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In addition, several programmes of work underpin this Government's commitment to equality in employment in the NHS. The Positive Action project gives NHS organisations tools and good practice examples of how to redress workforce under-representation; the national NHS Black and Minority Ethnic Leadership Forum ensures a stronger voice for BME leaders in the NHS; and the Breaking Through programme aims to support the progression of BME staff into senior leadership roles. In addition, the 10-point leadership and race equality action plan, which was launched in February 2004, challenges all NHS leaders to systematically address race equality with respect to both patient care and staff.
Lord Livsey of Talgarth asked Her Majesty's Government:
Whether they have given guidance to National Health Service trusts about the balance between central NHS targets and local priorities such as equality of opportunity in contracts and employment.[HL6990]
Lord Warner: Priorities for the National Health Service are set out in National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06-2007/08, which can be found on the Department of Health website at http://www.dh.gov.uk. These include details of healthcare standards, existing commitments and new national targets. All National Health Service organisations are expected to meet these priorities and to achieve financial balance.
The Department of Health has more than halved the number of national targets from 62 in 2002-03, to 44 in 2003-04 to 2005-06, and to 20 from 2005-06 to 2007/08, so the NHS can focus on the biggest priorities, leaving it free to manage other services as it sees fit.
The department also has external gateway controls in place to ensure that no additional centrally created targets are imposed outwith those contained within National Standards, Local Action or European Union legislation. Delivery of other commitments is a matter for local determination, and local organisations and communities will set their own timescales and milestones for delivery.
NHS: Care of the Terminally Ill
Baroness Finlay of Llandaff asked Her Majesty's Government:
Whether they will fund the Gold Standards Framework central team work on improving care of the terminally ill in the community from 1 September; and, if so, at what level.[HL7239]
The Minister of State, Department of Health (Lord Warner): The Government have provided £12 million of funding for the end-of-life care (EoLC) programme, to be spread out over the three years from 2004 to 2007. In 2006-07, the funding has been included as part of a block sum for strategic health authorities to manage. This incorporates funding for the Gold Standards Framework (GSF) central team, the GSF being a key strand of the EoLC programme. To ensure that the desired outcomes are achieved, the block sum will be accompanied by a service level agreement.
Baroness Finlay of Llandaff asked Her Majesty's Government:
What they will do to maintain work on improving care of the dying if redundancies have to be made in the central office of the Gold Standards Framework, which works to improve care of the terminally ill.[HL7240]
Lord Warner: The three-year end-of-life care programme to train generalist staff in the principles of palliative care, of which the Gold Standards Framework team is a part, is due to run until 2007. Additionally, the Government have recently announced the development of a strategy on end-of-life care. The strategy will be the means by which the manifesto commitment on palliative care and the programme of action on end-of-life care set out in the White Paper Our health, our care, our say will be delivered.
NHS: Community Services
Baroness Masham of Ilton asked Her Majesty's Government:
To what extent the policy followed by some primary care trusts of reducing numbers of district nurses and health visitors supports the objectives set out in Our health, our care, our community: investing in the future of community hospitals and services.[HL7148]
How services for people with long-term medical conditions or injuries will continue to be provided in their own homes following the reduction by some primary care trusts in the numbers of district nurses and health visitors.[HL7149]
To what extent the policy followed by some primary care trusts of reducing numbers of district nurses, health visitors and midwives supports their policy objectives of reducing waiting times, increasing care provided in the community and preventing ill health.[HL7150]
The Minister of State, Department of Health (Lord Warner): District nurses, health visitors and community midwives have a key role in delivering government policy objectives. It is for primary care trusts (PCTs) in partnership with strategic health authorities and other local stakeholders to ensure that there are sufficient staff to provide the primary care services needed by their local communities. This includes decisions about workforce numbers, grade and skill mix. This process provides the means for addressing local health care needs within the community.
Our health, our care, our say requires PCTs to work with their local community and staff to develop new approaches to meeting people’s healthcare needs. The expectation is for PCTs to enhance investment in community services and staff. Since 1997, there has been an increase of 37 per cent in the number of nurses working in the community.
Many National Health Service organisations are reviewing and rationalising the way in which they work to ensure that they are fit for purpose, and this includes considering the number of staff whom they employ and how they are best used.
NHS: Independent Sector Treatment Centres
Lord MacKenzie of Culkein asked Her Majesty's Government:
What steps are being taken to ensure independent sector treatment centres (ISTCs) carry out the number of operations and procedures for which contracts have been awarded; and whether the ban on National Health Service nurses working in ISTCs will be lifted.[HL7296]
The Minister of State, Department of Health (Lord Warner): The Department of Health monitors and oversees the operation of the independent sector treatment centre (ISTC) contracts, supporting the work of local contract managers responsible for each contract. The department works closely with providers and local National Health Service stakeholders to ensure the utilisation of capacity purchased. Providers are required to provide monthly reports on activity allowing action to be taken to address any shortfalls.
