NHS: Financial Tariff for 2015-16

Debate between Earl Howe and Baroness Howarth of Breckland

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, we remain absolutely committed to achieving parity of esteem between mental and physical health. The proposals for mental health services in the national tariff arrangements for 2015-16 will get us closer to that aim, should they be finally agreed.

[Baroness Howarth of Breckland (CB)]

My Lords, a great deal of concern has been expressed by specialist providers, particularly in the heart field where there is a review ongoing at the moment, that there might well be a reduction in funding. That would be disastrous for services. Can the Minister reassure those groups that there will be a fair assessment in relation to specialist provision?

[Earl Howe]

It is the view of Monitor and NHS England that providers of specialised services should make every effort to deliver care that is both clinically appropriate and cost-effective in order to manage demand—where, after all, their clinicians have significant influence. NHS England considers the proposed rule to be warranted—this is about the 50:50 split in the tariff—because rapidly growing expenditure that exceeds population prevalence growth is unlikely to reflect efficient and effective services, which, when one thinks about it, are in patients’ best interests overall.

Autism

Debate between Earl Howe and Baroness Howarth of Breckland

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, the new statutory framework for children and young people with special educational needs and disabilities, SEND, is designed to improve the integrated working across health, education and social care so as to deliver improved outcomes for a child and his or her family. Clinical commissioning groups and local authorities will be working together according to that statutory framework.

[Baroness Howarth of Breckland (CB)]

My Lords, the Minister clearly accepts that speed of diagnosis ensures that a child or young person gets into treatment faster. The faster they are in treatment, the more likely they are to make some progress in how they are able to function. However, does he accept that there is a disconnect between that diagnosis and the service delivery, particularly with under-fives, where children are waiting a considerable time for their local authorities to sponsor them into nurseries or facilities? What is happening to ensure that that improves?

[Earl Howe]

The noble Baroness makes a very good point. That is exactly why we have given clinical commissioning groups new duties to commission services for nought to 25 year-olds and young people to ensure that procedures are in place, to agree a plan of action, to secure provision which meets a child’s or young person’s reasonable health needs in every case, and to work with the local authority to contribute to the local offer of services for children in this position. That is now a statutory duty and I think it is a step forward.

Alcohol: Addiction

Debate between Earl Howe and Baroness Howarth of Breckland

Monday 12th January 2015 Lords Chamber

[Earl Howe]

No, my Lords, they are not. The Government have regular dialogue with the industry, but the industry does not formulate policy and never will do. There has been a delay on the new guidelines; the consultation on them had been planned for December last year but will not now happen until shortly after the general election. That is simply due to problems with Public Health England commissioning expert advice on guideline methodologies, which took longer than intended. The academic body that PHE wanted to do the work decided that it did not have the capacity to do so. A tender exercise was therefore necessary and the work is being carried out by a team from Sheffield University.

[Baroness Howarth of Breckland (CB)]

My Lords, the Minister is well aware of the effect of alcohol on unborn children. What are the Government doing for young mothers who are either addicted to drink or unaware of the difficulties that alcohol creates for their children in terms of education both through the health service and the education system?

[Earl Howe]

My Lords, the Royal College of GPs has a special focus at the moment on giving advice to GPs. We are also dramatically increasing the number of health visitors, who are, of course, highly instrumental in influencing the behaviours of mothers-to-be and young mothers.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Debate between Earl Howe and Baroness Howarth of Breckland

Wednesday 5th November 2014 Lords Chamber

[Baroness Howarth of Breckland (CB)]

My Lords, I will be brief, as I always am. I do not want to repeat what has been said before, much as I would love to be led down the path of talking abut the problems faced by care homes in the present financial climate. I must first declare an interest as a trustee of Livability, which provides a large number of care homes for disabled people and for other groups. I am therefore, as a trustee, in the role of a provider. I also want to speak very briefly on behalf of families and carers.

First, I say to the Minister that I welcome the regulations. I was interested in his spirited defence of them, and I know his great belief in them. There are aspects of the new regulations that strengthen the potential to hold care providers—such as my organisation—properly to account. That is all positive, but I simply want to address myself to the issues around the amendment on the Order Paper, because there is an issue and I would very much like the noble Earl to think about it.

