The Right Honourable Sir Robert Fellowes, GCB, GCVO, having been created Baron Fellowes, of Shotesham in the County of Norfolk, for life--Was, in his robes, introduced between the Lord Vestey and the Lord Charteris of Amisfield.
Lyndon Henry Arthur Harrison, Esquire, having been created Baron Harrison, of Chester in the County of Cheshire, for life--Was, in his robes, introduced between the Lord Clinton-Davis and the Baroness Crawley, and made the solemn Affirmation.
Baroness Masham of Ilton: My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In so doing, I declare an interest as President of the Spinal Injuries Association and a past patient of the spinal unit at Stoke Mandeville Hospital.
To ask Her Majesty's Government what they can do to improve the situation of patients with spinal injuries, resulting in paralysis, not being admitted to the National Spinal Injuries Centre at Stoke Mandeville Hospital, Aylesbury.
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, Stoke Mandeville Hospital is taking urgent action to ensure that the full complement of beds is open and that specialist nursing staff are in place to provide effective and safe care for those patients with a spinal cord injury. The trust has recruited an additional nine specialist nurses who will be working at the hospital shortly.
Baroness Masham of Ilton: My Lords, I thank the Minister for his reply. It is good news about the nurses who were recruited when a private hospital was shut. However, is he aware that the spinal unit is a centre of excellence of international repute but that the swimming pool has been shut for over a year, the canteen that the patients use has also been shut for over a year, and that Jimmy Savile raised £10 million with the aid of volunteers? It is disgraceful that a centre of excellence should be treated so parochially by the hospital trust.
Lord Hunt of Kings Heath: My Lords, first, I acknowledge the excellence of the centre and indeed the interest which the noble Baroness has taken in that centre for many years. As regards the pool, my understanding is that it was found to be contaminated and therefore had to be closed. I am glad to note that Sir Jimmy Young has contributed--
Lord Hunt of Kings Heath: My Lords, Sir Jimmy Savile has contributed £400,000 towards the refurbishment of the pool. We look forward to it opening. As regards the canteen facilities, my understanding is that both staff and the community health council were consulted on the changes and that the CHC representative on the working party offered no objection to that closure. Of course patients and visitors can access the catering facilities in other parts of Stoke Mandeville Hospital. As regards the support which the hospital gives to the centre, I stress that the hospital is enormously proud of having the centre in its midst. We believe that the hospital is giving the support that is required.
Lord Walton of Detchant: My Lords, is it not the case that, as the noble Baroness has said, this hospital is not only a major national centre but also has an outstanding international reputation for care of patients with spinal injuries and for research? Has the time not come when a mechanism must be found for protecting units of this nature which have a major national input by ring-fencing finance to insulate them from the vagaries of local trust financing?
Lord Hunt of Kings Heath: My Lords, I certainly agree that a centre of this importance needs to be assured that it will have certainty of finance over a long period. That is why we have made the changes that we have to the previous government's internal market to introduce much more sensible arrangements for the commissioning of services. That commissioning of services rests both on the views of local health authorities and primary care groups as to the kind of specialist services that are required and on bringing together at a regional level the views of other health authorities so that a sensible approach can be reached. I am sure that that is the best way forward for such specialist centres.
Lord Clement-Jones: My Lords, does the Minister recall that during the passage of the Health Act strong concerns were expressed about the move towards out-of-area treatments and their effect on specialist hospitals? What evaluation does the department plan to carry out on the implementation of the out-of-area treatment circular, and in particular on the impact on specialist hospitals, and when will such an evaluation be carried out?
Lord Hunt of Kings Heath: My Lords, of course this is a matter that we keep under review. Regional offices of the NHS executive have a particular responsibility for ensuring that the operation of out-of-area treatment works effectively and for intervening when there are problems. However, it is worth making the point that we would expect the use of out-of-area treatments to be relatively small--about 10 per cent. of the number of extra-contractual referrals that we used prior to the reforms--because the commissioning of services in the future will be done on the basis of long-term agreements based on patient flows and the decisions of health authorities and primary care groups.
Lord Morris of Manchester: My Lords, while I applaud my noble friend's obviously genuine concern for the hospital's future, is it not deeply worrying by any standard that, recently, 11 out of 12 spinal patients seeking admission were turned away? Is not the main issue that, while the trust administering Stoke Mandeville has a regional focus, Stoke Mandeville itself is a national institution? Will my noble friend urgently look again at the proposition that there should be central funding and that Stoke Mandeville should be given independent management?
I am not convinced that ring fencing at a national level is necessarily the right way forward. Many of the problems that have arisen at the centre have been due to a shortage of speciality nurses. It is pleasing that nine new appointments have been made enabling most of the beds in that centre to come back into use. There is much to be gained from collaboration between local hospitals and such centres: services can be shared; the local hospital has the kudos and benefit of having such a centre in its midst; equally the centre has the support of the local hospital and all the services that it offers. As I said, the route through is by strong commissioning based on the views of health authorities and primary care groups as to what specialist services are needed, and an income flow which matches the future patient flow.
Earl Howe: My Lords, notwithstanding what the Minister said to the noble Lords, Lord Clement-Jones and Lord Walton, does he acknowledge that the management staff of Stoke Mandeville are experiencing a difficulty in the sense that, from their perspective, there is a lack of clarity and certainty in
Lord Hunt of Kings Heath: My Lords, it is right that specialist commissioning is a particular focus of our attention--that is why there are specialist commissioning groups within each region of the English health service looking at the commissioning of services and producing guides and plans for the way forward over the next few years. Certainly in relation to the South East Region of the NHS Executive, spinal injuries are a particular focus of its endeavours at the moment. That work will be shared throughout other regions. I say again that the local trust in which the centre is situated recognises its crucial importance and is doing everything it can to support it. The successful efforts to recruit a further nine specialist nurses, which will enable most of the beds to be reopened, is a visible indication of that support.
The Minister of State, Department for Education and Employment (Baroness Blackstone): My Lords, the Government's Green Paper, Teachers: meeting the challenge of change, proposed a major change in teachers' remuneration. This will not be crude payment by results but promotion related to excellence. We offer the prospect of higher pay for high-performing teachers. We want to realise the full potential of our schools, and recruit and motivate talented teachers, as part of our drive to raise standards in schools.
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