Abattoirs

Baroness Gardner of Parkes Excerpts

Monday 11th July 2011 Lords Chamber

[Earl Howe]

My Lords, the agency has now proposed a stepped system of discounts. For the first 1,000 livestock units processed, the reduction on the full cost would be a maximum of 70 per cent. The next 1,000 livestock units would be subject to a 50 per cent reduction and the next 3,000 subject to a 25 per cent reduction. That will directly assist those smaller abattoirs, many of which are based in Wales.

[Baroness Gardner of Parkes]

I find it very unusual for the Minister who usually answers on health to be answering an abattoir Question, but I am very impressed by his knowledge. Can he tell us whether there is a health implication, whether the extra costs that were to be passed on were necessary for health and whether they will be continued to be carried out even if the costs are not being passed on?

[Earl Howe]

My Lords, there is no direct health implication. What has happened over the past few years is that the costs of regulation have progressively been borne by the Food Standards Agency, as opposed to the industry. There has been a decision taken in principle that the regulator should not subsidise the industry that it regulates. That is the reason for the review of the charging arrangements.

NHS: University Health Centres

Baroness Gardner of Parkes Excerpts

Monday 4th July 2011 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government whether NHS university health centres are being disadvantaged by the weighting of the registered list size and the introduction of prevalence quotas for the quality and outcomes framework.

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

My Lords, no. Payments to practices are based on an agreed calculation of health need and on equitable funding. The funding formula recognises patient numbers, with adjustments for the characteristics of the patient population and practice circumstances. The disease prevalence formula in the quality and outcomes framework provides fair rewards to all practices, but with stronger incentives for them to identify and treat patients with the greatest health need.

[Baroness Gardner of Parkes]

My Lords, I thank the Minister for that Answer, but is he aware that, although some practices in university centres receive support from the university, others are linked to GP practices which run services as a separate contract? Many of those have looked into the finances and found that it is so disadvantageous to them that they are not considering renewing or extending their contracts to supply what I consider to be necessary services. What will the Minister do?

[Earl Howe]

My Lords, naturally, before preparing myself for this Question, I looked carefully into the way in which university practices are funded. The advice I received is that there is no reason to be concerned on that front. Many university GP practices are funded quite generously. Where they can lose out is over the quality and outcomes framework, which is targeted mainly at elderly patients with long-term chronic conditions, so it is not surprising that university campus practices do not earn the extra money that they could. Nevertheless, we believe that there is no case for making an exception for university practices in the way that they are funded.

NHS: Health Improvements

Baroness Gardner of Parkes Excerpts

Wednesday 29th June 2011 Lords Chamber

[Earl Howe]

My Lords, where it is deemed appropriate to commission a service at scale but below the level of the NHS commissioning board, as I described in my original Answer, it will be open to clinical commissioning groups either to establish a lead group to take control of the commissioning and to agree budgets and pathways or for clinical commissioning groups to collaborate jointly. The advantage of the system that we are proposing is its flexibility. Depending on population size and the needs of an area, commissioning can be done at several levels.

[Baroness Gardner of Parkes]

My Lords, the Question was so difficult to understand that I thought it was about telemedicine. Does it cover the issue of reducing the number of accident and emergency services in London so that they are more equivalent to the stroke units, which, as the noble Baroness said, have worked so well? Many people say that fewer but more effective accident and emergency services would be better. On the other hand, is the Minister aware of the concern over the closure of the Royal Brompton’s heart section for children, which is essential to the future of that hospital?

[Earl Howe]

My Lords, my noble friend will know that an independent inquiry into children’s heart services is under way at the moment. It would be inappropriate for me to comment. I have not been involved at all but it would be inappropriate for Ministers to become involved. As regards ambulance and A&E services, we envisage that clinical commissioning groups will commission the great majority of NHS services for their patients, including urgent and emergency care and ambulance services. Prior to that, PCT clusters, which are being formed from the primary care trusts, will be responsible for commissioning ambulance services until 1 April 2013.