We have been approached by a number of organisations which said that families and residents are very concerned about these three aspects of the regulations. I have looked at the old wording and at the new wording, and I found that the new wording is more elegant but much more obscure for ordinary people to relate to. It is terribly important that ordinary folk in a care home—both the providers and those receiving the service—understand that they have a right to be told about complaints procedures.

Clearly, that is there already. I disagree with those who say it is not. All of it is to be found within the regulations and the follow-up documents by those who actually dig through them. I believe that the noble Earl hoped—as he listened to all the hours of discussion of these issues—that this would be absolutely crystal clear. If these issues are clear, they also help leadership and management. It is much easier for providers to tell their staff how to take things forward if the words are absolutely clear, and if there is some sense of being given flexibility or whatever the expectation is.

When it comes to proper planning for emergencies, providers have an absolute responsibility to ensure not only that they have those plans, but that in the interests of health and safety everybody understands them throughout. Not only the providers but the residents themselves must understand. It is possible to have a great discussion about these issues among those who are receiving care. It is possible to discuss complaint procedures, choice of food and what happens if there is a fire and people can only be got out of certain areas by particular routes.

What I am saying is much simpler than the rest of the discussion. I would like the Minister to look at the wording, because in my opinion this is about language rather than intent. We have excellent regulations but, if families and users are concerned about these three areas, the Government have a responsibility to listen. I know we have a listening Minister.

[Earl Howe]

My Lords, I am grateful for the questions and comments raised by noble Lords. I will do my best to answer them in the time available. Perhaps I may begin with the issues raised by the noble Lord, Lord Hunt. The noble Lord expressed his regret that certain phrases no longer appear in the regulations, and those concerns were echoed by the noble Viscount and the noble Baroness, Lady Howarth. I should like to reassure the House that, although the regulations do not include express references to the three things highlighted in the amendment tabled by the noble Lord, Lord Hunt—informing service users about complaints procedures, having emergency procedures in place, and offering choice of food—nevertheless providers must still demonstrate to CQC that they are doing those things.

This is possible because the fundamental standards work in a different manner from the current regulations. They set the outcomes about quality and safety that must be met, rather than just the processes that must be in place. They set out the ends, rather than merely the means. Because we describe these outcomes in regulation, we no longer need to spell out a long list of processes in regulation as well. However, all the areas highlighted by the noble Lord nevertheless fall within the scope of the new regulations. For example, planning for emergency procedures is covered by the new safe care regulation, which requires providers to ensure that care is provided in a safe way, and that they do all that is reasonably practicable to mitigate the risks of unsafe care. A provider that had no plans in place to deal with emergencies such as floods or staff shortages could not claim to be meeting the regulation, because they would not be doing all that is practicable to mitigate the risks to the health and safety of service users from emergency situations. In practice, not having a plan in place for emergencies will therefore be a breach of the regulations.

The obligation to offer a choice of food and drink falls within the new person-centred care regulation, and the newly drafted nutrition regulation. We have introduced a new person-centred care regulation which requires that a person’s needs must be met, and that their preferences must be taken into account and, where possible, met. I emphasise that this applies not only to food preferences, but to all other aspects of care as well. This is a significant step towards greater person-centred care, advocated by many over recent years.

In addition, the nutrition regulation states that a person’s nutritional needs must be met, and it will be a criminal offence to fail to meet this regulation in a way that causes avoidable harm or significant risk of such harm. These two regulations work in tandem to require that a person’s individual nutritional needs are met and their individual preferences are reflected wherever possible. This is a stronger position than merely requiring that people be offered a choice. Such a requirement could be met by offering a person a choice of two things that are neither desired nor suitable. On the issue of complaints, the new complaints regulation states:

“The registered person must establish and operate effectively a system for identifying, receiving, recording, handling and responding appropriately to complaints, and requests for action to be taken, by service users and other persons”.

A provider who does not make patients and service users aware of their complaints system could not claim to be making it accessible, or claim they had an effective means of identifying complaints. Therefore, they would be breaching the regulation. CQC’s draft guidance about compliance with the regulations, which is currently subject to consultation, includes more information about all of these areas. It is this guidance that sets out in more detail what CQC will look for when checking whether providers are meeting the regulations. If noble Lords are in any doubt or have anxiety after this debate and after what I have said, I assure them that I would be happy to feed in the concerns which have been raised this evening in the context of the guidance that is now in preparation.

