Police: Ambulance Support

Lord Hunt of Kings Heath Excerpts

Thursday 16th July 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, on the question of the London Ambulance Service’s performance, when does the Minister expect the LAS to perform according to the targets that it has been set?

[Lord Prior of Brampton]

The performance of the London Ambulance Service is improving, albeit too slowly. A new chief executive has just been appointed and the TDA is following the performance extremely carefully. We hope that improvements will continue to be made.

NHS: Reform

Lord Hunt of Kings Heath Excerpts

Thursday 16th July 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for his Statement. The Opposition support much of what he had to say. I will focus my remarks on the plan for seven-day working and then touch on a number of the other issues that he raised.

Ensuring our health services are there for everyone whenever they are needed, be it a weekday or a weekend, is essential to keeping people well and making the NHS sustainable. Of course the Opposition support the principle of what the Government are trying to achieve with seven-day working, and we will certainly work with them on making that possible. Where I urge some caution is in the manner in which the Government are attempting to achieve those changes.

The Minister will be aware that the NHS is in a rather fragile state at the moment. A&E performance has been very disappointing in the face of enormous pressures. He will know that primary care services are overwhelmed. We discussed in Oral Questions the failure of some ambulance services to meet their performance targets. We talked particularly about the London Ambulance Service. There is a shortage of staff and an overreliance on agency workers and undoubtedly patients are suffering as a result—on this Government’s watch. Staff are feeling pretty demoralised and rather unloved by the Government. It is important that the way the Government approach seven-day working does not make matters worse.

I am entirely unclear as to how seven-day working is to be achieved without significantly impacting the rest of the NHS. The real danger here, given the way the NHS will approach this kind of target, is that more staff will be produced at the weekend by cutting staff during the week. The Minister will be aware of the study published in Health Economics, which concluded:

“There is as yet no clear evidence that 7-day services will reduce weekend deaths or can be achieved without increasing weekday deaths”.

Clearly, it would be an absolute nonsense if we reduced weekend deaths but the price was an increase in weekday deaths.

The Government have produced no facts or evidence for the assertions they are making. If we are to take this seriously, we need to know a bit more about how the resources challenge and the current acute shortages in many staffing areas are going to be met—bearing in mind that the Government are cracking down on the use of agency workers; the ludicrous 2012 Immigration Rules, which mean that nursing staff who are not earning £35,000 a year after six years will be sent back to their country of origin; and the serious issue of staff morale.

The Minister mentioned the 2003 contract but will he confirm that the contract negotiated then was actually very largely based on the one negotiated by the previous Conservative Government in the 1990s? How does he think the Government intend to work in partnership with NHS staff to make those changes? The briefing from his department—phrases such as “declaring war on NHS staff”—does not seem to have got this policy off to the right start. The kind of provocative statements that are currently emanating from his department, no doubt under the authority of the Secretary of State, do nothing to create the conditions in which people in the NHS will actually want to work with the Government on developing these policies.

I also want to mention the impact of another five years of, in effect, real-terms pay cuts. What impact does the Minister think the Chancellor’s announcement on pay will have on future staff numbers and retention? I want to raise one issue with him, which is the subject of a statutory instrument in your Lordships’ House. If the pay of NHS staff is to be held down, how can he justify the 12% increase in fees by the HCPC, one of the key staff regulators for the healthcare profession? Will he withdraw this regulation? Does he not agree that it is absolutely disgraceful that staff are being asked to pay more money by what essentially is a government-owned quango when their own pay is being held down? It is utterly unacceptable.

Can the Minister tell me how this is going to be funded? Either the staff are going to be thinned out during the week or extra staff will have to be found. It is not just consultants and nursing staff; it has to be the whole infrastructure to make this work, including community services and primary services, and there will be a knock-on impact on social care costs. How is this going to be paid for? If he says that the Government are giving £8 billion to the health service overall, he knows that is dishonest. We know that that will probably be paid in 2021, according to the Treasury briefing. We also know that £30 billion per annum will be needed by then. Nobody I know in the health service thinks that it has any chance at all of closing that gap because the kind of efficiency saving required has never been achieved in this or any other health service. The excellent report on efficiencies by the noble Lord, Lord Carter, in itself will produce only £5 billion by 2017-18.

