Health: Multiple Sclerosis

Baroness Gardner of Parkes Excerpts

Wednesday 2nd February 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord will know that a drug called Sativex was recently licensed, which is derived from an extract of cannabis, as he will be aware. Having said that, I believe that NICE has issued no guidance to the NHS on the use of Sativex, so it is for local primary care trusts to make funding decisions based on an assessment of the available evidence and on the basis of the patient’s individual circumstances. As the noble Lord rightly said, Sativex treats the symptoms of severe spasticity caused by MS and is not a disease-modifying drug as such.

[Baroness Gardner of Parkes]

My Lords, I declare an interest as I have a daughter who has had multiple sclerosis for 30 years. For the past 13 years, she has been on beta interferon, which has been of great benefit to her. I understand from the press that there is a possibility of oral drugs rather than weekly injections in the future. Can the Minister tell us what stage that is at? I understand that the issue is still being considered by NICE as it is in the early stages. What progress is being made?

[Earl Howe]

My noble friend is absolutely right. There are two drugs, Cladribin and Fingolimod, which are oral treatments but they have not yet received licences. The trial results for Fingolimod are promising, but it is premature to say that the treatment will remove the need for the drugs in the risk-sharing scheme. Clearly, oral treatments are likely to have advantages over alternative treatments given by injection or infusion, but some concern has been expressed about possible side-effects and the likely cost to the NHS.

NHS: Targets

Baroness Gardner of Parkes Excerpts

Monday 20th December 2010 Lords Chamber

[Earl Howe]

My Lords, the announcement made by the previous Government for the one-week target was an unfunded, as well as very expensive, commitment. At the moment, the median wait for the 15 key diagnostic tests is 1.8 weeks—it fluctuates between 1.5 weeks and thereabouts. To bring that down to a maximum of one week would have cost many hundreds of millions of pounds. We judged that there are better ways in which to speed up access to diagnostic tests for a lot less money. That is why we recently announced that £25 million will be made available next year to help GPs to get direct access to tests for cancer without first having to make an appointment with a specialist. That money will buy up to 150,000 extra tests. We have thought round this problem—if I may put it that way—and thought around the conventional referral pathways. I believe that we will arrive at a very satisfactory result.

[Baroness Gardner of Parkes]

Can the Minister tell me his view as to how exactly things will work? Although some targets were considered bad, unnecessary and unproductive, others produced some good results. Will the targets be replaced by a code of practice or guidance, or will people simply be left to manage as best they can?

[Earl Howe]

My noble friend is right. Of course the waiting time target achieved a great deal in bringing down waits for elective procedures, but the target had some unwanted effects in that it distorted clinical priorities and, many people felt, took the focus away from many areas of care that deserved greater focus. We need to focus on outcomes for patients. Therefore, instead of setting process-based targets, our aim will be to ensure that, wherever possible, the NHS uses the measures that clinicians themselves use as a basis for improving their services—in other words, measures that are clinically credible and evidence based. That is how we have tried to frame the outcomes framework.

Department of Health: Arm’s-length Bodies

Baroness Gardner of Parkes Excerpts

Tuesday 16th November 2010 Lords Chamber

[Earl Howe]

The advantages will come from collocating all aspects of public health in one place, including the Health Protection Agency. I emphasise that there will continue to be independent advice on health protection. We will have a clear line of sight in all public health matters from the Secretary of State right down the chain to local authorities and to public health programmes implemented on the ground. We do not have that at the moment.

[Baroness Gardner of Parkes]

Is the Minister aware that, in health services in general—and I apply this also to these bodies—there is a tendency that if someone leaves a post, it is kept unfilled? Will the Minister assure us that, instead of allowing that to happen on an unspecified basis, the Government will make sure that if a post is essential it is retained and not left simply because a person has given up their job?

[Earl Howe]

My Lords, my noble friend makes a good point. We need to distinguish between posts that are administrative in nature, where we will see considerable reductions, as I have mentioned, and posts that relate to clinical activities. There is obviously a clear case for the latter posts to be advertised and filled where necessary.

Health: Chronic Fatigue Syndrome

Baroness Gardner of Parkes Excerpts

Monday 8th November 2010 Lords Chamber

[Earl Howe]

My Lords, it is important to make clear to the noble Countess that no definite picture has yet emerged from the published literature on whether the virus in question, XMRV, is implicated in CFS/ME. The National Expert Panel on New and Emerging Infections has considered all the available evidence about XMRV and has reported that no public health action is required at this time. The Advisory Committee on the Safety of Blood, Tissues and Organs, on the basis of current evidence,

“does not recommend further measures at present, but wishes to continue to monitor the situation”.

