the number of nursing associates and increase the number of training places for student nurses. The demise of the bursary means the Government no longer commission training places directly, depending instead on universities creating extra places and recruiting students. One pro-vice-chancellor I spoke to two days ago said that his university was negotiating to establish a course of nurse training. It was so complex and demanding that the university doubted it would be financially viable or that it would actually run. Abolishing the nursing bursaries is in the same category as charging for employment tribunals and the notorious employee share ownership scheme—they should be put in the “daft” box.

I turn to the majority of health service staff—the unsung heroes and heroines, many in comparatively low-paid jobs who the pay cap has been particularly tough on: cleaners, porters, catering staff, admin staff, medical secretaries and primary care staff. This also includes professions allied to medicine: midwives, health visitors, healthcare assistants, paramedics, ambulance staff, occupational therapists, speech therapists and operating department practitioners. I make no apology for repeating my noble friend Lord Clark’s list of important staff. Since I mention speech therapists, I recall a debate many years ago initiated by my noble friend Lady Turner of Camden, who has a long-term illness. She was a champion of speech therapists. It was a very moving debate. The supporting speech by the noble Earl, Lord Attlee, was particularly powerful. We need more champions of health service staff, even with half the dedication of my noble friend Lady Turner and the noble Baroness, Lady Emerton. Such champions could make a difference.

I am sure that I have left some categories out and I apologise if I have. They have all paid the price of the Government’s austerity measures, in terms of living standards for their families and coping with increasing pressures in their workplace. While on the face of it the Chancellor’s announcement that the Government will give conditional support to pay review bodies this year is welcome, we do not know how many pay review bodies he is referring to. Can the Minister enlighten us as to who will be covered? Can he explain what the Chancellor meant when he spoke about,

“pay structure modernisation for ‘Agenda for Change’ staff, to improve recruitment and retention”?—[Official Report, Commons, 22/11/17; col. 1054.]

I have a lot of experience of pay structure modernisation. It usually means leaving people stuck on their grade ceiling, plussages which are divisive and discriminatory, and moving on to new pay structures on condition that staff accept unwelcome changes to their terms and conditions.

The Chancellor has said that any deal will be linked to improved productivity. Can the Minister explain what is meant by “improved productivity” in the health service? Would it involve a porter pushing two patients along in wheelchairs, catering staff serving half a dinner, or nurses scooting up and down wards? It would conjure an image of “Carry on Nurse” if it were not so serious. How on earth can people be expected to work any harder?

One of the complaints of staff, particularly nursing staff, is that there is insufficient flexibility in working patterns. I am not surprised that the bill for agency staff has nearly doubled between 2011 and 2016, reaching £3.6 billion in England and £250 million in the other nations. If I were a trained nurse with young children, I would probably opt for the flexibility of agency working, rather than the increasingly heavy burdens of full-time staff responsibilities. The House of Lords Long-term Sustainability of the NHS Committee looked at the link between pay and morale. Those at the lower end of the pay scale were particularly badly affected. The committee made this recommendation about pay policy:

“We recommend that the Government commissions a formal independent review … with a particular regard to its impact on the morale and retention of health and care staff”.


The Government have not yet responded to this recommendation. Will the Minister say what the Government’s response is to the committee’s recommendation?

Finally, paying lip service to the NHS and issuing overblown statements about how the Government support it, while at the same time squeezing it by the neck, is unacceptable. Actions speak louder than honeyed words.

Queen’s Speech

Baroness Donaghy Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I want to speak up for public servants. I question whether we have the capacity in public services to sustain the enormous workload that is ahead of them and to carry out the heavy responsibility that is expected of them. The gracious Speech makes it clear that public servants are also-rans in the battle to balance the books. They have already had seven years of job cuts and pay cuts and it is clear that it will be more of the same in the next five years unless the Government change course. We need a sustained programme of public infrastructure investment and essential capacity-building for public servants and not just to throw money at emergencies.

