Health: Pathfinders

Baroness Gardner of Parkes Excerpts

Thursday 12th January 2012 Lords Chamber

[The Lord Bishop of Bath and Wells]

My Lords—

[Baroness Gardner of Parkes]

Can the Minister tell me—sorry, I would have given way to the right reverend Prelate. I had better press on. Does the Minister believe that the new legislation will change the problem that has always existed—that social care always felt that health should pay and health always felt that social care should pay? There may be good will and a wish to integrate, but can he assure me that the new financial systems in the health service will cover this point and prevent that problem continuing?

[Earl Howe]

My noble friend is right. This has been a perennial problem. We are addressing it in a number of ways. There are measures in the Bill which lay out duties on bodies. We are constructing the outcomes framework in a way that encourages integration of services with the right metrics. We are trying to align the outcomes framework in the NHS with that for social care and public health as well so that everybody is working to the same agenda.

Health: Neurological Conditions

Baroness Gardner of Parkes Excerpts

Thursday 8th December 2011 Lords Chamber

[Baroness Gardner of Parkes]

My Lords, I should declare my interest because a member of my family has multiple sclerosis.

My speech is to be a bread and butter one. As I am an Australian speaker, your Lordships will appreciate that my comments will be upside down, the butter first and then the bread. The butter is the special part: the noble Lord, Lord Walton of Detchant, who is such an expert on neurological matters, has authorised me to place on record part of the contribution that he would have made, but regrettably he is not able to take part in this debate.

This is what the noble Lord has asked me to say. This Government should be congratulated on their recent Statement on support for translation research—that is, translating results of basic scientific research into practical patient care. For example, discoveries in molecular biology and genomic medicine are beginning to identify treatment for some rare but serious neurological diseases such as muscular dystrophy. Many other inherited diseases are likely to benefit. There is a problem. The drugs discovered in this research will be very expensive and commercial benefits will be limited because the number of patients is not large. The Government will have to take note, as indeed they are doing, of the so-called orphan drugs. It is also important to note there have been massive developments in neuro-rehabilitation in diseases such as multiple sclerosis, Parkinson’s, epilepsy and Alzheimer’s. All can have their effect increasingly modified, to the patient's benefit, by drugs and physical as well as psychological interventions; and in this respect it is crucial that the Government should support the roles of specialised nurses, physiotherapists, occupational therapists and other healthcare professionals.

Now for the basic bread—my remarks. Neurological conditions are common in the UK. The majority of them are long term, which inevitably puts anyone diagnosed with such a condition in regular contact with the National Health Service and social services.

My eldest daughter has had MS for over 30 years and she is supported by a wide range of services available at present. Sarah has attended more than 60 outpatient clinics at the National Hospital for Neurology and Neurosurgery in Queen Square in those 30 years. However, she is conscious that, expert as her consultant is, she sees his team only every six months. It is help with the day-to-day living that people with long-term neurological conditions need. By making telephone contact with her MS nurse, she is able to access help from the allied health professionals within the hospital and within the community.

Sarah receives community neuro-physiotherapy for a short six-week burst every few years. This is to help her to maintain her daily exercise routine and to learn new exercises to tackle new symptoms as they arrive. Occupational therapists help those with disabilities to learn how to adapt to their own specific everyday life. The occupational therapist helps Sarah with gadgets and key life skills to make everyday living easier. The podiatrist has made specially fitting insoles and toe props for her shoes so that she can continue to move around to the best of her ability to some degree. The dietician has tailored her eating patterns to assist with her energy levels. Sarah is always clear about the benefits of the support she receives. She says that their intervention has always made just managing all right into managing better.

The specialist nurse has an essential role to play too. I have always emphasised the value of specialist nurses in any field and never more so than in neurological conditions. Sarah is a patron of the MS Trust. There are real fears that specialist nurse posts are not being filled when they become vacant. The MS Trust, which provides specialist education and training for MS nurses and other professionals working with MS, keeps a log of all MS nurses in post and is extremely concerned that their numbers are reducing. There are not enough MS nurses in post to cover the 100,000 people with this condition. I would speculate that the same could be said for other specialist nurses across the NHS. Just this week, Macmillan and the Skin Association have told me of the loss of specialist nurse posts dealing with those conditions. Specialist nurses may cost more to train but they repay the NHS in huge benefits to patients and save the NHS money in the long term.

