NHS: Research and Development
Baroness Gardner of Parkes Excerpts(12 years ago)
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Baroness Gardner of Parkes
To ask Her Majesty’s Government what proportion of funding allocated by the National Health Service for research and development at major teaching hospitals is provided to (1) the researchers themselves, and (2) administrators of funding.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the National Institute for Health Research awards funding transparently and competitively for research of high scientific quality that has relevance to the NHS and represents value for money. We therefore expect that the maximum is spent on research rather than on administrative overheads. Trusts with teaching hospitals received a total of £500 million from the NIHR in 2011-12.
Baroness Gardner of Parkes
I appreciate that funds go directly to the researchers from the body that the Minister mentioned and from the Medical Research Council. What I am concerned about is that I am told by those working, and possibly doing research, in these teaching hospitals that the bulk of the money is paid to the person doing the governance of research and development, and not a penny of that money is actually going to the researchers, who are funded in the way that the Minister has said. Ever since 2006, when that was set up, there has been a great growth of these people doing nothing but checking on the work of the real researchers.
Earl Howe
My Lords, every NHS trust or foundation trust has to oversee the governance of the research taking place within it. That is an inescapable part of the process. I do not think there is any confusion in anyone’s mind between support for research governance and the actual research itself, which is done by academics and clinicians working in academic and clinical departments. It is up to each trust to determine how its budget for research is allocated, but I can reassure my noble friend that the money is getting to where it needs to go.
Social Care
Baroness Gardner of Parkes Excerpts(12 years ago)
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Baroness Gardner of Parkes
My Lords, I am one of those old hands to whom the noble Baroness, Lady Pitkeathley, referred in her speech. No one knows more on this subject than she does and I pay tribute to the great work that she has always done. However, there is nothing new in this problem. It has grown hugely but there is nothing new about it. I was chairman of social services on a London council in the 1970s under the then Wilson Government. We were terribly short of money and had to choose between providing social care or saving the buildings in which we were doing it. We did not have the money for both. These extremely difficult choices have always had to be made.
Like the noble Baroness, Lady Pitkeathley, I am very disappointed that, one year on, we still have not had a real response to the Dilnot report. However, as she said, everything is stretched. The linkage between housing, health and care has always been terribly important. There is nothing new in that. I would be sorry to see unacceptable standards become the norm, as the noble Baroness fears, but we have reached the point where there is simply no money. Local authorities have done everything they can to reduce their expenditure. They have put a lot of the care out to agencies because that saves hugely on management costs and staff costs and they believe that that is more effective. I am not so sure of that. I met a woman who was going to take on a caring job and found that she had to see eight different clients a day at eight different venues, each one supposedly for an hour. However, in that hour she had to do everything for that client. As has been said, 15 minutes is more the norm—someone runs in, makes a cup of tea, gives the client a bath or dresses them and then is gone. If they are doing breakfast for people, those people are getting their breakfast at all times of the day because the same person is running from house to house.
The woman who applied to the local authority agency found that she would have been paid nothing for her travelling time between jobs, which could be half an hour or more. She would have had to locate each address herself and then go to it. The whole thing was not on. This is a very genuine and loving Latin American woman. I came across her through an immigration issue. She has been here for many years. She works for 48 hours non-stop, day and night, for an elderly lady. She lives with her, looks after her, gets up in the middle of the night and does everything. She does this on a self-employed basis. I have raised this matter before in the House. If you are self-employed, there is no talk of a working wage or even a minimum wage. There is no wage protection for carers who are self-employed. The family of the lady with dementia pays her £100 for two days and two nights—48 hours. That is £2-something an hour. How can we expect people to work for that sort of money?
We rely on people working. In the past you could rely on family because people lived near to one another. In my GLC days you could exchange your social housing and move nearer those who could care for you. None of that—or very little—is available now. Most people are lucky to have a roof over their heads at all. It has reached the point where local authorities have combined forces so that several boroughs can work together to reduce costs and spread the load. These things are not easy now. People are reaching the limit of their resilience. They have made efforts again and again. We keep trying and we make a little progress, and then we find that the demands are growing all the time. The huge growth in the number of elderly people who survive is perhaps something that no one could have foreseen. Perhaps it is a reflection of how successful our health service and way of life are. The basic issue is money.
I went—I think it was yesterday but I lose track of time—to a meeting on the future of nursing. Everyone talked about the need for more time for each nurse to do her job. We read press reports on this. Nothing could have been reported more than the issue we are debating. I have picked out three headlines. The first is very emotive and states:
“Hungry, sick, neglected: the care home scandal”.