It is interesting that a key point in our general election match, which resulted in a painful no-score draw, was the adverse publicity faced by the throwaway Prime Minister over the 20,000 police cuts and 5,000 armed police cuts at a time when the public wanted reassurance. It is interesting because, when Theresa May was Home Secretary, she took pride in taking on the Police Federation and cutting it down to size. These actions have consequences. If I were in the police force right now, I would be less concerned with being called a hero and more concerned that there would be someone to replace me at the end of my shift, that I could stick to the family leave I had planned, with no worry that it would be cancelled, and that I would be properly equipped in uniform and career development.

The background briefing to the gracious Speech states that the Government,

“values the important work that public sector workers do in delivering essential public services”.

However, there is not a single policy proposal as to how the Government intend to support that important work.

One of my areas of interest is health and safety. I worked closely with the Health and Safety Executive when I produced my report on construction fatalities. I have watched with astonishment as the HSE budget has been cut and cut again, with a 25% reduction in the number of HSE inspectors. By the end of this Parliament, the total HSE budget will have been halved. The cuts are still coming. At the same time, the Conservative Government have attacked health and safety legislation, nibbling away at the edges in a series of Bills. It is shameful.

I turn to the Civil Service. Although numbers have increased since December 2016, mainly as a result of leaving the EU, there has been an overall reduction of 20% since 2009. The Department of Health has lost 49% of its workforce since 2010 and the DCLG has lost 42%. Another five departments have lost over a quarter of their staff. Of course, the Cabinet Office, which supports the Executive rather than the country, has increased by 23%.

The workload around leaving the EU and making a minority Government work cries out for increased resources. The brightest and best will be seconded to the exit department, even if some remain within their departments. The numbers are woefully thin. Perhaps the Minister can tell us what will happen to the day-to-day work of government. The DWP has to run universal credit, which requires a heavy and ongoing administrative burden and has not yet been completely rolled out because of its complexities.

Most worrying to me is the capacity of HMRC. The Public Accounts Committee talks of a “catastrophic collapse” in customer service if more operations move online. The PAC was not convinced that HMRC had a credible plan to prevent a “disastrous decline” in service. It also questioned whether HMRC might be,

“painting too rosy a picture”,

of its success in reducing the gap between the amount of tax due and the total collected.

Time does not allow me to mention other services. I am grateful to my noble friend Lord Kennedy, the right reverend Prelate the Bishop of Southwark and the noble Baroness, Lady Pinnock, for their comments in Tuesday’s debate, and my noble friends Lady Sherlock and Lord Whitty for their comments in today’s debate. They encapsulated what I would have liked to say about those services.

In the past seven years, the Government have attacked the jobs, pay and pensions of public servants and have tried to separate them from their trade unions. The country will not run itself. I do not believe that this Government are capable of delivering strong public services. I am concerned about the inevitable collapse in some of our services that will happen in the next five years, and about the cost to the country of such neglect.

NHS: New Junior Doctor Contract

Baroness Donaghy Excerpts

Monday 18th April 2016 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, as a former chair of ACAS, I admit that I have never heard ACAS say, “We have reached the end of negotiations”, although that may be one individual’s view. Sometimes negotiations take a very long time and a lot of patience. If these negotiations have been done in the context of 99% of the population thinking that this contract could be imposed and then, all of a sudden, as we have heard this afternoon, it cannot be imposed, I wonder whether that climate has affected the negotiations. Perhaps ACAS can be brought back in to see whether it can bring about a settlement.

[Lord Prior of Brampton]

The noble Baroness will know that ACAS was involved earlier on in the negotiations, and it was under the auspices of ACAS that Sir David Dalton did his negotiations. I just repeat what I said before: theoretically you can go on with these negotiations in perpetuity. There was a huge desire on the part of the Government to settle this dispute and, as I said, we deeply regret that we were unable to do so.

National Health Service

Baroness Donaghy Excerpts

Thursday 14th January 2016 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I thank my noble friend Lord Turnberg for initiating this debate and congratulate the noble Baroness, Lady Watkins, on her wonderful maiden speech.

