Care Homes

Baroness Thornton Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

On my noble friend’s last point, there is a national surplus of care home beds—the figure I have here is some 50,000. Therefore, there is, to my knowledge, in no area a shortage of beds. We are dealing here with a series of local markets. The point that I emphasised earlier remains important. Should it come to the closure of a care home—an event of which we should have reasonable notice if it happens—we will ensure that those in that care home are properly looked after.

[Baroness Thornton]

My Lords, does the Minister actually think that a Written Ministerial Statement is sufficient to deal with the gravity of the treatment of the learning disabled in Winterbourne View care home, as shown on the “Panorama” programme, although I realise that that is not the subject of this Question? I agree with him that it is absurd to suggest that there is no role for private, voluntary, mutual and social enterprise providers in social care. How will the Minister ensure, therefore, that in the private sector—none of these things can happen in any of the other sectors—regulation is extended to cover the financial stability, including asset stripping, of organisations which provide these vital services for thousands of elderly people? I invite him to agree with me that it is very distasteful indeed that older people’s care should be regarded as a commodity to be traded.

[Earl Howe]

My Lords, I cannot help but agree with the noble Baroness’s last comment. I am sure she will know that we have embarked on a wide-ranging programme of reform of social care. We are considering the Law Commission’s recommendations for modernising social care law, and the report of the Commission on Funding of Care and Support is imminent. As I have said, many lessons have to be learnt from the events of recent weeks. We will want to reflect on them as part of our wider reform agenda. The business model that underpins many of these issues is a legitimate area for the Department for Business, Innovation and Skills to be looking at, although it will do so in a general rather than specific sense in relation to Southern Cross.

NHS: Reform

Baroness Thornton Excerpts

Monday 6th June 2011 Lords Chamber

[Earl Howe]

The noble Lord is quite right. The vital importance of education and training is one of the four main themes of the listening exercise. We have received some very interesting and significant proposals from the academic sector which Professor Field will no doubt reflect in his conclusions.

[Baroness Thornton]

According to information provided in response to a recent freedom of information request, in Hull GPs have 17 per cent of the budget whereas in the East Riding they have 69 per cent; in Derbyshire there are 12 finance officers supporting GPs, whereas in Bristol there are none; and in London there are 10 executive directors, of which three are public health directors, but nobody knows to which of the 32 boroughs they belong. How will the Government ensure patient safety in what I hope the Government might recognise is possible impending chaos resulting from the de facto implementation of key parts of the Bill, the dismantling of the SHAs and PCTs, the patchwork of growth of new organisation and the leaching away of experienced staff?

[Earl Howe]

My Lords, we are putting patient safety at the centre of the NHS by moving it to the NHS commissioning board. In that way, patient safety will be embedded into the health service through GP commissioning and their contracts with providers. We are strengthening the Care Quality Commission so that patients know whether providers are meeting minimum standards of safety. We are also developing outcome measures for patient safety so that everyone can see how organisations are performing and can be held to account by the people that they serve.

Health: Cancer

Baroness Thornton Excerpts

Tuesday 10th May 2011 Lords Chamber

[Earl Howe]

The noble Baroness raises an important issue, because these conditions are devastating even though they affect only a comparatively small number. There is a good deal of research going on into cancer, some of it funded by my department. I do not have details of whether that condition is the focus of any such programme but I will take away her concern and write to her if I have further information.

[Baroness Thornton]

My Lords, today the Cancer Campaigning Group, which represents dozens of cancer organisations including Kidney Cancer UK, has launched a survey of GPs in which 71 per cent agree or strongly agree that they will require specialist advice effectively to commission cancer services. Given that the cancer networks’ funding is not guaranteed beyond 2011-12, how will that commissioning support be provided? On an individual basis, how will support be provided to GPs when they have to tell a kidney cancer patient that they will not be able to afford to offer Afinitor? That is the drug the Minister referred to, which is not approved by NICE and which costs £200,000 per course of treatment.

[Earl Howe]

My Lords, there are drugs which NICE has recommended for kidney cancer, so Afinitor is not the only drug on the menu. GPs have a crucial role to play if we are to achieve earlier diagnosis of cancer and meet our ambition of cancer outcomes that are among the best in the world. The National Cancer Director, Professor Sir Mike Richards, is working with pathfinder GP consortia to understand how we can support them in commissioning services that deliver the best outcomes. He is clear, as are we, that cancer networks will have a central role in the reformed NHS as a place where clinicians from different sectors come together to improve the quality of care across integrated pathways.