The next one states:
“Urgent action needed to tackle care failings that lead to horrific abuse”.
These things are absolutely vital. Care inspections are very important, but will be effective only if they are unannounced and unexpected. If you have told people that you are coming, you will not get the true picture at all. Today, I read in the paper:
“Cruelty had been ‘normalised’ in parts of the NHS, the Health Secretary declared yesterday”.
It may be that that emotive word had been picked out, but what is happening in most cases is not deliberate cruelty. In many cases people are giving a marvellous service. However, the cases that all the press sensation is about are ones where staff are failing.
I was in hospital two or three years ago. I was put in a ward full of elderly people. All night the woman in the bed next to me said, “Help, help, help”—non-stop, for the whole night. Of course the nurse responding to that had become case hardened, because she had heard the woman saying “help” not just the night I was there but probably every day and night of the week. People are amazingly patient and good, but it is an impossible task. Everyone knows that it comes down to the need for more money—but where are we going to find it? The medical set-up is also in a state of chaos while staff adjust to all the changes. It is extremely difficult.
We want to see social care of good, reliable quality. We want to see specialist hospital facilities used only where there is a real benefit from them. We do not want people to be occupying hospital beds that could be used by acute care cases when another type of accommodation might be better. It is alarming for people. They know that they do not have the money to pay for things themselves. But the changes in family patterns—the geographical thing—are very worrying.
Expectation is another big problem. We have all raised expectations to a point where we expect everything to be perfect all the time, but no one has the money for that. This is an extremely complicated issue that we have to be very aware of, and today’s debate must help to increase awareness and show all the various aspects of it. There is no simple solution. I wish there was. It is going to take a lot of time and effort and we will still be relying to a very large extent on volunteers, which the noble Baroness, Lady Pitkeathley, knows so much about.
NHS: Accident and Emergency Services
Baroness Gardner of Parkes Excerpts(12 years, 1 month ago)
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Baroness Gardner of Parkes
To ask Her Majesty’s Government whether, in relation to proposals to restructure NHS services in north-west London, the Department of Health has entered into dialogue with Transport for London regarding traffic levels and their impact upon speed of access to accident and emergency services.
Baroness Gardner of Parkes
My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as a local resident.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the reconfiguration of front-line health services is a matter for the local NHS, and any decisions regarding changes to services will be taken locally. I understand that the local NHS has worked closely with Transport for London and also with the London Ambulance Service in developing its proposals for the future shape of health services across north-west London under the Shaping a Healthier Future programme.
Baroness Gardner of Parkes
I thank the Minister for that Answer. My Question could really apply to anywhere in the country. The general principle is how long it takes to get patients to hospital, particularly in emergencies, when it is a matter of life and death in some cases. In London, there is only one air ambulance; I understand that in Paris, there are four and in Sydney there are six. We cannot rely on one air ambulance to deal with the problem. Will the Minister consider the general principle of a national view of traffic in relation to access for ambulances?
Earl Howe
My noble friend makes some important points. As a general point, it is important to say that each ambulance service should plan to provide appropriate resources to meet local demand, because demand varies according to where you are in the country. Planning assumptions in meeting that demand should take into account the likelihood of severe traffic congestion. Plans of that kind may well include resources in addition to traditional ambulance provision, for example, using rapid response vehicles and motorbikes as well as utilising staff such as community paramedics or emergency care practitioners.
Care Services: Elderly People
Baroness Gardner of Parkes Excerpts(12 years, 2 months ago)
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Earl Howe
My Lords, we recognise that there is a need to drive up standards in this area. More care workers will be trained, including an ambition to double the number of care apprenticeships by 2017. We have commissioned Skills for Health and Skills for Care to develop, before the end of January next year, a code of conduct and minimum training standards for healthcare support workers and adult social care workers in England. We expect that these will cover minimum training or induction standards for a range of support tasks, including personal care and other activities. Through the Health and Social Care Act 2012 we are creating a system of external quality assurance for voluntary registers.
Baroness Gardner of Parkes
My Lords, is the Minister aware that it is not just an issue about criminals, but an issue about the total shortage of care, which the previous question addressed very clearly? Does he not think that in general care and healthcare we are sadly missing the SENs, and is it not time to develop additional levels of training to fill the gaps both in care homes and the National Health Service?
