Health: Cancer Drugs Fund

Lord Hunt of Kings Heath Excerpts

Wednesday 13th March 2013 Lords Chamber

Asked By

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether they plan to replace the cancer drugs fund with a new scheme.

[Lord Hunt of Kings Heath]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and refer noble Lords to my health interests.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, we will ensure that there are arrangements in place from 2014 to protect individual patients receiving treatment with drugs funded by the cancer drugs fund. From April 2013, the NHS Commissioning Board will take on oversight of the fund. For the longer term, we are considering ways in which patients can continue to benefit from drugs provided through the fund, at a cost that represents value to the NHS.

[Lord Hunt of Kings Heath]

My Lords, my understanding is that the Government’s original intention was that the fund would be replaced from January 2014. Can I take it from the Minister’s response that the Government are no longer continuing with the introduction of value-based pricing for drug remuneration in future?

[Earl Howe]

No, my Lords, negotiations are now in train with the pharmaceutical industry with a view to introducing a value-based pricing scheme for medicines licensed after 31 December this year. That is still the Government’s intention.

--- Later in debate ---

[Lord Hunt of Kings Heath]

My Lords, can the noble Earl assure the House that the introduction of a value-based pricing system will not delay the introduction of new drugs into the UK, given that the current system of remuneration for drug companies provides a clear incentive for early introduction in this country as opposed to other countries in Europe?

[Earl Howe]

The noble Lord is absolutely right. That, again, is a point that we are bearing very closely in mind in our discussions with the industry.

NHS: Mid Staffordshire NHS Foundation Trust

Lord Hunt of Kings Heath Excerpts

Monday 11th March 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, this has been an excellent debate. No one reading this report or its predecessor could be in any doubt about the suffering caused to many patients and their families by neglect and the lack of a caring attitude. I want to use my brief four minutes to make one plea to the Government, which is for a considered response. Mr Francis has produced a very large report, which I suspect in reality will be read by very few people, with a huge number of recommendations. I am afraid that he has fallen into the trap of so many inquiries, where instead of going for a few focused recommendations we have this huge canvas to consider.

Like the noble Lord, Lord Patel, my great fear is that we may be in danger of creating a massive bureaucratic edifice in dealing with what essentially was a failure in one trust. It is worth repeating that Mr Francis said that what happened in Mid Staffordshire was caused by a serious failure on the part of a provider trust, which did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the trust’s attention. Like my noble friend Lord Warner, I find it difficult to see the threads between what happened in Mid Staffordshire and the general attack that seems to be taking place on the NHS.

I understand the points made about whether the target-based performance approach impacted on quality of care and, indeed, on the involvement of clinicians in their organisation. I defend targets. I remind noble Lords that in 1997 we had the spectre of very long waiting lists. There was a patient charter that said patients should be treated within 18 months—even that was not being met. The result of the target approach has been to reduce waiting time limits to 18 weeks. When one had long waiting times, patients suffered and some people died. I do not think we should ignore it.

Equally, I have listened to the very eloquent speeches made by noble Lords tonight, who have spoken of the changes that need to be made in the NHS. They are valid comments. However, I am struck by the fact that noble Lords have really rather ignored the reality of everyday life in the NHS at the moment; the imposition of another massive structural change and an unprecedented squeeze on resources.

I declare an interest as a foundation trust chair and can say that, seen from the front line at the moment, we have a system under extraordinary pressure. Patient numbers are up, primary care accessibility is problematic and cuts in local government services reduce their ability to take patients out of hospitals and into their homes or care homes. Everywhere systems are under huge pressure. I think it is grossly unfair to ignore those pressures while, as the Secretary of State has consistently done in speech after speech, pointing out to the NHS its alleged deficiencies, without acknowledging the impact of the resource cuts or the uncertainties of the changes being brought about. As my noble friend Lord Warner pointed out, they will do nothing to deal with the big issue we all face, which is the number of frail elderly in our hospitals who ought not to be there.

Therefore, my plea to the noble Earl, Lord Howe, is that rather than thinking that the Government have to respond to each of those recommendations, they think seriously about the essential leadership they can give to allow for caring attitudes to be free in the health service, and to ensure that impossible pressures are not put on the system, from which it can only fail.