It is not just the NHS that helps people with long-term neurological conditions. Social services in local authorities provide adaptations, carers and help around the home so that the individual can continue to live within their community. The present pressures on local authority budgets are causing concern that they may result in cutbacks to services and, if so, this could have a very adverse effect on the lives of those dependent on those services.

The Department for Work and Pensions through Jobcentre Plus has a range of benefits that individuals can apply for. Many of these are under review as part of recent reforms. Disabled people are naturally concerned about the outcome of the Welfare Reform Bill and the detail is still awaited.

My daughter received help with travel costs, via Access to Work, from 1998 to 2007. This paid for a taxi to take her to and from work each day because she was unable to use any form of public transport at that time. Now that buses have been fitted with ramps, she can access these in her wheelchair scooter but she is still unable to sit for hours on buses, and distances travelled are therefore limited. However, she almost personally won that battle last year when London Buses decided that it could not allow buses to take electric buggies any more. She took up the issue with Transport for London and a decision has now been made on the exact weight of buggy that can be allowed on a bus without danger of breaking the ramp. The system seems to be working happily again. It was important to establish that before the Olympics and the Paralympics, when many people will be using that form of transport.

The Access to Work grant allowed her to stay in work, earning a wage and paying the requisite taxes, for a good 10 years longer than she would have been able to work without that support. The grant was a small amount compared to what she paid in tax and national insurance. It makes sense for the Government to ensure that this grant continues to be widely available.

If you are a person with a long-term neurological condition, it is vital that you have every opportunity to remain as well as you can. That will allow you to play your part in society. At the Neurological Alliance’s annual parliamentary reception a few years ago, the main speaker was Tom Isaacs, who has Parkinson’s. He was talking about long-term neurological conditions in general, and said that society and the NHS do not encourage people with long-term neurological conditions to become informed and to learn as much as possible about their condition. There are real worries that the services these people need to maintain their quality of life to the best of their ability may be lost in the changes.

I read that the Russians are developing a way of reproducing the myelin sheath, which is destroyed by multiple sclerosis. All such developments are a long way off, but a lot of research is being done. One thing we must accept is the indomitable spirit of people with these conditions, their unbelievably positive thinking and optimism. That is something we accept.

I also want to pay tribute to the number of voluntary organisations and charities that give their support to people with neurological conditions. There are too many to mention here and I would hate to miss any from the list, but their provision of information leaflets, practical advice, comfort in distress, and concerted efforts to make the conditions more widely known and understood is outstanding. We must also not forget the families and friends who help to care for individuals.

I congratulate the noble Lord, Lord Dubs, on bringing this subject to us, and this debate has been a good opportunity to place all these matters on record. I know that we have a caring Minister in the noble Earl, Lord Howe, and I am glad that he has found the time to be here for this debate, in spite of all the pressure he is under with his responsibility for the new health legislation.

Health: Oral Cancer Detection

Baroness Gardner of Parkes Excerpts

Tuesday 6th December 2011 Lords Chamber

Asked By

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government whether they will make representations to the General Dental Council to raise the priority accorded to oral cancer detection and for its inclusion as a recommended topic in the list of subjects for continuing professional development.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, yes, the department will be raising this issue with the General Dental Council. I understand that the General Dental Council is currently at the early stages of reviewing its continuing professional development requirements for registrants and plans to hold a formal public consultation on its draft proposals, probably in the first half of 2012.

[Baroness Gardner of Parkes]

That is a very helpful Answer because the profession wants to see that. As the Minister knows, I have encouraged the continuous inspection of people’s mouths whenever they present for some other cause. The really important thing is that when they are referred up, the person seeing that patient knows what the position is. In view of the report last week about the vast increase in hepatitis among young people due to alcohol, will the Minister comment on whether he thinks there is a parallel with our 2009 debate, when that was raised as a factor in the great increase in mouth cancer among young people?

[Earl Howe]

My noble friend is quite right that the worrying feature of oral cancer is that it is increasingly appearing in the young. The risk factors that have been identified for oral cancer are primarily smoking and consumption of alcohol, but particularly the two combined. It is important that we get to grips with this. A number of public health campaigns are in train, certainly on smoking, and our alcohol strategy is due out very shortly, which will also address drinking among the young.