As regards research into CFS/ME, the Medical Research Council is committed to supporting scientific research into all its aspects, including studies into the biological basis of the condition and evaluation of treatments. In 2009-10, the MRC spent £109,000 on research directly related to the condition.

[Baroness Gardner of Parkes]

My Lords, I am sure that everyone would agree that we would rather be too cautious, but can the Minister explain why anyone over a certain age is automatically excluded from being a blood donor?

[Earl Howe]

My Lords, this is a pragmatic decision by the advisory committee on donation. In the case of CFS/ME, which we are looking at at the moment, the committee recommended that the donation policy should be brought into line with other relapsing conditions, where the rule is that we do not take blood from people with such conditions.

Health: Neurological Conditions

Baroness Gardner of Parkes Excerpts

Monday 11th October 2010 Lords Chamber

Asked By

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what is their assessment of the role of allied health professionals in maintaining the health and social well-being of people with long-term neurological conditions.

[Baroness Gardner of Parkes]

My Lords, the notice of the opportunity for this debate was very short, but the topic is an important one and I am delighted that we are debating it this evening. I thank those who are speaking. I know that in some cases they have had to alter their arrangements to enable them to be here and that many others who also have a particular interest in or knowledge of the subject cannot be here today.

I start by giving noble Lords the Royal College of Physicians’s definition of long-term neurological conditions:

“Long-term neurological conditions (LTNCs) form a diverse set of conditions resulting from injury or disease of the nervous system that will affect an individual for the rest of their lives. They include: sudden onset conditions (eg acquired brain injury of any cause (including stroke), spinal cord injury) intermittent conditions (eg epilepsy) progressive conditions (eg multiple sclerosis (MS), motor neurone disease (MND), Parkinson’s disease (PD) and other neurodegenerative disorders) stable conditions with/without age-related degeneration (eg polio or cerebral palsy). Taken together, LTNCs are more common than most clinicians realise. Some 10 million people in the UK are living with a neurological condition which has a significant impact on their lives, and they make up 19% of hospital admissions”.

Many of us would be glad to learn the precise definition of allied health professionals. There are 15 health professions registered with the Health Professions Council, including speech and language therapists; radiographers; therapeutic radiographers; and prosthetists and orthotists, who mainly make artificial limbs—two different words but the same profession. There are also podiatrists; some still use the word “chiropodist”. A podiatrist is principally concerned with keeping patients steady and supported on their feet. The aim is to reduce falls, which are a main cause of serious injury and hospital admission for people with long-term neurological conditions. It is interesting to learn that Botox injections in the ankle and foot may help patients with cerebral palsy.

There are also physiotherapists. Some call themselves chartered physiotherapists, but they are the same profession whether they are chartered or not: it is just a distinction. There are paramedics. Television has made us all familiar with paramedics and it is interesting to see how their roles have developed and are constantly expanding as new treatments are discovered and put to use.

There are also orthoptists, who look after eye health; occupational therapists; dieticians; art, music and drama therapists; hearing-aid dispensers; practitioner psychologists; and clinical scientists. A clinical scientist oversees specialist tests for diagnosing and managing disease, advises doctors on using tests and interpreting the data, conducts research and devises new therapies.

Each of those professions plays a significant part in the care of long-term neurological conditions. Often, their work is interrelated. It is always to the benefit of the patient and makes the difference between maintaining quality of life and losing that quality. Usually, a multidisciplinary approach is needed and used.

Many Members of the House will know of my personal interest, but I will formally declare it again. My eldest daughter, Sarah, was diagnosed with multiple sclerosis at the age of 21. Now, 30 years later, she continues to make the most of life and plays a full part in the community. She is a patron of the Multiple Sclerosis Trust and only this year became a council member of the Royal Horticultural Society. She knows, as do all of us in her family, the real difference that allied health professionals have made in her life. Under the care of the National Hospital for Neurology and Neurosurgery, she has an excellent consultant neurologist, but the practical help and advice for everyday life is given by allied health professionals.