Health: Cardiology

Lord Hunt of Kings Heath Excerpts

Wednesday 6th March 2013 Lords Chamber

[Earl Howe]

My Lords, a variety of programmes is running, including Change4Life and the national screening programme. However, as my noble friend will be aware, the kind of sudden cardiac death mentioned in the Question is rather different from cardiovascular disease, which afflicts people in later life. We are talking in the Question about unexplained, very sudden cardiac death in the young, which we believe has little to do with lifestyles and much more to do with genetic susceptibility.

[Lord Hunt of Kings Heath]

My Lords—

[Lord Patel]

My Lords, will the Minister explain a little bit more about the proposed public consultation on screening? The evidence for the screening of families where a cardiac death has occurred, particularly in a young person—which is linked to a gene—is conclusive, so what is the public consultation about?

Medical Research: International Rare Diseases Research Consortium

Lord Hunt of Kings Heath Excerpts

Thursday 28th February 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, I declare my interests in the Register in the health service. Following on from the previous question, I understand that the commissioning costs of rare diseases will be met nationally by the NHS Commissioning Board. However, when patients require regular medication, which would presumably be prescribed by their GP, will funding responsibility fall on local clinical commissioning groups? If so, will they be given specified resources to fund what are often very expensive treatments?

[Earl Howe]

My Lords, the funding for expensive treatments will be very much the responsibility of the Commissioning Board. However, of course the noble Lord is right, because a patient with a rare disease will need to be treated along a pathway of care, some of which will be specialised and some of which will be more routine. It is therefore important that we build into our UK plan for rare diseases an awareness of that pathway so that this is a seamless process. The commissioning must be joined up between the board, clinical commissioning groups and, indeed, local authorities that provide social care.

NHS: West London Hospitals

Lord Hunt of Kings Heath Excerpts

Thursday 28th February 2013 Lords Chamber

[Earl Howe]

My Lords, I cannot comment specifically on that particular set of proposals. However, I can say that we made it very clear nearly three years ago that reconfiguration proposals, wherever they arise, should be underpinned, as should the arising decisions, by four reconfiguration tests. Local plans must demonstrate support from GP commissioners; a strengthening in public and patient engagement, which is the issue raised primarily by my noble friend; clarity on the clinical evidence base for whatever is proposed; and support for patient choice. We expect that where proposals of this kind arise, those four tests need to be met.

[Lord Hunt of Kings Heath]

My Lords, again I declare my interest in health. On that, I am puzzled because of what has happened in the case of Lewisham A&E where the clinical commissioning group itself is clearly absolutely opposed to the downgrading of that A&E service. Why has the Secretary of State determined to go ahead with those changes?

[Earl Howe]

Five out of the six clinical commissioning groups involved in that area were supportive of the changes. It is true that Lewisham CCG was not. However, the four tests were looked at and it was clearly determined by the trust’s special administrator that those tests had been met.

Health and Social Care Act 2012 (Consequential Amendments) Order 2013

Lord Hunt of Kings Heath Excerpts

Wednesday 27th February 2013 Grand Committee

In conclusion, I hope I have demonstrated that the draft order contains no more than is consequential on the Act. It makes some minor but necessary changes to keep the statute book up to date, in particular to ensure that clinical commissioning groups are subject to the requirements of the Audit Commission Act. I commend the draft order to the Committee.

[Lord Hunt of Kings Heath]

My Lords, I am sure that the Grand Committee will be grateful to the noble Earl for his very comprehensive description of this very important order. I refer the Committee to my health interests, contained in the register.

It is a curiosity of Department of Health orders that we are having this debate on an affirmative resolution on a quite unexceptional order, and yet around us great debate is going on about the competition statutory instrument—which the noble Earl will know a little bit about, I suspect—which is a negative order. The noble Earl has explained that this is essentially making changes to primary legislation and that is why it has to be considered in this way. However, having made reference to the order on public procurement, SI/2013/257, is the noble Earl in a position to update the Committee on whether or not he intends to revoke the order?