Public Bodies Bill [HL]

Baroness Thornton Excerpts

Monday 9th May 2011 Lords Chamber

Let us be quite clear: the glow that we feel about the HFEA may be slightly tarnished. We have to ask which of the functions we need to retain. I seek an assurance from the Minister that the medical research authority will be set up soon and that it will take over all the research functions of the HFEA. Let us have a debate about whether the HFEA delivers now when it comes to improving care and outcomes for the patients. That, I think, is when we will find that it is currently found wanting.

[Baroness Thornton]

My Lords, I thank the noble Baroness, Lady Deech, my noble friend Lady Warwick and other noble Lords for their determination to have the future work of the HFEA and the HTA clarified during the course of the Bill. I join others in thanking the Minister for his patience and accessibility in discussing the different aspects of the issue.

We have had another excellent debate that has illustrated why it was necessary to bring the issue back to the Floor of the House for further discussion. The House needs to heed the voices raised across the Chamber—as well as the pleas contained in the letters that we have received from some of the parents of Alder Hey children, the letter in the Times this morning signed by a galaxy of medical experts and the briefing from the BMA on behalf of several organisations—as a sign of increasing concern.

Since Report, the Minister has kindly written to me explaining further the Government’s proposals for the HFEA and the HTA and the staged break-up that seems to be the Government’s preferred option at the moment. In brief, the break-up involves HFEA and HTA functions being transferred to the CQC except for research-related functions, which will be transferred to the health research regulatory agency, presumably covering what have been broadly referred to as the ethical issues. To facilitate this, as the noble Baroness, Lady Deech, explained, a special health authority will be created in 2011-12 and there will be primary legislation to establish the agency proper in the second Session of this Parliament. Presumably, the ethical issues will therefore be dealt with by the interim body in that process. Notwithstanding the proposals of the noble Lord, Lord Willis, regarding the Health and Social Care Bill when—indeed, if—it reaches us, it is clear that there will be primary legislation to establish the new research body.

I am further grateful to the Minister for his explanatory letter because it served to strengthen my view that these bodies should never have been in the Bill in the first place. It also illustrated for me the question that I want to put to him: why go through such disruption, risk, lack of stability, potential loss of expertise and expense for the next two years prior to the introduction of primary legislation to establish the new health research agency, which will address all of these issues? Why not agree the amendment that establishes an independent assessment of the work of both bodies? That could feed into the pre-legislative process and consultation, which will include all the questions that need to be asked, leading to primary legislation in about two years’ time. If the Government go down the route that the Minister is proposing, they intend to launch a consultation this summer, as outlined in the Minister’s letter to me, and then presumably will break up the agencies at some point towards the end of this year and the beginning of next. That means that at the beginning of 2012 the agencies would be broken up and then, by the end of 2012, we would start the pre-legislative programme to set up the new research agency.

That is why we on these Benches will be supporting all these amendments. It is not that either the HTA or the HFEA should be preserved for ever; indeed, it is clear that my noble friend Lord Winston and the noble Lord, Lord Patel, have grave problems with the HFEA. I make the point to the noble Lords, which I have also done outside the Chamber, that that is not the point of the Bill. Passing the amendments would actually be more likely to address their concerns than would leaving the situation as it is. In other words, there is no guarantee that their concerns about the HFEA, which I am sure are legitimate, would be addressed if we left the Bill as it is without the reassurances.

The one thing that we know is that there is going to be a health research agency. It is an idea of merit. It is also a proposal that is ideally suited to the expertise and inclination of this House; the Select Committee, the pre-legislative scrutiny, the draft Bill and, if I may say, the skills that the Minister brought to bear when he helped to create both these agencies make this the place where that process should start. I am certain that that would ensure a good outcome.