Earl Howe
My Lords, we need to focus on a mixture of things. As my noble friend rightly says, we need to look at workforce numbers and capacity. We need to look at minimum training standards, which I have referred to, and we need to look at quality. We are doing that by targeting for the first time personal assistants and their employers with greater support and learning through the Workforce Development Fund, which will help with recruitment and retention. We need better leadership because high-quality leadership is essential for the delivery of all the proposals in the care and support White Paper, and we are setting up a new leadership forum to bring together expertise. I should add that we need better intelligence on the ground as well, and that we shall see from the local Healthwatch organisations when they are established.
NHS: Walk-in Centres
Baroness Gardner of Parkes Excerpts(12 years, 2 months ago)
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Earl Howe
My Lords, I am sorry to hear of the experience of the noble Baroness’s friend. I asked my officials to let me know which walk-in centres were available within striking distance of this building. There are, in fact, five NHS walk-in centres in or very near central London. I am aware of another privately run centre as well. A quick search on NHS choices will bring you to a menu of options.
Baroness Gardner of Parkes
My Lords, will the Minister tell me whether all general medical practitioners have surgeries where you can walk in at some time of the day? That would take quite a load off people. Is that an obligation? My practice has this and it is marvellous. You can go in at 8.30 on any morning and will be seen if you are an emergency. Is that common? Is there a need for more of that?
Health: Cancer
Baroness Gardner of Parkes Excerpts(12 years, 2 months ago)
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Baroness Gardner of Parkes
To ask Her Majesty’s Government what assessment they have made of the increase in cases of cancer of the head and neck, in particular in younger age groups.
Baroness Gardner of Parkes
My Lords, my reason for bringing this debate today is to improve awareness of the increase in cases of cancer of the head and neck, and to consider what actions should be taken to deal with these very unpleasant and often fatal conditions. Tongue cancer and mouth cancer are the most common in the group of cancers of many sites within the head and neck area. My particular interest is oral cancer, which, as a former dentist, I look on as cancer of the mouth, but the definition includes head, neck and throat cancers, and the title of the debate is to widen the subject.
Oral cancer is the 15th most common cancer in the UK. Assessment is important but progress towards earlier diagnosis, urgent follow-up and specialist treatment is the real essential. Great work is being done in study, research and treatment, in London by the Eastman Dental Institute, King’s College London Dental Institute and the Royal Marsden, and others in different parts of the country. I would like to record my thanks to these organisations, and to the Oracle Cancer Trust, a charity that does much to help patients and increase awareness, for the data it provided me for this debate.
To quote from a review article published in Oral Diseases in 2010:
“Worldwide, oral cancer has one of the lowest survival rates and poor prognosis remains unaffected despite recent therapeutic advances. Reducing diagnostic delay to achieve earlier detection is a cornerstone to improve survival. Thus, intervention strategies to minimise diagnostic delays resulting from patient factors and to identify groups at risk in different geographical areas seem to be necessary. The identification of a ‘scheduling delay’ in oral cancer justifies the introduction of additional educational interventions aimed at the whole health care team at dental and medical practices”.
In the UK, between 1989 and 2006 there was a 51% increase in oral, tonsil and base of tongue cancers in men, from seven per 100,000 of the population to 11 per 100,000. Unfortunately, almost half of the oral cancers are diagnosed at stages 3 or 4, which are the advanced stages. Delay in diagnosis is now considered to be either patient delay or professional delay. Diagnostic delay is measured by the number of days elapsed since the patient notices the first signs and/or symptoms until a definitive diagnosis is reached. Studies suggest that 30% of patients delay seeking help for more than three months following the discovery of symptoms of oral cancer. There is a great need to improve public awareness not only of the condition but of the need to seek assessment as soon as possible, thus increasing the possibility of effective treatment. Early diagnosis can decrease morbidity and may improve overall long-term survival. In cases of laryngeal cancer, diagnostic delay has a remarkably worsening effect on survival.
What is the cause of oral cancer? Most cases of carcinoma are linked to lifestyle factors and should therefore be preventable. Most important is the excessive use of tobacco and alcohol, and in some groups, betel quid juice is relevant. Diet is significant, and another reason in favour of fresh fruit and vegetables. The recommended five portions a day should include red, yellow and green fruits. In a minority of cases, particularly among younger patients where known risk factors are absent, human papilloma virus, HPV infection, is now thought to be a likely cause. HPV infection has also been considered as a cause of oropharyngeal cancer. It is hoped that the recent HPV vaccination programme in teenage girls may have a longer beneficial impact on the incidence of this cancer. People with poor dental health, such as sharp broken teeth, dental sepsis or trauma from ill-fitting dentures, are at a slightly increased risk. An ulcer—a lesion that breaks the surface lining of the mouth—that fails to heal within two weeks with the appropriate therapy and correction of any possible causative factors, and for which no other diagnosis can be established, should be suspected of being a malignant ulcer. Hardening or enlargement of the lymph nodes in the neck are another warning sign, and attention must be sought by the patient.
