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Earl Howe: My Lords, the noble Lord, with his knowledge of London, speaks with great authority and he will know that reconfiguration is high on the agenda in London. Efficiencies can be created, but we
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The Lord Bishop of Liverpool: My Lords, I declare an interest in that the Church of England is a provider of sessional chaplains in the National Health Service. Given the importance of chaplains to the well-being and recovery of patients and given the value of their work with staff, especially those under stress, will the Minister encourage NHS trust hospitals to resist reducing those services?
Earl Howe: My Lords, as I hope was apparent from our debate in the House the other day, the Government attach great importance to chaplaincy in the NHS. The kind of encouragement that the right reverend Prelate speaks of is something that I will consider. I need to be sure in my mind of how best to do that, but his point is well made and I will take it back to the department to see what we can do.
Baroness Wall of New Barnet: My Lords, will the noble Earl assure the House that in looking for economies in the health service-I am sure that there are opportunities to do that-he will safeguard the vanguard policy of the last Government, which is fortunately retained by this Government, to ensure that patients' experience comes first and foremost? Would he also perhaps take an idea from me to look at how we deal with patients who do not attend-DNAs, as we call them-despite having had prior notice? Failure to attend is costly and inefficient for the health service.
Earl Howe: The noble Baroness is quite right that patients who do not attend their appointments cost the NHS a great deal. How do we deal with the issue-I am sure that the previous Government wrestled with it, too-if we are to avoid charging patients for failing to turn up? I would resist the idea of charging because I do not think that it is a road down which we should be going in secondary or primary care. However, the ways in which we can encourage patients to turn up on time should attract greater focus in our efforts towards achieving efficiency.
Earl Howe: My Lords, to ensure that the quality of NHS services continues to improve in a climate of constrained growth, we must achieve greater productivity, but that means designing services for better quality and value for money. It does not mean downgrading
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Earl Howe: My Lords, I do not think that we have prejudged it because extensive work has already been done in the department. It found that if, for example, a medicine has a high price attached to it, people might be deterred from taking it because of their fear of being a burden on the NHS. Equally, if a medicine has a low price put on it, someone might wrongly perceive that the lower price was linked to lower quality. That is based on research. It is not simply civil servants reacting to an idea; there is a lot of work behind it.
To ask Her Majesty's Government how they will ensure that patients will be seen in reasonable time by doctors and other primary care professionals following the publication of the revised NHS operating framework which removes NHS patient targets.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, the revised NHS operating framework stops central performance management of process targets that have limited justification. The NHS must be free to manage services at a local level, and will be accountable to the patients and the public it serves. To ensure this, we shall continue to collect data measuring access. Incentives for timely access such as through the quality outcomes framework, the NHS constitution and the contractual regime remain in place.
I might add that his Government did not achieve that. I take it that the coalition Government's objective is not that, but the House might like to know what they think is a reasonable waiting time. We got it down to 18 weeks. What does the noble Earl think it should be?
Earl Howe: My Lords, it is right for me to make clear that the previous Government achieved a great deal in bringing down waiting times-there is no doubt that that was a major worry for patients-and they are to be commended for that. The noble Baroness is concerned that we do not let the situation slip, and I fully share that concern. As I have indicated in brief terms, two main issues will prevent it happening. The first is that the legal duty on commissioners to commission services that comply with operational standards around
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Baroness Pitkeathley: My Lords, the noble Earl emphasises localism in the NHS, and that is very welcome, but is he aware that patients and their organisations have expressed great anxiety about not having enough people and structures to check how their local services are doing, especially-as patients and their organisations know very well-because there are some conditions for which early diagnosis is essential if cure is to be achieved?
Earl Howe: My Lords, the noble Baroness is quite right. For example, on the waiting time targets for cancer referrals, we have made no changes because there is a clinical underpinning to those targets. She is also right to say that there is often insufficient information for patients on which to base decisions. We are very keen to build and develop information channels so that patients can be better informed and are able to make better choices about their care.
Lord Alderdice: My Lords, is my noble friend aware that one of the difficulties with targets for waiting times was that clinicians were forced to ensure that all patients fitted into the waiting times, when they were aware that some were a great deal more urgent and some not so urgent at all? Can he reassure me that in devolving more power back to clinicians and more opportunities back to local people-patients and carers-those differences between people's requirements will be taken full account of rather than simply some artificial and arbitrary time limit?
Earl Howe: My noble friend is right because, when all is said and done, many of the centrally imposed targets were quite arbitrary. For example, why 18 weeks, not 17 or 19? It is worth saying that the targets that clinicians and managers set themselves are often a great deal more stringent than the ones that politicians are likely to set.
