NHS: Accident and Emergency Services
Baroness Gale Excerpts(9 years, 10 months ago)
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Baroness Gale (Lab)
My Lords, I, too, thank the right reverend Prelate for bringing this important debate before us today. I may take a slightly different angle from other noble Lords. We are all aware of the problems facing accident and emergency services, but the current pressures on them are exacerbated by a consistent failure to properly support people with long-term conditions such as Parkinson’s, both before and after hospital admission.
In 2012-13, people with Parkinson’s had more than 65,000 unplanned or emergency admissions to hospital, often due to falls, infections or cognitive issues. In England, those over 65 with Parkinson’s are three times more likely to have an unplanned admission to hospital than other people of the same age. In addition to creating serious pressures on already overstretched hospitals, this costs the NHS around £177 million each year. However, with proper support at an early stage, many of these admissions could be avoided.
Giving people with Parkinson’s the right information and equipment can often help them to manage their condition, rather than relying on accident and emergency services once they reach crisis point. Services such as physiotherapy, dietician support or falls prevention are also a great help in averting health crises, yet access to these services remains inconsistent. Good quality early intervention would significantly reduce the high number of people with Parkinson’s coming into accident and emergency departments in the first place, thereby relieving some of the pressures that hospitals are now facing.
There is also an urgent need to improve care for people with Parkinson’s once they are admitted to hospital, in order to reduce both avoidable harm and the length of time they are required to stay. Patients with this condition currently spend around 75% longer in hospitals than others of a similar age, equating to more than 128,000 excess bed-days a year. In 2012-13, these excess days cost the NHS more than £20 million. A key reason for this is that many people with Parkinson’s who are admitted to hospital often experience serious disruption to their medication. Parkinson’s medication regimes are often complex, sometimes requiring up to 30 doses at specific points throughout the day. It is vital that people receive their medication on time, because delays can rapidly worsen their symptoms. We have discussed many times in your Lordships’ House the need for these patients to get their medication on time, every time. Anyone with Parkinson’s who does not receive their medication on time is put at risk, and these incidents can create a vicious cycle of escalating care needs for patients with Parkinson’s and overwhelming pressures on hospital staff.
However, there are a number of straightforward and cost-effective steps that hospitals can take to reduce medication errors and excess bed-days for people with the condition. They include giving patients the option to administer their own medication, as recommended under existing guidelines; taking up Parkinson’s UK’s training opportunities on the importance of medication timing; and making sure that there is always a supply of Parkinson’s drugs in emergency medication cupboards so that they are easily accessible when someone with the condition is admitted.
I am sure the Minister recognises that there is a clear link between the lack of adequate support for people with long-term conditions like Parkinson’s, and the serious pressures being experienced by accident and emergency services. Taking steps to reduce both avoidable admissions and avoidable harm will protect individuals, alleviate the strain on hospitals, and benefit our health service as a whole. I hope that the Minister will take the opportunity to outline how these problems can be addressed as part of the Government’s wider response to the current situation.
Care Bill [HL]
Baroness Gale Excerpts(11 years, 4 months ago)
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Baroness Wall of New Barnet
My Lords, I also support all these amendments, particularly in relation to the previous discussion of getting older people out of beds that they are blocking, as I think the noble Baroness, Lady Greengross, put it. That is perhaps an inappropriate word but, in reality, those are the facts. The care plan that everybody has talked about is important, and hugely effective when it works. I have to admit that in my own hospital—I declare my interest as chair of Barnet and Chase Farm Hospitals Trust—it does not always work. Very often, the breakdown with the local authority can come from the start of the agreement on a care plan—what will happen to the individual, how many X-rays they will have, where they will go at the end and so on.
One of the good things in the new system—there are several—is the CCGs. The relationship between clinical commissioning groups and local authorities is proving, in the very short time that it has been working in my area, effective. The more pressure on commissioners in terms of getting hospitals running better, the more interest they have in making sure that local authorities are doing their bit as well. That partnership, in my view and my experience of the past months, has been working much better, which, for us, is a very good thing.
Baroness Gale
My Lords, I will speak to Amendments 92ZZEA and 92ZZEB. Clause 22 is titled:
“Exception for provision of health services”.
Subsection (1) is crucial, as it sets out the legal test for when NHS continuing care or registered nursing care should be provided and when the means-tested social care system may lawfully provide for nursing care.
Recently, I have been listening to people give evidence to the APPG on Parkinson’s, which I chair and which has been conducting an inquiry into NHS continuing care. Listening to the witnesses, it has become very clear that there are often lots of problems with the health service and social care services arguing over funding. People are having difficulty accessing continuing care under the NHS and have to get over lots of barriers. It is quite heartbreaking to hear the problems that people are having.
The wording of Clause 22 still carries a potential risk for those who self-fund their care. There are various provisions in the clause that allow local authorities to arrange for health services that should be provided by the NHS. Once councils start delivering healthcare, when they traditionally used to deliver means-tested and chargeable social care, there is a risk that someone—somewhere in the system—will mistakenly conclude that the council can charge for those services. There is a need to ensure that self-funders are not exposed if they are found to be eligible for NHS continuing care, or registered nursing care, and the package of delivery is with the local authority. These matters were raised by the Joint Committee scrutinising this Bill but have not yet been addressed.