On whistleblowing, I welcome the Freedom to Speak Up report, which contained a number of important recommendations to foster a more open culture. The Minister will know that in recent years there have been a number of other examples of appalling care in social care settings, including Orchard View, Oban House and, of course, Winterbourne View. Many of those scandals were exposed only once undercover reporters infiltrated the care home. Of course, we welcome the action the Government are taking, but does the Minister agree with the point I have made to him previously: that if the Government really want an open culture in which people can raise their concerns, that has to apply right up the line, meaning that the leaders of NHS organisations can speak openly about their own concerns about the direction of policy and the actions of Ministers? He will know that at the moment those people are slapped down if they make any criticism at all of the Government. You will not get an open culture until everyone in the system feels that they can be open. At the moment they cannot.

We support the steps in the Kirkup report to improve the regulation of midwives but if the Government are so concerned about modernising regulation, why have we not had the Law Commission Bill containing a comprehensive approach to the modernisation of health regulation for individual professionals? Why are we carrying on with this antiquated approach and these wretched Section 60 orders, which cause a lot more expense and delay in the Minister’s department? Why has the new speeded-up system of dealing with regulation, for regulators such as the Nursing and Midwifery Council, been held up for many months now? Of course, one of the reasons why it has had to increase its fees is that the Government will not agree to this legislation coming before Parliament to streamline its proposals.

It is pretty disgraceful that the Rose report, which was mentioned, was not published alongside the Statement. Why are we having to wait until after this Statement to look at it? The noble Lord knows that Ministers received it months ago. What is in the report that they do not want the public to see?

On the merger of Monitor and the NHS Trust Development Authority, I welcome the appointment of Mr Ed Smith, who is a high-calibre chair. He is also pro-chancellor of Birmingham University, which is a very strong recommendation. I also like the name “NHS Improvement”. But how many staff in Monitor and the NHS Trust Development Authority have any concept of improvement, given their current record of bullying, hectoring and intimidating the agencies they are responsible for? Can I assume that there is going to be a drastic change of personnel in that combined organisation? Will the Minister confirm that no one employed in that organisation will earn more money than the Prime Minister, given that the Government have chosen to attack NHS chief executives in relation to their salaries? Will he also confirm that they will not use agency staff? Does he not find it rather ironic that Monitor, in order to instruct NHS bodies not to use agency staff, has employed temporary staff? What is sauce for the goose is sauce for the gander.

There is a dangerous gap between the kind of fantasy land that Ministers talk about in the health service and the reality of life on the ground. On the ground, people are struggling every day to meet the pressures with limited money and no support from the Government. The health service is in real danger of falling over. The Government should stop blaming the NHS and take responsibility.

[Baroness Walmsley (LD)]

My Lords, I, too, thank the Minister for repeating the Statement. It reflected much of what I heard this morning from the Secretary of State at the King’s Fund. It is a brave and realistic approach but there are some yawning gaps in it compared to what I should have expected in a major statement about NHS reform. However, I welcome several points.

The focus on culture change and nurturing staff is absolutely right. The NHS is the best and most cost-effective service in the world only because of the skills and commitment of its staff, yet we are told that in some places staff morale is poor. This is very sad to hear. It was good to hear earlier this morning about the beneficial effect on morale in those hospitals that are responding positively to being put in special measures.

I welcome the new personnel, processes and training that are being put in place to ensure that staff can safely express concerns about the quality of care, so that each member of staff can take part meaningfully in the improvement pathway of his organisation. We could do with ditching for all time the expression “whistleblower” with all its negative connotations. I welcome what the Secretary of State called “intelligent transparency”, a no-blame focus on what went wrong and how to put it right. In common with the noble Lord, Lord Hunt of Kings Heath, I think that merging the TDA and Monitor could be a good thing, with this focus on no-blame improvement. That should help, but we still need more signposting for patients and service users about how and where to complain if they have poor care in what is a very complex system.

I of course welcome the focus on better data-gathering, especially in the field of mental health, where we are rather short of it. Managers cannot make good financial decisions without the facts about what everything costs. Businesses could not survive like that and neither can the NHS.

I welcome the long-awaited publication of the Rose report and the acceptance of its recommendations. I look forward to seeing what they are. We need a new focus on the quality of NHS management. If we are to rise to the challenge of the £22 billion of efficiency savings, we need excellent managers and finance directors as well as excellent doctors and nurses. I welcome the fact that the noble Lord, Lord Rose, extended his remit to CCGs.