Lord Crisp: My Lords, as the chief executive of the NHS in England from 2000 to 2006, I think that I had better declare an interest on this matter. Although what the Government announced recently were some minor and probably quite sensible changes to targets, they also sent a big message. The message is about localness, which is very welcome, but there is also a very risky message, which is that waiting no longer matters. I know that the noble Earl understands very well that the NHS listens to what Ministers say. How will he ensure that people in the NHS understand that waiting is still a very important issue?
Earl Howe: My Lords, the noble Lord is absolutely right. I believe that the message that he wants sent has been sent by the NHS chief executive in his letter to NHS bodies. It is certainly a message that the Government want to send. Timeliness is important. A great deal has been achieved. We do not want to squander that, but we think that clinicians should now be given the
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Baroness Wall of New Barnet: Does the noble Earl agree that it would be appropriate for hospitals such as Barnet and Chase Farm to carry on with our internal stretch targets, which we do not declare anywhere, but which ensure that our patients are aware that it is a good hospital to go to? They are not arbitrary-trust me, they are not; they are real-and they make a big difference.
Earl Howe:I have always drawn-and I think that my ministerial colleagues do as well-the distinction between targets that are useful for internal management purposes and for patient decision-making and targets that are micromanaged from Whitehall. There is a distinct utility in the kind of targets that the noble Baroness is talking about because, as she knows, they are often very good proxies for outcomes.
Forty-five Lords completed valid ballot papers. A paper setting out the complete results is being made available in the Printed Paper Office and the Library. That paper gives the number of votes cast for each candidate. The successful candidate was Viscount Younger of Leckie.
Twenty-six Lords completed valid ballot papers. A paper setting out the complete results is being made available in the Printed Paper Office and the Library. That paper gives the number of votes cast for each candidate. The successful candidate was the Earl of Clancarty.
In accordance with Standing Order 51, that, as proposed by the Committee of Selection, the following Lords be appointed to join with a Committee of the Commons as the Joint Committee on Consolidation etc. Bills:
(c) in respect of draft remedial orders and remedial orders, whether the special attention of the House should be drawn to them on any of the grounds specified in Standing Order 73 (Joint Committee on Statutory Instruments);
(a) in relation to any document containing proposals laid before the House under paragraph 3 of the said Schedule 2, its recommendation whether a draft order in the same terms as the proposals should be laid before the House; or
In accordance with Standing Order 73 and the resolution of the House of 16 December 1997, that, as proposed by the Committee of Selection, the following members be appointed to join with a Committee of the Commons as the Joint Committee on Statutory Instruments:
Lord Hunt of Kings Heath: I shall speak also to Amendments 14, 74, 79, 96, 124 and 125. I start by offering my congratulations to the noble Lord, Lord Hill, on his ministerial appointment. This is my first opportunity to be able to do so from the Dispatch Box. I have greatly appreciated his approach and his evident willingness to listen to the points put to him and respond in a most helpful way. I hope that the noble Lord will accept that our amendments are in the same spirit. They are designed to be constructive and to probe some of the detailed provisions in the Bill before us.
I am sure we all share the same aim of wanting to enhance and improve state education and to do so in a way that fosters collaboration between schools and has a positive impact on the state education system as a whole within each local authority area. The way schools become academies is an important element of that and is covered by Amendment 6A. The Bill sets out two academy arrangements. They are an academy agreement and academy financial assistance. This probing amendment seeks to remove the latter approach in Clause 1(2)(b).
The reason for an academy agreement is clear: there has to be an agreement and payments under it have to continue for a minimum period of seven years or indefinitely with seven years' notice. There is also the financial assistance route. In discussions on the first day in Committee, the Minister said:
"The point of having two ways of establishing an academy is that in addition to the current funding agreement route, it was thought to be sensible also to have a flexible way of approaching the subject, particularly in so far as the new free schools might be concerned".-[Official Report, 21/6/2010; col. 1221.]
The Minister was subsequently asked by the noble Lord, Lord Greaves, whether it is the Government's intention to use the legalisation before us rather than the 2002 Act for free schools. The Minister promised to clarify that, and my amendment allows him an opportunity to do so. Interestingly, in the Minister's statement on free schools policy, in answer to a question from the noble Baroness, Lady Walmsley, he said that in regard to the financial assistance funding arrangements in Clause 1(2)(b), which can apply to all academies, not just free schools:
"The point of having a grant rather than a seven-year funding arrangement is that, particularly with a free school, which is a new and untried school, the Secretary of State might not want to be bound into an agreement for seven years and might prefer something that gives him greater flexibility".-[Official Report, 21/6/10; col. 1192.]
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