It is quite a while since I have spoken on health or social care matters, but I am fearful for the future. The ingredients of broken promises on social care funding, inadequate funding of the National Health Service, increasing demand and creeping privatisation mean that the pressure cooker may one day explode. The Government seek to avoid blame by making doctors and nurses subsidise our health provision, and finding a scapegoat in local government for the failures of social care. Student nurses are paying for their own training and working for nothing in the NHS for half their time; their pay has been capped and they are paying for their lodgings; safe staffing ratios have been scrapped; and nurses are doing even more outside work for the privilege of working up to 70 hours a week. That does not create a positive climate for the future.

The Government need to take a step back on the junior doctors dispute, which has been badly handled. The overwhelming vote of 98% on a 76% turnout is not just a problem for the Government; it places an enormous responsibility on the doctors’ leaders, because any settlement is going to look like a comparatively poor deal. It is important to allow ACAS to get on with its job. I read a very moving letter in the paper from the father of a junior doctor, who said of his son:

“He regularly works weekends and nights, and spends much of his ‘free’ time adjusting his sleep patterns. He almost always works between one and three hours extra daily because of understaffing … His social life is almost nonexistent due to exhaustion and antisocial hours”.

All that is on a basic pay of £28,000 a year, and he is paying for his own insurance fees as well as very expensive examinations.

Finally, the recent hasty announcement to devolve health budgets to five London boroughs is not genuine devolution. It is more like being persuaded into a life raft only to find the substantial figure of Boris Johnson jumping in at the last minute. Apparently, he is going to oversee the process—clearly, part of the “Keep Boris Busy” campaign. The massive funding gap for social care will be slightly narrowed at the expense of healthcare, and the London boroughs will take the flak. These piecemeal experiments will lead to more complex structures, more contracting out and huge dividends for management consultants, who will hope to increase their £600 million a year income. The losers will be patients and the elderly. I really am fearful for the future of the NHS.

Barts Health NHS Trust

Baroness Donaghy Excerpts

Thursday 19th March 2015 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I want to ask a question about a trade union representative who was dismissed from the authority two years ago for raising some of these very issues. She was a member of UNISON, and I declare an interest as a former member. I wonder whether, in working closely with trade unions, a better step would be to look after the interests of all the staff and to be not afraid to listen to some of the difficulties. The authority fought that case tooth and nail. She won at an employment tribunal but did not get reinstatement. Can the Minister give us a reassurance that in future there will be a more constructive relationship with the trade unions?

[Earl Howe]

My Lords, I cannot disagree with the philosophy expounded by the noble Baroness. It is very important that not just the trade unions but members of staff generally feel involved and have a sense of ownership of the organisation for which they work. I hope it is of some reassurance to the noble Baroness that staff and health partners will be fully involved in the development and implementation of the improvement programme and that a staff representative will be a member of a new improvement board at Whipps Cross.

Care Bill [HL]

Baroness Donaghy Excerpts

Tuesday 21st May 2013 Lords Chamber

[Baroness Donaghy]

My Lords, I welcome the introduction of the Care Bill. There are areas which I hope to see strengthened, but it represents a basic framework on which future generations should be able to build. My concern is how we make the words a reality. It is not the first time that this has been mentioned in debates. Will future funding restraints prevent any real improvements? How can we ensure the essential co-ordination between hospital care and home or residential care? My final concern is around the capacity and welfare of our workforce in health and social care and in local authorities. To make the words a reality the Care Bill must, in the words of Age UK,

“make a tangible difference to the lives of people with care and support needs who are currently effectively ignored by the system”.

The Bill contains measures to ensure a single national eligibility threshold for care services, but if, as the noble Lord, Lord Rix, has already mentioned, the regulations set the minimum level at “substantial” rather than “moderate”, it would affect 100,000 people and would render a national system meaningless. Age UK asks for the Bill to be strengthened in a number of ways, for instance by linking eligibility for social care to the achievement of outcomes based on the individual’s well-being, as defined in the Bill. The requirements on local authorities to plan to meet the diverse needs of their populations and to promote quality and choice could be strengthened by requiring service commissioners to monitor and take action where necessary. Clause 8, describing the kinds of support which local authorities must offer, should include issues such as transport.