The amendments are different from the simple deletion amendments that we tabled in Committee and on Report, particularly the third amendment, because it accepts the principle that the Minister may transfer or modify the functions under Clause 5 in respect of these bodies but would require the Minister to have first established the Government’s new regulatory body with a separate ethics committee. It would ensure that there were no gaps between what is happening now with the current bodies and the Government’s intended independent regulatory body in future, a point that many noble Lords have made. However, it would not preclude an examination and independent assessment of the work of both these bodies. It would ensure that the critically important ethical functions performed by these bodies were recognised and catered for, which, in a way, is where we came in at the first stage of the Bill.

[Earl Howe]

My Lords, I thank noble Lords who have moved or spoken to these amendments. I recognise and understand the sentiments underlying them. I do not in the least wish to argue against or downplay the importance of cost-effectiveness in any legislative changes that we propose, or of ensuring that the right successor arrangements are in place for discharging the relevant functions of the HFEA and HTA. I therefore hope that what I am about to say will satisfy noble Lords that in most key respects I am in the same place as they are regarding the points at issue.

Since our debate on Report I have written to the noble Baroness, Lady Thornton, to set out my reflections on the points that she and others have made. There were common themes: a desire for greater clarity on where the Government intend to transfer the functions of the HFEA and HTA to; concern that the dispersal of functions across a range of bodies would risk fragmenting regulation; and concern over loss of expertise. I have considered these concerns carefully. As I have made clear, we intend to consult in the late summer on the options as to where certain functions would be most appropriately transferred. That remains our aim. However, having taken into account the strength of feeling about keeping functions together, we now intend to proceed on the basis that our preferred option is for all HFEA and HTA functions to be transferred to the Care Quality Commission, except for certain research-related functions that will transfer to the proposed health research regulatory agency. We shall therefore consult on this basis but, at the same time, remain open to receiving views on the way forward from all stakeholders through the consultation process. I hope noble Lords will agree that this preferred option will address concerns about the potential impact of fragmentation.

The noble Baroness, Lady Deech, expressed the fear that the Government’s proposals would lead to a vacuum as regards the ethical focus of these bodies—in the decision-making process for research and treatment involving embryos in particular. Let me explain what we intend. Ethical safeguards—for example, the type of embryo and gamete that can be used in treatment, the need to consider the welfare of the child, and the need for consent in respect of human tissue—are clearly enshrined in legislation in accordance with the wishes of Parliament. These safeguards will remain firmly in place.

In keeping an integrated approach to HFEA functions, the CQC would be the focal point for ethical considerations of treatment licensing that arise from the Human Fertilisation and Embryology Act. There is no reason whatever to suppose that it is not up to fulfilling that role. I say to my noble friend Lord Newton that my department’s officials have had discussions with the CQC senior managers about the proposed transfer of functions. The CQC is confident that these can be taken on effectively. The health research agency will provide a focal point for the ethical consideration of research using embryos. It will draw on expert advice, as the HFEA does now. The aim is to simplify and rationalise the ethical approvals process for all kinds of research. Far from the ethical focus for each type of activity being lost, it will be actively preserved.

My noble friend Lord Willis suggested that we might use the Health and Social Care Bill, now in another place, as the vehicle for the proposed changes, rather than this Bill. I recognise the force of his proposal. He will know why we have chosen not to go down that road. We do not want to add to what is already a substantial Bill. It is important, too, that the Government retain momentum for their planned changes across the ALB sector. The ALB review process has already garnered significant rationalisation across the health sector and we do not want that rolled back. By keeping the HTA and the HFEA within the Public Bodies Bill, we can deal discretely with complex issues and undertake detailed consultation and impact assessments in a timely and considered way. We also, as I have indicated on several earlier occasions, wish to avoid reopening the Human Tissue Act and the Human Fertilisation and Embryology Act, which command widespread agreement. Our desire to maintain momentum is why we plan to establish a special health authority to continue and strengthen the work of the National Research Ethics Service and to be a starting point for the simplification of research approval processes. That special health authority would be the platform on which we would build the fully fledged research regulator.

NHS: Chiropody and Podiatry Services

Baroness Thornton Excerpts

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

My Lords, my noble friend makes an important point. She will know that there are universities that specialise in the training of chiropodists and podiatrists, and we place great reliance on them. What will emerge from the new architecture that is foreshadowed by the Health and Social Care Bill is a much greater sense of local prioritisation regarding needs. Flowing from that, with the advice and guidance of Health Education England, which will be the national body supervising workforce requirements, we may well see further centres of excellence in training emerging.