The noble Lord, Lord Hunt, described the regulations as light-touch, and the noble Viscount, Lord Hanworth, suggested that the Government were somehow pursuing a deregulation agenda by introducing these regulations. I must say to the noble Viscount in particular that that is a complete misreading of these regulations. Indeed, his speech indicated to me that he is labouring under a number of serious misapprehensions. Past experience has shown that there are limitations to prescriptive regulation. It is very difficult to make regulation exhaustive. The list might come to be the upper limit of what is provided, rather than the floor below which care should never fall. For example, the old national minimum standards for care homes included very specific requirements that set out the minimum bedroom sizes in square metres. In practice, this minimum became the default normal size for rooms.

The guiding principle behind the fundamental standards is that they set an overall outcome that must be met. The responses to our consultation showed that the vast majority of respondents agreed with this, and thought that the regulations were clearer as a result. I hope that that reassures the noble Baroness, Lady Howarth, in particular. Importantly, this approach allows the CQC to take a more rounded look at quality and safety as it inspects, rather than taking a tick-box approach to inspecting done solely against prescriptive regulations.

Health: Rheumatoid Arthritis

Debate between Earl Howe and Baroness Howarth of Breckland

Monday 16th June 2014 Lords Chamber

[Earl Howe]

My Lords, we are encouraging single-handed practices not to disband but to federate themselves—if that is a good word—with other practices in the area, and certainly to seek the support of their clinical commissioning group. That would ensure that the range of professional training available is utilised and that there is peer support where appropriate. Therefore, while many single-handed practices do a very fine job, there is scope for them to collaborate with their colleagues in the local area.

[Baroness Howarth of Breckland (CB)]

My Lords, I am sure that the noble Earl will tell me that it is the responsibility of either NHS England or the local health commissions, but is he not alarmed by the number of GP practices being suggested for closure at the moment, and by the long waiting times that patients have to endure in many areas? In some country areas you cannot see your GP for four weeks. Should the Government not have at least some concerns on that?

[Earl Howe]

My Lords, we are concerned by reports of patients having difficulty accessing their GPs. That is why a whole range of work is currently going on in NHS England to look at the issue, to see how general practices can be helped and to enable them to see more patients. However, more generally, we in the Government have amended the GP contract to free up GPs’ working time. We have abolished well over a third of the QOF indicators precisely to do that. The Prime Minister’s Challenge Fund—£50 million-worth of funding—enables GPs to open up different ways of working; for example, consulting patients on Skype and working hours other than nine to five.

Health: Transition to Adult Health Services

Debate between Earl Howe and Baroness Howarth of Breckland

Wednesday 11th June 2014 Lords Chamber

[Earl Howe]

I fully agree. I think that much of this will succeed only if services work together around the needs of young people as well as their families and carers, and if the families and the young people themselves feel involved in the way in which their care is being organised and planned.

[Baroness Howarth of Breckland (CB)]

My Lords, in terms of developing the specification, can the noble Earl tell us how stakeholders are to be involved? In particular, will the young people themselves now have a voice? I declare an interest as the president of Little Hearts Matter, which deals with children with single-ventricle problems.

[Earl Howe]

I think that we can pay considerable tribute to the Children and Young People’s Health Outcomes Forum. It is one of the bodies that have highlighted the need for more effective transitions and for new outcomes indicators to measure them. Its framework for this year includes a proposal that, where possible, all data should be presented in single-year or five-year age bands up to the age of 25 to support better monitoring. Moreover, the forum asked the National Network of Parent Carer Forums to develop a narrative of what good integrated care looks like in transition. The CQC report has drawn quite heavily on that report in its conclusions.