I was interested in Article 4, which refers to the Audit Commission Act. My understanding is that either the Audit Commission has already been abolished or it is shortly to be abolished. I am not going to open up that debate today but it has been put to me that one of the benefits of the Audit Commission is that the fees it sets help keep audit fees down generally. My question to the noble Earl is: if clinical commissioning groups now have to use the big auditing firms, is there not some concern that fees will rise over time because there is not the discipline of the Audit Commission being able to provide an audit service itself? Given that the management costs available to clinical commissioning groups are quite limited, that would be a concern. Other than that, of course I am happy to support this order.

NHS: Healthcare UK

Lord Hunt of Kings Heath Excerpts

Thursday 14th February 2013 Lords Chamber

[Earl Howe]

My Lords, we are determined that that should not happen. We recognise that the whole of the UK healthcare sector, both private and public, has a great deal to offer internationally. This does not just apply to a few elite organisations. We want to support any NHS organisation that wants to work internationally by helping it to build its capacity and capability to do so. We also want to help industry. In doing that, I stress that we view it as of paramount importance that any work undertaken in no way harms or compromises the quality of patient care here in the UK.

[Lord Hunt of Kings Heath]

My Lords, the NHS clearly has much to offer other countries. Does the Minister find it puzzling, as I do, that, in one sense, we are promoting the NHS all over the world yet, when people from other countries want to come and study here, particularly in health and medical sciences, they find that the visa restrictions are obstructive? When will the Government review their whole policy on visas?

[Earl Howe]

My Lords, the noble Lord raises a pertinent issue in the context of medical trainees. We are addressing it. In particular, we are looking at a request from Saudi Arabia to send postgraduate medical trainees to this country. We believe that we have found a way through that, and will continue to work on that issue for the benefit of other countries as well.

Health: Healthcare Assistance

Lord Hunt of Kings Heath Excerpts

Wednesday 13th February 2013 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether they will reconsider the decision not to regulate healthcare assistance in the light of the Health and Care Professions Council’s preliminary finding, published in December 2012, that there are significant shortcomings in a voluntary register.

[Lord Hunt of Kings Heath]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and refer noble Lords to my interests in the register.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

The department notes the Health and Care Professions Council’s findings. Levels of assurance are already in place for healthcare assistants, including supervision by regulated professionals and registration of their employer with the Care Quality Commission. In addition, new training and conduct standards for healthcare assistants will be published shortly. We will review the need for further assurance of healthcare assistants in light of the recommendations of the Francis inquiry.

[Lord Hunt of Kings Heath]

I am grateful for that response. Does the Minister agree that the significance of the council’s report is that in relation to social care assistants it has concluded that a voluntary register is not sufficient? Does he agree that the same argument applies very much to healthcare assistants? With regard to the Francis inquiry recommendations, will he undertake for the Government to seriously consider reversing their policy on this matter?

[Earl Howe]

My Lords, we have made it clear that each and every one of Robert Francis’s recommendations will be considered extremely carefully, including the recommendation in relation to healthcare assistants. However, it is worth noting that while the Health and Care Professions Council has signalled some potential limitations to a statutory regulator holding a voluntary register, and we take account of that, nevertheless that does not mean that these potential limitations would apply to other organisations wanting to set up a voluntary register. Our view is that that avenue should be explored. The HCPC also flagged up some major limitations in attempting to regulate healthcare assistance. Those messages bear thinking about.

Social Care Funding

Lord Hunt of Kings Heath Excerpts

Monday 11th February 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, we are grateful to the noble Earl for repeating the Statement.

It is accepted on all sides of the House that our current social care system is living through the worst of all possible worlds: a cruel lottery in which people who go into later life with everything for which they have worked so hard on a roulette table and the most vulnerable are always the biggest losers. So it needs to change. The Secretary of State has today published a modest plan that will make the system fairer than it is today, and he is to be congratulated on that. We welcome elements of what he has announced. A cap of £75,000 is certainly better than no cap at all. Raising the means-test threshold will help more people on lower incomes to get some help with their charges. It is a step forward, but it is a faltering one, and only one of a series of measures that are required if older people and people with long-term conditions are to be given sufficient care and support. We need a holistic, cross-party approach.

