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In some excellent speeches today, we have heard concerns that noble Lords legitimately have about the challenges facing the health and social care system. I would not seek in any way to underestimate those challenges, though I will respond to them. We just need to bear in mind the huge advances that have
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On this question of targets and priorities, I remember a search for how many priorities the health service had in about 1993, when I was working for the National Association of Health Authorities. We discovered about 57 and thought that we had better stop there. Whichever party is in government, there are lots of things that they will wish to achieve in a publicly financed national healthcare system. We, too, went down the target route. I believe that that was essential at the time, as we put resources into the NHS plan. Many of those targets have now achieved their purpose, and we are moving on to system reform, in which there are a number of components.
First, there is a lot more emphasis on the individual personal care that patients should receive from the NHS, much more accessible services and more choice. Of course there have to be some central targets; that is the deal with the taxpayer. It is absolutely right on such an issue as waiting times that the Government set a target for the NHS as a whole. The system of regulation and standards at the national level allows you to give much more freedom to individual organisations at the local level, with the financial incentive that payment by results gives to reward the best performers. We move from a situation where there have been a lot of centrally directed targets to a new system where there is a great deal of emphasis on the personal service to the individual patient, but with the safeguards of national regulation and safety standards. I am sure that that is the appropriate way to go.
We have all had a go at restructuring the health service and the noble Baroness invites us to have yet another go in health and social care. We have learnt that, whatever the structures, the key thing is whether people work together. Are there the right incentives? Can we remove the barriers to organisations working together? We have decided that it is better to try to get the incentives right to encourage people to do the right thing and to work together.
Nowhere is this more necessary than in commissioning. The changes that we have made, such as the reduction in the number of strategic health authorities and primary care trusts, 70 per cent of which will now be coterminous with the relevant local authority, have been a sensible approach alongside improvement in the capacity of the NHS to commission effectively. The noble Earl, Lord Howe, talked about commissioning capacity. I accept that the commissioning skills of many PCTs needed to be enhanced, but we believe that reducing the number of PCTs and strengthening commissioning capacity is the way to achieve an effective inter-relationship both between PCTs and NHS organisations and between PCTs and local authorities in the services that they provide. That will lead to a much greater integration
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The noble Baronesses, Lady Masham and Lady Shephard, talked about the role of GPs and the out-of-hours experience. Let me say just one thing about the GP contract, to which quite a lot of attention has been given in recent months. The essential part of that contract is the direct relationship between the performance of GPs, in the quality and range of services that they give to their patients, and the financial rewards that they receive. That relationship is unique in modern healthcare systems throughout the world. The question of money has been about GPs exceeding the expectation of the degree to which they would provide the services according to the quality contract. We can build on that, but the structure is there to incentivise GPs to do the right thing by their patients. The result has been more services in primary care, more and better access, and more services such as minor surgery.
On the question of out-of-hours services, my experience in Birmingham is that the role of the PCT in securing the quality of those services has led to very much enhanced service at the weekends and in the evenings. However, I take note of comments that have been made. We expect PCTs to act as guardians of safety and quality, which noble Lords have discussed.
Baroness Shephard of Northwold: My Lords, I very much appreciate the fact that the Minister is trying to address the concerns expressed in the debate. Does he accept that there is a fundamental difference between the kind of geographical area that must be served in Birmingham and the kind of geographical area that must be served in, for example, North Yorkshire or Norfolk, and that in the latter cases sparsity of cover has a real effect?
Lord Hunt of Kings Heath: My Lords, I am always tempted to talk about Birmingham, because that is what I know best. I recognise that there are very different characteristics and that some of the organisational issues and challenges that would be faced in Norfolk and North Yorkshire are very different from those to be faced in downtown Birmingham. However, the key issue is still the same. It is the responsibility of the primary care trust to ensure that people in those areas receive a quality service. That is what we will monitor them against.
We have heard a lot about deficits. First, I apologise to the noble Lords, Lord James and Lord Selsdon, for the fact that their Written Questions have not been answered. I have double-checked, and I am assured that they await my earnest attention. I will ensure that the noble Lords receive those Answers as quickly as possible. I will certainly ensure that the DoH improves its performance.
We have had a problem this year with deficits, and we decided that it would be much better to sort them out once and for all and to put the NHS back on a sound footing than to allow the deficits to continue and to fester. That has meant that some very difficult
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The noble Baroness, Lady Masham, rightly mentioned MRSA. These are very tough challenges, but we have ensured that the NHS is taking the issue seriously. We have set a very challenging target and have local targets for C. difficile. The indications are that MRSA rates are coming down. We need to redouble our efforts, but I do not think that anyone in the health service is under any misapprehension that this very serious matter has to be tackled. My noble friend Lord Morris is right about the essential principles of the NHS and the tackling of health inequalities.