In legal terms, local authorities are prohibited from providing anything authorised or required to be provided under the NHS Acts. This means that social services cannot provide care home accommodation if a power or a duty to provide the accommodation exists under any of the NHS Acts. Clause 22 has narrowed this down to just “required”, for example by omitting the “power” or authorisation provision. That leaves local authorities able to provide accommodation that the NHS has a power to provide. I believe that disputes and confusion have occurred between councils and the NHS over continuing care, and this seems to be a recipe for more. The Bill should be amended to prohibit local authorities providing a service or facility that is authorised or required to be provided under the NHS Act 2006.
My amendment would mean that local authorities would be prohibited from providing health services that are authorised or required to be provided under NHS Acts. My aim is to make it clear who can deliver what, so as to avoid self-funders being at risk, however small that risk might be, of having to pay for care that they should be getting free.
Clause 22(4)(a) also states that a local authority may, despite the prohibitions, arrange for care home accommodation with nursing care if it has consent to do so from the clinical commissioning group. This may also put self-funders at risk of being charged for services that should be free.
These amendments would introduce an explicit clause that sets out that, where a local authority provides services on behalf of a clinical commissioning group, the authority may not recover the cost from the individual whose needs are being met. I trust I have set out clearly why these amendments are needed and I hope that the Minister will agree with me.
Earl Howe
My Lords, it is vital that care and support, health and other services are joined up, as this offers the potential to make measurable improvements in individuals’ outcomes and experiences of care and support. Clause 3 places a duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other health-related services such as housing. Amendment 81C, tabled by the noble Baroness, Lady Wheeler, raises the issue of co-operation duties on the NHS; I have no issue with that sentiment. Clause 3 is intended to reflect the similar integration duties placed on NHS England by Section 13N, and on clinical commissioning groups by Section 14Z1 of the National Health Service Act 2006, in the context of this Bill.
Clause 6 imposes a general duty to co-operate between the local authority and other relevant authorities that have functions relevant to care and support. Clause 7 supplements this by creating a specific duty to co-operate in individual cases.
Clause 22 sets out the limits on what a local authority may provide by way of healthcare and so, in effect, sets the boundary between the responsibilities of local authorities for the provision of care and support, and those of the health service for the provision of healthcare. Our intention is to replicate the effect of the current prohibitions on what a local authority may provide by way of healthcare, which are imposed under Sections 21 and 29 of the National Assistance Act 1948 and Section 49 of the Health and Social Care Act 2001. This is a matter eloquently raised by the noble Baroness, Lady Gale, in tabling Amendments 92ZZEA and 92ZZEB.
The word “authorised” in Section 21 of the 1948 Act has resulted in much confusion and case law. The intention behind Clause 22 is therefore to simplify the language and to make the boundary clearer without moving it. Make no mistake: where nursing care is being funded by the health service, it will continue to be unlawful for a local authority to recover the cost of this from the individual. It is the relevant clinical commissioning group that would be responsible for this cost.
On Amendment 82A, I wholeheartedly agree with my noble friend Lady Barker that no one should be given medical treatment or be medically assessed against their wishes where they have capacity to make such a decision. I hope that my noble friend will be reassured that the existing legal position and clinical practice is clear on that point.
Amendments 87ZZA and 81B were, again, spoken to by the noble Baroness, Lady Wheeler. The prominence of health and wellbeing boards will be strengthened through their role in signing off the joint plans that are required as part of the £3.8 billion pooled fund between local authorities and the NHS to support joined-up and integrated working. The need for local commissioners to engage with their health and wellbeing boards is made clear through their composition, which includes the director of adult social services, the director of children’s services, the director of public health and a representative of each relevant clinical commissioning group. The duty to co-operate already applies to these health and wellbeing board members.
Baroness Pitkeathley
My Lords, I support almost all the amendments in this group because I acknowledge their importance, particularly from the point of view of the Joint Committee, which similarly placed a great deal of store on the provision of information and advice. Indeed, it suggested that there should at the very least be a national campaign to promote the new arrangements to those who might use them.
I rise to speak briefly to Amendment 86H, to which I have put my name, along with the noble Baroness, Lady Browning. Social workers on the whole do not get a good press. They are heard of only when things go wrong. Most of the time the vast amounts of quiet, patient work that is carried out by social workers in local authorities, the NHS and the voluntary sector is ignored. We should give their skills and the vital contribution that they make to help people find their way around complex systems more recognition. The noble Baroness made it clear that she is suggesting that a social worker needs to be involved not in all cases, but just when present and foreseeable needs are classed as complex. In those cases we must take into account that people’s ability to take in information is tremendously variable, depending on their situation and state of mind at the time. I have lost count of the number of conversations I have had with service users and carers who are totally bemused by the information they are given or the access that they have even when they manage to get hold of some information.
I will never forget the carer who gave me a wonderful illustration some years ago. She said, “I feel as though somewhere out there is a great mushroom of information. If I could just find my way up the stem, I’d find out where all this information is, and it would help me. But I don’t even know where the stem begins, and nobody seems to be able to help me”. Information in its raw state is often very difficult to interpret. It is the skill of the social worker in assessing what information is needed, when and in what form it is needed in complex cases, and signposting the information and advice that is required in every case. Those particularly complex cases need social worker involvement. Such cases are not being met and will be even less well met in the future with the new system and range of information that will be available.