In relation to wave 1 ISTC contracts, no currently employed NHS nurses (or anyone who in the previous six months was employed by the NHS) can be recruited by independent sector providers.
For phase 2 ISTC contracts clinical staff including nurses will be allowed to offer their non-contracted hours to independent sector providers subject to the approval of their NHS employer and that the use of this non-contracted time is consistent with patient safety.
In addition to this ISTC schemes that involve a transfer of activity from the NHS to an independent sector provider already allow nurses to work in ISTCs through secondment or retention of employment arrangements.
NHS: Longridge Primary Care Trust
Lord Alton of Liverpool asked Her Majesty's Government:
What representations they have received from general practitioners and local users regarding the effect on the Longridge district of Lancashire of the reconfiguration of the existing primary care trust; and why they declined a request for a meeting by Councillor David Smith, on behalf of objectors to the proposal.[HL7215]
The Minister of State, Department of Health (Lord Warner): The Department of Health has received 94 letters from general practitioners and the public and a petition with 3,500 signatures objecting to the inclusion of Longridge in the new East Lancashire Primary Care Trust. The request for a meeting with Councillor David Smith was declined, since there was no scope for reversing a decision that had already been taken following full public consultation.
Lord Alton of Liverpool asked Her Majesty's Government:
What consideration they have given, in developing proposals for the reconfiguration of the primary care trust in the Longridge district of Lancashire, to the existing partnerships and traditional links with Preston, and to the views of patient and public involvement.[HL7216]
Lord Warner: Strategic health authorities led the public consultation on new primary care trust (PCT) configurations between 14 December 2005 and 22 March 2006. It was clear from the public consultation that there were concerns about the inclusion of Longridge in the new East Lancashire PCT area. The Cumbria and Lancashire Strategic Health Authority board reached the conclusion that the commissioning of healthcare would be more effective if the administrative boundaries of PCTs were coterminous with those of local authorities and, therefore, that Longridge should be included in East Lancashire PCT for those purposes. However it accepted that management of the Longridge Community Hospital should rest with the new Central Lancashire PCT and that the referral of patients by general practitioners in Longridge to Lancashire Teaching Hospitals should not change. The SHA's proposals on this issue relating to East Lancashire PCT were accepted by the Secretary of State for Health in her announcement to Parliament on 16 May and incorporated in the subsequent Primary Care Trusts (Establishment and Dissolution) (England) Order 2006 made on 24 July.
NHS: Mixed-sex Wards
Lord Marlesford asked Her Majesty's Government:
Which hospitals in England have mixed wards; and what is the estimated date by which they expect each of these hospitals to have single-sex wards.[HL7262]
The Minister of State, Department of Health (Lord Warner): Guidance issued to the National Health Service requires the provision of single-sex accommodation through single rooms, single-sex bays within a mixed ward, single-sex wards or combinations of these types.
The 2004 position of each NHS trust was published on 26 May 2005 and is available on the Department of Health's website at www.dh.gov.uk and in the Library. The small number of hospitals that did not achieve these objectives at that date were building new hospitals. The latest of these developments is scheduled for completion in 2010.
NHS: Neonatal Screening
Baroness Howells of St Davids asked Her Majesty's Government:
Whether they will commission a national clinical framework for sickle cell and thalassaemia to help ensure that the potential benefits of the national newborn screening programme are fully realised.[HL7242]
The Minister of State, Department of Health (Lord Warner): The implementation of the screening programmes for sickle cell and thalassaemia has raised the profile of the conditions and increased the demand for services with increased numbers of cases being identified. A range of work is in hand to support clinicians responsible for patients with thalassaemia and sickle cell and help to ensure that patients have access to the same quality of care, including neonates identified by the screening programme.
A professional group led by the British Society for Haematology (on behalf of the British Committee for Standards in Haematology), and the UK Forum on Haemoglobin Disorders and supported by the Department of Health and the voluntary sector has developed national standards for the clinical care of children with sickle cell disease due for publication later this year. Standards for the clinical care of children and adults with thalassaemia in the UK were published in June 2005. The guidelines were sponsored by the UK Thalassaemia Society and endorsed by the department.
A clinical network has now been established to ensure that the potential benefits of the screening programme are achieved and that the complications that require specialist care are managed in the right place with appropriate resources. Around 20 centres will provide comprehensive care, standardising and improving care in this area.