AHPs are important to people with long-term neurological conditions, as they provide a vital input throughout the whole disease process—I emphasise the whole disease process—from early intervention to prevent disability, through the management of complex symptoms, to end-of-life care. For the National Health Service, they provide effective management of admission and discharge from hospital, thereby minimising hospital admissions and reducing length of stay. Maintaining people at home, thus preventing in-patient admissions, is very cost-effective for the National Health Service; £2,000 is the minimum cost of any admission. The use of specialist expertise to manage specific symptoms including those related to cognition, fatigue, pain, spasticity, speech and swallowing improves quality of life for the person with the condition, enabling people to maintain important life roles, such as working or looking after their family, reducing the cost to UK taxpayers. Interventions also prevent additional complications through treatment.

Allied health professionals enable people to self-manage and to remain within the community, again reducing national health costs. Allied health professionals bridge the gap between health and social services, working with people in home, work and leisure environments. In the current climate of wishing to ensure that health and social services are working together, the allied health professionals are vital. They are well placed to work with the new GP consortia to engineer service redesign and provide leadership for services. Multidisciplinary teams can provide a holistic and co-ordinated approach to intervention.

Professor Alan Thompson at the National Hospital for Neurology and Neurosurgery at Queen Square stated that,

“any model of care for MS has to have both breadth and expertise to address the wide range of problems and the flexibility to cope with variability, unpredictability and changing pattern of need”.

I believe that applies to all the long-term neurological conditions set out in the definition from the Royal College of Physicians.

Physiotherapy is probably the best known of the functions carried out by the allied health professionals. Although familiar to all, it is not always appreciated that benefits are not only physical but psychological and socio-economic. I was rather shocked to learn that there is not a single specialist physiotherapist for the 4,000 multiple sclerosis cases in Northern Ireland, and I wonder why that is so. For people with motor neurone disease or multiple sclerosis, physiotherapy cannot regenerate tissue that has been destroyed, but works to maintain functional strength, endurance and independence. In Parkinson’s disease, physiotherapy helps to maintain general levels of fitness and enable patients to maintain independence for themselves. It helps to prevent or manage falls, for example, by working on specific balance training. A physio usually works with an occupational therapist to look at ways in which to free the home environment of hazards. The Parkinson’s Society refers to the vital role of allied health professionals in neurology in treating the individual patient and not just the condition; it is important that each patient receives the therapies that they need at the right time to ensure the best management of their condition. That will prevent unnecessary deterioration and reduce the burden on the health and social care system.

Radiographers are necessary in diagnosis to provide accurate imaging examinations. The importance and limitation of the short window wherein a scan can benefit a person who has suffered a stroke has often been discussed in your Lordships' House. Speech and language therapists not only help with speech—a most necessary task to restore confidence after a stroke. They can also help patients with swallowing difficulties, which can occur in various conditions due to changes in mouth secretions. Podiatrists provide essential assessment and foot care for a wide range of patients, including those with cerebral palsy and peripheral nerve damage. Those podiatrists specialising in biomechanics are particularly relevant to the elderly. Dieticians are the only qualified health professionals who assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Their input is of great value in hospitals, care homes and the wider community.

Each of the allied health professions plays a vital part in the treatment of people with long-term neurological conditions. I have spoken about some of these professions, but my speaking time is over. I pay tribute to all for the wonderful job they do and recognise that it is the working together of those professions that makes them so effective. As long as people have these neurological needs, they will continue to need and value the great work being done by the members of the allied health professions. The points I have made summarise why all long-term neurological conditions are difficult for the NHS to manage, but the allied health professions are having a real impact.

I have not spoken about dementia but I am delighted that the noble Baroness, Lady Greengross, is here and I hope that she will do so, as it is so important in our lives. I would be glad to hear the Minister confirm that he understands the importance of the role played by the allied health professionals and that their work with patients will continue.

Health: Diet

Baroness Gardner of Parkes Excerpts

Tuesday 13th July 2010 Lords Chamber

[Earl Howe]

My Lords, first, I pay tribute to the noble Lord’s distinguished chairmanship of the Food Standards Agency. The Government recognise the important role that the agency plays, and a robust regulatory function will continue to be delivered through the FSA. As part of our wider drive to increase the accountability of public bodies, and reduce their number and cost, we are also looking at where some of the functions of the FSA sit best to ensure that they are delivered most efficiently. No decisions have yet been taken, but we are examining the matter carefully.