I also welcome the new requirement for hospitals and groups of doctors to provide a seven-day service but I share some of the concerns of the noble Lord, Lord Hunt, about how it will be delivered. People do not get sick to order just on weekdays, so that is important. I should, however, like assurance that this does not necessarily mean putting any further burden on individual hard-working doctors, nurses and laboratory staff. Good planning is needed to avoid further burdens. However, this will certainly mean the recruitment of more trained staff. We need assurance that they are in the pipeline. Can the Minister say, for example, what the Government are doing to stem the flow of staff, trained by the NHS at a cost to the taxpayer, who leave the country as soon as they qualify?

What was missing from the Statement and the speech this morning was context and understanding that filling the £30 billion black hole in the NHS requires a whole-Government response. If patients are to be in charge, they need good health education so that they know what a healthy lifestyle means. They need access to sports and leisure facilities and nutritious food, and they need warm, dry homes. Integration needs to be a lot broader than just integration between health and social care. Unless social care is properly funded, the NHS will not be able to find its expected £22 billion of efficiency savings while making the improvements outlined in the Statement because of the knock-on effect on acute hospital beds. Yet while there has been more money for the health service, there has been nothing but cuts in social care.

The thrust of the Statement was about getting it right first time and, if not getting it right the first time, then certainly the second and subsequent times. This has to be right for patient safety and confidence but also for cost-effectiveness. If we are to rise to the increasing demand on the health service, we must get it right as near as possible every time and we must support the staff in doing so.

National Institute for Health and Care Excellence

Lord Hunt of Kings Heath Excerpts

Monday 13th July 2015 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government why the National Institute for Health and Care Excellence was asked to suspend its work on safe staffing guidelines regarding nurses.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

The Government are committed to supporting NHS trusts to put in place sustained safe staffing by using their resources as effectively as possible for patients. The existing National Institute for Health and Care Excellence guidance on maternity settings and acute in-patient wards will continue to be used by NHS trusts. NHS England, working with NICE and other national organisations, will continue with this work in other areas of care and other healthcare professional groups.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the noble Lord, but that does not explain why NHS England put pressure on NICE to stop working on guidelines on safe staffing levels, despite the recommendation of Sir Robert Francis following the Mid Staffordshire inquiry. Was it because NHS England was no longer prepared to fund the implications of such work? Given that NICE has now decided to continue with work on A&E guidelines, will the Minister assure me that the Government will insist that the NHS implements those guidelines?

--- Later in debate ---

[Lord Prior of Brampton]

The noble Lord raises a good point. We need to train as many of our own nurses as possible. There will be times when we get those calculations wrong and it will be necessary to bring in nurses from overseas. That is not a desirable outcome for many reasons, which there is not time to go into today. We need to train more ourselves.

[Lord Hunt of Kings Heath (Lab)]

My Lords, will the Minister have another go at the Question? I still fail to understand why an independent body, NICE, was instructed by NHS England to discontinue work on safe staffing guidelines. What on earth caused NHS England to do that?

[Lord Prior of Brampton]

NICE has not been instructed to cease its work on safe staffing standards; on the contrary, it has been asked by NHS England to provide it with appropriate guidance.

Health Funding

Lord Hunt of Kings Heath Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness will know that decisions on these matters are left to local authorities, and we wish to give them as much discretion as we can.

[Lord Hunt of Kings Heath (Lab)]

My Lords, there is not much discretion if the Treasury decides to take away £200 million in-year on public health programmes from local authorities. If the intention is to squeeze the public health budget, will the Government therefore take action at national level to compensate for this by legislating to reduce the amount of fat, salt and sugar in food and drinks that are aimed mainly at children and young people?

[Lord Prior of Brampton]

My Lords, prevention is very important to the Government and a very important part of the NHS Five Year Forward View. The reduction of £200 million in the grant to local authorities should be seen in the context of a total grant of £3.2 billion; it is a 6% reduction. Public Health England has a campaign to raise awareness of the damage that sugar and salt, as well as smoking and alcohol, can do to people’s lives.

National Health Service: Sustainability

Lord Hunt of Kings Heath Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, as we are touching on procurement, I declare an interest as president of GS1 and the Health Care Supply Association. I, too, warmly welcome the debate of the noble Lord, Lord Patel, and the excellent way that he put forward his arguments. Of course, the issue of sustainability has been asked almost every year since the NHS’s formation in 1948. Right from the start, voices said that public expectations were too high and called for explicit rationing of services. We know that almost as soon as the NHS was established, our friends in the Treasury were keen to see the introduction of charges. Indeed, in the early 1950s, charges for spectacles, dentures and then prescription charges were introduced. This was followed by the 1953 Gillebaud commission. At the time, it was thought that NHS costs were spiralling out of control and Gillebaud was asked how we could reassert control over NHS spending. In fact, he came to the conclusion that there was a popular misconception about a vast increase in costs and ended up recommending a big increase in capital expenditure.