Finally, on turning words into deeds, good quality information and advice is needed. The most stressful thing for any family caring for the frail elderly is finding their way through the maze, feeling unsupported and fearful that they are not accessing the best possible services for their loved one. Website information is welcome, but some people need more intensive help. The clause on advocacy has already been mentioned. It should be strengthened, perhaps by creating a positive duty on local authorities to ensure that someone has the help and advice they need.

Secondly, despite not being written in the scope of this Bill, future funding is critical for its success. As many of us have said in this and previous debates, there have been real-terms cuts to social care funding: 7.7% in 2011-12 and 6.8% in 2012-13. The rising levels of unmet need are such that 800,000 people who need care now are not receiving it. The Nuffield Trust calculates that,

“there would be a funding gap of between £7 and £9 billion by 2021/22 if funding were held constant in real terms”.

It adds:

“These funding pressures would rise to between five and six per cent a year if the recommendations of the Commission on Funding of Care and Support were implemented, resulting in a total funding gap of £10 to £12 billion by 2021/22”.

This gap will have to be faced by the next elected Government and will probably be met only by a combination of productivity savings, managing chronic conditions, holding down pay and taking a larger share of public funding. The social care funding gap is likely to be between 3% and 6% a year, depending on trends in chronic conditions, and Dilnot costs of course. The Nuffield Trust concludes that:

“The NHS in England may face continued austerity measures into the early 2020s”,

which is something of an understatement.

The Local Government Association supports the intentions behind the Bill but has pointed out that,

“the government’s austerity programme … does not fit well with the aspirations of the Bill”.

Policy decisions and financial decisions have become detached. The point about underfunding has also been made by the Care & Support Alliance and Age UK.

The need to co-ordinate health and social care is going to become even more desperate. In its response to the Francis public inquiry report, the Nuffield Trust states:

“The reality is that more and more trusts will be treating large numbers of sicker, older adults in an atmosphere of pay restraint and frozen budgets”,

and recommends that,

“the highest priority for initial development of fundamental standards be given to care of the frail older people on acute wards … and that this priority should shape any new requirements for data collection in NHS trusts set by the NHS Commissioning Board or the Care Quality Commission”.

The NHS is already creaking under the weight of our failure to solve the social care crisis. When I was a carer, I fought tooth and nail for my mother to be allowed to stay in hospital until her health improved rather than be sent back to the care home where she spent the last 18 months of her life—not that her care was good in hospital; it was a choice between bad and worse. I understand the dilemma of families who want to do the best for their elderly relatives. Perhaps we need more halfway house temporary accommodation, jointly funded by the NHS and local authorities or charities, to relieve the undoubted pressure on hospital beds. If care standards in residential homes were better, that would relieve pressure on hospital beds.

The changes proposed in the Bill will put enormous pressure on staff in the health service, social care and local authorities generally. The Joint Committee on the draft care and support Bill has already raised the issue of initial and ongoing training and support needed for local authority staff and social workers. Others have dealt with the certification of care workers. Long shifts and low pay are a real problem in residential homes and often determine the quality and commitment of staff. With all these new responsibilities being piled upon staff by this Bill, we should not forget our responsibility to meet their capacity and welfare needs. Also, the statutory requirement for candour may not sit easily with a more market-oriented approach to health and social care. This would also place a tremendous burden on some staff.

Finally, I have not referred to the “Dilnot-lite” elements of the Bill. Of course it is disappointing that the Dilnot figure was not accepted. The proposed figure will benefit very few people, particularly with the additional £12,000 a year overhead costs, but it is a start and having a framework is very important.