[Baroness Thornton]

My Lords, I hope that the Minister will forgive me for being slightly personal, but I wonder how often he trims his toenails. I expect that he can actually reach his own toenails unlike many elderly people who cannot reach theirs, do not have anyone to do it for them and cannot afford a podiatrist. Would the Minister be happy to have his toenails trimmed once every three months, which seems to be the standard offer by health centres and GPs at the moment? I am sure that he will share my concern that even that service is under threat from the cuts at PCT level. Will the Minister undertake to ensure that podiatry services for the elderly become a priority for the National Commissioning Board?

[Earl Howe]

My Lords, I am fortunate in being able to cut my own toenails. However, the noble Baroness makes a serious point about the elderly. It is often the lack of that simple service that prevents elderly people being as mobile as they wish and sometimes confines them to their own homes. This is a serious issue in terms of the way that we can prevent unplanned hospital admissions due to elderly people falling over. The process that I have referred to whereby we will see joint health and well-being strategies emerging from the health and well-being boards at local level should ensure a sufficient supply of the workforce over a period of time.

NHS: Consultation on Reform

Baroness Thornton Excerpts

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

The noble Baroness makes a very important point about local directors of public health, who most certainly do need the right qualifications for that role. As she will know, they will be jointly appointed by local authorities and by the Secretary of State and we need to ensure that they can perform their role properly. The four main themes to the listening exercise are: choice and competition; public accountability and patient involvement; clinical advice and leadership—that may be an area that impacts on her question; and education and training. In some ways it is difficult to separate those issues; they are all of a piece and we do need to look at them very carefully.

[Baroness Thornton]

My Lords, if the current listening exercise hears the almost universal concerns about the Government’s proposal to introduce a new economic regulator into the heart of the NHS—concerns, I have to say, that were expressed but ignored by the Secretary of State right through the autumn and the spring—will the Government be removing that part of the Health and Social Care Bill?

[Earl Howe]

My Lords, no, because we are clear that the current system requires independent oversight of competition within the health service. Essentially, we have an unregulated health service at the moment; the Government in which she played a distinguished part as a Minister rolled out the independent sector treatment centre programme but its terms were, in the judgment of many, not fair. We need independent scrutiny and determination of pricing in the health service to ensure that there is a fairer playing field for all those providers of NHS services.

NHS Reform

Baroness Thornton Excerpts

Monday 4th April 2011 Lords Chamber

[Earl Howe]

We are assigning particular staff to pathfinder consortia. Those staff will remain within the PCT clusters. They will not transfer officially to the consortia because the consortia are not officially in existence yet. The point here is to have staff who are dedicated to supporting the emerging consortia over the next few months. This is already in train.

[Baroness Thornton]

My Lords, given the progress that has already been made in dismantling the PCTs and the strategic health authorities ahead of legislation, and the millions given to GP consortia to establish their role as commissioners, are the Government not in danger of pre-legislative implementation? Does it not beg the question as to where the role for pre-legislative scrutiny, or indeed any meaningful scrutiny in the House, might be on the matter? Will the Minister assure the House that, when we eventually receive the Health and Social Care Bill, reorganisation will not have progressed beyond the point of no return?

[Earl Howe]

My Lords, the noble Baroness will know that her own party’s plans included a 30 per cent reduction in administrative and managerial costs throughout the health service. We agree with that and we have got on with it. It is right that, when a Government come in and announce their intentions, as we did, expectations should be managed, as we are doing, and uncertainties should be allayed. The way to do that is to get on with the process.

NHS Reform

Baroness Thornton Excerpts

Monday 4th April 2011 Lords Chamber

[Baroness Thornton]

My Lords, I start by thanking the noble Earl for repeating the Statement. I have to confess that this is a very puzzling moment. I do not recall a Statement in the middle of the proceedings of a Bill—a Bill that has only just finished in Standing Committee in the Commons. I would be grateful if the noble Earl could tell me whether there has ever been a Statement announcing a break, natural or otherwise, in the middle of the passage of a Bill. I wonder what might happen in this natural break, whatever that is. Perhaps the Minister can define this new parliamentary term. How long will it be? Why is it really necessary? What is likely to take place during that period? What exactly are the Government intending to do during that period? It seems to me that the things that the Government have said that they are going to do during that period should have happened anyway before the Bill was introduced and that they should have been ongoing. This should not be necessary.

