NHS: 111 Telephone Service

Baroness McIntosh of Hudnall Excerpts

Monday 13th May 2013 Lords Chamber

[Earl Howe]

I agree. NHS England and clinical commissioning groups are engaged in that publicity. I think it will be a while before the general public are fully aware of what NHS 111 has to offer, but I have in my brief a series of very complimentary testimonials about 111 that show that many members of the public are already enjoying its benefits.

[Baroness McIntosh of Hudnall]

My Lords, would the Minister accept that many people who are not directly involved in the health services find it quite hard to understand why NHS Direct was dismantled in favour of the 111 service, which has clearly not been working terribly well? Does he agree that the fact that this change has not succeeded tremendously well does not give one great confidence that other changes that appear to have been relatively unnecessary will go through successfully?

[Earl Howe]

I agree. It is unfortunate that the launch of this service was not nearly as satisfactory as was planned. The adverse performance in certain areas of the country has rather overshadowed the very good, if not excellent, performance in other areas, so while not belittling the issue the noble Baroness raises, I think we have to get it in proportion.

Health: Tuberculosis

Baroness McIntosh of Hudnall Excerpts

Wednesday 24th April 2013 Lords Chamber

[Baroness McIntosh of Hudnall]

My Lords, the Minister will be aware that the problem of multidrug resistance is not confined to TB; there are many other areas where we have every reason to be fearful about the development of drug resistance. Is the noble Earl satisfied that enough is being invested in research into the development of new drugs to be reasonably confident that we are making proper inroads into this problem?

[Earl Howe]

My Lords, the Government are supporting a range of research programmes to promote the development of new diagnostics, drugs and vaccines for TB. These include £6.5 million for the Foundation for Innovative New Diagnostics, £23.3 million for the Global Alliance for TB Drug Development and £10.5 million for the AERAS Global TB Vaccine Foundation. However, I will look into other areas of disease where there is drug resistance, and if I can supply the noble Baroness with further information I will be happy to do so.

Social Care Funding

Baroness McIntosh of Hudnall Excerpts

Monday 11th February 2013 Lords Chamber

[Earl Howe]

First, I completely agree with my noble friend that the leak to the media over the weekend was highly regrettable. I do not know how it occurred. It certainly was not of my making or that of my ministerial colleagues in the Department of Health. We wished to make this announcement to Parliament first of all, and I am sorry that that did not happen.

My noble friend’s second question relates to the national minimum eligibility threshold. We believe that that can be introduced in advance of the Dilnot package because what it is designed to do, as I explained earlier, is to give people greater certainty about their access to care wherever they live around the country, particularly for those who move from one place to another. That is a separate issue from those covered by Dilnot, although it was one of those which the commission considered. It is separate from the issue of the cap or the means test, which we believe can logically come in at a later date.

[Baroness McIntosh of Hudnall]

My Lords, as one of those in the Chamber today who is not an expert on social care matters, I ask the noble Earl whether he can reassure the great many people who are hearing about this for the first time as to what it means in practice for them when they have to start paying for social care—or, more particularly, when they become in need of social care. When we have a Budget, newspapers often produce ready reckoners, showing the impact of tax rises, reductions or whatever is being introduced on people in particular circumstances. Will the Minister encourage his department, and encourage his department to encourage local authorities, to produce the kind of information that ordinary people can understand, which will show them in easily understood, ready-reckoner terms what they will be in for if they need long-term care?

[Earl Howe]

My Lords, I absolutely agree with the noble Baroness on how important this is. It is quite complex to explain the whole system in words. The system will depend on the operation of a sliding scale which, by its nature, is difficult to describe other than pictorially. Nevertheless, the basics of the rules of these funding arrangements are straightforward and can be described. They are, as the Statement described, two essential elements, being the maximum level that people have to pay for their care—which we are setting at £61,000 in 2010 prices; £75,000 in 2017—and the means test, which is £100,000.

Of course, there are nuances around that, such as around couples and how the system will work for them. That is a question that the noble Lord, Lord Hunt, asked me which I did not answer. At present, a couple could potentially face two sets of unlimited care costs. By protecting them from these costs, the reforms offer them significant benefits which need to be spelt out. In most circumstances, even if a couple both had care costs at £75,000, the level of the cap, they would contribute less than this because housing assets do not count towards the means test if one of the partners remains resident in the home. All those sorts of things need to be made clear. We will do our very best to work with others to ensure that these messages have not only the greatest clarity but the greatest coverage.