Through the years, we have had many other reports. Harold Wilson in opposition did not think much of royal commissions. He famously said that they took minutes and wasted years. But he was very fond of them in government and set up a royal commission on the NHS. Interestingly, its brief included the possibility of a greater reliance on other means of funding the NHS. But it was not convinced of that, and said that the claimed advantages of insurance, finance or substantial increases in charges—or co-payments, as we now call them—would outweigh the disadvantages in terms of equity and administrative cost. Mrs Thatcher had another go. Patrick Jenkin set up an internal review to look at the sustainability of the NHS, with potential restrictions of coverage, but it never published the results and no change took place. Now again, we are debating the sustainability of the NHS and the suggestion that a royal commission should be established.

I do not doubt that the challenges put forward today are formidable, but I agree with my noble friend Lord Turnberg that the NHS is still sustainable. For all the problems that we face, the US Commonwealth Fund’s analysis of the NHS two years ago, on comparative terms, as the number one health system in the world at least gives us some confidence that we have something that is worth preserving—albeit one that needs developing as we try to deal with some of the issues that noble Lords have raised.

That does not underestimate the financial gap and the productivity challenge facing the noble Lord, Lord Prior, in his new responsibilities. We talked about the £30 billion gap by 2020. We have heard the forecast from NHS England that if we achieve a 2% to 3% per annum rise in productivity, we could reduce that to £8 billion. The Government have promised that £8 billion, but I doubt that it will be seen until the 2020-21 financial year, judging by the documents published alongside the Budget yesterday. We know that historically the NHS has achieved a 0.8% productivity gain, so that would make the gap £21 billion and not £8 billion. More recently, in the last Parliament, there was a 1.5% productivity gain, but that dipped in the last two years because of the post-Francis impact of increased staffing and, because there had been cuts in training commissions, agency costs spiralled out of control.

Then we had the report of the noble Lord, Lord Carter. My noble friend Lord Reid is quite right: clearly, in relation to procurement, there is money to be got. But even if we implemented the whole of the Carter report, which includes some brave decisions about the employment of staff midweek on wards, it would produce only £5 billion. Put all that together and clearly there is a big gap. Last year provided deficits of £822 million: this year they are projected to be £1 billion.

Alongside that, the Government are actually increasing demand rather than discouraging it. Understandably, more people want access—but 24/7 access? The NHS Choices website is always encouraging people to use the service more and more. It was right for my noble friend Lord Desai to ask the noble Lord about the tension between this desire to give greater accessibility and the issue of demand management. We are reaching a difficult point where the two are not deliverable.

I hope that the Minister will say how he thinks productivity will be improved, but another issue that is vitally important is the quality of management and leadership in the NHS. The challenge is daunting: the productivity gap, the move to seven-day working without the use of agency staff—let alone health and social care integration. At the same time, we know that at the moment performance is deteriorating. Clearly, we need the best possible managers and leaders. I am sure that the Minister has read the Health Service Journal report on leadership, chaired by Robert Naylor, which came out last month. It said that a third of trusts have either vacancies at board level for key leaders or were employing highly expensive interns. There is a 20% vacancy rate for financial directors and chief operating officers. One in six trusts has no substantive chief executive. One in 10 has retained the same CEO for more than a decade, but the median time in post for a trust CEO is a mere two and a half years. One in five CEOs has been in post for less than a year.

Nigel Edwards of the Nuffield Trust has said that high executive turnover,

“has a chilling effect on the willingness of chief executive officers to take bold initiatives and encourages a passive and responsive culture”.

In other words, the fact that chief executives are in fear of losing their jobs encourages the kind of culture that will make sure that we cannot deliver the productivity challenge. I agree with my noble friend Lord Warner that there is no chance whatever that the Government will get to 2020 with a 3% to 4% productivity gain with the current culture—a blame culture with incessant interference by the regulatory bodies and supervising bodies into the work of NHS trust chief executives.