Baroness Gale
My Lords, I rise to speak to Amendments 83ZA and 86A, tabled in my name. For individuals entering the world of care and support for the first time, it can be a confusing, complex and protracted process. The introduction of information and advice services for those individuals will be very welcome.
I mentioned earlier that I chair the APPG on Parkinson’s and that we are currently conducting an inquiry into NHS continuing care. Continuing care is a package of care that is arranged and funded by the NHS and is free of charge to the person receiving it. The decision for eligibility rests not on a person’s condition but on whether the need for care is primarily due to health needs. While there are just over 57,000 people in receipt of NHS continuing care in England, it is unknown how many people may actually be eligible in law and have not even applied for it, or who have failed in their attempts to be assessed properly for it. As part of the inquiry into NHS continuing care, I have been hearing from people about their real problems in accessing NHS continuing care. We found during our inquiry that people with Parkinson’s and other long-term conditions are not given information about NHS continuing care. The impression that I have been given is that, because it will cost the NHS considerably, people are not encouraged to apply for it. This leaves people with no option but to go to the means-tested social care system to have their health needs met. That situation is entirely unacceptable.
As Clause 4 introduces a duty on local authorities to establish and maintain an information and advice service, it is important that all the appropriate information and advice are provided. With the further integration of health and social care, it is essential that individuals are in full possession of the facts about all aspects of the support to which they are entitled. While the list currently provides some crucial aspects for people receiving care and support, I believe that NHS continuing care is a glaring omission. We hear of the two services arguing the differences between what is a health need, which is free at the point of use, and what is a social need, which is currently charged to the individual. This can often lead to the individual either being forced unnecessarily to pay for their own care while the debate goes on or being left trapped in their hospital bed. Although NHS continuing care is part of the health system, it must be included in the list provided by the local authorities as set out in Clause 4. People who may be eligible for NHS continuing care are also likely to have such needs that they could be in receipt of support provided by their local authority. If their needs change so as to render them eligible for NHS continuing care, there should be a seamless transition to that system that does not affect the standard of support they receive.
A strong information and advice service must include information about an assessment for health provision, so that individuals can go to this service confident that they will find out everything they need about care and support. The Care Bill offers an unprecedented opportunity to address these defects within the NHS continuing care system. Including it in the list of matters about which people should be given information and advice would promote awareness of its existence and prompt councils to refer people for assessment where they appear to be eligible for NHS continuing care. I trust that the Minister will take note of the points that I have made and that he will be able to accept these amendments.
Baroness Barker
My Lords, I declare an interest in that I work with a number of charities involved in the provision of information and advice about health and social care.
When I read this policy, it seemed to me that it reflected the practice of giving information and advice as it has been done for the past 20 years. I am not sure that that model of information and advice-giving is sustainable. It has depended largely on local bodies, many of which are in the voluntary sector and extremely professional in their services, but which provide a lot of generic, low-level advice. I do not think that that is sustainable—I was going to say in the longer term but, given the way that local authority budgets are going to have to decrease by a third by 2015, I do not think that this is sustainable in the short term either.
In future, there will increasingly be a move towards providing information digitally. New organisations and new social enterprises, such as IncomeMAX, are already heading down that path, and a number of local authorities are increasingly turning much of their provision over to that way of doing things. That is fine for people who are very well informed and who can access information in that format. What I cannot see is a sustainable funding model for the sort of high-level, complex financial advice that the noble Lord, Lord Lipsey, was talking about. This is necessary when people need to be enabled to go through the process of making decisions about, let us face it, the biggest asset that they have, which is their home. We are talking about something on an altogether different level.
We should also note that the system that we have had until now in terms of the provision of advice about social care was predicated on there being different eligibility criteria throughout the country. That is not going to be the case in future.
Like many noble Lords, over the past three or four years since Andrew Dilnot first appeared on our horizons, I have attended many seminars and lectures where people have tried to work their way around this problem. Two things strike me as being important. First, we cannot lay all the obligations on local authorities alone. At least in part, the NHS has to realise that it has to fund information and advice as part of the overall health and well-being package. I freely admit that I have yet to come across people in the NHS who truly understand the basic importance to health of information and advice. One of the first things that the department and the Government could do is to work on how we explain to commissioners in the health service why the outputs of information and advice services are important to them.
Secondly, we already know—the noble Baroness, Lady Greengross, and I know very well—that if you ask a group of older people who have assets what is the number one thing that they want, they say that they want independent financial advice. They do not believe that the people who sell them products are independent. They are right not to do so. That is a problem for the providers of those products. The only way of getting around this that might work is if, in future, some of those products have an element of money within them that is somehow passed into a pooled fund of money that comes from the private and statutory sectors and which can be put towards the provision of independent advice. That is not a worked-out idea, but it contains within it something of the ideas that the noble Baroness, Lady Greengross, mentioned, which are the key points in all of this. She is right that there is a need for regulated advice. I am not quite sure at which point a person needs that. Is that regulated advice something that they need before they come to a decision about which financial product to choose? The law that governs the regulations that exist at the moment usually comes into play when somebody decides to buy a particular product, so there is a real problem about when people have access to the right type of advice. The noble Baroness is on absolutely the right track. Somehow, in all of this, we need to arrive at a point at which resources are spent by people with the right knowledge and the right degree of independence to enable them to come to the right decisions.