NHS England: Health and Social Care Act 2012

Debate between Earl Howe and Baroness Howarth of Breckland

Wednesday 7th May 2014 Lords Chamber

[Earl Howe]

My Lords, as I have indicated already, we view funding as just one part of the story in achieving parity of esteem. However, we will hold NHS England rigorously to account for this and we have regular meetings to talk about that. We have set NHS England that strategic objective and we have singled out in particular action on crisis intervention, extending access to IAPT therapies and developing options around access and waiting time standards. Therefore there are a number of detailed issues that we expect NHS England to address.

[Baroness Howarth of Breckland (CB)]

My Lords, can I ask the Minister to draw attention to one other area? I was alarmed to read in a recent POSTnote —the very last paragraph of a document that is often very factually based and helpful to the House—that HIV/AIDS is likely to suffer from being commissioned by one group, delivered by another and overseen by yet another. I am quite sure that that is an area where we would want good co-ordination, and I hope that the Minister will ensure that it is properly monitored.

[Earl Howe]

The noble Baroness is right to draw attention to sexual health services as an area that needs to be joined up. We are very aware of that. The commissioning arrangements are as she has stated but we are as confident as we can be that in most areas of the country the services are joined up, even if commissioned separately. It is an area that we keep under review very closely.

Children and Families Bill

Debate between Earl Howe and Baroness Howarth of Breckland

Wednesday 20th November 2013 Grand Committee

[Earl Howe]

Well, my Lords, if I could repay the compliment to the noble Lord, Lord Hunt, he has very eloquently presented the case for the Government to go away and think further about this, which indeed we will do. I come back to what I said at the beginning of this debate: the message from this Committee has been delivered loudly and clearly. I am grateful to noble Lords for that. I say again that the Government’s mind is not closed on this issue.

[Baroness Howarth of Breckland]

As one of those who are not quite so eloquent but are equally committed to the cause, I think that the Government would be in a far better position if we had some timescale. We now know when Report stage is likely. I am much attracted to what the Minister said. I would much prefer that we had a universal position that protected adults as well as children because of, as he said, the influence that adults have on children. Many more noble Lords might, like me, be influenced if they knew that something was likely to happen. The anxiety is that, unless we press this, nothing will happen.

[Earl Howe]

The noble Baroness underestimates her own eloquence here. I thank her for that and I shall reflect carefully on what she has said.

NHS: Children’s Congenital Heart Services

Debate between Earl Howe and Baroness Howarth of Breckland

Tuesday 23rd July 2013 Lords Chamber

[Earl Howe]

My Lords, I am informed by NHS England that it will be including adult heart surgery in its review of the care for people with congenital heart disease, but of course I cannot pre-empt in quite what way the conclusions will flow from that.

[Baroness Howarth of Breckland]

My Lords, during the previous difficulties and confusion when there was much lobbying and debate, the people who found it most difficult to follow the information and the evidence were parents. Presumably, they are the most important stakeholders, particularly in the case of children’s congenital heart disease. Can the Minister convey to NHS England the importance of finding clear and sometimes simple ways of helping parents at a time when they are stressed, anxious, worried about the geography and not able to understand the outcomes? They do not always have the best information with which to make decisions.

[Earl Howe]

My Lords, the noble Baroness makes an extremely important point. I know that NHS England is cognisant of the need to ensure not only that parents are included in this consultation but that there is a system going forward which will inform parents appropriately.

Autism

Debate between Earl Howe and Baroness Howarth of Breckland

Monday 17th June 2013 Lords Chamber

[Earl Howe]

I can give my noble friend that assurance. The autism strategy is, of course, a cross-government strategy. A number of departments will look at their role in supporting it, including the Department for Work and Pensions and the MoJ. I am hopeful that when we come out in October with some considered proposals, my noble friend will take heart from the fact that this has involved all relevant government departments.

[Baroness Howarth of Breckland]

My Lords, one of the great concerns of people with autism is the transition arrangements between young people and adults, particularly the difficulties created now that education and social care provision are separated in adult education centres for these children and young people. What is intended to ensure that this does not continue to disadvantage these young people?

[Earl Howe]

My Lords, the Children and Families Bill, which was introduced into Parliament this month, will usher in from next year new joint arrangements for assessing and planning commissioning services for children and young people with special educational needs. We realise the difficulties that young people with autism can face in making that transition to adulthood. Under the autism strategy, my department and the Department for Education funded the social policy research unit at the University of York to examine how statutory services are currently supporting young people on the autistic spectrum. Its report, published in February, points the way to some important lessons that we should take on board during the review.