Health: HIV

Baroness McIntosh of Hudnall Excerpts

Thursday 29th November 2012 Lords Chamber

[Earl Howe]

My Lords, my noble friend is absolutely right that this is a complex condition. As regards a response to the BHIVA report, we are planning to publish an integrated sexual health strategy which will embrace all aspects of sexual health, including HIV. The vast majority of HIV in the UK is sexually transmitted. HIV and sexual health services are closely linked, as he will know, and we believe that it is in that strategy that the appropriate guidelines should be set out.

[Baroness McIntosh of Hudnall]

My Lords, will the noble Earl bear in mind that the stigma around people with HIV is still an extraordinarily important issue? Will he encourage healthcare providers to ensure that as much as possible is done to reduce this disincentive to people to come forward for testing?

[Earl Howe]

The noble Baroness is of course right to say that stigma is an issue, and it is doubtless why many people do not come forward for testing. Through the National HIV Testing Week we are encouraging doctors in all parts of England to consider this matter and to see what role they can play in terms of having the right conversations with patients who are in the most at-risk groups.

Winterbourne View

Baroness McIntosh of Hudnall Excerpts

Tuesday 30th October 2012 Lords Chamber

[Earl Howe]

I agree fully with the noble Baroness. The aim and aspiration for this group of individuals is that they should benefit from personalised services. What that means is that their needs should be individually assessed professionally by multi-disciplinary teams. The noble Baroness did not do this, but there are some who suggest that we need to get rid of in-patient services altogether. There are individuals who will continue to require in-patient services, but these should be used only in very limited cases. We need to aim towards a situation where no one is sent unnecessarily into in-patient services for assessment and treatment. We know that that has not been happening. For the small number of people for whom in-patient services may be needed for a short period, the focus has to be on providing good quality care that is safe, caring and open to the community, which is another important aspect, and that people can move on from these services quickly. Planning starts from day one to enable people to move out of the in-patient setting into more appropriate care as quickly as possible. That comes back to intelligent commissioning.

[Baroness McIntosh of Hudnall]

My Lords, is it not the case that a great many workers in this sector are extremely low paid? Does the Minister think that there might be any correlation between the fact that they are low paid and the quality of care they deliver? I do not mean to imply that there is any excuse for the sort of behaviour that was revealed in the “Panorama” programme, but could any form of pressure be applied by regulators and commissioners to the commercially driven organisations that provide this care so as to prevent them continuing to employ people on very low wages to do such sensitive work?

[Earl Howe]

My Lords, there is more than a nugget of truth in what the noble Baroness says. Many of us have been troubled for a long time that work of this kind is insufficiently valued by society, and that is reflected in the rates of pay. That is why I am a firm believer in raising skills in this sector as a reflection of the value we place on care workers. The programme that we have in train over the coming months should steadily deliver that. To come back to the commissioning question, I am also a believer in ensuring that commissioners should be satisfied that the settings to which they send individuals have an appropriate mix of skills to look after the people concerned. That has not always happened. There is no single answer to this, but I identify myself with the particular point she has raised about remuneration.

Health and Social Care Act 2012

Baroness McIntosh of Hudnall Excerpts

Wednesday 25th April 2012 Lords Chamber

[Earl Howe]

My Lords, I am in tune with the sentiments that the noble Baroness has expressed. I am sure that she will be in no doubt that my department will be monitoring the implementation of the Act very closely. Of course Ministers will continue to provide information to Parliament—for example in response to Questions and in Select Committees and, indeed, in debates if noble Lords put down Motions. I am sure that we will provide a lot of information both on the implementation of the Act and on health and social care more widely in the months and years ahead.

[Baroness McIntosh of Hudnall]

I wonder if the noble Earl can explain a remark that he made early in his original Answer to the noble Baroness, Lady Deech, when he said that all government Bills are subject to post-legislative scrutiny within five years. I am sure that that is true in some way, but not in a way that I personally understand, and I am sure that it is not entirely clear to the House in what way such scrutiny is carried out. It certainly is not what is commonly meant by post-legislative scrutiny—that all Bills should be subject to it.

