The smoking ban, welfare benefits and Broadmoor Special Hospital

As mentioned in the previous post, I spent a big chunk of yesterday visiting Broadmoor Special Hospital, in my capacity as Chair of the Independent Advisory Panel on Deaths in Custody.  Most of the discussion and the issues we looked at will inform the work of the Panel.  However, a number of other issues emerged in passing.

It was mentioned that many of the patients now had more money than they did before the smoking ban, as they no longer spend money on cigarettes.  I asked whether the introduction of the smoking ban – applied throughout the hospital site – had raised any specific issues (I remember comments when the legislation was going through Parliament about the problems that were thought likely to arise in prisons and other institutions).  In practice, comparatively few difficulties had arisen.  Nicotine interacts with some medications and this had had to be monitored closely at the time the ban came in and dosages needed some adjustment.  Many patients, we were told, now acknowledged that they were physically healthier, although some had switched their spending from tobacco to chocolate and sweets.

Tensions did arise when individuals were transferred from prison (where smoking is still permitted) to the hospital and have to stop smoking.  However, the biggest source of tension was the difference in income of those transferred from prison and those detained in the Hospital under mental health legislation.  Apparently, prisoners and those transferred from prison only receive “pocket money” of around £17 per week.  Those detained under mental health legislation and who have never been in prison are on welfare benefits and, following a court ruling that it is unlawful to reduce benefits for those detained in hospital for long periods, receive some £80 to £100 per week.  This is clearly an anomaly and I have to admit to being quite relieved that it is not a problem for which my Panel has to find a solution.

I become Minister of Death for the day ….

I spent a big chunk of yesterday visiting Broadmoor Special Hospital, in my capacity as Chair of the Independent Advisory Panel on Deaths in Custody.  The visit was fascinating, staff were very generous with their time and I learned a lot.

I also enjoyed the security arrangements, which are rather more rigorous than most that I have encountered.  You need a photo-ID, you provide two fingerprints for matching on entering and leaving the hospital, most electronic items have to be left in lockers outside the hospital, and you need to go through a metal detector as well as being searched.  When all that is completed you are issued with a visitors’ identity badge, which carries your photograph, your name and job title or designation.

Presumably, when it came to a job title, only a certain number of characters could be entered on the badge and “Chair of the Independent Advisory Panel on Deaths in Custody (Ministry of Justice)” obviously didn’t fit.  I found myself bearing the label: “Lord Toby Harris, Minister of Death”.

Fortunately, the font size was quite small, so I think (hope?) that none of the patients could read it ….

That Was The Parliamentary Session That Was

Parliament has been prorogued. The 2008/9 Parliamentary Session ended on 12th November 2009 and the new Session begins with the Queen’s Speech on 18th November 2009.  I suspect the 2008/9 Session will be remembered for the expenses and other scandals that engulfed both House rather than for the legislation enacted during it.  However, some major Bills were passed and became Acts of Parliament.  These included the:

