Health: Neurological Services

Baroness Ford Excerpts

Tuesday 20th November 2012 Lords Chamber

Asked by

[Baroness Ford]

To ask Her Majesty’s Government what progress has been made in improving neurological services, and in particular the provision of epilepsy services, in the United Kingdom.

[Baroness Ford]

My Lords, I am very glad to have the opportunity to table this Question for short debate this evening, which is now a longer debate. It covers a really important topic at a time of great change and potentially great opportunity for the National Health Service. The opportunity is there to improve neurology services if the clinicians and managers in charge of the new arrangements enable this to happen. But the converse is also true: there is also a risk that current service levels, already unacceptable in many parts of the country, will deteriorate, and I hope that the Minister will address that risk in her response.

I begin my declaring my interest as honorary president of Epilepsy Action, the national charity. I have had the privilege of being associated with Epilepsy Action for some years now and the work that it does and support that it provides for people with epilepsy and their families is simply tremendous. I also have close family experience of the condition and so completely understand the frustrations and challenges that managing the condition brings and of the hit-and-miss nature of the services in different parts of the country.

First of all this evening, I would like to draw attention to the wider issue of neurology services in general. The National Audit Office published a report in 2011 into services for people with neurological conditions, and it is worth reminding ourselves that neurological conditions affect about 8 million people in the UK. The report was not positive. Despite an astonishing 38% increase in spending between 2006 and 2010, there was no commensurate improvement in outcomes. Specifically, people received little or no support after diagnosis. Ongoing care was often fragmented and unco-ordinated. People admitted to hospital as an emergency were usually cared for by health professionals without any neurology experience or knowledge, and perverse performance incentives resulted in a cycle of referral, discharge, and referral. So, one has to ask, where was the money going?

The Public Accounts Committee did just that, and in response, produced an excellent report that set out six recommendations on how the situation could be improved. To their credit, the Government agreed to implement four of these. Can the Minister tell us what progress the Government have made on the PAC recommendations that were accepted? First, can she tell us what progress has been made in the promise to offer a care plan to each person with a neurological condition? The promised implementation date was April 2012. Secondly, the Government agreed to develop a generic neurological quality standard, again by 2012. Can she say what progress has been made in this? Thirdly, a commitment was also given to a plan for driving improvements in quality. This was promised by April next year and so an update on progress would be welcome. Finally, a promise was made to produce a neurological dataset—an extremely important commitment by the Government—by April 2014. Although that is still some way off, again, an update would be welcome.

All of these commitments were made by the Government and will go some way to helping the situation. But I would also like to ask the Minister whether the Government will again consider the recommendation by the PAC to appoint a national clinical lead for neurology. Given that there are currently 8 million people with neurological conditions in the country, that is not a huge ask. We have very welcome national clinical leads for other conditions such as dementia and diabetes, conditions that affect far fewer people, so why is the chief executive of the NHS so resistant to appointing a clinical lead in this important area, particularly as we know there is real room for service improvement and money is not being well spent? Perhaps the Minister can tell us.

The Minister might also like to say why the Government were resistant to mandating joint commissioning at exactly the time when the new NHS arrangements are expected to be significantly more joined up than before. It occurs to me that mandating joint commissioning is simple common sense now.

Turning to epilepsy services in particular, the Minister is aware of the 2009 report by Epilepsy Action, Epilepsy in England: Time for Change. We debated it in this House in September 2010. At that time, I expressed my great frustration that many of the basic building blocks of a decent service were still not in place. Two years on, there has been a slight improvement—I stress slight—but no real movement in getting to an acceptable standard of service.

That brings me to the changes planned for the NHS. The opportunity is clearly there to improve the service for people with epilepsy. But is the will there, and is the leadership there? The new clinical commissioning groups will have a critical role to play in providing and improving services. They could develop a much better quality service than has been the case in the past. But so far the evidence in terms of their planning is not reassuring. Epilepsy Action has been carrying out research into how the NHS in England is preparing for the reforms set out in the Health and Social Care Act. We will publish this research in January 2013, but our findings so far show that two thirds of the clinical commissioning groups that were surveyed do not have, and do not intend to produce, a written needs assessment of the health and social care needs of people with epilepsy. How on earth can appropriate services be provided without a clear assessment of need?