However, I welcome the recognition in this Statement of the concerns that people have about the speed of change. I question the use of the word “continue” in the Statement in the context of listening and engaging. Frankly, if Mr Lansley had been listening and engaging, this Statement would probably not have been necessary. However, if it means that the Secretary of State really is going into listening mode, I welcome that and look forward to seeing it.

I welcome the fact that the Statement touches on the areas that are of concern to people. I also welcome the recognition in the Statement of the 10 years or so of investment by my Labour Government, which is why the NHS is as successful as it is today. However, I also note that the Statement, just like Andrew Lansley’s Second Reading speech when the Bill was introduced in another place, elides the question of Part 3, which gives great powers to a utility regulator—the new economic regulator, Monitor. Therein lie many of Mr Lansley’s problems, because people have worked out what the implications of that part of the Bill are for the NHS. When will Mr Lansley start to listen to the concerns that have been expressed by the Health Select Committee, all the royal colleges, the health regulators, all the bodies representing employees and staff in the NHS, including the BMA, the patients’ organisations, his partners in this Government, the Liberal Democrats, many of the voluntary organisations involved in health—those concerned with diabetes, heart disease, cancer, asthma and dementia, for example—and, in particular, organisations concerned with long-term conditions?

We can build a picture of what has happened in the past week or so. First, the Prime Minister was wrong-footed by Ed Miliband on 16 March on whether the health service would now be subject to European Union competition law. It seems to me that he went away, found out about it and confirmed that that was the case. Will the Minister confirm that? There has been a stream of media stories reflecting serious concerns about the Health and Social Care Bill. Most recently, in the Daily Telegraph, Sarah Wollaston MP urged her party to drop plans for the radical reorganisation. On 1 April, Elizabeth Rigby, chief political correspondent of the Financial Times, reported concerns about the rapidity of change.

On 2 April, the Telegraph said that the Prime Minister was drawing up key changes to the Bill and planning amendments. This article is remarkably detailed about meetings at Downing Street with David Nicholson, the head of the NHS, and Mr Lansley. It says that Mr Lansley was not for compromising and that reforms had gone too far to be undone, which was the subject of a question that I asked in Oral Questions only today. I ask the noble Earl to confirm whether that is the case.

The Statement also reflects the fact that Mr Lansley is very firm about the Government’s intentions for the NHS, but it is not consistent with the stories in the media about the activities at No. 10 Downing Street. Will the noble Earl tell us who is correct about these matters? I will draw a veil over what the noble Lords, Lord Owen and Lord Tebbit, have said about this matter in the past few days.

I am concerned about exactly what will happen during this natural break, which brings me to my final questions. My concern is that this break is being taken in order to strike a deal. I can just imagine a possible conversation between Nick Clegg and the Prime Minister. Nick Clegg says to the Prime Minister, “We want local accountability strengthened”, which I think many of us here would agree with. The Prime Minister then says to Nick Clegg, “Okay, but your people in the Lords must deliver Part 3 of this Bill to establish the economic regulator, Monitor, without dilution of its powers”. There is no doubt that that would be the prize for the Conservatives. It has been recognised by the noble Lords, Lord Owen and Lord Tebbit, and by the noble Baroness, Lady Williams. I fear that this is about keeping the coalition together rather than any assessment of what the NHS might need at this moment. The past few days have seen David Cameron conceding that he and the Health Secretary have failed to get their message across. There have also been anonymous briefings from No. 10, to which I have referred.

I am further concerned that this is about playing politics with the NHS. Will the Minister reassure the House that that is not the case? This is too important to be used as a political football or to see decisions taken about the NHS simply to save David Cameron’s face or Nick Clegg’s face. What is required now is a rethink, a pause in the legislation and some root-and-branch changes.

Health: Obesity

Baroness Thornton Excerpts

Monday 4th April 2011 Grand Committee

[Baroness Thornton]

My Lords, I congratulate the noble Lord, Lord McColl, on his persistence in calling this debate; he is well known for his concern about this issue. I also offer congratulations to my noble friend Lord Brooke on having lost a lot of weight by reducing his intake of food by 10 per cent since June last year. I am not going to tell the Committee what he has gone to or from, but it is very impressive. In a way, that proves a point made in the remarks of the noble Lord, Lord McColl.

