Medical Innovation Bill [HL]

Baroness McIntosh of Hudnall Excerpts

Friday 24th October 2014 Lords Chamber

Amendment 10 not moved.

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

I must inform your Lordships that if Amendments 11 and 12 are agreed to, I cannot call Amendment 13 on grounds of pre-emption.

Amendments 11 and 12

Moved by

NHS: Hospital Waiting Times

Baroness McIntosh of Hudnall Excerpts

Thursday 10th July 2014 Lords Chamber

[Earl Howe]

A handful of trusts are unable to report the full range of figures on their waiting times. They are given support to enable them to do so either by Monitor if they are foundation trusts or by the NHS Trust Development Authority.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I do not believe that the House heard the noble Earl address the issue raised by my noble friend Lord Turnberg. It was not about cash but about share. Can he expand a little on why the share of GDP allocated to the National Health Service is set to go down?

[Earl Howe]

The share of GDP is only one measure. We have to take into account the state of the economy. If the party opposite had been elected to office, it had in fact decided that the share of the cake should be less than the one we have allocated. We have had to strike a balance and I believe that we have done so in a responsible way.

Health: Talking Therapy

Baroness McIntosh of Hudnall Excerpts

Tuesday 3rd December 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Lord’s perception would be shared by many, which is why we have been very clear in our mandate to NHS England that parity of esteem is of the essence, and we will hold the service to account for that. I do not have the specific statistics that the noble Lord seeks but we know that more people are being treated in secondary mental health services now than two or three years ago. However, the proportion who needed to be admitted to in-patient psychiatric care fell over that period, and that reflects increasing emphasis on care in the community.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, as someone who has benefited from CBT on a number of occasions, may I ask whether the noble Earl agrees that it is not just a question of whether people need the therapy but rather that they receive enough of it? Following the question of the noble Lord, Lord Alderdice, about the number of people who could benefit from this, what is the average number of sessions of talking therapy that a National Health Service mental health patient will receive and is it, generally speaking, enough?

[Earl Howe]

My Lords, I apologise to the noble Baroness as I do not have that information in my brief. If it is available, I will write to her with the answer.

NHS: Accident and Emergency Services

Baroness McIntosh of Hudnall Excerpts

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

The answer to the noble Baroness’s question is yes. We are looking very carefully at workforce issues and the mix of skills needed in those A&E departments that have been struggling. I refer not simply to A&E consultants but also specialists in their field—perhaps alcohol is a good example—who can deflect the pressure away from staff looking after acutely ill patients.

[Baroness McIntosh of Hudnall]

My Lords, building on the question from the noble Baroness, Lady Finlay, is there evidence that current difficulties in the administration of A&E departments are discouraging young doctors from regarding emergency medicine as an attractive specialism? Are the Government doing anything to encourage them to look at emergency medicine more favourably and to ensure that, if they do so, there will be jobs for them in the departments?

[Earl Howe]

That is very much in the focus of Health Education England, which oversees workforce issues in the health service. There has been a shortage of A&E consultants for some time and Health Education England is looking at that area very carefully. A&E is a discipline that has not traditionally proved attractive to trainee doctors for a number of reasons. It is very stressful and the remuneration is perhaps less than in other areas of medicine. That needs to be addressed and is very much an area of scrutiny.

Public Health England Advisory Board Membership

Baroness McIntosh of Hudnall Excerpts

Thursday 4th July 2013 Lords Chamber

[Earl Howe]

My Lords, yes.

[Baroness McIntosh of Hudnall]

In view of the answer that the Minister gave to my noble friend a few moments ago about not operating a positive discrimination policy, is it possible or even likely that the next round of advertisements will also result in the appointment only of men?

[Earl Howe]

I simply cannot tell because we do not know which candidates have come forward. It may be that no women come forward. I hope that that is not the case. We make a point of advertising our appointments on the website of Women on Boards UK Ltd—the noble Baroness may be aware of it—which is an open UK-wide organisation for women seeking to leverage their professional skills, if I can put it that way, on to leadership roles. We will see what happens, but I assure the noble Baroness that while there will not be positive discrimination, there certainly will not be negative discrimination either.

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.