I endorse the views of the noble Baroness, Lady Byford, on the contribution of the WRVS. I also agree with her about the challenges of increased longevity; it is clearly a major challenge for our health and social care systems. Direct payments are available and, we believe, have been greatly welcomed. Thirteen local authorities are piloting individual budgets in order to get evidence to enable decisions to be taken on whether this should be rolled out nationally. Clearly, again, we see great potential there.
Baroness Byford: My Lords, my briefing from that paper indicated that that would require primary legislation. Will the Minister clarify that?
Lord Hunt of Kings Heath: My Lords, I am not aware that it needs primary legislation, but I will double-check to make sure that I have got that right.
The noble Lord, Lord Selsdon, made some interesting comments, particularly on the potential of new equipment. There is no question but that there will be huge gains in productivity and speed of access to treatment the more quickly we can adopt proven new technology. We are committed to encouraging the NHS to embrace innovation as fast as it can. I also agree with him on the need to look at the provision of services in a bottom-up way. My understanding is that the resource allocation review will be completed by autumn 2007, and I am sure that there will be a great deal of interest in that.
The noble Baroness, Lady Gardner, questioned how well partnerships are working. She suggested that it might be all right at director level but that, for people working in the field, it is not so hot. I do not share that view. None of these partnerships works without the staff of both organisations being committed. I accept that sometimes barriers come in the way of that, but the progress that has been made on delayed discharges and in the hundreds of Health
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The noble Baronesses, Lady Gardner of Parkes, Lady Byford and Lady Shephard, referred to resources. I will not repeat what I said in last week’s debate on social care. There has been growth in the social care sector. Of course, I know people are arguing that it is not sufficient. The LGA report, Without a Care?, has proved to be of great interest to us all. It says that there is enough money in the system, but that it is in the wrong place. For local delivery mechanisms, the Government need to shift resources from acute NHS care to social care. I know that the LGA has also expressed serious concerns about whether central government funding is keeping pace with demographic change. These are issues that fall to be considered in our discussions in the next spending round. But I say to the noble Baroness, Lady Barker, that account was taken in reaching the 2004 spending settlement of pressures arising from rises in demand, pay and prices. There may be a debate about how successful that has been, but part of the spending review settlement process is to pick up and identify those issues.
There is of course continuing debate about the question of personal care as opposed to nursing care. Noble Lords will recall with fondness our great debates on these matters. Coming back to the LGA and the comments made by the noble Lord, Lord Bruce-Lockhart, I would say to the noble Baroness, Lady Barker, that we are working closely with the LGA and the ADSS to identify long-term funding requirements for social care that will inform the spending review. We warmly welcome those kinds of debates. We understand the issue of demographic pressures. The evidence presented by Sir Derek Wanless is a matter of great interest to us all and we will feed it into the process. I also accept the comment made by the noble Baroness, Lady Gardner of Parkes, about promoting financial flexibilities. We will continue to do that and to ensure that advantage is taken of them.
The noble Baroness, Lady Fookes, made a fascinating speech about the links between the long-term unemployed and their health and life outcomes. She will know that I have just come from the Department for Work and Pensions, so what she said was music to my ears. The work being done by Tomorrow’s People sounds wonderful. She says that advice coming from a neutral source for people who have perhaps been on incapacity benefit for a long time may be better received. I understand what she is saying, but the Pathways to Work pilots that my previous department undertook also showed that, when you work positively with people and give them the confidence and support to consider work again, even if they thought that they would never get back to work, that can have a remarkable and hugely beneficial impact when they do get back into work. I agree with her that having employment advisers based in GP surgeries is an excellent idea. It means that when a GP is asked to sign a sick note they can offer a constructive alternative. That would be very positive.
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Noble Lords made a lot of comments about the value of community hospitals. The experience of the noble Lord, Lord Taylor, was interesting and very encouraging. Let me repeat the Government’s policy on community hospitals. We have made it absolutely clear that we want more services to be provided in settings that are convenient for patients, such as community hospitals, primary healthcare centres and similar facilities. We have also made it clear that closures should be proposed at local level not in response to short-term budgetary pressures but only where a particular facility is not considered clinically viable or is not being used effectively.
In this great world of devolved decision-making, which both parties are now signed up to, it is not for Ministers to intervene when there are local discussions. It would be wrong for us to do so. Our job is to signal the importance of what many community hospitals can provide. That is why the £750 million capital programme was brought into being; it will encourage the provision of better facilities. On 22 December, my noble friend Lord Warner announced the first schemes to receive funding from the programme. So while I accept that at the moment some difficult decisions have to be made, noble Lords can be assured that we believe that community hospitals are a very important part of the development of community services.
Lord Selsdon: My Lords, before the noble Lord sits down, I thank him for the eleven and a half minutes that it took to get the Answer to my Parliamentary Question, which I am holding in my hand.