Care Bill [HL]
Baroness Gale Excerpts(11 years, 4 months ago)
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Baroness Gale
My Lords, Amendment 88H seeks to amend Clause 12. The clause provides an excellent framework for assessments to be carried out by local authorities. However, the clause should be tightened to ensure that the framework is fully and properly implemented.
People with Parkinson’s and long-term conditions have problems in accessing NHS continuing healthcare. The APPG on Parkinson’s, which I chair, is holding an inquiry into NHS continuing care. We have been hearing about the difficulties people experience in finding out about NHS continuing care and the further difficulties in getting an assessment. Even when people are assessed, the assessment can be fraught with problems such as assessors not really understanding the condition and even assessments happening without people knowing about them.
Clause 12(1)(g) states that the regulations may,
“specify circumstances in which the local authority must refer the adult concerned for an assessment of eligibility for NHS continuing healthcare”.
The Care and Support Alliance believes we must ensure that local authorities and health services work together and make people aware of NHS continuing care and that people are referred on to continuing care assessments when there is a health need.
The importance of this cannot be understated. Social care is means tested and healthcare is free, so whether someone is funded by the NHS or through means-tested social care systems has significant cost implications for that individual. The Care Bill provides a perfect opportunity for councils to ensure that people who may well be eligible for free NHS continuing care are rightly signposted to, and assessed for, it.
Clause 12 offers guidance about what may be in the regulations relating to assessing social care needs and assessments for carers under Clauses 9 and 10. It states that regulations “may” make provision on the circumstances in which the local authority must refer the adult for continuing care. This does not go far enough and the word “may” should be amended to “must”. If there is not a clear mandate placed within these regulations, the vital issue of signposting for services and systems such as continuing care could be overlooked in the drafting of these important regulations.
The regulations must make provision for the circumstances where local authorities may refer the adult on to NHS continuing healthcare. There is a lack of knowledge about who is eligible and the funding that people are potentially entitled to, so we should have certainty that these regulations will stipulate these circumstances. This should lead to a greater awareness of NHS continuing healthcare and greater access.
These attributes could ensure that all assessments are carried out in a way that supports the individual, take into account their needs and the needs of their families and carers, ensure that the appropriate professionals and experts are involved in the assessments and that people are referred on to NHS continuing healthcare as appropriate. I know that “may” and “must” are very small words, but I hope that the Minister will take note and agree to the amendment.
Earl Howe
My Lords, the Care Bill marks a historic step forward in improving the rights of adult carers. Although successive Governments have recognised the contribution carers make and have supported Private Member’s Bills about carers, this is the first time that the Government have included specific provision for carers’ rights to social care in their legislative programme. These provisions have been warmly welcomed.
Amendments 88E and 88F, tabled by the noble Baroness, Lady Pitkeathley, bring to the attention of the Committee the important role that the NHS can play in helping those with caring responsibilities look after their own health, identify themselves as carers and access information and advice.
Clinical commissioning groups already work with local authorities through health and well-being boards to understand and plan for identifying and supporting carers. Many clinical commissioning groups already have, or are developing, joint carer strategies. Importantly, the pooled health and care budget for 2015-16 announced last week as part of the spending round will help health and care and support to work together in supporting carers.
I quite agree that it is, of course, crucial that steps are taken to help individuals with caring responsibilities to identify themselves as carers. The Department of Health has provided over £1.5 million to the Royal College of GPs, nursing and carers’ voluntary organisations over recent years to develop training and resources to help those working in primary and community healthcare to support people with caring responsibilities. We will consider further bids to extend this work programme, including extending support to nurses working on hospital wards and outpatient departments.
I listened with care to the noble Baroness, Lady Royall, in this context and I would say that carers of people with cancer will benefit from steps which NHS England and the Department of Health are taking, some of which I have already referred to. I would also say that the current initiatives have unleashed an enormous amount of enthusiasm among frontline staff, and both nurse and GP carer champions and voluntary sector carers’ ambassadors have been recruited. They are increasing understanding about supporting carers locally at both strategic and practice levels.
In terms of identifying carers and helping them to access support, it is also critical to align assessments undertaken by other bodies, including NHS continuing healthcare assessments undertaken by clinical commissioning groups. If a carer is identified in the course of an NHS continuing healthcare assessment, the national framework for NHS continuing healthcare and NHS-funded nursing care makes clear that the clinical commissioning group should inform them about their entitlement to have their needs as a carer assessed and, where appropriate, either advise the carer to contact the local authority or, with the carer’s permission, refer them to the local authority for an assessment.
The provisions in the Care Bill provide a lower threshold for a carer’s assessment than exists now. A situation where the person whom the carer supports is being assessed for NHS continuing healthcare is highly likely to be regarded by a local authority as one where it appears the carer may have a need for support. A carer’s assessment would then be triggered. Clause 10(5) already requires a carer’s assessment to include an assessment of whether the carer is able and willing, and is likely to continue to be able, to provide care for the person needing care. Moreover, regulations under Clause 12 may make provisions for joint assessments. We will consider such particular circumstances further as we develop these regulations.