I know that the Minister has huge experience—apart from CQC, he chaired a highly successful trust in Norwich, Norfolk—and I know that he understands this. At heart, Ministers set the tone and culture. I appeal to him to start to change the culture. He will have to put much more trust in people in the field to achieve this change. Of course we have to intervene, as my noble friend Lord Warner said, when an organisation is clearly failing, but if we carry on the way we are doing at the moment we will simply not achieve what we need to achieve, and I believe that the health and social care system will fall over.

I know why noble Lords wish to see a royal commission established—on the face of it, it is very attractive. But I sound a note of warning. My experience of the NHS is that the moment you set up a committee of inquiry, it is always used as an excuse to put off difficult decisions. In a sense, we have in the Five Year Forward View a challenging and agreed programme—agreed by almost everybody—for the way forward. If a commission were established, it would have to be clear that its remit accepted the five-year forward plan as the way to go. I fear the killing effect of a royal commission that took two years and then a Government taking another two years to make up their mind about challenging funding issues such as co-charges. We have already had the Barker commission, set up by the King’s Fund, which went into most of the issues that noble Lords raised.

At the end of the day, I agree with my noble friend Lord Reid that the political process will always come to the fore. The sustainability of the NHS ultimately depends on political will. In the end, it is down to Governments to make sure that the NHS provides what the public want. Do the public want the NHS to be sustained? Yes, they do.

--- Later in debate ---

[Lord Patel]

I thank the Minister for his response, and I am encouraged by his last comments. A 10% gain is still a gain—I would not have expected him to agree. By the way, I did not use the words, “royal commission”. I asked for an independent commission. I understand why political parties may not like the idea of a royal commission, but I am encouraged by what the Minister said.

I am grateful to all noble Lords who have taken part. It has been an excellent debate and the stature of those who have spoken indicates the interest in the subject. I do not think that the matter will be left today, just for another debate. I have to say to the noble Lord, Lord Hunt, that I get the feeling that political parties want to keep the health service in some trouble all the time, so they can use that for the next election.

[Lord Hunt of Kings Heath]

My Lords, the noble Lord is far too cynical.

[Lord Patel]

I wonder what makes me cynical.

Health: Children and Young People

Lord Hunt of Kings Heath Excerpts

Tuesday 7th July 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, we have had a very good debate, and I am pleased that the noble Baroness, Lady Hollins, has enabled us to do it. Rather like the noble Baroness, Lady Walmsley, I want to start by focusing on physical health issues. As she said, the frightening obesity rates among young people are associated to a certain extent with lack of exercise, but I agree with her on what she said about food, eating and poverty.

We have heard the noble Lord, Lord Prior, speak at a number of seminars recently. He has stressed the Five Year Forward View, which the Government have endorsed. One of the encouraging things about that report is that I see—I think for the first time—some passion coming from NHS management about the need to deal with public health issues. That document points out the issue of obesity among young people and the problems that it is going to store up for the future. It also recognises the role of government in terms of legislation. Does the Minister accept the need for legislation when it comes to basic issues of the amount of salt, sugar and fat in foodstuffs, particularly those marketed at young people? He will know that in this country young people drink more of those super-sugary drinks than in any other country within Europe. Of course there is always a balance to be struck between the emphasis on individuals, the parental role and schools, but in the end legislation is sometimes required. I urge the noble Lord that his department ought to be battling in Whitehall to get some legislation around the protection of young people.

I hope that the noble Lord will respond to the point made by the noble Baroness, Lady Walmsley, about academy schools and their ability to go outwith much of what is sensible in relation to the teaching of young people in this area. Also, alongside the issues of food and healthy eating, there is a real concern about where exercise for young people has gone within our schools.

Frankly, we have now reached a point of hysterical obsession with testing young people, and that is crowding out the agenda and the focus. When I talk to year 6 teachers about the SATS testing that now has to be undertaken, I realise that in many schools they are doing nothing else but preparing for the tests for six months, mostly all the wretched testing around maths and English to the exclusion of almost anything else. We are reducing children’s education to a miserable exercise, one in which teachers do not believe, but they are being forced to do it. This is the Government’s obsession, and of course Ofsted has lost any notion of independence in terms of its own role.

The noble Lord may ask what all this has to do with him. It has plenty to do with the health department now that it is no longer concerned with NHS performance—or at least we are being told that, because the 2012 legislation promised it. The department has the space in which to argue in Whitehall for some of the measures that now need to be taken.

I agree with the noble Earl, Lord Listowel, about the whole issue of access to leisure facilities and the impact of local government reductions on many of them. Many local authorities have decimated their leisure service provision, which has a devastating impact on the ability—particularly of those who do not have access to resources—to use such facilities. This will become a very serious problem for the future.