5.25 pm
Baroness Gardner of Parkes: My Lords, we have just two minutes left. I thank the noble Lord for how well he has answered the debate, but I must comment on the usual party political from the noble Lord, Lord Warner. I want to make it clear that I have no official status in anything that I have said today. He thought that I was quoting party policy. If the party takes it up, I shall be delighted, but I do not have any official role.
I was pleased to hear the noble Baroness, Lady Masham, talk about specialist nurses, because I could not speak more highly of any group. I loved the contribution made by my noble friend Lord James of Blackheath. It is typical that no one asks questions about millions of pounds. On any committee, if you are debating something that costs £50, you will spend half an hour on it, but the millions go through on the nod. So it is good to have someone like my noble friend Lord James closely following up those matters.
All the contributions to the debate were marvellous. They were so varied that we have had a thorough debate. My noble friend Lord Taylor set out a wonderful history for us, one that sets an example for others. My noble friend Lord Selsdon is always a joy to listen to, as he is one of the best speakers in the
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Motion for Papers, by leave, withdrawn.
Compensation (Exemptions) Order 2006
5.27 pm
The Parliamentary Under-Secretary of State, Department for Constitutional Affairs (Baroness Ashton of Upholland) rose to move, That the draft order laid before the House on 29 November 2006 be approved.
The noble Baroness said: My Lords, this order was laid before your Lordships’ House on 28 November 2006, and a correction slip was issued on 13 December 2006 to correct two errors in that draft. One was a formatting error and the other the date for issue of the trade union code of practice, which I confirm was 28 November.
The order specifies the classes of persons and organisations that are exempted from the statutory requirement to be authorised to provide a regulated claims management service under Part 2 of the Compensation Act 2006. Other related instruments setting out the scope of regulation and detailed regulations that underpin the framework were debated in your Lordships’ House on 5 December and came into force on 14 December. The conduct rules for authorised persons were published in December and the authorisation process was commenced.
The definition of claims management services in the Act is deliberately wide to ensure that there are no loopholes. The aim of the regulation is to target those who provide claims management services in certain specified sectors: personal injury, financial products and services, criminal injuries compensation, housing disrepair, unemployment and industrial injuries disablement benefits on a commercial basis. Individuals working in a voluntary capacity—for example, in citizens advice bureaux or legal advice centres, or where claims management advice is given to a friend—are therefore specifically excluded from the scope of the Act.
The order, which was debated in the other place on 22 January, is made under the power in Section 6(2) of the Act. The Government consulted on the order and discussed the proposals with a range of key representatives to ensure that the definitions accurately described the persons or classes of persons to be exempted. The order exempts legal practitioners, provided they act in the normal course of business permitted by the professional rules to which they are subject; the exemptions will apply only in so far as those concerned are already regulated in the provision of claims management services.
Those providing a regulated claims management service are regulated under the Financial Services and Markets Act 2000. This covers the handling of insurance claims by insurers, including where the
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The order also exempts independent trade unions. The exemption for trade unions was debated at length during the parliamentary passage of the Act. We took seriously the concerns raised and have limited this exemption to trade unions that are certified as independent by the certification officer under the Trade Union and Labour Relations Consolidation Act 1992 in providing regulated services to members and members’ families. The strict criteria set out in this Act qualify a trade union, and the added requirement of a certificate of independence will help prevent a claims management business attempting to set itself up as an independent trade union and thus avoid regulation.
The exemption for trade unions does not extend to any subsidiary company, whether owned wholly or partly by a trade union, and any such company will be required to seek authorisation to provide a regulated claims management service. A condition of the exemption is that trade unions are required to act in accordance with a code of practice issued by my noble and learned friend the Secretary of State on 28 November. The code sets out some key standards that exempted trade unions will need to apply in the provision of regulated claims management services to their members.
My department will work with the Trades Union Congress and the certification officer on monitoring the operation of the code of practice. A requirement of the code is that individual trade unions have an effective means for members to pursue a complaint. Clear breaches of the code can be reported to the TUC or to the Secretary of State. These will be investigated and appropriate action taken against individual trade unions. Very serious breaches of the code could lead to the exemption being withdrawn from an individual trade union, which would then have to apply for authorisation or cease providing claims management services.
The order also exempts: charities and not-for-profit advice agencies; the independent complaints reviewer; students’ unions; the Motor Insurers’ Bureau; the Medical Protection Society and the Medical Defence Union; and individuals who refer or introduce a claim but only if they meet the strict criteria set out in the order. This exemption may apply to garages and body-shops that pass on referrals for fees, reward or gain, but only if they meet the tests I have outlined today. The order provides for an exemption from the need to be specifically authorised and does not imply exemption from the rules of conduct.
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The primary aim of claims management regulation is to protect consumers by regulating the conduct of those who provide these services for commercial gain. We recognise that the regulation of the claims management sector alone is not enough to ensure consumer protection. It is vital that all aspects of claims handling are effectively regulated to ensure proper safeguards for consumers, and my department is working closely with the Law Society, the Financial Services Authority and others to achieve this. I beg to move.
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