The timetable for the Mesothelioma Bill clashes with the Committee stage of this Bill, so I will not be able to be present for the early stages, but looking around I feel sure that all angles will be well covered by noble Lords on all sides of the House.

NHS: South London Healthcare Trust

Baroness Donaghy Excerpts

Tuesday 8th January 2013 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Lord, who I know well appreciates the scale of the problem with which the administrator was grappling. This trust was losing more than £1 million a week. That is not a sustainable position in the current NHS, or even when times were rosier as regards the financial settlement. It is important for me not to say anything that will pre-empt my right honourable friend’s conclusion, but I am aware, from the press release issued today by the trust special administrator, that, as the noble Lord rightly says, the wider health economy has been taken into consideration, including the role of Guy’s and King’s College Hospital, in a number of areas, including, in particular, in emergency care and in obstetrician-led maternity care. I would commend to the noble Lord a summary of the recommendations, which is on the department’s website today. I hope he will find that helpful in giving him a sense of the breadth of the administrator’s purview.

[Baroness Donaghy]

Is the Minister aware of the extreme anxiety among the population in Lewisham about the possible future closure of the A&E department in Lewisham? The population of 250,000 is estimated to rise to 300,000 in a very few years’ time as a result of a huge increase in the birth rate. There are very deep social needs and there is no doubt whatever that there is unanimity among the professionals and the population about the importance of maintaining that hospital. Is the Minister also concerned that one report that was produced, which was supposedly a clinical report, in fact turned out to be written by the communications department? Is he satisfied that the process has been a fair one and that there has not been a prejudgment in the consultation exercise?

[Earl Howe]

My Lords, all questions of process must be for my right honourable friend to consider, including that one. I emphasise the Government’s approach to reconfiguration decisions. When the Government came into office, we took a very clear decision about four tests that needed to be applied to any sustainable reconfiguration within the NHS: the changes, whatever they were, had to command support from GP commissioners—that is to say, the clinical community; the public must be engaged in the process; the recommendations must be clinically sustainable and sound; and, as the statement mentioned, they must leave patients with a clear choice of good-quality providers. Those safeguards were not there before, but they are there now and my right honourable friend will be looking at those tests when he considers not just the matter of Lewisham but the totality of the administrator’s recommendations.

Social Care

Baroness Donaghy Excerpts

Thursday 29th November 2012 Lords Chamber

[Baroness Donaghy]

My Lords, I am extremely grateful to my noble friend Lady Pitkeathley for her perseverance in this important area. Those of us who sat through the debates on the Local Government Finance Bill can be in no doubt about the parlous state of local government funding, and the Question asked in the House yesterday about cuts in arts funding in Newcastle brought it home even more how councils are having to set priorities which are assessed on the least harm rather than the most good. I start from the standpoint of being a supporter of local government, but that is not to say that there are no failings in the system, if you can call the state of social care in this country a system. I will concentrate my remarks on care for the elderly and, in particular, those who need nursing care as opposed to residential care.

A growing number of frail elderly people are living alone when it is no longer safe for them to do so. The care they receive, if they receive it, is often totally inadequate for their needs. This is not new, as the noble Baroness, Lady Barker, pointed out, it is just getting worse. Let us look at the demographics. Last year, 720,000 people reached the age of 65, the largest number ever to do so. They are the cod liver oil generation and they are better nourished than any previous generation. Some continue in paid employment, and a considerable proportion of their number will still be around in 2031 when they reach the age of 85. That is good news, but by then many more will require support in their homes or in residential or nursing care. Moreover, many among those 720,000 people are already caring for elderly relations, as I did a few years ago. They are finding out for the first time in their lives the extent of the financial and administrative hurdles they have to overcome on behalf of their loved one or ones.

Today’s 85 year-olds are not a sufficient political lobby to frighten any Chancellor of the Exchequer into taking action on social care, but the generation that retired last year is a different matter. Their experience as carers and their concern for their own futures will affect the political agenda. By way of a word of advice to my noble friend Lady Pitkeathley, if she moves the same Motion for debate this time next year, she ought to ask the noble Lord, Lord Sassoon or his successor to reply instead of the noble Earl, Lord Howe, because this is a Treasury issue.