Last week, the Francis inquiry exposed some very serious issues within the National Health Service which impact on the quality of care for a growing number of older people in our hospitals, often with several different illnesses. The NHS is overwhelmed with the demands being made on it, the tightening of its finances and the rightful emphasis on safety and quality. The changes being made by the Health and Social Care Act focus on the commissioning responsibility of general practitioners but, overwhelmingly, the real need for GPs is to focus on improvements in primary care, including accessibility and support for older people in their homes. Just when local authorities are needed to do so much more to help prevent admissions to hospital and to have much faster and more sensitive support for people discharged from hospital, they are having to cope with huge reductions in expenditure.

It is hard not to feel a sense of disappointment when listening to the noble Earl—first, because a Statement on a subject of such importance was briefed to the media before Parliament; because the Government have abandoned any efforts to build a cross-party consensus before rushing to announce their proposals; and because they have chosen to rewrite the Dilnot report with figures of their own, breaking the careful logic so apparent in Dilnot’s report.

There are four problems with what has been announced today, which I will address in turn. First, it fails the fairness test. We will have a durable solution to the problem only if we can answer this question: will it help every person and every couple to protect what they have worked for, whatever their wealth and savings? This package falls way short. According to Demos, the £35,000 cap, as recommended by Dilnot, would benefit about 3.2 million pensioners. A per person cap of £75,000 will benefit only 1.4 million. For the average couple, the cap is £150,000. That might be enough to protect detached houses, but it will not protect the average semi-detached home in large parts of England.

The Secretary of State selectively quoted Andrew Dilnot and, specifically, what he said about the £75,000 cap. I remind the House that Dilnot said that the cap was,

“higher than we would have wanted—£11,000 higher than the top end of our range —and I regret that”.

Will the noble Earl confirm that people with modest to average homes and savings are not protected under this plan? The Secretary of State claimed that insurance companies will step in with new products so that more people can protect their assets but, in oral evidence to the Health Committee, the Association of British Insurers said that it did not believe that the capped-cost model would result in a market for pre-funded care assurance. I would be grateful if the noble Earl could say what confidence he can give the House that a market will emerge. What discussions have been held recently with the insurance market?

The second issue that I am concerned about is that this addresses only a small part of the overall social care funding problem. With this decision, the Government have prioritised the funding of a cap on care costs with new money, over and above addressing the crisis in council social care budgets. Will the noble Earl confirm that this was against the advice of Andrew Dilnot to the cross-party talks? What it means in practice is that vulnerable people will continue to face rising charges as councils put up fees to cope with the growing shortfall in their budgets. This is the effect of the Government’s care policy in practice: they are asking people to make up the councils’ shortfall, making it more likely that they will have to pay right up to the new £75,000 cap. To many people, that will not feel like progress.

More than £1.3 billion has been cut from local authority budgets for older people’s social care since the coalition came to power. Care charges are rising well above inflation and councils are warning that by 2024, they will be overwhelmed by the cost of care. Does the noble Earl accept that forecast and, if he does, how will the plans announced today help to address it? It is true that the Government have raised the capital threshold to £123,000, and we welcome that, but can the noble Earl give the House any confidence that the extra support people will receive through a more generous means test will not be more than offset by increasing care charges, caused by collapsing council budgets? Many people may not know that the cap does not reflect what people actually pay for care but a local authority average, and does not include accommodation costs. As the noble Earl will know, accommodation costs can be considerable. Do the Government have any proposals at all to cap those costs, given the risk that they might rise as care home owners take advantage of additional state support?

The third element relates to inheritance tax. In 2007, a flagship pledge was made to increase the inheritance tax threshold to £1 million by the party to which the noble Earl has the honour to belong. Just eight weeks ago, the Chancellor said that he would increase the threshold in two years’ time, so what has happened in the past two months to make the Chancellor change his mind? The irony will not be lost that they are now increasing death taxes to pay for their plan. The noble Earl has said that the rest will be made up from national insurance. Does he think it is fair to ask the working-age population to pay for something else, rather than older people? Also, what safeguards will be available for people who have paid for their own care costs up to the cap and then have responsibility taken over by the local authority? What happens when the fees paid by that person are more than the local authority is willing to pay? Would that mean the person having to move from the home they are in to another and, if so, is the noble Earl aware of the risks involved in moving frail, elderly people from the environment that they have become used to?