There are many potentially malignant conditions, but I do not have time to list them today. It is for clinicians to be aware of these and to diagnose them. The public need simply to be aware that any noticeable change in the mouth should not go unheeded. Dental professionals need to keep abreast of the latest developments, and they can do this through lifelong learning, as they remain the major diagnosticians. However, it is essential that family doctors should be aware of oral anatomy so that they know the difference between normal and abnormal. When carried out competently, screening of oral mucosa should not take more than three minutes, and training should mean that these procedures are effective. Dentists should give advice to patients to enable them to recognise the signs and symptoms at an early stage and thus to seek early treatment. This would help, but it needs to go wider than that; pharmacists and dental hygienists need to do this as well.
A study published in 2010 in the British Dental Journal showed that oral cancer is an important health issue in Scotland. Some of the young appreciate that alcohol and tobacco are causative factors, but the findings suggest that even among people who have the disease, understanding of the link between alcohol, tobacco and oral cancer is still limited. A number of people could recall the related television campaign and supported the view that it had played an important part in their own diagnosis and treatment. The West of Scotland Cancer Awareness Project, funded by Cancer Research UK, led many patients to make an initial appointment with a health professional to have symptoms investigated. I understand that this is the body which financed the television programme. This is a most important message, and a number of patients with oral cancer reported that it was the programme that had saved them. I hope that the Minister will pass that message on to the Department of Health.
Intra-oral cancer is particularly lethal, whereas cancer of the lip is less so. In my early practising days, many of my patients presented with a white patch on their lower lip. This is called leukoplakia and is considered pre-cancerous. In those days it was common to see men walking around with a fag hanging on their lip. Holding a cigarette or pipe almost constantly in place on that spot was one of the main causes of the symptom. Leukoplakia still occurs but for different reasons, as lifestyle habits have changed. The important thing to realise is that any white or red patch in the mouth should not be ignored. It requires proper assessment and treatment without delay.
I cannot say too often that early diagnosis is essential for the successful treatment of any cancer. Years ago, when we had free dental examinations, people went more regularly to the dentist, and early lesions were discovered, mostly by dentists. Dentists are usually still the first to see a mouth cancer, but it is essential that GPs are aware of the need to do routine checks, particularly if the patient has not had a dental check-up for some time.
Above all, the public need to be aware of the warning that comes with any change in their mouth, or any ulcer that does not heal. They should present immediately for assessment and possible treatment. If the practitioner—doctor, dentist or nurse—believes that there is cause for concern and the condition does not improve with treatment within two weeks, the patient should be referred for a biopsy, which is the only definitive diagnostic tool. If cancer is suspected, the referral must be marked “urgent”, in accordance with NICE criteria, to reduce the pre-treatment interval. The number of patients who attribute their successful treatment to the fact that they saw a Department of Health warning or information is high.
I will make a few brief points to close. There needs to be a referral change. In your Lordships’ House I have for some years pressed for mouth examinations to become routine when any patient attends an accident and emergency department or polyclinic—about which we seem to hear less now—and that in the interests of treating numbers and managing to finance this, unqualified staff could be trained in the first instance to carry out a quick check. If there is any cause for doubt about the mouth condition being normal, they would refer the patient up the line to either a specialist nurse or a dental hygienist who would then decide whether they should be referred further so that appropriate treatment could be provided, urgently if indicated. The previous Labour Government agreed that this would be a worthwhile thing to do and confirmed that semi-skilled health workers could carry out these brief mouth checks. It would not require qualified dentists or doctors at the preliminary stage. I still think that this would be very valuable and I press the Minister to give it serious thought.
Health: Diabetes
Baroness Gardner of Parkes Excerpts(12 years, 4 months ago)
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Earl Howe
My Lords, I am aware of several local initiatives that are doing great work in accessing those in both black and minority-ethnic communities along the lines mentioned by the noble Lord. We have made important progress in strengthening our approach to promoting equality in health and social care and in tackling these inequalities that exist. That is especially important in relation to the Asian community. I am thinking in particular—the noble Lord mentioned the need to roll out initiatives—of the NHS Heath Check programme supported by the guidance on prevention issued by NICE and the Change4Life Programme, which now has a bespoke element to it targeted specifically at ethnic-minority communities.