We all believe that care is in desperate need of reform, that it is urgent and that cross-party consent is probably the only way we are going to achieve it. Having said that, I first participated in a debate on the urgent need to integrate health and local government services for the elderly in 1973—so the word “urgent” is losing its meaning. It is shocking to learn that social care for older people in England makes up about 1% of total public expenditure in the UK. We know that much of NHS expenditure is also concentrated in this area, to some extent subsidising the failure of social care, the lack of adequate housing and the diminution of the role of extended families. Although the Government have announced new social care funding, rising from £1.18 billion in 2011-12 to £2 billion per year by 2014-15, which of course is welcome, that is in the context of overall cuts and cancelled funding from central government of £3.5 billion.

This area has always been underfunded. Age UK has said that,

“care is not fit for purpose”.

Each year, the level of unmet need has increased as people are excluded from accessing services or have their care packages reduced. In 2009-10, the total hours of support purchased by local authorities for older people fell from 2 million hours to 1.85 million hours. People who are unable to undertake essential personal care tasks find themselves ineligible for support depending on where they live. It is estimated that 800,000 older people with care-related needs receive no support of any kind from public or private sector agencies. This figure is likely to rise to 1 million people by 2020. Those who are poor and have no family support face a grim future.

As the noble Baroness, Lady Wheatcroft, said, although funding is of course very important, we must look to different ways of spending it. We should find out why our elderly are more isolated than elderly people in some other countries in Europe, where specially built communities exist. Perhaps older people in this country cling on to their own— sometimes hopelessly inappropriate—accommodation because it is preferable to going into a home or living with their children. Of course there are purpose-built homes with community facilities now, but we must find ways of ensuring that, once someone has bought a property in such a purpose-built facility, the annual service and maintenance charges do not overtake their budget and reach nightmarish levels. At a time when housing budgets are facing dire shortfalls, it may seem fanciful to demand new forms of housing or to persuade the elderly to move from the suburbs into the city, as they do in Copenhagen, but when times are desperate we need to be at our most imaginative.

Another area that I think deserves independent examination is the administration of the estates of deceased nursing home residents, many of whom have no living family member. I realise it is not something that the CQC can deal with, but I feel that a lot of money is being made by some solicitors, and probably banks, with little oversight. This is an area where local authorities could become entrepreneurial—the salaries of the staff who are employed would be covered several times over and the elderly residents’ interests would be better protected.

We should ask ourselves whether nursing homes, as presently constituted, are the right model for the future. There is no doubt that cuts in local authority funding force authorities to cut the fees they pay to private nursing homes, which forces many to close. After all, local authorities fund about half the places, but shareholder value may well be the decisive factor. Is the comfort and well-being of the patients in nursing homes given more priority than their potential for bed-wetting? I ask these questions because of my own experience. The CQC report is, if anything, an understatement of the real problem. I wish my noble friends Lady Pitkeathley and Lord Warner, and other colleagues, all the best in their endeavours to keep Dilnot alive.

Winterbourne View

Baroness Donaghy Excerpts

Tuesday 30th October 2012 Lords Chamber

[Earl Howe]

My noble friend is absolutely right: this is not a simple matter. That is why we believe that commissioning should not be remote from those for whom care is commissioned. There needs to be regular monitoring by commissioners of the quality of the service that has been commissioned. Equally important, commissioners need to satisfy themselves on the suitability of the placement in the first instance. Best practice and guidance are clear: people with learning disabilities, autism or behaviour that challenges should benefit from local, personalised services and should be supported to live in the community wherever possible. The creation of clinical commissioning groups and health and well-being boards will encourage that local dialogue and insight to make sure that the services available in an area are appropriate and of a capacity for those who require them.

[Baroness Donaghy]

My Lords—

[Baroness Emerton]

My Lords—

[Baroness Northover]

My Lords, I have been keeping a tally and it is the turn of the Labour Party and then the Cross-Benchers.