  • Apprenticeships, Skills, Children and Learning Act:  this provides a statutory framework for and a right for 16-18 year-olds to apprenticeships; gives employees a right to request time-off for training; gives local government responsibility for funding education and training for 16-18 year olds; changes school inspection arrangements; creates a new parental complaints service; and strengthens accountability.
  • Banking Act:  this provides a permanent system for dealing with failing banks; and gives the Bank of England a new “financial stability” objective.
  • Borders, Citizenship and Immigration Act:  this changes the rules on naturalisation; gives new functions (and new duty to safeguard children) to the UK Border Agency; and introduces powers to control all those arriving in the UK from the rest of the Common Travel Area.
  • Business Rate Supplements Act:  this gives upper tier local authorities (in London, the Greater London Authority) the power, following consultation, to levy an additional business rate for economic development purposes (including Crossrail in London).
  • Coroners and Justice Act:  this reforms and updates the law on coroners; extends the laws on child pornography to cover non-photographic images; increases the flexibility on hearing evidence from vulnerable witnesses etc.
  • Health Act:  this gives statutory force to the new NHS Constitution and sets out the responsibilities of patients and staff; introduces direct payments for health services to give patients greater control over the services they receive; makes provision for more information on service quality to be made available to patients and others; and introduces new measures to protect young people from the harm caused by smoking.
  • Local Democracy, Economic Development and Construction Act: this makes provisions to encourage the greater involvement of people in local authority decision-making; creates an obligation on councils to respond to petitions; establishes a new body to represent the interests of tenants; and places a new duty on local authorities to assess economic conditions in their area and to work with Regional Development Agencies to produce a single regional strategy.
  • Marine and Coastal Access Act:  this reforms the law on marine regulation, fisheries management and marine conservation; and enables the creation of a walkable route around the English coast.
  • Parliamentary Standards Act: this created the Independent Parliamentary Standards Authority.
  • Policing and Crime Act: this strengthens police accountability; creates an offence of paying for sex with trafficked or coerced women; tightens regulation of lap-dancing clubs; and amends police powers for dealing with young people drinking in public.
  • Political Parties and Elections Act: this strengthens the powers of the Electoral Commission; alters the definition of election expenses; and requires greater clarity on the source of political donations.
  • Welfare Reform Act: this abolishes Income Support and moves all claimants on to either Jobseekers’ Allowance or, if sick, on to Employment and Support Allowance; introduces a new regime of sanctions for non-attendance at JobCentres; and provides additional powers for the enforcement of child maintenance arrears.

In addition, the House of Lords spent seven full days debating the Postal Services Bill, which would have enabled a minority stake in the Royal Mail Group to be sold whilst ensuring that the Group remained in public ownership, would have transferred the Royal Mail’s historic pension deficit to the Government and would have created a regulatory regime for the postal services sector under OFCOM.  In the event, the Bill, having passed all its stages in the Lords, was introduced in the House of Commons and then abandoned.  The Bill has now fallen with the end of the Parliamentary Session. Three major Bills that have had their Second Reading debates and some Committee discussion in the House of Commons have been the subject of Carry Over motions, which means that they have not fallen with the end of the Parliamentary Session and their progress through Parliament can be resumed in the new Session.  These are the:

  • Child Poverty Bill:  this would give statutory force to the Government’s 1999 commitment to eradicate child poverty by 2020, placing a duty on Ministers to meet income poverty targets and requiring the regular production of a child poverty strategy.
  • Constitutional Reform and Governance Bill:  this would end “by-elections” to replace the remaining hereditary peers that sit in the Lords when they die; would make it possible for members of the Lords to resign or to be suspended/expelled; introduce a new Parliamentary process for the ratification of Treaties; establish a statutory basis for the running of the civil service; end the Prime Minister’s role in appointing senior judges; introduce new rules on protests around Parliament and a variety of other constitutional adjustments.
  • Equality Bill:  this would harmonise and extend anti-discrimination legislation; would place a unified duty on public bodies; extend discrimination protection to the membership of private clubs; require employers to review and publish gender pay differences within their organisations; extends age discrimination legislation outside the workplace; and much else besides.

The number of defeats suffered by the Government this session is the lowest in any full session since the Labour Government was elected in 1997.  This session the Government was defeated on 24 occasions (out of 89 votes in total).  Last session there were 29 defeats.   By contrast there were 45 Government defeats in the 2006/7 session and 62 in the 2005/6 session.  To put these numbers in context: the last Conservative Government under John Major suffered only 62 defeats in the entire 1992-97 Parliament.

Labour now has 212 members in the Lords and is the largest Party, but this only amounts to 30% of the total membership of 705.  There are 190 Conservative peers (27%), 183 cross-benchers (26%), and 71 LibDems (10%) – the remainder comprise 26 Church of England bishops/archbishops and 23 non-affiliated or other. The reality of these numbers is that the Government does not have an automatic majority to carry through its legislation.  At any one time, the opposition parties can combine to defeat the Government, particularly as a significant proportion of the cross-benchers will usually vote with the opposition, depending on the issue.

Winning the battle on hospital acquired infections?