I turn now to Amendments 78F, 79E, 79H and 88C relating to disabled children. I would not wish to underestimate the challenges that families can face in supporting these young people. Policy on supporting children and families of course lies with the Department for Education. The Minister for Children and Families’ view is that there is already sufficient provision under Section 17 of the Children Act 1989 to provide for the assessment and support of children in need, including disabled children, and their parents. The Department for Education’s investment in parent carers’ forums and short breaks provision for disabled children in recent years have helped to shape family support.
In addition, the special educational needs reforms in the Children and Families Bill, which received its Second Reading in this House yesterday, are intended to give parents much more choice and control about the support they and their children receive. My noble friend Lord Nash confirmed yesterday, at Second Reading, that the Department for Education would consider how legislation for young carers might be changed. I simply ask noble Lords to be a little more patient in waiting for those proposals.
Before turning to the effect of Amendments 79F, 79J, 79M, 88H and 88K, tabled by the noble Lord, Lord Hunt, and members of the Opposition Front Bench, I would like to confirm, as I hope my words just now have, that both the Minister for Care and Support and the Minister for Children and Families are clear about the need to protect young carers from excessive and inappropriate caring by using “whole family” approaches.
Young carers should be regarded first and foremost as children and they should be assessed and supported in the context of children’s legislation. The Minister for Children and Families has confirmed that his department will look at what it can do to remove any legal barriers preventing young carers and their families from receiving the support they need under children’s legislation. We will also work to ensure that children’s legislation works with adult legislation to support the whole family in a meaningful way.
These amendments would extend the requirements on a local authority to prevent and reduce the needs of children caring for either an adult or a child. The local authority would also be required, when identifying carers in the area with needs for support, to include young carers aged under 18. One of the key principles when considering young carers is to address first what is needed to support adults in the family with care and support needs, and then see what remaining needs for support a young carer in the family has.
I hope I can reassure noble Lords that, first, through the provisions in Clause 2 to establish prevention as a core duty of local authorities, and secondly, through the provisions in Clause 12 to make regulations about a “whole family” approach to assessment of adults, we are ensuring that adult care and support makes the appropriate contribution to supporting children and young people with caring responsibilities as well.
Of course, provision of preventive services for adults would be of benefit to other family members, including children, by preventing or delaying either an adult’s needs for care and support or an adult carer’s needs for support. As it stands, without this amendment, I believe that the provisions of Clause 2 will help children and young people significantly.
Amendment 88H looks to require the Secretary of State to make regulations in all the areas listed in Clause 12(1). I reassure the noble Lord, Lord Hunt, that this is our intention, as these are essential in ensuring that the assessment is carried out in an appropriate and proportionate way. In relation to the noble Lord’s Amendment 88K, I confirm that we intend in regulations to make clear that a local authority should have regard to the needs of children in the family, and indeed we would wish to encompass other significant family relationships as well.
As I have set out, robust arrangements are in hand to ensure that carers are identified and supported by the NHS and local authorities, and that both parent carers of disabled children and young carers are adequately and appropriately supported under children’s legislation. The Department of Health and the Department for Education will continue to work closely together to ensure that children’s and adult legislation join up in respect of supporting adults with parenting responsibilities, and in the period of transition from children’s to adult services. I hope that those remarks will be sufficient to enable the noble Baroness to withdraw her amendment.
Health: Anorexia
Baroness Gale Excerpts(11 years, 9 months ago)
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Baroness Gale
My Lords, I also thank my noble friend Lord Giddens for bringing this important debate before us tonight. As others have said, it is well known that the majority of those who suffer from food disorders are women, but there is a growing problem now among men. Many people who suffer from food disorders turn to websites for help, but often these websites glory in anorexia, giving tips on how to eat even less or avoid eating for long periods. Chatrooms are available to give more encouragement to continue not to eat.
I looked at some of these websites yesterday. They show photographs where all one can see are young women with their bones showing through their skin; they are horrific. One site even had the “Thin Commandments” for eating less. I will mention just three:
“Being thin is way more important than being healthy…Thou shall not eat fattening foods without punishing yourself accordingly… Losing weight = Life, Gaining weight = Death”.
Only last week, the Sunday Times Style magazine featured the fasting diet, which advocates the “5:2 diet”, which involves fasting for two days every week and then “the pounds will disappear”. This new fasting trend has been widely reported this month, with another national paper even working its way through an all-month diet plan, including a list of recipes for 200-calorie “fasting suppers” to help us on our way. The Sunday Times article encouraged people not to overlook the importance of rigidly counting calories and cutting down to one meal per day. It quoted a woman teacher at the University of Illinois, who said:
“If you are having more meals, be very careful about measuring exactly what you eat. Don’t guess. People don’t realise how calorie-dense certain foods are. You can blow 100 calories in less than a minute, which, in this scenario, is not good”.
It also includes advice from a woman professor at the University of Surrey’s psychology department, who said:
“If I get through the next two fast days, I can buy a new lipstick or treat myself to a massage. If I stick to four fasts, I can buy that new pair of shoes”.