Health: Early Diagnosis

Baroness Gardner of Parkes Excerpts

Monday 21st November 2011 Lords Chamber

[Earl Howe]

My Lords, the Government have no current plans for a specific national campaign to raise awareness of diabetes. On the other hand, as part of Change4Life, which we are continuing with, we aim to raise awareness about diet and physical activity, and to create what we hope will be a mass movement to help to reduce obesity and related conditions, including diabetes. The campaign encourages everyone to,

“eat well, move more and live longer”.

There is also the very important ingredient of the NHS Health Check in this area, which the noble Lord is familiar with, for people in England aged 40 to 74. We think that this has the potential to prevent over 4,000 people a year from developing diabetes.

[Baroness Gardner of Parkes]

My Lords, I am sure that the noble Earl is well aware that not only lung cancer but all forms of cancer benefit hugely from early diagnosis. Will he ensure that one existing problem is dealt with, perhaps through further encouragement of medical education? In the very rare cases of osteosarcoma, and to a certain extent oral cancer, GPs are not really aware; cases are referred to them and are missed. Surely this must be a matter of further training in the specialities of these rare conditions.

[Earl Howe]

My noble friend is absolutely right. It is widely recognised that GPs have very important roles in prevention and early diagnosis of cancer of all kinds but that, until recently, there has been very little information available to enable GPs to benchmark their own activity and performance against that of other practices. We have launched what we are calling GP practice profiles, which will bring together a range of outcomes and process information relevant to cancer in primary care, so that GPs have comparative information available to benchmark their own performance. I think this will be a major plus in taking these variations forward.

Health: Cancer Drugs Fund

Baroness Gardner of Parkes Excerpts

Monday 14th November 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness makes a good point. We endeavoured to publicise the fund in April when it was created. We have reminded the health service to make the fund’s existence known wherever possible. The specific answer to her question is no, we do not plan a publicity campaign. However, we wish to ensure that clinicians in the service are as fully aware of the fund as they should be. I believe that they are, certainly at the level of secondary care.

[Baroness Gardner of Parkes]

My Lords, I have read in the paper that some very expensive cancer drugs will now be approved by NICE on the understanding that DNA testing will assess whether the patient will benefit from them. This was one of the arguments to do with giving terribly expensive drugs. Will these drugs also now be available from the same source after 2013?

EU: Economy

Baroness Gardner of Parkes Excerpts

Wednesday 2nd November 2011 Lords Chamber

[Earl Howe]

My Lords, the issue of advertisements is slightly different from the issue surrounding logos, in particular the NHS logo. What I can tell the noble Lord is that where independent providers have their own logo and wish to use it, they can within the specifications outlined in the NHS guidelines. In cases where organisations are providing both NHS and private services, and those could include a general practitioner, then the information relating to the private services must not carry the NHS brand or logo type, and information relating to the private services must be kept separate from the NHS ones.

[Baroness Gardner of Parkes]

I have been a national health dentist. Surely the national health logo could be in the premises without necessarily being on the advertisement. It is important that practitioners should be clear on these matters. Patients want to know what services are available, whether they are national health or private and what the choices are, and it would be a deficiency on the part of a national health practitioner not to at least have information available. How can you differentiate so that it is not claimed that the NHS logo has been involved when you are basically a national health practice?

[Earl Howe]

My Lords, other than for GPs, dentists and pharmacists, where use of the logo is voluntary—although it is very widely used—providers of NHS services are required to display the NHS logo as a sign of their commitment to the NHS patients that they treat. That is fine as far as it goes. However, where private services are also being delivered from the same premises, there are clear rules laid down that the NHS logo must be nowhere near any information about those services and that patients have to be absolutely clear what service they are receiving, whether it is NHS or private.

Health: Healthcare Assistants

Baroness Gardner of Parkes Excerpts

Monday 24th October 2011 Lords Chamber

[Earl Howe]

I agree with the latter part of the noble Baroness’s question in so far as I am quite sure that many healthcare assistants would like to be recognised for their skills. The question is whether statutory regulation or voluntary registration is the best and most proportionate route to achieve that. As regards the first part of her question, I regret the slant that the Times took on my remarks, because if a nurse has been struck off because they are considered to pose a risk to patients, then they must be referred to the Independent Safeguarding Authority, which would have the power to bar them. On the other hand, if a nurse is struck off for, say, misprescribing drugs to patients but is still capable of performing care tasks such as washing and bathing, they could still work as a healthcare assistant under appropriate supervision—depending on the circumstances. So there is no blanket prescription in this area; one has to look at the competencies of the individual and whether they are safe to work with adults.