Health: Children's Heart Services

Debate between Earl Howe and Baroness Howarth of Breckland

Wednesday 12th June 2013 Lords Chamber

[Earl Howe]

That is indeed the core of the disappointment felt by the clinical community and noble Lords: that we are little further forward in terms of deciding exactly where these services should be delivered. The noble Lord is also right to say that support for a philosophy of improving children’s heart services by concentrating surgical expertise to provide round-the-clock cover and develop networks of care is as strong as ever. There is a rare consensus on the clinical case for improving services on the pathway of care for children. The IRP has said that its report is not a mandate for going back over the ground of the past five years; indeed, it commends a great deal of the work done by the JCPCT. The IRP says that that work should be built upon. The JCPCT should not necessarily feel bruised by this, although I am sure that it will feel thoroughly disappointed. However, its groundwork has been publicly appreciated, and it is now for NHS England to take that work forward as swiftly as it can.

[Baroness Howarth of Breckland]

My Lords, I speak as the patron of Little Hearts Matter, the organisation that represents a large number of families who have children with heart conditions, particularly hypoplastic left heart syndrome, which is extremely serious and needs highly skilled intervention. Who does the Minister think is most disappointed about the failure of the review? I probably meet more families and children than most of your Lordships—children who await open heart surgery or extremely complex technical interventions, and whose anxiety is huge; and parents who thought that they were going to have clear answers on where their children would receive treatment and on the quality of those interventions at the end of the safe and sustainable review. I ask the Minister to take back with him all those disappointments and to look not only at safety, which is key to the families. Many of them would travel to wherever you took them if they were sure that the operation would be successful. As a woman from Yorkshire and the east of England, I understand that gap, but what the families want most is quality of service.

As the noble Lord, Lord Warner, pointed out, there is also great disappointment about the link being made with adult services because of where those services are located. Despite the review, there is a lack of understanding of the needs of children. There are certainly transitional difficulties and I ask the Minister whether it is those issues or other issues that have led to children being considered alongside adults. Will he take away with him the disappointment felt by families who are waiting longer for interventions because this has caused delay?

[Earl Howe]

My Lords, I am accountable to this House for government policy, but it is important for the noble Baroness to understand that this has been an NHS-led review. Many of her questions are for NHS England now to address. Of course there will be huge disappointment and concern among the families of those who require surgery in this area. I want to emphasise that until a decision is reached, the centres now delivering children’s heart services will continue to do so and will be fully supported in doing so.

However, we cannot ignore a series of recommendations from the IRP that has roundly criticised the methodology of the JCPCT. It concluded that the JCPCT’s way forward was flawed because the analysis was insufficiently thorough. If our aim is to improve the quality of outcomes for these children, I do not believe that it is in anyone’s interests to try to say to ourselves that we can make do with a half-good set of solutions. I do not suggest that the noble Baroness is saying that; of course she is not. We need to be thorough about this without spending another 10 years over it. I hope that I have given the sense to the House that NHS England is determined to progress this rapidly but thoroughly and, above all, in a consultative way. The families will have a chance to have their say in that process.

NHS: Leeds General Infirmary

Debate between Earl Howe and Baroness Howarth of Breckland

Tuesday 23rd April 2013 Lords Chamber

[Earl Howe]

My Lords, my noble friend raises quite a large number of points. I simply say to her that in regard to Leeds, which is the matter on which I have been briefed, the decision to suspend surgery was taken because concerns had been raised from a variety of sources about the safety of surgery at the unit. Mortality data were supplied to the National Institute for Cardiovascular Outcomes Research with significant flaws, and until those flaws had been rectified, it was impossible to be sure that the trust was operating within acceptable mortality thresholds. Those mortality concerns have, I understand, been resolved, which is why low-risk children’s cardiac surgery has been resumed at the hospital. However, NHS England’s appeal on the Safe and Sustainable review—which, I emphasise, is quite separate from the events of late March and early April—has to be a matter for NHS England. The review of children’s heart services was an NHS review, independent of government, and if NHS England wants to appeal the decision and thinks that there are good grounds for doing so, that is a matter for it.