[Earl Howe]

My Lords, my understanding is that formal post-legislative scrutiny is a relatively new invention. It came in under the previous Administration in, I think, 2008. So until now there have been very few if any—there may have been one or two, a handful—formal post-legislative scrutiny processes. But we will, of course, see this as a more regular feature going forward.

Health and Social Care Bill

Baroness McIntosh of Hudnall Excerpts

Monday 19th March 2012 Lords Chamber

[Lord Wilson of Dinton]

I add my support to what the noble Lord, Lord Fowler, and others who have spoken against the Motion said. I am deeply concerned about the implications of the Motion for the Civil Service.

Every day in government, Ministers consider policy issues and depend on the Civil Service for advice. Anyone who has been a Minister understands the private space in which civil servants give their best advice. There is a major public interest in advice being given without fear of it becoming part of the political arena, in the press or in Parliament. If risk registers are published, the very act of publishing them will draw them into the public arena and politicise the advice. This is not about lying, or about being dishonest in any way, but the duty of civil servants is to the Ministers they serve and to the Government of the day. They have a job to do and they must do it to the best of their ability, but they must do it in a way that does not cause difficulty for the Government.

It is in all our interests that risk registers are honest and look at the worst case, and put it in terms that leave the Minister in no doubt about the risks that are being taken. If those documents are going to appear in the public arena, they are bound to be sanitised in some form. Advice will either be put in a way that does not fully expose the dangers, or worse still it will not be given. There is a real risk that important advice will be driven off the paper into oral remarks, which are not what the Minister needs. The Minister needs a document that he or she can read after the meeting, and ponder and mull in the stillness of their own room. If we push these documents into the political debate, we will lose a crucial part of the role of the Civil Service. If we do it a lot, over time there is a real risk that Ministers will want around them civil servants who are themselves political, because they have become part of the political debate.

This is a very dangerous pressure to put on the constitution. I understand the worries about the Bill, but this is not the right way to attack it. It would be a dreadful mistake if this House were, in the heat of the moment, to set a precedent that affected the Civil Service in its ability to serve the Government of the day.

Across all parties there is an understanding about the need to observe the conventions under which the Civil Service operates. I appeal to the House not to add its weight to this issue of the risk register in a way that might do damage, because the damage would be not only to this Bill and this department. Whitehall is watching; it is really concerned about this issue, and if this goes the wrong way it will have implications and reverberations across government in ways that I am sure this House would not want. I urge the House not to support the Motion.

[Baroness McIntosh of Hudnall]

Would the noble Lord share with the House his view as to what weight should be attached to the Information Commissioner’s judgment on this particular risk register? Is it his view, in the light of his remarks, that the views of the Information Commissioner should be ignored, overridden, or appealed on to the point at which they are no longer relevant? That appears to be the course of action the Government are now trying to take.

[Lord Wilson of Dinton]

It is not for me to advise the Government on what to do, but I hope they will appeal, because the issue involved is of huge importance. I read the Information Commissioner’s first judgment and I do not find it satisfactory. It is written in a way that suggests that it does not understand the issues in government. I think the issue at stake is of sufficient importance for the Government to fight its corner, and for this House not to add its weight to it.

[Baroness Murphy]

My Lords, I declare that I am a member of the British Medical Association and a fellow of the Royal College of Psychiatrists.

The risk register is a complete red herring and we all know that this is an attempt to delay the implementation of the policies in the Bill. The Bill has received extraordinarily careful scrutiny. In fact, it has received better scrutiny and a warmer response from government Ministers in addressing amendments proposed by all sides of the House than any Bill with which I have been associated in the past eight years. At the moment, I can think of nothing worse for the National Health Service than to have these policies delayed yet again by further uncertainty and greater procrastination.

The risk register saga was so obviously a political ruse from the beginning that I did not even bother to speak on it when it was first introduced. It was so obviously a red herring, produced for the benefit of the House to debate a slowing down of the Bill, that it was not worth addressing.

[Baroness McIntosh of Hudnall]

Would the noble Baroness explain to the House whether it is her view that the Information Commissioner has deliberately delayed the progress of the Bill? That seems to be the implication of her remarks.

[Baroness Murphy]

That is not the implication of my remarks at all. The Information Commissioner has not released his full judgment and will not release his reasons for some time, so we cannot debate that.