Last night I hosted an event last night in the House of Lords for delegates from all over Europe attending a conference  co-hosted by the Department of Health and the European Centre for Disease Prevention and Control, enabling them to meet Parliamentarians from both Houses (and all Parties) with an interest in tackling healthcare associated infections (HCAIs).  The delegates (from just about every EU nation and a number of EU-candidate countries) were those people who in their country are responsible for coordinating policies and programmes to reduce HCAIs.

Until the event, I confess that I had not realised quite how much progress had been made in this country in this area.  However, speaking to some of the overseas delegates it was quite clear that as far as they were concerned the conference was not just about exchanging experiences, but was very much about learning how the British NHS had done so well in the last few years.

The UK has a particular interest in tackling HCAIs and the conference was focusing on Meticillin Resistant Staphylococcus aureus (MRSA).  Antibiotic resistance is important because it makes infections harder to treat.  MRSA is not a unique UK problem but a concern for most countries.

In 2004, the NHS in England was set the ambitious target of halving the number of MRSA bloodstream infections which was widely believed to be unachievable. In 2007, the NHS was also set the target of reducing Clostridium difficile infections by 30% by March 2010/11.

I was delighted to hear that both of these allegedly unachievable targets have been achieved.

The MRSA target has been exceeded with a national reduction of 66% up to June 2009 from the 2003/04 baseline year. Data for the 12 months up to June 2009 show Clostridium difficile infections in patients aged 2 and over are already down 42% compared to the 2007/08 baseline year.

What was also striking was the enthusiasm of the NHS and Department of Health staff present for the work that they are doing. It is sad that their impressive success is not more widely known.

Andrew Lansley has Stephen Dorrell breathing down his neck – which one is a more plausible Health Secretary?

I am told that the top echelons of the Conservative Party and large numbers of Tory backbenchers think that Andrew Lansley has “gone native” in his time as Shadow Health Secretary.  He is regarded as having got “too close” to the NHS and is not seen as the man who would deliver the sort of root-and-branch “reforms”surgery that the Conservatives really want to embark upon should they become the Government after the next General Election.

Now the Health Service Journal reports that Stephen Dorrell, who was the last Conservative to hold the post of Secretary of State for Health, has attacked Lansley’s vision for NHS “reform” and implying that Lansley would be too timid in making changes to the way in which the NHS works.  Dorrell’s speech to the Conservative Party Conference failed to include the usual ritualistic praise for the relevant Shadow Minister and he didn’t once mention Lansley by name.  Only afterwards – when questioned – did he mouth that Andrew Lansley had his “full support”.  Then, when asked about Lansley’s “vision”, he damned it with faint praise saying “We want to see not so much a new idea but a clear view” and that it needed “filling out”.  Finally, he played right into the speculation about Lansley being too close to the NHS saying:

“The guy has done it for six years; he does understand the service. Andrew is respected in the service, he does know what he’s talking about and he has a clear idea of what he is trying to do.  But right across the public services, what we’ve got to have is a bit of sunlight.”

With friends like that Lansley should feel nervous.

Allegedly, David Cameron “will not hear” of moving Lansley out of the health brief.  Not hearing advice to do something, doesn’t 0f course mean that you won’t do it.  If he offers Lansley 1000% support, I guess we know that Dorrell’s got a new job …..

How much money will want GPs to permit the scrapping of their catchment areas?

Andy Burnham is announcing plans to scrap geographical catchment areas for GPs.  This is a sensible proposal that reflects the complexity of modern living and gives patients more choice.  It means that commuters could register with a GP near their workplace or that people could stay with a particular GP even if they move away.

Inevitably, the British Medical Association have expressed reservations, saying “it’s going to be very complicated”.  This sounds like the usual BMA code for “give us more money”.  Earlier this week GPs finally agreed that they were prepared to vaccinate their patients against swine flu (isn’t that what being a doctor is all about) provided they were paid £5.25 a shot.  So I predict that dealing with a non-local patient (even if they are exempted from ever having to do home visits and such patients will often be younger, more mobile and fitter) will require still more payment.

In the run up to the creation of the National Health Service in 1948, to buy the doctors’ support  Nye Bevan “stuffed their mouths with gold“.  Ever since then, the doctors have expected the same treatment any time there is a change in the way the NHS is run.  This will be another example.