[Baroness Howarth of Breckland]

My Lords, does the Minister agree that the people most affected by this are the children and many of the families who do not understand and cannot comprehend what is going on at the moment across these services? I declare an interest as the patron and trustee of Little Hearts Matter, which deals with hundreds of children who have half a heart and therefore all have surgery across the country. The Government may not have a direct interest in dealing with this matter but what are they going to do to make sure that the health services reassure these families that wherever they get surgery it will be safe for their children?

[Earl Howe]

My Lords, children’s heart surgery has been the subject of concern for more than 15 years. Clinical experts and parent groups have repeatedly called for change, and there is an overwhelming feeling in the NHS that the time for change is long overdue. The review that has taken place was about making sure that children’s heart services are as good as they possibly can be, and that has to be the message to the parents involved. It is of course an extremely complex issue but it is generally accepted that concentrating surgical expertise will deliver better outcomes for the children concerned. In view of the legal proceedings, it is very difficult for me to go any further than that at the moment.

Care Quality Commission

Debate between Earl Howe and Baroness Howarth of Breckland

Thursday 14th March 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness is quite right: there is no room for complacency in this area. Care has to be right every time, not just three-quarters of the time. I noted from the CQC’s report that, although it recorded a number of common issues undermining the majority of good home care from a significant minority of providers, many of these were fairly minor. However, the noble Baroness has alighted on a very important failing among several of the agencies inspected. I do not have national information on late and missed calls but in the work that we are doing with local authorities, providers and, indeed, the CQC, all of whom share responsibility for driving improvement in services, this will inevitably be an area of focus for it.

[Baroness Howarth of Breckland]

My Lords, does the Minister agree with me that while the examples of good practice are very welcome, what was most surprising was the comment on safeguarding, which noted that many services are not meeting the requirements of good practice in relation to reporting to local authorities and have out-of-date procedures? Bearing in mind the plethora of advice from the Department of Health, what do the Government intend to do to bring these services into line as these are the most serious cases, where people are in real danger?

[Earl Howe]

My Lords, strengthening adult safeguarding arrangements is a key priority for the Government. We are committed to preventing and reducing the risk of abuse and neglect to adults who are in vulnerable situations and generally to supporting people to maintain control over their lives. As the noble Baroness may know, we are legislating to put safeguarding adults boards on a stronger statutory footing. That will better equip them both to prevent abuse and to respond to it when it occurs.

Care Homes

Debate between Earl Howe and Baroness Howarth of Breckland

Monday 28th May 2012 Lords Chamber

[Baroness Howarth of Breckland]

My Lords, does the Minister agree that one of the greatest inhibitors of long-term, consistent care is funding for individual placements? I speak and declare an interest as the president of Livability, which delivers long-term care for some elderly and a large number of younger disabled people. The great difficulty is ensuring that local authorities will commit to funding in the long term at an appropriate level.

[Earl Howe]

The noble Baroness is of course right, which is why it is so important that we reach what I hope will be a cross-party consensus on the future funding of long-term care and social care generally. We have committed to legislating as soon as we possibly can on that subject.

Health: Clinical Commissioning Groups

Debate between Earl Howe and Baroness Howarth of Breckland

Thursday 26th April 2012 Lords Chamber

[Earl Howe]

As my noble friend may remember from our debates on the Health and Social Care Bill, we have undertaken to ensure that no member of a commissioning support organisation may also be a member of the governing body of a CCG. Having said which, it is important that CCGs have the freedom to take advice on back-office functions and other matters that will assist them in their clinical decisions.

[Baroness Howarth of Breckland]

My Lords, I have spent a great deal of time working in governance with professionals from many different groupings and, however experienced professionals are in their own trade, they are not always very clear about governance issues. This is often true of trustees in voluntary organisations as well as in clinical governance in the health service. What plans does the Minister have for training and advice to the new bodies in order to ensure that people who often believe that they know the answers really do know them?

[Earl Howe]

The noble Baroness makes an extremely important point, which is why we have laid great stress on training and ensuring that the NHS Commissioning Board will develop appropriate guidance on procurement, avoiding conflicts of interests and avoiding unfair competition entering the arena.

