The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
It is the responsibility of commissioners and local providers to ensure that services have the staff they need to deliver high-quality care for people with multiple sclerosis. Listening to and learning from patients to improve care is a top priority for the Government. We are committed to putting patients at the centre of services. Commissioners are under a legal duty to involve patients and the public in the commissioning of services.
Lord Dubs (Lab)
My Lords, that is a bit disappointing. Does the Minister agree that MS nurses provide an invaluable service for patients as regards treatment, advice and access to services? Does he further agree that MS nurses can save costs elsewhere in the health service because they can reduce the pressure on GPs and on hospital admissions? Would it not be sensible for the Minister to say positively, “We need to ensure that every patient with MS should have an MS nurse to provide help and support”?
Earl Howe
My Lords, I agree with the noble Lord, Lord Dubs; there is no doubt that MS specialist nurses provide support that is extremely valuable for MS patients and their carers. They help to manage relapses and give advice, they act as a gateway into counselling and physiotherapy, and they help to minimise hospital admissions and reduce the need for consultant appointments. I do not disagree with the noble Lord at all. However, it is worth reminding ourselves that NICE guidelines on multiple sclerosis set out that after diagnosis, patients should be,
“put in touch with … a skilled nurse or other support worker”.
We expect those who work in the NHS to take account of NICE guidance.
Baroness Brinton (LD)
My Lords, given the Minister’s last response, is it not extremely worrying that currently 25 multiple sclerosis nursing posts are under threat of redundancy—about 10% of all MS nurses? Shifting back to generalist nursing care would be a waste of an extremely valuable resource in both health and economic terms, as has been outlined. What is being done to encourage hospitals to maintain this vital service, which can save clinical and out-patient costs, too?
Earl Howe
I have already mentioned the NICE guidelines, which we expect NHS professionals to take account of. In that context it is worth saying that the guidelines are due to be updated later this year, and patients and patient groups will have the opportunity to feed into that. However, in the end it is up to local healthcare organisations, with their knowledge of the needs of their local populations, to determine the workforce required to deliver safe and effective patient care within their available resources.
Baroness Pitkeathley (Lab)
My Lords, given what the Minister has said about the variations, can he explain a bit more about the tremendous regional variations in the numbers of patients who have access to an MS nurse, because this causes great confusion to patients and their families? For example, I understand that in the east of England there are 220 patients per MS nurse, whereas in the north-west there are as many as 650.
Earl Howe
I am aware of those variations. Making the NHS more responsive to the needs of people with long-term conditions such as MS is a key government priority. We have committed to it in the NHS mandate, the NHS constitution and the outcomes framework. Strategic clinical networks have a key role to play in providing expertise and guidance and to smooth out the variations that the noble Baroness mentions. She may be aware that NHS England has appointed David Bateman as the first national clinical director for neurological conditions, whose job it will be to look at the very issues that she has raised.
Baroness Gardner of Parkes (Con)
My Lords, I declare an interest as I have a daughter with multiple sclerosis. I think that I mentioned this some time ago, but is my noble friend aware that the Chelsea & Westminster Hospital waited years to get an MS nurse but had her for only a short time before she was poached by the Royal Free? Then no replacement MS nurse was even considered; the next vacancy on the list was considered and, as far as I know, the MS nurse has still not been replaced. Is there some problem? Is there a shortage of MS nurses? How was one so easily poached from one hospital by another? Is it a case of no one really wanting to spend the money on that and wanting to treat it is as a general thing, comparing it to all other jobs in a hospital? Can anything be done about that?
Earl Howe
My Lords, something can be done. First, patient groups can speak up and can speak to commissioners. As I said in my original Answer, we are committed to putting patients right at the centre of services, which means giving them a voice in the services that are commissioned. I am not aware of the situation in the Chelsea & Westminster Hospital, but my noble friend may like to know that there are now more than 3,300 more nurses working on NHS hospital wards than there were in 2010. That is a positive trend.
Lord Turnberg (Lab)
My Lords, is this not part of a wider problem, in that we have seen a marked reduction over the past few years in specialised nurses working in the community, where they can do so much to help keep patients safe and out of hospital? Should we not be seeing joint funding between the local authorities and the CCGs to fill this gap, which is looming all the time?
Earl Howe
Yes, my Lords, that is why we are creating the Better Care Fund, with £3.8 billion worth of shared money between the NHS and social care, starting in 2015, to make care seamless for the patient, whether it is NHS or social care. That fund has scope to do exactly what the noble Lord wishes to achieve.
Lord Wigley (PC)
My Lords, does the Minister appreciate the cross-border issues that sometimes arise between north-east Wales and north-west England, where multiple sclerosis patients may get some primary treatment in England but the level of support services, such as nurses, may be different over the border? Can he ensure that there is discussion on this between his department and the National Assembly in Cardiff to ensure that people do not miss out for that reason?
Lord Monks (Lab)
My Lords, will the Minister comment on the remarks made to me by an MS sufferer I know very well that MS is a Cinderella service in the NHS and does not get its fair share of resources? Does the Minister agree with those remarks?
Earl Howe
I think that has been true. We are very clear that neurology and, for that matter, specialised neurology, should assume a higher priority than it does. That is why it is so welcome that Dr David Bateman has been appointed as the first national clinical director, which I believe will raise the profile of all neurological conditions. However, the status of NICE guidelines and the quality standard that is coming down the track, which NICE will produce in a year or two, will also help to raise the standing of this very serious condition.