Whilst Andy Burnham’s changes are desirable, what will make the biggest difference will be to allow patients to switch from one GP practice to another simply and without penalty.  At present, anyone who wants to join a GP practice by switching from another local practice without having moved home is treated with suspicion and distrust – the assumption is that they must be a trouble-maker who has dared to question the infallibility of their existing GP (and therefore are not the sort of patient any other GP would want on their books).

Mayor Boris Johnson should follow Mayor Bloomberg’s lead and ban smoking outside as well as in

Mayor Boris Johnson has been in New York on an arduous fact-finding mission meeting his counterpart Mayor Bloomberg.  I hope he took the opportunity to discuss the proposal that New York’s smoking ban inside buildings should be extended outside as well – with a view to adopting a similar approach in London.

There is no doubt that the ban on smoking in workplaces, restaurants, bars and inside places of entertainment has been hugely beneficial to the health of both smokers and non-smokers alike.

However, the cloud of toxic smoke outside buildings, on pavements and in the so-called open air, as unreformed addicts puff away is now more and more noticeable as one becomes increasingly used to the relative purity of the air inside buildings.

It would be deeply unfortunate if New York succeeds in making its city more attractive by extending the smoking ban as envisaged.  London cannot be allowed to lag behind on this.  I trust that Mayor Johnson will not allow London’s competitive position to be eroded.  Do your duty Boris.

Another step towards a democratically-commissioned health service?

Local Government Chronicle is reporting that plans are nearly finalised for a “health integration board” covering fifteen London Borough Councils and their respective NHS Primary Care Trusts.  To be honest the article is rather fuzzy as to what precisely is happening, but the idea is clearly to look at ways of integrating the work of commissioning local health services with the similar work that the Boroughs do in respect of social care.  Already the Chief Executive of Hammersmith and Fulham Council doubles as Chief Executive of the Primary Care Trust and there are a number of models of joint commissioning around in London and elsewhere.

The key point in this is that it will be a move to providing some local democratic ownership of NHS decision-making.  It runs rather contrary to the approach that is being promoted by the Department of Communities and Local Government whereby local authorities are taking on a wider scrutiny role for local public services in their area (which would obviously includes health).  However, as far as the public are concerned, a model that enables their democratically-elected local councillors to take the strategic decisions about the shape of local healthcare is probably more transparent and attractive than a model where those same councillors are merely empowered to ask questions of the unelected bodies that are responsible for the NHS.

The long-term direction of travel remains unresolved and a London Health Integration Board will certainly be worth watching to see what it delivers.

Deaths in Custody Panel’s initial work programme now on MoJ website

The Ministry of Justice website has finally put up the update report from the Independent Advisory Panel on Deaths in Custody that I chair.  This has taken quite a while to appear, but in fact the Panel has been in operation since April, has had two full meetings, and has reported its initial work programme to the Ministerial Council on Deaths in Custody.  This work programme has now been agreed and the various strands of work are being taken forward.

NHS hospitals repeatedly fall foul of computer viruses – because they don’t keep their anti-virus software up-to-date

The Health Services Journal (reporting an investigation by More4 News) says that NHS computer systems were infected by more than 8000 viruses in the last year, most of which would have been avoided if the NHS Trusts concerned had kept their anti-virus software up-to-date.

This would be worrying enough (consequences described included the breakdown of patient appointment systems), but the complacent response of the Department of Health is breathtaking.

According to the HSJ:

“The revelation that NHS trusts have been poor at keeping their anti-virus software up to date has provoked concerns that they are vulnerable to viruses that could cause confidential patient data to be disseminated.

 “But a spokesman for the Department of Health said the electronic patient records systems provided through the national programme for IT were “protected by the highest levels of access controls and other security measures”.”

However, my understanding has always been that once an individual machine has been compromised – depending on what malware has been installed – then all the data accessed or stored by that machine is potentially vulnerable.  So if so many Trusts are failing to maintain up-to-date anti-virus software, then confidential patient data IS at risk.

The Department of Health spokesperson went on to say that:

“local NHS trusts were legally responsible for complying with data protection rules and were expected to record any breaches.”

So that’s all right then …….