Frankly, it is absolutely disgraceful to suggest that if you give up food you can buy yourself a new lipstick or a new pair of shoes, especially these days when people have to go to food banks. Yet, a national newspaper tells us to give up food and buy a new pair of shoes.
These articles tell women that it is okay to fast. Whether they are overweight or underweight, they are being told that it is okay not to eat and that body shape is the most important thing about them. It is well known that body image and low self-esteem affect many teenage girls. There is social pressure in which the fashion and advertising industries play a part. There are many ways in which responsible behaviour within these industries can be promoted.
My noble friend Lady Kingsmill, who I am pleased to see in her place tonight, produced a report for the British Fashion Council in 2007 called the Model Health Inquiry, which made 14 recommendations, including one that no model should be aged under 16 and that the ban should be rigorously enforced. I believe that that recommendation has been accepted. Will the Minister say whether the Government are working with the fashion industry to implement all 14 recommendations in the report, especially the one which says that Ministers and British fashion industry sponsors should review the level of financial support to the BFC as a matter of urgency, to allow it to sustain the wider role proposed in this report? I appreciate that the report is six years old but perhaps the Minister can say something about working with the fashion industry on this matter.
How do we get the message across to vulnerable teenagers and those who need help? Where do they go for help? Is the information on food disorders advertised in GPs’ surgeries? What support is given to schools and further education colleges to advertise on the premises? Is there a case for teachers learning how to look for the signs and then offering practical support? Left to themselves, sufferers may seek help on websites and get the unhelpful advice that I spoke of. We know that advertising works and I hope that the Minister will be able to give some idea of what help the Government can give in the places where young teenagers are.
Health: Neurological Conditions
Baroness Gale Excerpts(12 years, 11 months ago)
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Baroness Gale
My Lords, I congratulate my noble friend Lord Dubs on securing this really important debate today. Many noble Lords will be familiar with the condition of Parkinson's disease, for which there is no known cure. When one is diagnosed with Parkinson's, one has it for the rest of one's life and has to adjust to one's new life. That is why research needs to continue and must not be the victim of cuts. It was reported in the national press at the weekend that academics claimed in a study that they feared that the cuts would prevent or cut back on research into Parkinson's and other diseases. I hope that that will not happen, otherwise further delays will be inevitable in finding a cure for Parkinson's and other neurological conditions.
People with Parkinson's need a range of health and social care support, which will change as the condition progresses. I will highlight a few of these areas today. The APPG on Parkinson's, which I chair, carried out an inquiry in 2009 and later published its findings in a document entitled Please Mind the Gap: Parkinson's Disease Services Today. The report highlighted disparities across the UK in access to support by people with Parkinson's. Two years on, gaps still exist and I am concerned that the current upheaval in the NHS in England, combined with the financial pressures, could exacerbate the situation.
The charity Parkinson's UK runs an audit each year in collaboration with the Healthcare Quality Improvement Partnership to see whether NICE guidelines for Parkinson's disease are being adhered to. The results are reported in the quality account of each trust and are an excellent way to see if evidence-based standards of quality care are met across the country. The audit has revealed gaps, but the tool provides a way for primary care trusts to measure the areas for improvement. Currently the HQIP is conducting a consultation on which audits will be incorporated into the quality accounts for 2012. If audits such as that for Parkinson's are not included, it will be a backwards step in promoting quality. Clinical audit is one of the most effective ways to measure where standards are being met and to look for service improvements. There is a risk that trusts will only prioritise those they are required to complete and that others will not take place. The National Audit Office has recently conducted an audit to see if services for progressive neurological conditions represent good value for money. The findings are expected to be released soon and will provide an assessment of the support for people with neurological conditions.
Several noble Lords mentioned the value of specialist nurses. I will mention Parkinson’s nurses. Parkinson's UK has invested more than £12 million to pump-prime specialist Parkinson's nursing posts across the UK, demonstrating its commitment to improving standards of care within the NHS. However, 20 per cent of PCTs still have limited or no coverage. Losing community-based Parkinson's nurses could cost the NHS up to £19.5 million in increased admissions and demands on consultant time. Losing hospital-based Parkinson's nurses could cost the NHS up to £15.6 million in longer times spent in hospital. Employing an extra 60 Parkinson’s nurses would provide adequate access across the UK and could save £7.1 million.
Clinical commissioning groups need support and guidance to commission good-quality Parkinson's services that are cost-effective. This support needs to come from networks and clinical senates that understand Parkinson's and can advise clinical commissioning groups about what is needed. Will the Minister give a commitment to support clinical commissioning groups by ensuring that there are neurology networks across England and neurology specialists on clinical senates?
Continuing care is a vital package of care that is arranged and funded by the NHS and is free of charge to the person receiving the care. The decision on eligibility rests not on the condition but on whether the need for care is primarily owing to health needs. My concern is that, in these austere times, decisions could be influenced by financial concerns rather than solely by clinical criteria. It seems that there is an increase in cases being assessed as social care needs, rather than as healthcare needs. Of course, one of these is free for the person with Parkinson's and the other can be highly expensive. A national support tool exists to help score someone's health needs, but it is not sophisticated enough for a condition such as Parkinson's or for the side effects of Parkinson's medication. There is also a lack of awareness of Parkinson's among some assessors. People with Parkinson's and their families report inadequate periods of time for the assessment, resulting in a false impression of the person. Judgments can be made on nursing home or hospital notes that do not adequately reflect the person's symptoms and fluctuations. Will the Minister agree to conduct a review of this tool so that it does not disadvantage people with progressive and fluctuating neurological conditions?