Health: Hepatitis C

Baroness Gardner of Parkes Excerpts

Monday 20th June 2011 Lords Chamber

[Earl Howe]

The noble Lord is quite right that generally speaking there is no problem about using human tissue samples for research purposes where those samples are anonymised. In other circumstances, of course, the Act demands that the principle of consent should apply.

[Baroness Gardner of Parkes]

My Lords, obviously there is no general screening programme for hepatitis, and we appreciate the severity of cases such as that involving contaminated blood, which has just been referred to, but can the Minister explain what an ordinary person should be looking for before submitting themselves for screening? It must be advantageous to have such conditions diagnosed early rather than late.

[Earl Howe]

My noble friend is absolutely right that early diagnosis is always a good thing for this condition as it is for many others. We know who the risk groups are, and therefore the important thing is to target screening and testing at those groups. Predominantly, the at-risk groups are injecting drug users or former injecting drug users; they account for well over 80 per cent of cases of hepatitis C. Those groups are the focus of our efforts in primary and community care, and especially in prisons.

Health: Multiple Sclerosis

Baroness Gardner of Parkes Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My Lords, I am aware of those reports. We have received concerns from most, if not all, of the neurological patient groups, as the noble Lord mentioned. He might like to know, however, that to help trusts develop specialist nursing roles, the department published some time ago a guidance document, Long Term Neurological Conditions: A Good Practice Guide to the Development of the Multidisciplinary Team and the Value of the Specialist Nurse. That was created in conjunction with a number of healthcare charitable organisations. It outlines why services for neurological conditions are important, it shows the importance of those multidisciplinary teams, and it clarifies the contribution of specialist nurses.

[Baroness Gardner of Parkes]

What is the position when a specialist nurse for MS or any other condition—I declare an interest as I have a daughter with MS—leaves a hospital and the hospital decides that it is not recruiting any more people? I know that local providers are independent, but can the department give some sort of guidance that specialist nurses should not be overlooked when they replace staff and that they should consider the special role that they have carried out?

[Earl Howe]

My noble friend makes an important point. The guide that I have just referred to in answering the noble Lord, Lord Walton, emphasises the important role of specialist nurses in the care of patients with neurological conditions. However, the key in the future will be better commissioning at a local level joined with better workforce planning at a provider level. If those charged with training and workforce planning tap into the commissioning plans that commissioning consortia determine, we will have a genuinely joined-up system that is also informed by the patient’s point of view.

NHS: Chiropody and Podiatry Services

Baroness Gardner of Parkes Excerpts

Tuesday 26th April 2011 Lords Chamber

Asked By

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what plans they have to ensure the continuing provision of training and practice in chiropody and podiatry services under new commissioning consortia and the National Commissioning Board.

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

My Lords, it is the responsibility of local National Health Service organisations to commission services to meet the needs of their community and the education and training necessary to deliver them, including the provision of chiropody and podiatry services. This will continue in the future.

[Baroness Gardner of Parkes]

I thank the Minister for that reply. Does he share my concern that GP consortia may lack the necessary strategic overview to prioritise longer-term preventive care options and ensure future podiatric care? Can he further clarify whether Health Education England, or some other body, will have full responsibility for seeing that adequate numbers of podiatrists and chiropodists are trained?

NHS: Reorganisation

Baroness Gardner of Parkes Excerpts

Thursday 24th March 2011 Lords Chamber

[Baroness Jolly]

My Lords—

[Baroness Gardner of Parkes]

Following the question from the noble Baroness, Lady Thornton, could I ask my noble friend more about this transfer? Does he recall that, in previous reorganisations of the health service, large numbers of people claimed redundancy payments and then got very favourable jobs afterwards? Does he not think that the six months that he mentioned as the claw-back period is probably not enough at a time when the health service is very stretched? Also, will he consider what the noble Lord, Lord Walton, said about reorganising some of those posts now to avoid that situation?

[Earl Howe]

My Lords, we are beginning to reorganise the system. Under current rules, we are enabled to do so. I understand my noble friend’s particular point about the claw-back arrangements but there is perhaps a countervailing argument over what is fair and unfair in redundancy arrangements. In that sense, one cannot push the issue too far. Having said that, we are on track with the retirement scheme. We are seeing a deliberate and carefully managed process of reducing staff numbers at primary care trust level, leading up to the clustering of primary care trusts, which I am sure my noble friend knows about.