I address my remarks to the growing crisis that is childhood obesity. There are high levels of concern about obesity in westernised society, and about obesity in children in particular. The National Child Measurement Programme was implemented in the UK to monitor changes in average body size among children who are starting or about to leave primary education. It showed that, in 2008-09, almost one in 10 children—9.6 per cent—aged four to five was obese, while for 10 to 11 year-olds the figure was almost one in five, or 18.3 per cent. Over the past 10 years obesity among six year-olds has doubled, and it has trebled among 15 year-olds. With such levels of obesity, diseases such as type 2 diabetes are now being seen for the first time in children.

I draw on a recently published report entitled The views of young children in the UK about obesity, body size, shape and weight: a systematic review. It was undertaken for BMC Public Health and published on 25 March, and I commend it to all noble Lords. Among other things, it states that recent research shows that,

“Children are likely to experience immediate physical and psychosocial problems as a result of being obese and are at a higher risk of obesity as they grow older”.

Therefore,

“Children’s attitudes to and beliefs about their bodies”,

including high levels of body dissatisfaction, raise enormous concerns.

I have to confess that so far, taking their rhetoric with all possible seriousness, I am underwhelmed by the Government’s strategy for tackling childhood obesity. It seems that they are intent on removing all the levers that might make a difference nationally. For example, today the school dinner grant loses its ring-fencing and can be used to cover other budgets in schools which, it is safe to say, will lead to a rise in prices of possibly up to 17 per cent and a fall in take-up of school meals. The official national statistics on school lunch prices show that the average price for a two-course meal across primary and secondary schools with catering provided by the local authority was £1.88 in 2009-10. The Observer reported yesterday that more than 30 local authorities plan to increase the cost to children in the coming months, with some schools seeing an increase of as much as 17 per cent to £2.60.

Research by the School Food Trust reveals, not surprisingly, that the uptake of school meals correlates with price changes. According to its studies, a typical lunch brought in from home is not as nutritious as the average school lunch, which must meet national food standards. Packed lunches can also be repetitive. Therefore, despite reports of increased lunch fees in some areas, the School Food Trust says that it is “really encouraged” that many schools have continued to put the same level of investment into their school meals and has welcomed proposals to make it easier for schools to offer price deals such as ‘buy one get one free’ for larger families. Indeed, writing in yesterday’s Observer, Jamie Oliver said that he hopes the Government will continue to invest in,

“quality school food and the integral support and training of kitchen staff”.

However, we then have to add into the mix on school meals that the Welfare Reform Bill is a leap in the dark on this matter and raises the issue of the future of free school meals. Apart from the fact that it may mean children who need them may not get them, it introduces instability in funding.

Food education in schools is also incredibly important. It was made compulsory for children in secondary schools in 2008 and is due to come into schools this September. However, it is already under threat of being removed from the curriculum completely.

On nursery schools, in responding to the publication of recommendations by a government-commissioned panel on voluntary food and nutrition guidance for early years settings in England, Charlie Powell, director of the Children’s Food Campaign, said:

“While we welcome the substance of the recommendations from the Advisory Panel on Food and Nutrition in Early Years, we already know—from years of experience—that more voluntary guidance is almost certain to be largely ignored”.

That is simply not good enough. We should have legal standards for nursery food.

I agree with what Charlie Powell said when the Health Secretary announced the responsibility deals. He stated:

“They are little more than a continuation of schemes that were being done anyway by the Food Standards Agency—until the Government took away its nutrition remit”.

So instead of introducing effective measures to tackle alarming levels of childhood obesity—such as regulation to protect children from junk food marketing—the Government’s pledges require little or no extra work on the part of food businesses, which are delighted by the support they are receiving from the Government.

I urge the Department of Health to ensure that these voluntary commitments are independently monitored and evaluated and to set a timetable for regulation for when, as we expect, they fail to improve public health. As the noble Lord, Lord Patel, said, it is an embarrassment that Diabetes UK and the British Heart Foundation joined alcohol health charities in not signing up to the deal.