Budgetary considerations mean that there is little incentive for the NHS to tell people about their rights to continuing care, nor has the NHS any incentive to make timely decisions once someone has applied for NHS continuing care. If a person's case is rejected, the appeals and tribunal processes can be lengthy at a time when a person may be at their most vulnerable. There are cases that have been in the system for over three years.
Many people with Parkinson's face having their continuing care funding withdrawn in the later stages of their illness. The reason given is often that their decline is now predictable or that they have stabilised despite the severity of their situation. It seems to me that this is a total contradiction to the families involved, who are bearing witness to a distressing and progressive loss of function in their loved ones. Reports suggest that PCTs are instigating reviews not because of a change in health needs but because of budgetary constraints. Funding is then withdrawn following reassessment. The reason given is that presenting health needs are deemed to have stabilised despite the severity of the condition or that their decline has become predictable. This is despite the decision support tool for NHS continuing healthcare noting that well managed needs are still needs. The King's Fund and the Alzheimer's Society have recently reported a similar pattern of decisions in respect of people with dementia. Will the Minister agree to consider this difficult matter of continuing care and to make it clear to all concerned that people with an advanced degenerative health condition should not have their continuing care or nursing care contribution packages withdrawn on the basis that their decline in health is predictable or that the condition has stabilised? At the same time, will he clarify who will undertake eligibility assessments and appeals for continuing care under the new system and consider how it will ensure that decisions are person-centred and made independent of budgetary constraints?
I think a theme has been developing over the course of noble Lords’ contributions today. I know that people are fearful and worried in today’s climate. I hope that the Minister can give some assurances on this. People with progressive neurological diseases have enough worries about their illnesses. They need reassurance that they will be able to get, for example, the support of the specialist nurses they need. This makes good economic sense, and I hope the Minister will consider this and can reassure people with these conditions that we can alleviate at least some of their worries.
Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011
Baroness Gale Excerpts(13 years, 4 months ago)
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Baroness Gale
My Lords, I support my noble friend Lady Thornton in regretting that the Government are delaying the implementation of this important piece of legislation. I find it very difficult to understand why the Government are prepared to take such risks with the health of our children and young people. All the evidence shows that tobacco advertising encourages children and young people to start smoking. Most people start smoking when they are young—some as young as eight years of age. I met a 14 year-old the other day who had started smoking when she was nine. Even today children are smoking, despite all the measures that have been put in place. That is why this legislation should be in place—to do everything that can be done to prevent children being tempted. They are unaware of the health dangers and, surely, legislation should be enacted to shield them from the dangers of smoking.
According to a statement from the Department of Health, deferring this legislation in accordance with the Growth Review, announced by the Chancellor and the Secretary of State for Business Innovation and Skills in November 2010, the Government’s overriding priority is to return the UK economy to balanced sustainable growth, in particular by reducing the regulatory burden on business. The Department of Health says that the priority was to amend the commencement dates in order to provide confirmation for business as soon as possible. The Department of Health also said that it fully recognises that this will defer the public health benefits and that it fully took this into account in reaching its decision. I find it hard to understand that this Government are prepared to delay the implementation in the full knowledge of the damage that will be done mainly to young people and children. There is so much evidence to show that children and young people are heavily influenced by the advertising of tobacco. Surely this should be the Government's overriding priority—the health of children and young people.
If we accept the figures set out in the impact assessment to the Health Act 2009, this delay could mean that up to 4,000 more young people in England will start smoking. We know that the long-term effects on their health will be detrimental and at great cost to themselves, and that there will be a financial cost to long-term healthcare as a result.
On the two policy aims of the regulations, the Department of Health says it expects to amend the display regulations to mitigate the burdens on business, while maintaining the expected health gains. Can the Minister say how this can possibly be achieved, because one policy aim contradicts the other? The Government cannot have it both ways. Children and young people should be our top priority.
Health: Parkinson’s Disease
Baroness Gale Excerpts(13 years, 10 months ago)
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Baroness Gale
To ask Her Majesty’s Government what is their response to the recommendations of the report of the All-Party Parliamentary Group for Parkinson’s Disease, Please Mind the Gap: Parkinson’s Disease Services Today.
Baroness Gale
My Lords, I declare an interest as chair of the All-Party Group for Parkinson’s Disease and as a member of the charity, Parkinson’s UK. Parkinson’s is a long-term neurological condition and can be hugely debilitating. The fluctuating yet progressive nature of the condition means that symptoms can vary from day to day and even from hour to hour. Access to the right health and social care can make a huge difference to people with Parkinson’s. It can enable them to live a more independent life for longer and preserve dignity and quality of life. With the right support, people can hold down a job and continue to lead a full life. When the necessary complicated medicines regime is carefully managed, symptoms can often be minimised.