I do not want to spoil the noble Baroness’s Question for Oral Answer on Thursday, and she might have mentioned it, but the Government and certainly the Chancellor have rather undermined NHS England when he swiped £200 million from the public health budget of local authorities in-year. There is a sense in which the Government are saying that of course prevention is important, but their first action after the election was to reduce the amount of money available to local authorities to act in this area. The noble Baroness, Lady Stedman-Scott, made some important points about families, which I hope the noble Lord will respond to.

We have debated the issue of mental health some four times, I think, over the past few weeks. That is important because it is an important subject, but we know from the Royal College of Psychiatrists, which is one source of information for this debate, that one in 10 children and young people suffers from a diagnosable mental health disorder. Half of all diagnosable mental health conditions start before the age of 14, and 75% by 21. We also know that the figures are even more worrying for young people from BME backgrounds. The Health Select Committee report published in November 2014 talked about,

“serious and deeply ingrained problems with the commissioning and provision of children’s and adolescents’ mental health services”.

I know that the Government are going to talk about the task force, and that is welcome, but perhaps I may put four questions to the Minister. First, why is the funding for children’s mental health services still so low in view of all the problems that have been identified? Secondly, I understand that, of the joint strategic needs assessments that are written by each public health director for their local authority, very few mention children’s mental health services. I also suspect that even fewer pick up the point made by the noble Earl, Lord Listowel, about the health concerns around looked-after children. Why is that? Does the Minister believe that directors of public health need to have their attention drawn in their annual report to the importance on the state of the health of their local authority, and that this is an important area for them to be concerned about?

Finally, I want to ask about the introduction of waiting time standards for mental health services. The Minister will know that this was introduced in April 2015 and people are guaranteed talking therapy treatment within six weeks, with a maximum wait of 18 weeks. For individuals experiencing a first episode of psychosis, access to early intervention services will be available within two weeks. I recognise that it is early days; we are only four months away from the start of these new standards, but I wonder whether the Minister can say something about how he thinks the service is progressing.

NHS: Whistleblowing

Lord Hunt of Kings Heath Excerpts

Tuesday 30th June 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord rightly expects a fundamental change of culture among NHS bodies, but does he agree that one way in which that could be helped would be if Ministers welcomed criticism from chief executives and leaders of those bodies of unrealistic expectation on the part of Ministers and of there being too few resources? Does he agree that such leaders are stamped on for making their views known, which is simply not conducive to encouraging openness in their own organisations?

[Lord Prior of Brampton]

The noble Lord makes a good point. If one looks back at the history of Mid-Staffordshire, one sees clear evidence that the priorities of that organisation were too skewed towards hitting financial targets and meeting other extraneous objectives such as becoming a foundation trust. The message to all NHS organisations should be that patient safety and quality of care come first.

Mental Health Services

Lord Hunt of Kings Heath Excerpts

Thursday 25th June 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I very much welcome the debate and very much support the speech made by my noble friend Lady Thornton. I also welcome the work done by the CQC, which identified some good practice but also raised some very serious failings in services. My noble friends Lady Massey, Lord Graham and Lady Thornton have rightly focused on CAMH services and the failures that have been very well documented. We know that the budget for CAMH services has been cut in real terms from £766 million in 2009-10 to £717 million in 2012-13. As we have heard, NHS England’s own 2014 tier 4 CAMHS report confirmed that 16% of patients travelled more then 100 miles to receive treatment, with many going more than 200 miles. It is clear that access for these young people to 24/7 services has worsened, with A&E or a police station often the only place to go.

I have no doubt that the Minister will put his trust in the crisis care concordat. I acknowledge the excellent work that has been done, and the concordat is clear: people experiencing a mental health crisis should have access to the help and support that they need 24 hours a day, seven days a week. But what is the status of the concordat? Is it being performance managed? Who, ultimately, is accountable for its implementation?

The CQC recommends that representatives of local crisis care concordat groups ensure: first, that all ways into crisis care are focused on providing accessible and available support; secondly, that commissioners are to be held to account; and thirdly, that they should engage with partners to encourage innovation. The question is how. If, for instance, their action plans are insufficient, what is going to happen and who is going to make them turn them into effective action plans? The concordat does not specify which organisation should lead this work locally. Why on earth not? The care concordat approach is an excellent one, but it lacks bite because no one is being held accountable for its implementation. Can the Minister sort this out and make sure that someone is truly held accountable?