Health: Visitor Service

Baroness Gardner of Parkes Excerpts

Monday 14th March 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is undoubtedly right that in many areas the current health visitor workforce is very stretched. They are there as a universal service but, at the same time, they try to target their efforts to families in the greatest need. Some struggle to do so, which is why we have set this ambitious programme of recruitment over three to four years. It is a very tough target—I do not disguise that from the noble Lord—but we think that it is necessary if we are to focus on the needs of the most disadvantaged families.

[Baroness Gardner of Parkes]

Is the Minister aware that many people apparently now view health visitors with suspicion as agents of the state? They are frightened, as the noble Lord has said, of the child being taken away. Does the Minister therefore think that one great answer is the system of adoption whereby children can be fostered by someone who could adopt them if, for example, the drug addict mother does not overcome her addiction, but which also leaves open the possibility of the child returning to the mother? That gives the mother an opportunity to recover. It is a very good scheme and it is in operation in some parts of the country. Would it not be a help in addiction cases?

[Earl Howe]

My noble friend makes a good point. The kind of intensive interventions that she is referring to are very much the domain of the family nurse partnerships, which are there to assist and support those families with the greatest needs, particularly single mothers, families where there is addiction and so on, and try to keep the family together. With regard to the health visitors, however, I take her point that there is suspicion out there. It comes down to creating a relationship of trust with a named health visitor, and we have seen the success of that over the past few years. The results of the assessments have been very positive.

Health: Sickle-Cell Disease

Baroness Gardner of Parkes Excerpts

Monday 14th March 2011 Lords Chamber

[Earl Howe]

The noble Lord is quite right. One of the successes in recent years has been the universal screening programme for sickle cell that has certainly raised awareness among all communities about this devastating condition. The screening programme alerts healthcare professionals to the needs of children with the disease and also enables them to provide the necessary support for families.

[Baroness Gardner of Parkes]

Do people who have sickle-cell disease carry any form of card or identification as people with various other conditions do? As a dentist, I know that the definitive test is a blood test. Patients told you they had it, but no one expected you to pick it out in some person coming in the door. I wonder whether there might be a case for having some kind of identification.

[Earl Howe]

I am sure my noble friend’s suggestion is a very good one. I do not think that the practice of carrying identification is by any means universal, but is it perhaps one that could be commended to the relevant patient groups.

Health: Alcohol Minimum Pricing

Baroness Gardner of Parkes Excerpts

Tuesday 1st March 2011 Lords Chamber

[Earl Howe]

My Lords, as ever, the noble Lord is absolutely right. Overall consumption of alcohol is going down, but we are seeing very alarming rates of consumption among certain groups of young people. As Sir Ian Gilmore has pointed out, liver disease is appearing among the young, which is extremely worrying. The Government are determined to grasp this issue. Public health policy generally is co-ordinated by a public health Cabinet sub-committee. It will work on an alcohol strategy, which we will publish in the summer in the wake of our White Paper on public health. There is no single solution to this problem. The issue of proxy purchases, which for alcohol, I believe, is already an offence, is difficult to police and enforce. However, the noble Lord is right that we need to focus on it in our strategy.

[Baroness Gardner of Parkes]

My Lords, the original questioner mentioned public health in general, but is the Minister aware that alcohol is a cause of great disturbance in accident and emergency departments in all hospitals, particularly on Friday and Saturday nights, when ordinary people who go in with injuries are subjected to very unpleasant treatment by those who are brought in following an alcohol-related incident?

[Earl Howe]

My noble friend makes an extremely important point. We estimate that alcohol harm costs the NHS around £2.7 billion a year. Forty per cent of all accident and emergency admissions are in some way connected with alcohol—I think a higher percentage on Friday and Saturday nights—and 7 per cent of all hospital admissions are accounted for in some way by alcohol. This is a very serious problem: 8,500 people die from alcohol in the UK every year and there are over 1 million hospital admissions relating to alcohol.