Baroness Gardner of Parkes
My Lords, are separate statistics kept about ethnic groups? If not, would it not be an advantage to do so in terms of research, particularly as type 2 diabetes is very much dependent on diet and might be quite different in different sections of the community? What is the prevalence of diabetes in the ethnic community as opposed to other communities and what is the prevalence of type 1 diabetes as opposed to type 2 diabetes?
Earl Howe
My advice is that type 1 diabetes is not a particular issue in ethnic-minority communities. We are talking about type 2 diabetes, which is five times more common in black and ethnic-minority groups, six times more common in south Asian ethnic groups, and three times more common in areas of social deprivation than in the rest of the population. There are particular clinical risks associated with those from ethnic minority communities who have diabetes. Complications include particularly heart disease—south Asian people are 50% more likely than the general population to die prematurely from coronary heart disease—and the prevalence of stroke is also much higher in African, Caribbean and south Asian men.
Social Care: Sustainable Funding
Baroness Gardner of Parkes Excerpts(12 years, 5 months ago)
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Baroness Gardner of Parkes
My Lords, in view of the answers to the previous supplementary question and to the first Question, which stated that decisions should never be made purely on grounds of cost, is the Minister aware of a case in one of the London boroughs where a woman who has had multiple sclerosis for years and has been cared for by a very loving husband has now been told that she may be obliged to go into a care home because providing her care package at home is costing £79,000, while a care home could be provided for £71,000? That would perhaps not destroy, but put a terribly unfair strain upon, her marriage after all these years. Can the Minister assure us that in the Government’s plans for health and social care, factors other than cost will be considered?
Carers: In Sickness and in Health
Baroness Gardner of Parkes Excerpts(12 years, 5 months ago)
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Earl Howe
I shall have to ask the noble Baroness to be patient for a few more minutes regarding the Statement I am about to make. However, I can tell her that the White Paper and the draft Bill will make a reality of our vision for transforming care and support both for carers and for the people they look after. As for the noble Baroness’s first point, she is absolutely right to flag this up as a concern. In the last financial year, we provided funding of almost £1 million to the Royal College of General Practitioners, Carers UK and the Carers Trust to take forward a range of initiatives, of which I am sure she will be aware, to increase awareness in primary healthcare of carers of all ages, including better training for GPs, and also to look at how we can build on that for the future with the medical colleges and nursing organisations and in hospitals and community health services. The NHS Health Check programme could be a very important ingredient in making sure that the health of carers is monitored and taken fully into account.
Baroness Gardner of Parkes
The Minister is aware of the great debt that we all owe to carers, particularly family carers. Can he assure me that respite care for those people, or those for whom they are caring, will be possible and will continue? It makes a very big difference if people can have even a small respite break.
Earl Howe
My noble friend is quite right. My department has allocated an additional £400 million to the NHS over four years, 2011 to 2015, to provide carers with breaks from their caring responsibilities. The 2012-13 NHS operating framework makes it clear that PCTs, local councils and local voluntary organisations should work together on plans to support carers. Those plans have to be published by 30 September at the latest. They must make clear the amount of money to be made available to support carers and separately identify the amount to be made available for carers’ breaks.
NHS: Definition of Exceptional Case
Baroness Gardner of Parkes Excerpts(12 years, 5 months ago)
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Earl Howe
My Lords, under the NHS Constitution, all patients have the right to an individual review of a decision not to fund a particular treatment if they and their doctor believe that it would be appropriate. They also have the right to an explanation of the basis of the decision. The commissioner must in turn have a process to enable such individual funding requests to be considered, so the watchwords here are transparency and publishing an explanation.
Baroness Gardner of Parkes
Does the Minister agree that there are other decision-making bodies? I refer in particular to the UK National Screening Committee. Is he aware that, probably correctly, it makes its decisions only on research results? Why does it claim that it does not have the money to spend on research into Streptococcus B infections, when international research shows a clear choice for screening as opposed to risk assessment? That change that has been made in other countries has resulted in reductions of strep B infections in children of 80% in the USA, 60% in Spain, 82% in Australia and 71% in France. The screening of pregnant mothers could prevent that very serious condition, which can be fatal, being passed to a small number of babies.
Earl Howe
My Lords, the UK National Screening Committee advises Ministers and the National Health Service in all four UK countries on all aspects of screening policy, including for group B Streptococcus carriage in pregnancy. The committee is currently reviewing the evidence for screening for that condition in pregnancy against its criteria. It will take into account the international evidence and a public consultation on the screening review will be opening shortly.