[Baroness Gardner of Parkes]

My Lords, the same article in the Times referred to people without any experience whatever being appointed as healthcare assistants. While that might be splendid in terms of more people helping in the hospital, is it not important to develop training standards of some level to replace the lost SENs—state-enrolled nurses—and to be sure that these care assistants are reasonably competent in what they are being asked to do?

Nursing: Elderly and Vulnerable Patients

Baroness Gardner of Parkes Excerpts

Wednesday 19th October 2011 Lords Chamber

Asked By

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government whether they will work with the Royal College of Nursing to review and adapt the training of nurses to resolve the present problems of care and nursing for elderly and vulnerable patients.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, it is the responsibility of the Nursing and Midwifery Council, the NMC, to set educational standards that higher education institutes’ educational programmes must abide by. The Nursing and Midwifery Professional Advisory Board, the PAB, brings together all relevant stakeholders, including representatives from the service, professions, NMC, Royal College of Nursing, Unison and the higher education institutes, and is well placed to advise the department on workforce education and training matters.

[Baroness Gardner of Parkes]

I thank the noble Earl for that reply. Does he agree that while we are all pleased to see graduate nurses achieving new heights, there is considerable concern, following the abolition of SENs, about the loss of those caring, practical nurses who did not require university entrance levels? Has he seen Sheila Try’s report, Why is Nursing Failing? A Student Centred Action Plan, and, if not, will he ask his department to look at that?

[Earl Howe]

My Lords, we do value the contributions that SENs provide, those who are still in practice. It is certainly the case that the NMC no longer approves programmes for nurses on part 2 of the register and there are no plans to reintroduce educational programmes to part 2 of the register. What we have done is to develop guidance on widening the entry gate to preregistration programmes for those individuals who show the necessary values and behaviours but who otherwise do not possess the traditional academic qualifications. I am aware of the report that my noble friend mentioned. Sheila Try has written to me and I have asked the department to consider the recommendations that she has made.

Multiple Sclerosis

Baroness Gardner of Parkes Excerpts

Thursday 13th October 2011 Lords Chamber

[Lord Willis of Knaresborough]

My Lords, one of the great problems—

[Baroness Gardner of Parkes]

My Lords—

[The Chancellor of the Duchy of Lancaster (Lord Strathclyde)]

I know that my noble friend has been trying to get in and I think that we should let her.

[Baroness Gardner of Parkes]

My Lords, I declare an interest in that I have a daughter who has had MS for 30 years. Recent research announced in Russia indicated that they believe they are developing an answer to rebuilding the myelin sheath, which would be great progress in multiple sclerosis treatment. Can the Minister assure us that when that research is available we will follow it here and introduce it at the earliest possible time?

[Earl Howe]

My Lords, new and innovative treatments for MS are being developed in a number of countries. It is quite clear that any new treatment of this kind should be subject to the rigours of the regulatory system before it is made available to NHS patients. Many of them will not have been fully tested to ensure efficacy and safety, but we will of course examine every novel and innovative treatment that has the potential to benefit patients.

Health: Diabetes

Baroness Gardner of Parkes Excerpts

Thursday 14th July 2011 Lords Chamber

[Earl Howe]

I have already mentioned the Change4Life programme, which is designed to raise awareness across a number of public health areas, including obesity and overeating. I think also of the Healthy Schools programme, which instils the need to eat healthily and take exercise in youngsters at an early age. As the noble Lord will know, there is no magic bullet for the problem of obesity. It is something that must be addressed in a variety of ways through public health programmes and general practice.

[Baroness Gardner of Parkes]

My Lords, does the Minister agree that foot ulceration precedes 85 per cent of amputations? A study in Southampton showed that, by keeping people in hospital and treating them well through preventing foot ulcers, over 36 months not only did patient outcomes improve but the National Health Service saved £1.2 million in in-patient time.

[Earl Howe]

My Lords, I am grateful to my noble friend. I have an astonishing figure in my brief. On average, 73 amputations of lower limbs occur every week in England because of complications to do with diabetes. It is estimated that, with the right care, 80 per cent of amputations carried out on patients suffering from diabetes would be preventable. That is the scale of the challenge. We are clear that this is a major issue for diabetes. NICE has published guidelines on in-patient management of people with diabetic foot ulcers and infection. That is vital because amputations are often preceded by ulceration. That is also why the national clinical director for diabetes considers diabetic foot care and prevention to be a major priority.