[Baroness Donaghy]

Is the Minister satisfied that not a single senior manager or owner went to jail as a result of the Winterbourne View scandal? Given that, how on earth is a culture change going to be promoted in these organisations? Can he assure the House that the responsibility and any judicial changes will be considered as part of any review?

[Earl Howe]

My Lords, the noble Baroness makes an important point. We have been clear that those who lead organisations where people suffer abuse or neglect should be held accountable. We have made it clear that there is a gap which needs to be addressed. A range of options is available through regulation; for example, by barring people from running care homes or hospitals ever again or, indeed, through criminal sanctions. As I have mentioned, very soon we will publish our final recommendations on what more can be done to prevent abuse and protect those who are in vulnerable situations.

Health and Social Care Bill

Baroness Donaghy Excerpts

Monday 19th December 2011 Lords Chamber

[Baroness Farrington of Ribbleton]

My Lords, I rise to speak about the importance of the role of the police. I made my maiden speech in your Lordships’ House on the subject of care of mentally ill people taken into custody in police cells. I was struck at that stage—I declare a former interest as a member of a police authority and a visitor of police cells—that time after time, I was informed and became aware that people were being taken into custody, not because it was most appropriate, but because their problems were mental health related. They were being taken into police cells for their own protection or for the protection of other people, because there was nowhere else for custody officers to deal with this. I hope the Minister will take this carefully into account when looking at the role of the police, in particular at that initial point of contact. Sadly, many people who end up in custody and police cells have problems that are either mental health related or drug or alcohol related. It creates a problem for the police service, particularly at weekends. It also leads to a reaction to those people who have behaved in a way that causes them to be taken into custody so that they end up in prison, rather than receiving a course of treatment.

[Baroness Donaghy]

My Lords, I support the amendments of the noble Baroness, Lady Finlay of Llandaff, which refer to allied health professionals, and I want to widen them to include the whole health team. We have been talking about structures, consultation, rights of representation, and roles and responsibility in the new structures, but we need to ensure that the service is delivered to the patients by the health team. Nowhere does the Bill appear to acknowledge the importance of the majority of staff in the health and care services: the invisible majority. I know from working in universities for 33 years that there are academics and students, and then all the rest who are often referred to in the negative as non-teaching staff. In the health service, there are doctors, sometimes nurses, and patients, while the rest are rarely referred to as people: they are back office or integrated services. I want to place on record the importance of the health team: the cleaners, caterers, maintenance staff, technicians, receptionists, secretaries, administrators, finance staff, and those involved with transport, as well the allied health professionals mentioned by the noble Baroness, Lady Finlay.

When I was a non-executive director of a foundation trust, we had to deal with the issue of staff who were employed by PFI projects. It is not my intention to discuss the rights and wrongs of PFI, but to illustrate the huge efforts required to ensure that the PFI staff felt part of the health team, even though the foundation trust had no direct management responsibility. The same applies to contracted-out staff generally. Some, though not all, of the problems of hygiene in hospitals and failure to feed vulnerable patients were caused by the separation of these contracted-out staff from the health team. If transport is not co-ordinated, a patient can be in a ward for an extra day. An efficient receptionist can make the difference between an efficient department and a failing department. Those are only two examples. There has been a deafening silence about the health team, and I am seeking a statement of support for all the staff in the health service and an acknowledgement that the future of the service, whatever that is after this unnecessary Bill, will depend on the health team being able to work together in an integrated way.

[Baroness Cumberlege]

My Lords, I address my remarks to Amendment 330ZAB and others that concern the composition of the health and well-being boards, and I would like to say a word in general about the boards.

To me, they are a spark of inspiration. In the next grouping we will have some specific amendments from noble Lords concerning integration, and we have heard a bit about it already today. I have been conscious that throughout the Committee debates the virtues of integration have often been referred to by my noble friend Lord Howe, and part of the integration he has cited is that very valuable tool, the health and well-being board, bringing together social services, health, and importantly, local healthwatch.