In 2009, the All-Party Group for Parkinson’s Disease conducted an inquiry into access to health and social care for people with Parkinson’s, with the support of Parkinson’s UK. I thank the noble Lord, Lord Walton, for his excellent contribution to the inquiry panel. It brought to light stark inequalities in Parkinson’s services across the UK. We found that a postcode lottery dictated people’s chances of receiving the support they need. This included seeing a specialist Parkinson’s nurse, access to professionals such as physiotherapists and speech and language therapists, and ongoing review and rehabilitation. For instance, at that time more than one in four people with Parkinson’s had never seen a Parkinson’s specialist nurse, yet they can cut hospital admissions by 50 per cent. Although the number of nurses has substantially increased since then, mainly due to sustained investment by Parkinson’s UK, it is vital that we do not see numbers fall back to the unacceptable low level. The inquiry found that half of people with Parkinson’s had never seen a physiotherapist, whose treatment can avoid falls and injuries.
Worryingly, new threats to physiotherapy are emerging across the country. Some posts left vacant by retirement are not filled, leaving local people with Parkinson’s without one of their most valued services. The previous Government put in place the national service framework for long-term neurological conditions, which set out key requirements for health and social care. The Department of Health is sending conflicting messages about the future of this framework. When will a decision be made? Can the Minister assure me that, if it goes, it will be replaced by something sufficiently robust?
This brings me to the likely impact of the Government’s health White Paper. Some of the language used by the Government suggests that “localism”, “choice” and “innovation” are more important than equal access to best treatment. Regional difference, we are told, is a good thing, driving up standards through competition. Consider that from the point of view of someone with Parkinson’s, living in an area with no Parkinson’s nurse, little access to a neurologist and no available physiotherapist or speech and language therapist, where people have to argue their case to receive NICE-approved treatments. Meanwhile, in the PCT next door, or perhaps a neighbouring GP consortium, services are much better. This approach simply seems unfair; will it drive up standards?
One area of concern is the decision to give GPs more power over commissioning. Most GPs have limited knowledge and experience of Parkinson’s disease. They typically have just one or two patients with Parkinson’s on their books. With a highly complex condition such as Parkinson’s it is clearly necessary for decisions to be taken at a wider strategic level. Within the new structures outlined in the White Paper, the only way to ensure a comprehensive approach to commissioning high quality Parkinson’s services is for the NHS commissioning board to have responsibility for this and to provide clear and specific commissioning guidance and outcomes for Parkinson’s services. To ensure we have high quality Parkinson’s services, we need specific, evidence-based quality guidelines and outcome measures. In other words, the Government must provide a standard against which patients can measure their service and, if services fall short, there should be robust mechanisms to hold providers and commissioners to account.
What assurances can the Minister offer that patients, including those with disabilities or conditions such as Parkinson’s, will be supported to seek redress in a meaningful way? One idea is that people with long-term conditions should be represented on the proposed health and well-being boards. Can the Minister say something about that?
The provision of moneys for social care is another area of concern. Local authorities say that the £2 billion for social care will fail to plug the hole left by the 28 per cent cuts they are facing over four years, compounded by the pressures of an ageing population. Further, freed from ring-fencing and national audit, there is no guarantee that moneys will be spent as intended. Councils are already cutting back by changing eligibility criteria so that only those with the most critical needs receive support. Many people with Parkinson’s and other conditions already find services inadequate. A resident of Cumbria told our inquiry:
“My only involvement with Social Services was [with] regards to a seat for the bath and I had to wait 16 weeks for this”.
Another strong message from our inquiry was that more needs to be done to support carers. One carer told us:
“It is difficult to put into words the feeling of abandonment and loneliness I feel ... Carers have enough to cope with without the constant battle to get some attention for their loved ones”.
I welcome the Government’s refreshed set of priorities for carers. In particular, PCTs are being given £400 million for carers’ breaks over the next four years, which I hope will benefit some of those who care for people with Parkinson’s and other conditions, often with very little support or respite. Who will ensure that this money is spent as intended? Another concern is that the removal of ring-fencing will make the allocation of carers’ funding to local authorities much more opaque. To ensure transparency, the Government should at least publish the nominal amount each council has received through the carers grants.
Given the current necessity to spend limited funds wisely, in the case of Parkinson’s, quality care is proven to be cost effective. Will the coming changes mean that some areas will lose their Parkinson’s nurses? Research has shown that such nurses can reduce hospital admissions by 66 per cent, which could be saving the NHS in England approximately £7.5 million.
If the Government are committed to reducing health inequalities, I urge the Minister to consider the report of the All-Party Parliamentary Group for Parkinson’s Disease, whose findings are drawn from expert evidence from more than 360 people with Parkinson’s as well as from their carers, health and social care professionals and key organisations. The report finds that huge inequalities exist in access to the care and support that are needed by people with Parkinson’s and by their families and carers. I hope that the Minister will agree that access to the right services should not depend on where people live.
On behalf of everyone affected by the condition, I urge the Minister to do all that he can to ensure that there is a strategic, comprehensive approach to commissioning Parkinson’s services that is underpinned by robust quality standards and by an effective, accessible system that will allow local people to hold services to account. I understand that the NHS commissioning board and GP consortia will have a statutory duty to reduce inequalities in healthcare provision.
My final question to the Minister is how he envisages reducing geographical inequalities in service provision, including for those with Parkinson’s. I look forward to the Minister’s response, and I thank all noble Lords who are taking part in this important debate tonight.