Dr Vivienne Nathanson, the head of science and ethics at the BMA, said:

“Children and parents are surrounded by the marketing of unhealthy cereals, snacks and processed meals. This has to stop”.

Two of the partners in the Government’s responsibility deal had the following to say. The Food and Drink Federation rejected the need for restrictions on advertising and a spokesman said:

“Any simplistic scheme that demonises products does not take into account the complexity of people’s lifestyles and the way they eat”.

The boss of McDonalds, Peter Beresford, has made clear that he rejects TV advertising restrictions. He said that McDonalds is not to blame for rising obesity, adding:

“There is no good food or bad food, only bad diets”.

Statistics show that about 70 per cent of commercials shown during children’s viewing are for food and that, of these, between 80 per cent and 100 per cent are for junk food. We are sending the wrong messages to children at a time when we are seeing this terrible increase in weight problems. As noble Lords will be aware, because I promoted a Private Member’s Bill on this matter some years ago, I am strongly opposed to allowing advertising of foods high in fat, salt and sugar during the pre-watershed hours. National Consumer Council expert Sue Dibb has said:

“Anything less than full restrictions on TV ads and promotions for high fat, salt and sugar foods before the 9 pm watershed would be extremely disappointing”.

I agree with that.

On sport and exercise, the Government’s record is again not good. We saw last year the U-turn that they had to make on school sports and the scrapping by the DCMS of the free swimming programme, designed to be a key part of the London 2012 legacy plans. I agree with the noble Lord, Lord Patel, that nudge and suggestion have yet to prove themselves. I have not limited myself to talking about the Department of Health because this is a cross-government matter. I therefore have two questions for the Minister: is there a cross-government approach, and where are the interventions and levers? Although I shall not repeat the questions of the noble Lord, Lord Patel, I add my name to them.

NHS: Standards of Care and Commissioning

Baroness Thornton Excerpts

Thursday 31st March 2011 Lords Chamber

[Baroness Thornton]

My Lords, I start by thanking my noble friend for initiating this debate and for emphasising the importance of standards of care and of the effect on patients of the proposed changes to the commissioning regime. Indeed, I congratulate all speakers in this debate. On this occasion, the point of my noble friend’s remarks was possibly, “We’re all in this together”, in dealing with the standards of care. However, he also said that we face some major challenges here, which are the challenges that he posed, as did several other noble Lords, including the noble Baronesses, Lady Emerton and Lady Hollins, and my noble friend Lady Sherlock. The question is: will the Bill help or not?

I welcome the noble Lord, Lord Owen, to both this debate and our wider discussions. I look forward to reading his pamphlet, Fatally Flawed, this weekend, and I suggest that the Minister might choose to do the same. However, I will resist the temptation to join the noble Lord in what would be a Second Reading speech.

I start by quoting a young woman who works in healthcare and who spoke last Saturday to between 200,000 and 500,000 people—personally, I think it was nearer the latter. In many ways, her simple eloquence says it all about how thousands of dedicated health workers feel. She said: “I am an NHS physiotherapist and have been for 13 years. My patients are people living with complex disability from conditions such as MS, brain injury, spinal cord injury and stroke. I work with a wonderful team of NHS workers such as occupational therapists, speech therapists, psychologists and rehab assistants, as well as social workers, to support our patients to overcome barriers to their independence, often supporting them back to work and working with their carers to support them to stay in their homes for as long as possible … David Cameron told you all in his election campaign that he would ‘cut the deficit, not the NHS’. Well, if 50,000 frontline NHS posts at risk doesn’t count as a cut, I shudder to think what does … For the sake of my patients, I fear the introduction of ‘any willing provider’. I fear that it will fragment services, will make the postcode lottery of care worse, and the most vulnerable patients, those least able to stick up for themselves—the kind of patients I treat every day—will be hit the hardest. Good quality patient care relies on good communication. How can we guarantee this, when services that currently work together are pitched into direct competition against each other? … In parts of the country, physios are already starting to see the rationing of care to just one or two treatment sessions, regardless of need … This is not the NHS I signed up to work for. I don't believe it is the kind of NHS that people in this country want”.