Equally, fewer than one in five clinical commissioning groups that responded has appointed a clinical lead locally for epilepsy. In the absence of a national lead, there is a serious vacuum if there is no local leadership either. Is this something that the Government are prepared to tolerate? How can we possibly maintain and improve services against such a backdrop?

My plea to the Minister is that the Government get on top of this and send out a very clear message to clinical commissioning groups that long-term neurological conditions have to be taken seriously and services planned appropriately. The services for people with epilepsy have not been at anything close to the NICE guidelines for many years. It would be a tragedy if the changes that the Government are implementing now cause the situation locally to deteriorate further because there are welcome changes at a national level, particularly in respect of national or specialised commissioning.

As I understand it, once the changes are implemented, specialised commissioning will become the responsibility of the NHS Commissioning Board. This is a major change and offers a real opportunity to improve services. A single national specification and single national commissioning policy should lead to more consistent standards of care and an improvement in care in those areas where the quality of care in the past has been highly variable. This is a big step forward and I would ask the Minister if she might say a little more about this in her summing up.

Greatly to be welcomed also is the move to commission epilepsy surgery for children nationally. The Government have committed to a three-fold increase in the availability of this surgery, which is fantastic news. Perhaps the Minister could also say whether there will be a commensurate increase in the availability of surgery for adults with epilepsy too, given that we know how totally life-changing and life-enhancing the surgery can be when used appropriately.

There is a huge opportunity to improve services for people with a range of neurological conditions, and we particularly welcome the planned clinical network for neurology. This is a really good step forward. There have been some important changes in the way that the Government have looked at these issues nationally and the new arrangements are to be applauded, but the worry persists—it has been a constant worry all the way through the passage of the Health and Social Care Act. That worry relates to how well the clinical commissioning groups will focus on long-term neurological conditions such as epilepsy, how they are to be held to account for the services that they provide and what the Government will be prepared to do in the event that such services continue to fall short of the basic guidelines set out by NICE. Epilepsy services are already a long way off being acceptable. The last thing we want is for that situation to persist.

Olympic and Paralympic Games 2012

Baroness Ford Excerpts

Thursday 8th November 2012 Lords Chamber

[Baroness Ford]

My Lords, I, too, thank the noble Baroness, Lady Doocey, for introducing this important debate. I register my previous interest as chairman of the Olympic Park Legacy Company. I also pay tribute to the noble Baroness’s work on the London Assembly, where she led the scrutiny of the project with great distinction from day one. I am also greatly looking forward to hearing the maiden speech from the noble Lord, Lord Deighton. I had the pleasure of working with him in his most recent capacity as chief executive of LOCOG, and I know that he brings many exceptional qualities to this House.

The London Games were the first Games to be won explicitly on legacy. Whether that legacy was about inspiring a generation or transforming east London, the ambition was simply huge. Never before has a host city promised so much but, as we know, London delivered, and delivered big time, over the course of the most remarkable summer of sport that most of us will ever experience. One important legacy that we must acknowledge is the strong feeling—this is strange for us, of course—that we are all a nation of achievers now. Building complicated infrastructure ahead of time and under budget? That is us. Was it us winning an unprecedented haul of medals in spectacular fashion? Was it us staging an immaculate Olympic and Paralympic Games in a way that united the nation in pride and admiration, and in a capital city where public transport became a byword for efficiency? Yes, us. We achieved all that and so much more. We must never lose that great pride, admiration and real national self-confidence that the Games sprinkled on all of us. Let us hold on to that; it is very important.