Organ Transplantation

Debate between Earl Howe and Baroness Howarth of Breckland

Monday 27th February 2012 Lords Chamber

[Earl Howe]

My Lords, it is a well established principle of law that there is no property in a corpse. This means that, as a general rule, the law does not regard a corpse as property protected by rights. In other words, there can be no ownership of a dead body. However, the law does prescribe what may lawfully be done with the body of a deceased person. For example, a person can say while they are alive what they would like to happen to their body after death, such as donation of organs. My noble friend raises an extremely important point about A&E. The number of donors from A&E units is improving but it is generally recognised that it had to because performance was not good. Since 2007-08 there has been a 388 per cent increase in donations from emergency medicine, which is good news, but there is much more that could be done. The transitional steering group that we have set up under the chairmanship of Chris Rudge is looking at that area as a priority.

[Baroness Howarth of Breckland]

My Lords, it is widely recognised that the Government and the previous Government have made huge strides in this area but from a fairly low position. Many countries in Europe—particularly Spain—do much better than we do. What are we doing to ensure that we are learning from others and making the improvement even faster? Every day is someone else’s life.

Health: Cancer Drugs Fund

Debate between Earl Howe and Baroness Howarth of Breckland

Monday 14th November 2011 Lords Chamber

[Earl Howe]

My Lords, it is of course for the devolved Administrations to make their own decisions about their individual needs and budgets. It will depend on whether commissioners in Wales are willing to accept the cost of treating a patient with a drug that is not normally available in Wales. I cannot generalise but it is up to Welsh commissioners to take that decision.

[Baroness Howarth of Breckland]

My Lords, I am aware that 2013 is approaching very fast. Does the Minister’s department have a timetable for the strategy that will be in place once the strategic health authorities have gone? Will there be consultation on those plans?

[Earl Howe]

My Lords, as I told the noble Baroness, Lady Morgan, discussions are ongoing as to the arrangements that will be in place after the abolition of strategic health authorities. I cannot say that we have definite plans in place but I hope that we will be able to announce our plans soon.

Health: Obesity

Debate between Earl Howe and Baroness Howarth of Breckland

Wednesday 19th October 2011 Lords Chamber

[Earl Howe]

I agree with my noble friend that it is about educating both children and parents about healthy diets and healthy eating, and encouraging children at school to take up healthy diets.

[Baroness Howarth of Breckland]

My Lords, I know that the Ministry is very keen on co-ordination, and I am sure that one of the reasons why the team from the Food Standards Agency was moved into the Department of Health was to ensure that it could work on these issues. The Minister will remember that this team was outstandingly successful in its work on the salt campaign and was moving on to work on fat and sugar, which would have helped with the obesity problem. I understand that the team is now being disbanded. Is that sensible in the light of the Question of the noble Lord, Lord McColl?

[Earl Howe]

I am not aware that the team is about to be disbanded but I will take that concern away and write to the noble Baroness about it.

EU: Food Labelling

Debate between Earl Howe and Baroness Howarth of Breckland

Monday 17th October 2011 Lords Chamber

[Earl Howe]

My Lords, I am not sure that I would accept the epithets that my noble friend has applied to this regulation. We have led the way in these negotiations. It is true that it has taken some time but we have come away with most, if not all, of our key objectives met. Nutritional information will now be displayed in a consistent manner on the back of all pre-packed foods, which is a major plus. A voluntary approach has been secured for front-of-pack nutrition labelling and for non-pre-packed foods, including those sold by caterers. It will also be made easier for alcohol companies to include energy information on their products on a voluntary basis. This will give people the information they need to make informed choices about what they eat and drink, which is the whole idea.

[Baroness Howarth of Breckland]

My Lords, is that truly the view of the Foods Standards Agency? I understand that we have different policies being developed in England, Scotland and Wales, but without differences being truly ironed out. I also understand that we have three departments—Defra, the Foods Standards Agency and the Department of Health—working at this in England alone. Does the noble Earl not think that there is room for confusion and a lack of cohesion when we do not have better co-operation?