The Bill is gratifyingly lean in its suggested membership of the board: just six essential members. However, in Clause 191(2)(g) it gives flexibility in allowing the board to appoint:

“(g) such other persons, or representatives of such other persons, as the local authority thinks appropriate”.

However, in the same clause, 191(9), it must consult with the members of the board. That seems absolutely right and proper. The success of these boards will be in their balance. That is very important, and what we cannot afford is a single constituency trying to pack the board with its own colleagues. The board itself can put a brake on that, and keep the balance right.

The board itself can appoint additional members, and I can see that being invaluable if the board has chosen a subject which it wishes to target, such as obesity, as mentioned by my noble friend Lady Jolly. Poor housing was also mentioned, as well as alcohol, sexual health, prisons, probation, or children. There is nothing to stop the board giving the individual a short tenure, if the board so wishes. However, if we concede to all these additional, very persuasive arguments that are being put for adding more and more members—I had a quick count of all the amendments on the Marshalled List—we would have statutory boards in the order of 24 members. That is a nightmare for quick decision-making.

I chaired a joint finance committee years and years ago, when we were trying to do the same thing, and we had a board of that size. It became a talking shop. No one would take the decisions that were really necessary. With great respect to local government, where I spent 20 years, we do not want another committee of the council. These boards have to be different.

I said I thought the concept was a spark of inspiration, but I can see this spark extinguished very quickly if we end up with big, unwieldy, cumbersome talking shops. The health and well-being boards should be composed of the great innovators; people with unusual and challenging ideas; people who are prepared to think the unthinkable; imaginative people, fleet of foot, trying new ideas, and abandoning them if they do not work out. Above all, they should be the risk takers.

We know that innovation seldom comes from large, cumbersome committees. It very often comes from young people sparking off ideas. These are people who are probably quite difficult to work with. The Steve Jobs, the Bill Gates, the James Dysons of this world, determined to get their ideas from the drawing board into our homes, changing our lives for the better. They are the people who are not afraid of disruptive innovation.

The NHS thirsts for innovation, but it cannot face the disruption. One of the examples of successful disruptive innovation that I came across is Hairdressers for Health. In a very impoverished area south of Manchester, where you heard the crunch of broken glass under your feet when you walked, where graffiti was everywhere, where the school was protected by razor wire, the hairdressing salon was one oasis of peace and sanity. A junior director of public health, who was very anxious to increase the uptake of cervical screening, recruited the hairdressers to ask their clients—people will know that hairdressers always refer to their customers as clients—whether they had had a cervical screen and, if not, to give them the reason why they ought to go and have one. The hairdressers were given a book of difficult questions that they could answer and a phone number if they got stuck. The results were really impressive. When I asked the women why they went for cervical screening, they would say, “Tracy does my hair. She does it beautifully and I really trust Tracy”.

There are a million reasons why you should not go down that road. If you had a big, cumbersome committee, I can just hear the remarks, “The hairdressers aren’t up to it. The hairdressers really won’t have the information. The clients won’t believe the hairdressers”. No, here was a courageous young director of public health, not working through a huge board, thinking really laterally and doing something terrific. That is what we want from these health and well-being boards. We do not want large committees full of worthies shirking innovation because it is just too risky. Of course, there are always a million reasons why you should not do something. What started as an inspiration is quickly reduced to the boring status quo because that is safe. It takes an awful long time to get back to the boring, safe status quo.

When people decide for themselves, they are more likely to be successful. I applaud the flexibility of the Bill. I see merit in every case that is being put today. The case is being put extremely persuasively, but I urge your Lordships to resist the temptation to tie the hands and stamp on the autonomy of the new boards. We need them to be a success. I am working at the moment with some that are in shadow form. The good will that is in those boards is terrific. We should be enhancing and cherishing that and not directing exactly how they should work. If we do that, I regret that we will simply have just another committee of the council.