I read a letter sent very recently by the Minister’s right honourable friend Mr Alistair Burt to the mental health crisis care concordat national signatory organisations. It is a remarkable letter of four pages, reading as eloquently as I would expect because DH officials drafted it. I have told the Minister before that DH officials are very good at writing letters and reports. However, it is all words. There is absolutely nothing in it. It has nothing to say about forcing the pace locally on implementing the concordat.

Of course, the Government have form here. I will not cross swords with the noble Baroness, Lady Walmsley, about credit for the parity of esteem amendment. All I will say is that it might have been her amendment but it was our votes “wot done it”—but we look forward to working together in future. Yet, despite the law, the NHS is determined not to implement it. We start with what can only be described as the outrageous decision of NHS England the year before last to discriminate in mental health funding as opposed to other services.

We have been told that funding for 2014-15 in mental health was planned to rise by £120 million. What was the actual outturn figure? Why do the Government say that more money will go into mental health whereas my understanding is that the forward plans of mental health trusts show that many are planning for a reduction because they have no confidence whatever that clinical commissioning groups will actually do what they were told? NHS England has direct control over CCGs. Why is it not informing CCGs that they must put more money into mental health services?

We now have transformation plans. My understanding is that the Government tasked every CCG with creating transformation plans outlining what they will do to deliver mental health. How will we judge whether those have been successful? We know that mental health data collection is poor. We also understand that the Government are producing guidance for CCGs on how to complete the transformation plans. A key question is: they produce the plan, but then what? Who will actually hold them to account for delivering on it?

That leads me to the better care fund. The Minister knows that this is designed to provide a joint approach to the planning and delivery of health and social care services. Now, given the pressures on A&E, which is really what this is meant to address, and given that we know that because of the cutbacks in mental health services more and more people with mental health issues come to A&E, I would have thought that mental health services would be at the heart of these better care fund plans. However, my understanding from Written Answers to PQs is that of the £5.3 billion of plans submitted in September last year, a mere £370 million was planned for investment in mental health services. That is an extraordinarily low figure. It means that the health service is determined not to implement parity of esteem despite it being a legal requirement. Finally, when will the Government get serious about making the NHS not only respond to guidance or plans but actually act in relation to mental health according to the law of the land?

NHS: Immigration Rules

Lord Hunt of Kings Heath Excerpts

Wednesday 24th June 2015 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what their response is to the Royal College of Nursing report concerning the impact of immigration rules on the employment of foreign nurses within the National Health Service.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, ensuring we have the right number of nurses is vital. That is why we are taking the issue of nursing recruitment seriously and have prioritised and invested in front-line staff, so there are over 8,600 more nurses on our wards. Health Education England’s workforce plan for England for 2015-16 forecasts that, following further increases in the number of training commissions, the proposed levels for nurse training will deliver over 23,000 more nurses by 2019.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord will know that the RCN report estimates that as a result of the migration rules around 7,000 nurses will be forced to leave the NHS because they do not reach the £35,000 per annum employment threshold. Despite the modest increase in the number of training places, is he confident that that gap can be filled, alongside dealing with the current recruitment crisis, the extra nurses needed for seven-day working, the extra nurses needed for improved patient-staff ratios and the Government’s indication that they want to rule out the use of agency nurses in future? When will all those policies be adopted alongside the 7,000 reduction in overseas nurses?

NHS: Innovation

Lord Hunt of Kings Heath Excerpts

Thursday 11th June 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank my noble friend Lord Wills for opening this debate in an excellent way. I am going to talk a little bit about NHS procurement so I should declare an interest as president of both GS1 and the HCSA.

It is my great privilege to anticipate the Minister’s maiden speech, congratulate him on it and welcome him to your Lordships’ House. He is a distinguished businessman, politician and, latterly, was chairman of the fantastic Norfolk and Norwich University Hospital and the Care Quality Commission. I think it is fair to say that he inherited the CQC in a somewhat fragile state. It is to his great credit that he and chief executive David Behan have stabilised the position. I do not take the Roy Lilley approach to the CQC. Of course there will always be issues about its methodology and the way it practises regulation, but I have no doubt that under the leadership of the noble Lord, Lord Prior, the CQC was definitely going in the right direction, and we owe him a great debt for that. I should also say that I particularly appreciated the fact that he and his chief executive made themselves available frequently to politicians, and that approachability is also very much respected and appreciated. I am sure that that will also characterise his frequent appearances in your Lordships’ House in our many health debates.