In this short response to the debate I am going to argue that we would not start here with reform and I will ask some questions about the risks to standards of the proposed commissioning system. I put a plea to the Minister: could we perhaps have some new words in his answers to these debates? I have looked back at the debates and discussions in the House since the White Paper was published last July, and time after time the Minister has stuck admirably to the Andrew Lansley brief, with what is becoming the famous NHS techno-jargon that weaves a web of words but really does not serve to comfort, or even leave one any the wiser. It is very noticeable that when the Minister comes off script and is back to his old, clever self, we prefer it and I, for one, understand things better.

We are nearing the point, after many questions and sustained criticism from professionals, patients and even the Minister’s partners in the coalition, when we need some real answers to real concerns, not least on the commissioning that is the subject of this debate. Notwithstanding the progress of the Health and Social Care Bill, I invite the Minister to agree that there is no doubt that the period 2011-14 is likely to be the most challenging ever faced by the NHS. The NHS is faced with the challenge of producing £20 billion in efficiency savings, putting considerable pressure on the system to maintain current standards of care. Given those constraints, we on this side of the House are still of the view, perhaps even more so now, that this is not the right time to embark on the largest structural reorganisation in NHS history, which includes scrapping those layers of the NHS structure with real experience of commissioning—family care trusts and strategic health authorities—and putting the power in the hands of untested and inexperienced consortia.

I am not saying that PCTs and SHAs have been unfailingly brilliant; in some cases, they have not even been good or average. There was and is significant room for improvement, and I think we would all agree on that. Most notably, clinical leadership and engagement in PCTs has often been weak, local accountability has been lacking and imbalances in status and power that exist between commissioners and providers appear to have limited substantially the former’s ability to influence service provision, to say nothing of the lack of clinical presence in the whole process. However, we believe that it would have been better to tackle this problem rather than to turn the whole NHS upside down.

What of the transition? Responsibility for maintaining and improving the quality of services will fall initially to the new PCT clusters. At a time of major reorganisational transition it will be especially important to have in place adequate performance measures supported by transparent and robust mechanisms, through which the GP consortia and PCT clusters can account to local people for the quality and performance of local health services. I do not see how this can be achieved when PCTs are being decimated either by the efficiency cuts or people jumping ship to work elsewhere. Perhaps the Minister can say how he thinks this will be achieved.

We know that PCTs are responsible for commissioning a range of primary, community, secondary and tertiary health services, often in partnership with local authorities—for instance, in mental health—and, indeed, other PCTs, through networks or consortia for specialised services, and primary care clinicians through practice-based commissioning. That has already been mentioned by the noble Lord, Lord Patel—cancer networks being one of these. This is a complex landscape and it is about to become even more so. It will grow a whole new bureaucracy of its own if the competition which the Government intend to put at the heart of the Bill, whatever one believes about that, is as envisaged.

The majority of concerns with the health Bill in relation to commissioning of services fall into five broad areas: multidisciplinary commissioning; commissioning of long-term conditions; specialist commissioning; a lack of national guidance leading to fragmentation; and communication and co-ordination between providers and commissioners. A theme that runs throughout these areas is concern about the involvement of GPs and the ability of relevant commissioners to secure appropriate clinical input when commissioning services.

The King’s Fund report of the beginning of March highlights the need for strong, strategic commissioning to reconfigure some services such as cancer, cardiac and stroke care across large geographical areas. It argues that this will not be delivered by the Government's health reforms, which will abolish the strategic health authorities currently responsible for leading this work and leave GP consortia to fill the gap, which they are unlikely to be able to fill—to which I add that that will probably be the case for at least 10 years or so.

Briefly, on long-term and specialist conditions, throughout the debates since last July various advocates and campaigning organisations on almost every long-term condition have commented on the proposed reform. The Minster must accept that the Alzheimer’s Society, the cancer campaigns, diabetes organisations and many others are very worried about the commissioning for their conditions becoming fragmented and incoherent, to say nothing of end-of-life care and, for example, treatment for children with very serious conditions.

The Government are asking those who have fought long and hard for recognition of and improvement in the treatment and care of people to take on trust that everything will be okay. The Minister needs to accept that this clamour about commissioning, although we are joining it, is not motivated by Her Majesty’s Opposition being oppositionist; it is about a long list of concerns, questions and anxieties that we have to address without the proposed revolution. I look forward to the Minister’s reply.