This comes back to what my noble friends Lord Birt and Lord Wilson and the noble Lord, Lord Fowler, said about what these risk registers contain. I know very well because I have written risk registers for the National Health Service. I have sat down with my chief executive, and with my chairman when I was a chief executive, and we have written these things for public consumption. The Cabinet Office has a very nice risk register, but it is for public consumption; it is not to do with the private discussions between senior civil servants or advisers. I have worked as an adviser at the Department of Health, and this is not the kind of thing that comes up in conversations between Ministers where you want to be really frank.

We now have an out of date, almost two years’ old risk register that will not be relevant to the passage of the Bill. We have assessed the detailed risks of the Bill better in this House than in any other forum I can imagine. Those who have sat through the progress of the Bill, line by line and word by word, know very well that we have improved it. I am sure there are areas that many of us would still like addressed, but for all kinds of reasons we are not able to do so. I beg the House not to delay the Bill. If we delay it further we will have no guarantee that we will be able to get it through before Prorogation. I see this simply as a ruse not to implement these polices. We would gravely let down the National Health Service by not implementing them, and I urge noble Lords not to support the Motion of the noble Lord, Lord Owen.

Health: Smear Tests

Baroness McIntosh of Hudnall Excerpts

Monday 13th February 2012 Lords Chamber

[Baroness McIntosh of Hudnall]

Following that question, will the Minister tell the House how widespread uptake is and to what extent there is any difference between the various groups of young people in being prepared to take up the offer of vaccination? This is clearly the best hope that we have of bringing down the incidence of cervical cancer in the long term.

[Earl Howe]

The latest figure I have is that there is around 82 per cent uptake among eligible girls. However, for screening the uptake is lower. The figure I have for 2010-11 is that 78.6 per cent of eligible women had a test result in the past five years and 3.4 million women were screened. In the case of screening, it depends on whether the women themselves respond to the screening call. In the case of vaccination, it will depend on the attitude of parents and medical advisers.

Health and Social Care Bill

Baroness McIntosh of Hudnall Excerpts

Thursday 15th December 2011 Lords Chamber

[Baroness Williams of Crosby]

I beg leave to withdraw my amendment, with the simple comment that I thought the reply of the Minister—which was, as usual, very well argued—strengthened the case for both of my amendments even more than I had thought before, and I am grateful for that. Strong leadership, as the Public Accounts Committee calls for, was exemplified by the Minister but should include the Secretary of State. However, may I now move on to the next group?

[The Deputy Chairman of Committees (Baroness McIntosh of Hudnall)]

If the noble Baroness would indicate what she wishes to do with Amendment 296, that would be helpful.

[Baroness Williams of Crosby]

I apologise. I thought I had begun by saying that I would withdraw the amendment and then made some remarks afterwards.

Smoking

Baroness McIntosh of Hudnall Excerpts

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

My Lords, I do not agree with the noble Lord’s analysis. It is true that, on current evidence, the legislation is having a beneficial effect; I would not dissent from that. However, we know that voluntary behaviour change is eminently possible. It would explain why, between 1996 and 2007 when the legislation came in, secondhand smoking exposure in children in England declined by 70 per cent. That was driven by not only the evidence but also awareness campaigns and increased awareness in the lead-up to the legislation. Therefore, voluntary action can have a beneficial and marked effect.

[Baroness McIntosh of Hudnall]

My Lords, since the Minister mentioned enforcement, I wonder whether he would like to comment on the issue more generally. I take the point of my noble friend Lord Foulkes about road safety issues that arise from smoking in cars, as well as health issues. Is the Minister content that enough is being done to enforce restrictions that are already in place, for example on the use of mobile phones in cars? Is it not the case that the burden of enforcement always will fall mostly on the police, and that they are unlikely to be able to carry out those duties very effectively when they are under such pressure to cut their numbers?

[Earl Howe]

The noble Baroness makes a very good point. Currently, enforcement in the hands of the police centres mainly on dangerous driving. That may take the form of people illegally using mobile phones while driving or perhaps smoking in a dangerous way. However, I take her point that there is a limit on the extent to which the police can be expected to extend their remit. There is also a sensitivity in this area. The idea of police stopping a car in which somebody in the front seat is smoking on suspicion that there might be a child inside may stray over the boundary of what society would consider an acceptable use of police time.