NHS: Nurses
Lord MacKenzie of Culkein asked Her Majesty's Government:
What proportion of (a) permanently employed nurses, and (b) nurse bank staff have not received mandatory training; why funds made available for this training have been used for other purposes; and what steps are being taken to ensure that NHS trusts, including primary care trusts, develop and fund mandatory training for nurses.[HL7295]
The Minister of State, Department of Health (Lord Warner): All health professionals have a duty to keep up to date in the field in which they practise. The relevant regulatory and professional bodies lay down requirements for this and failure to reach the necessary standard may call the practitioner’s registration into question. The post-registration training needs of National Health Service professionals, including nurses, are decided by local NHS organisations against regulatory requirements, local NHS priorities, and through appraisal processes and training-needs analyses informed by local delivery plans and the needs of the service.
We believe that funding for training generally should be used to ensure that staff at all levels have the opportunity to access training opportunities. In this way some may progress through the skills escalator to professional training programmes. However, it is for each strategic health authority to decide its own priorities for investment and to focus training resources where they are most needed.
NHS: Pathology Services
Earl Howe asked Her Majesty's Government:
What is their latest estimate of the level of inappropriate pathology testing and its annual cost to the National Health Service.[HL7238]
The Minister of State, Department of Health (Lord Warner): No estimate of the annual cost of inappropriate testing is available. However, the independent review of pathology services in England chaired by Lord Carter of Coles, in its report published on 2 August 2006, copies of which are available in the Library, identified several possible factors which could lead to inappropriate testing. These included unnecessary repeat tests and the practice of defensive medicine. The independent review did not find robust evidence in this area but estimated that a figure of 25 per cent for tests carried out in primary care and repeated unnecessarily in secondary care following the patient's admission to hospital might be approximately right.
The Department of Health has accepted the independent review's recommendation to set up a series of pilot projects in England to build a sound evidence base on which to take forward reform of National Health Service pathology services, including reduction of inappropriate testing.
NHS: Primary Care Trusts
Lord Wedderburn of Charlton asked Her Majesty's Government:
Whether they will require every general practitioner surgery in England from which National Health Service services are offered to display the address, telephone number and e-mail address of the primary care trust under whose auspices that surgery operates.[HL7365]
The Minister of State, Department of Health (Lord Warner): Each practice is already required to include primary care trust contact details in its practice leaflet which all practices are required to produce and make available in the surgery to their patients and to those people wishing to become patients.
NHS: Trust Chairmen
Lord Livsey of Talgarth asked Her Majesty's Government:
Whether there are any guidelines on the number of hours per week which a chairman of a local National Health Service trust should be able to devote to that post.[HL7152]
The Minister of State, Department of Health (Lord Warner): Chairs of National Health Service trusts are expected to devote on average 3 to 3.5 days per week to their role at the trust.
NHS: Turnaround Teams
Baroness Barker asked Her Majesty's Government:
Further to the comments by the Lord Warner on 7 June (HL Deb, col. 1269), what budget the Department of Health has allocated for the provision of turnaround teams to work with National Health Service trusts, primary care trusts and strategic health authorities; and [HL6877]
How many turnaround teams have been sent to work with National Health Service trusts, primary care trusts and strategic health authorities since January 2006; and what has been the cost of these teams; and [HL6878]
Whether the cost of turnaround teams for National Health Service trusts, primary care trusts and strategic health authorities are met by individual trusts or authorities or by the Department of Health centrally; and [HL6879]
Which firms supply the personnel for turnaround teams for National Health Service trusts, primary care trusts and strategic health authorities.[HL6880]
The Minister of State, Department of Health (Lord Warner): In December 2005, the Secretary of State for Health announced the creation of turnaround teams. These teams visited the National Health Service bodies identified as facing particular financial difficulties.
This assessment stage resulted in KPMG rating organisations as 1) Immediate priority. Need for urgent intervention to drive turnaround 2) Additional expertise/resource needed to support the turnaround. 3) Drive/focus. Maintain high priority of actions. 4) Regular challenge of management. Encourage to share what works and deliver easy wins.
A list of the firms providing support to the trusts in these categories has been placed in the Library. The Department of Health is funding the national programme office and the strategic health authorities turnaround directors but trusts and primary care trusts are responsible for funding the support they decide they require.
The department will spend in 2005-06 and 2006-07 about £11 million (excluding value added tax and expenses) on the turnaround programme at a national and SHA level covering local baseline assessments, a national programme office, one-off local support payments and SHA turnaround directors.
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