[Earl Howe]

I take the noble Baroness’s point. Obviously, the Government would like to see greater consistency in front-of-pack labelling. We know that, if we can achieve it, that is likely to increase consumer understanding and indeed the way that consumers use the information. Now that the regulation is finalised, we have the opportunity to discuss with all stakeholders the way to achieve that. It is advantageous that there is the flexibility available for us to do that.

Smoking

Debate between Earl Howe and Baroness Howarth of Breckland

Thursday 8th September 2011 Lords Chamber

[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.

[Baroness Howarth of Breckland]

My Lords, I know that the Minister is very concerned about the effects on children. Could he remind me of the timetable to remove displays from tobacconists’ stores so that children do not see them and are not encouraged to smoke, because that legislation can already be put in place and carried through?

[Earl Howe]

The noble Baroness is right. We believe that the Government’s commitment around the introduction of tobacco display legislation strikes the right balance. We have amended the implementation dates. Displays will come to an end in large shops on 6 April next year, and in small shops on 6 April 2015.

Health: Hospital-acquired Infection

Debate between Earl Howe and Baroness Howarth of Breckland

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My Lords, yes, and that is now a requirement on all NHS trusts.

[Baroness Howarth of Breckland]

Does the Minister agree that the length of stay that a patient has increases the risk, particularly among elderly patients? Can he tell me how many elderly patients are now staying in hospital for greater lengths of time because they are not being discharged into appropriate local authority provision?

[Earl Howe]

The noble Baroness is quite right that delayed discharge poses a risk, not only in terms of infection but in terms of mobility and other issues that affect the elderly. We are clear that if this problem is to be eased, further funding is required at local authority level, which is why we have made available up to £1 billion over the period of the spending review to ensure that the issue is addressed.

Mental Health

Debate between Earl Howe and Baroness Howarth of Breckland

Wednesday 10th November 2010 Lords Chamber

[Earl Howe]

My Lords, many GPs understand the issues very well and are keen to get on with the agenda. Our proposed model of GP commissioning means that practices will have flexibility within the new legislative framework to form consortia in ways designed to secure the best healthcare and outcomes for their patients. That will include mental health and could involve, for example, taking commissioning decisions collectively with perhaps a lead consortium for mental health.

[Baroness Howarth of Breckland]

My Lords, I know that the number of young people being detained in adult mental health hospitals is decreasing steadily, but can the Minister tell us, first, how many remain, and secondly, what policy will be set out in the framework for seriously disturbed young people who will be contained within the community?

[Earl Howe]

My Lords, the noble Baroness is right to say that there is legislative provision to ensure age-appropriate accommodation for young people in particular suffering from mental health difficulties. A range of products has been produced by the National Mental Health Development Unit to assist hospitals to meet the legal requirement to provide that age-appropriate setting. It does not mean, of course, that no under 18 year-olds may be treated on adult psychiatric wards as there are circumstances where that is appropriate. But my understanding is that this legislation is being observed and is making a difference.

Health: Cancer

Debate between Earl Howe and Baroness Howarth of Breckland

Monday 21st June 2010 Lords Chamber

[Earl Howe]

I am very grateful to my noble friend. It may help the House if I briefly explain what PDT is. It is a technique that uses laser or other light sources combined with a light-sensitive drug, which in combination destroy cancer cells. When the light is directed in the area of the cancer, the drug is activated. As my noble friend indicated, although this is an invasive procedure, it is minimally so; and its advantage is that, unlike radiotherapy, no cumulative toxicity is involved, so someone can be treated with PDT repeatedly. However, there are difficulties, one of which is that there is no obvious clinical leadership in this field, and that has to be addressed. There need to be centres of excellence in order for the right lessons to be learnt and the right research to be done.

[Baroness Howarth of Breckland]

My Lords, there is no doubt that, once patients are at the hospital, they are likely to get the treatment, but can the Minister assure us that GPs will be encouraged to make speedy referrals? In the cases that I know of, the difficulty has been in getting from the GP to the centre of excellence in order to get the treatment.

[Earl Howe]

The noble Baroness is quite right, which is why in the NHS there is such an emphasis on speed of referral when a GP first suspects that cancer may be present in a patient. This is an area to which we are very alive, and I hope that we will be able to make further announcements about it in due course.