What is the impact of this announcement on the considerations of the joint Select Committee that is now considering the draft Bill? I understand that it is shortly to report. Will it be asked to reopen its discussions and, if the noble Earl intends to publish further draft clauses, can he say what parliamentary process will be arranged for their scrutiny? I should also like to ask the noble Earl whether, through the usual channels, we might have an early opportunity to debate this announcement. The noble Lord the Leader of the House was very kind last week, when the Francis inquiry Statement was made. He said that he would see whether a debate on the Francis report could be arranged and, to his great credit, my understanding is that a Question for Short Debate tabled by the noble Lord, Lord Patel, has been prioritised for debate. I think it will be on 11 March. Could the good offices of the noble Earl be put to the same effect, so that we could indeed have a very early debate?

In conclusion, up to a point we of course welcome what has been announced today. It is a start but it will not lead to more integration of care. Indeed, it may well entrench the separation between two systems: of free at the point of use NHS and of charged-for social care. It is interesting that Demos described it this morning as being “unambitious” and “miserly”, and that it,

“will do little to solve one of the most vital social problems facing our generation”.

Would it not have made more sense, rather than developing these piecemeal plans in isolation, to have set them out as part of a single vision for a sustainable health and social care system in the 21st century?

NHS: Clinical Commissioning Groups

Lord Hunt of Kings Heath Excerpts

Wednesday 16th January 2013 Lords Chamber

Asked By

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government why the NHS Commissioning Board is discontinuing the poverty element in the funding formula for allocation to clinical commissioning groups.

[Lord Hunt of Kings Heath]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interests on the register.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, I can reassure the noble Lord that the board has not discontinued the poverty element of the funding formula. The board was concerned that while the formula provides an accurate model of healthcare need as currently met, if implemented it would target resources away from those areas with the worst health outcomes. It has therefore decided to give all clinical commissioning groups the same growth while launching a fundamental review of allocations.

[Lord Hunt of Kings Heath]

My Lords, I am grateful to the noble Earl for that explanation and understand that a flat-rate increase is to be given next year on top of the existing formula. Will he assure me that if the national Commissioning Board, after this review, decides not to go down the route that the previous Secretary of State, Mr Lansley, wanted this review to take—namely, to take money away from the poorer areas and give it to the well off areas—it will see no interference whatever from Ministers in relation to that decision?

[Earl Howe]

My Lords, that is a very important principle. It is one of the reasons why we felt that the NHS Commissioning Board should be responsible for the allocation of resources to CCGs and not Ministers, to avoid any perception of party-political interference. However, the Government’s mandate to the board makes clear that we would expect the board to place equal access for equal need at the heart of its approach to allocations. That is why ACRA has been charged with developing formulae independently to support the decision that the board takes.

--- Later in debate ---

[Earl Howe]

My Lords, we are determined that it should not happen. I am as aware as the noble Lord of the perception of party-political bias, and it is highly undesirable that there should be such a perception. That is why, in the mandate to the NHS Commissioning Board, we have stated simply that we believe that the right basis for allocating resources is to place equal access for equal need for healthcare services at the heart of whatever formula the board decides to follow.

[Lord Hunt of Kings Heath]

My Lords, perhaps I may come back to that very important point. The fact is that the advisory committee, presumably following guidance from Ministers and officials, came up with a formula that would have taken money from poorer areas and allocated it to richer ones. That is why the national Commissioning Board decided not to accept it and to go for an across-the-board increase. In the noble Earl’s discussions on the mandate, will he ensure that the Commissioning Board is enabled to come to its own view on these decisions?

[Earl Howe]

Yes, my Lords. In this case, the board concluded that the formula proposed by ACRA accurately predicted the future spending requirements of CCGs, but it was concerned that the use of the formula on its own to redistribute funding would predominantly have resulted in higher levels of growth for areas that already have the best health outcomes compared with those with the worst outcomes. In other words, the formula on its own would have disadvantaged precisely the areas that the noble Lord is most concerned about. On the face of it, this would appear to be inconsistent with the board’s purpose, which is to improve health outcomes for all patients and citizens, and to reduce inequalities, which is a key aspect of the mandate.