We must never forget that a very important aspect of that success is the legacy of political partnership which characterised the project. We achieved all that over the summer partly because this great project was, from the outset, a model of cross-party support. It is often claimed that sport transcends politics, and the Olympic project demonstrated that very clearly. One of the most valuable things to emerge from this experience would be a commitment from us all, but particularly from our most senior politicians, that some issues require putting politics aside and a cross-party approach.

National infrastructure is one such area, where, if the Olympics tell us anything, it is that we can be the envy of the world when it comes to construction excellence and complex project management. The ODA demonstrated that. The execution of large projects is made immeasurably easier when there is political agreement and support underpinning them. The same goes for planning. The Olympic park in both Games mode and legacy mode was subject to some of the most complex planning applications ever seen in London and arguably in the UK and these were not without contention, as the noble Baroness, Lady Doocey, hinted. But the various national and local authorities and communities came together to deliver the quickest and most efficient decisions I have seen in 30 years of working in the planning system. A worthy legacy would surely be to understand how this was accomplished and to build on this experience when over the next few years we come to renew important infrastructure, such as our main airports and power stations.

The legacy of the Olympics was about much more than physical infrastructure. In this debate, I think many noble Lords will draw attention to the sporting legacy, the economic legacy, the arts and cultural legacy and so on but for the last four years my passion has been the legacy of the Olympic park itself and its surrounding area. It is this aspect of which I am most proud and which, if noble Lords will permit me, I will draw on for a moment or two.

When the Government and the then Mayor of London Ken Livingstone promised in 2005 that the Games would transform the East End it was a massive ambition because, notwithstanding the advantages of location in terms of proximity to the City and to central London, the four boroughs immediately surrounding the park remained the most deprived in London—indeed, some of the most deprived in the United Kingdom. The big challenge was to develop a bespoke site capable of hosting the largest and most complex sporting event in the world in such a way that it could then be capable of immediate transformation into a new set of neighbourhoods, which would in turn integrate into the existing communities and assist in raising the level of prosperity and achievement across all of those communities.

That sounds straightforward when you say it quickly but in 30 years of working on large, complex brownfield sites I have never experienced anything so professionally challenging, although ultimately rewarding. As the noble Baroness, Lady Doocey, has said, it is to the great credit of the ODA, the Lee Valley Regional Park Authority and the OPLC that today, a mere two months after the Games have finished, 500 workers are active on the site and that transformation from Games time to legacy time is well under way. Not only did millions of visitors experience a beautiful park in Games time exceptionally fit for purpose, but the legacy planning application for the post-Games park was approved well before the Games started, allowing this immediate transformation to take place.

The commercial planning was well under way also. The athletes’ village was sold prior to the Games to provide both affordable and market housing and is currently being retrofitted into apartments and family homes. The first are due for completion in 2013. The noble Baroness, Lady Doocey, mentioned Chobham Manor but the whole aquatic centre, the velodrome with its cycle circuit, the splendid copper box, the hockey centre and tennis facilities are all currently being reconfigured for legacy uses and all with new owners or tenants in place. I understand that the massive broadcast centre, a million square feet of commercial space, is about to be let and the magnificent parklands are being transformed as I speak.

The Mayor of London decided to take over the project personally this year and he has still to finalise a range of uses for the mighty Olympic stadium, which we all came to adore during the Games. One thing we do know from the Games is that we have a new national athletics stadium, replete with the most amazing memories and a worthy successor to Crystal Palace as our national venue. That was always the plan. Its status has been cemented by the fact that the 2017 World Championships will be held there.

If other sporting and economic uses can sit alongside athletics in that stadium, so much the better. When I began this process in 2009, that was my sole objective. It is for the Mayor of London now to deliver this. The ultimate success of the Olympic Park, due to re-open on 27 July 2013 as the Queen Elizabeth Olympic Park, will not be known for certain for some years. The noble Baroness is quite right: we must continue to hold to the fire the toes of those responsible so that they keep their Olympic promises, but I am as confident as I can be that the foundations for that legacy have been solidly built.