This is a very important question. We have the great paradox that this country has, as my noble friend Lord Turnberg suggested, a hugely impressive life science base and much-valued R&D. Even today, with all the pressures on UK pharma, there are still many drugs in the top 100 globally which have been developed in this country, yet we have a real problem in adoption by the National Health Service. My fear is always that unless we can dramatically change the approach of the NHS, we will put at risk future global investment in this country.

I shall start by referring to the points raised by my noble friend in opening the debate, on giant-cell arteritis. I have come across similar problems in another disease area—we have had debates on them in your Lordships’ House: one on PAWS GIST, and another on neurofibromatosis NF-1—and my experience is exactly the same as my noble friend’s. The problem is where there are small numbers of patient groups and effectively no national strategy. CCGs simply do not have the capacity, capability or desire to do anything about it at a local level, and GPs are inundated with guidance on one thing or another, making it very unfair to attack GPs on this matter. It is clear that we lack a strategy within NHS England for dealing with these patient groups—these disease areas—where they involve a small number of people. Like my noble friend, I have had a number of meetings with officials at NHS England who are clearly completely overwhelmed by the task in hand. There is no decision-making structure that I can see where you can ask, “Who in NHS England is responsible for giant-cell arteritis?”. It is quite clear that no one has responsibility. They may well have a clinical director who has some vague oversight, but that is as good as it gets.

What has happened to the clinical directors is disgraceful. Under the Labour Government they were employed in the department, with direct access to Ministers. Now they are part-timers in NHS England, with no support and no access to the top of the office, and are left in an impossible position. I hope the noble Lord will sort that out. I also hope he will encourage NHS England to take a much more progressive view on innovation. I welcome a number of the Government’s initiatives, such as AHSNs and the current accelerated access review. Those are strongly welcomed. I know that Mr George Freeman, in his department, shares the concern that we have about the need for adoption in the NHS. However, someone has to sort NHS England out.

We have already heard about the problem of drugs that do not go through the NICE cycle. Basically, NHS England has set up a rationing tool to delay their introduction; that is why there are so many committees—it is simply a rationing tool. The gross example of this relates to the new PPRS agreement on drugs. In that area I congratulate the Government on negotiating an agreement whereby over a five-year period, if drug costs go up a certain level, a rebate is paid out to government. Every quarter a rebate is paid back. I think we have now gone through 18 months, so another rebate is due shortly. The money coming back could have been used to finance new and innovative medicines, but no—it is simply being taken and put into general allocations. There was an opportunity there for the pharmaceutical industry to finance the introduction of innovative new drugs, because we know what the drug costs will be over a five-year period. However, my understanding is that because NHS England was not part of those negotiations, and despite what it says in the NHS Five Year Forward View and Simon Stevens’ commitment to innovation, the practice of NHS England is in fact to stamp on innovation, because the only thing it is interested in is containing costs, and it sees that at a very crude level.

As the noble Lord will know, the 2012 Act has effectively been disowned by the Secretary of State. Every announcement that has been made in the last few weeks suggests that we are going back to good old command and control, and thank goodness for that. The Minister needs to take a grip on this, otherwise we will have another debate on innovation every year. Frankly, it is clear that the NHS is not going to adopt proven innovative new developments, techniques and medicines.

My final point concerns the report of my noble friend Lord Carter, which was published today. I am very grateful to my noble friend for the work that he has done, and I absolutely agree with him when he says that a better approach to purchasing will bring good returns. Again, it has been abundantly clear that we need a central, directional approach to procurement if we are to get those savings. The question that I want to put to the Minister relates to a new approach to purchasing, where essentially the Department of Health or NHS England, on behalf of the NHS, will commit itself to volume purchasing in order to get the kinds of savings that we want. Can he ensure that in the discussions that he takes forward it will be clear to the people doing the negotiations that part of the outcome will be a willingness to invest in innovation? I think that there is the potential for very good, longer-term agreements with industry in which the NHS, because it can commit to volumes, can achieve considerable savings. However, the deal has to be that the NHS adopts new, innovative products and medicines, rather than a penny-pinching approach, which in the end will be cost effective.

I know that some of those matters come within the responsibilities of the noble Lord, Lord Prior. He is warmly welcomed to this House and to his position, and we very much look forward to hearing his maiden speech.