[Baroness Gardner of Parkes]

My Lords, does the Minister agree that one major problem with diet is far too much liquid in the form of alcohol? Is he aware that in the other place, at afternoon tea between 4 pm and 6 pm, many groups hold an event to which many of us are invited, and frequently we are not even offered the option of tea but encouraged by the catering department to have alcohol at four o'clock in the afternoon? Does he not think that we could do something about that, closer to home?

[Earl Howe]

My Lords, I have no doubt that my noble friend is correct. I am sure that she will wish to place the correct representations in the right ear, and I will assist as best I can.

NHS: Pain Management Services

Baroness Gardner of Parkes Excerpts

Wednesday 7th July 2010 Lords Chamber

[Baroness Gardner of Parkes]

My Lords, pain management is very important and I am grateful to the noble Lord, Lord Luce, for introducing this debate. I should declare an interest in that I have a daughter who has had multiple sclerosis for almost 30 years. To a degree, she has been fortunate in that she has not suffered pain. But many sufferers of multiple sclerosis suffer severe pain. Some of them have pain in their mouths—trigeminal neuralgia. In oral dental training, the trigeminal nerve is a very important nerve in the face. It is the one that we have all heard about and we all hope that people will never get trigeminal neuralgia as it is considered to be the most horrendous pain that exists and is very difficult to deal with. Although various things can be done, sometimes that involves surgery, and for someone with multiple sclerosis that is very difficult. So pain is a major issue.

Many years ago I went to the Eastman Dental Hospital to see Professor Harris. When I got there, they said, “Have you come for the pain control clinic?”. I said “No”. I had never heard of the clinic. But it was interesting that Professor Harris was doing tremendous research at the Eastman Dental Institute into pain control. He must have retired some time ago, but this work is being continued.

Someone sent me a valuable tome on trigeminal neuralgia, which I kept for years. I occasionally glanced at it, but I never really read it. I offered it to the Lords Library but was told that it was far too specialised. I eventually sent it to one of the dental training schools because it was too important to be thrown out.

Pain affects many people. The noble Lord, Lord Luce, talked about acute pain, as well as chronic pain, which is what we are dealing with now. Chronic pain can be severe pain, which is the most worrying aspect. People can manage to put up with a little unpleasantness from time to time, but severe, constant pain is terrible to endure. Apart from anything else, it is demoralising and exhausting. Pain can be a valuable warning that something is wrong, but I agree with the noble Lord, Lord Luce, that pain should be classified as a disease in its own right.

In 2006, I fell off one of those old buses, which I foolishly tried to hop on. It was at the lights and, unfortunately, I did not make it. I was tossed in the air and I broke one of my vertebrae, but I did not discover that for some time, although it was a little painful. By the time I was diagnosed it was too late to do anything about it surgically, but I was put on hydrotherapy, which was fantastic and dealt with the problem.

Another important point is that, often, the specialist nurses and therapists who work with these individuals pick up the pain issue and are able to refer people to the right place for pain management control.

Unfortunately, my time is up and I cannot say any more. This is a most important debate and I thank the noble Lord again.

NHS: Budget

Baroness Gardner of Parkes Excerpts

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

My Lords, I am very much in tune with the noble Lord’s general theme. As I said in the House last week, it has to make sense for us to look at each and every arm’s-length body. We need to consider what it does and what it was designed to do, decide how critical those functions are and how well they are fulfilled and then decide whether we can achieve better value for money by doing things differently. I do not want to promise the noble Lord a bonfire, as I have not yet taken any decisions, but I assure him that I will be rigorous in my approach to this whole exercise.

[Baroness Gardner of Parkes]

My Lords, as a former chairman of a hospital trust, I know that when staff are consulted about the way in which savings can be made they come up with very constructive ideas. Could not the cumulative effect of many hospitals seeking the comments and advice of their staff lead to considerable savings and improved efficiency in running the hospitals?

[Earl Howe]

My noble friend makes an extremely good point. Much of the thrust of what we are trying to do is to achieve much greater local ownership by clinicians, staff and managers of the problems that we can all identify. The ideas that my noble friend has put forward already operate in many trusts, but they should be imposed more widely.

Health: Cancer

Baroness Gardner of Parkes Excerpts

Monday 21st June 2010 Lords Chamber

Asked By

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government whether they have proposals to use photodynamic therapy (PDT) for the treatment of cancer, particularly oral cancer.

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

My Lords, it is for clinicians to decide on the suitability of treating a patient with photodynamic therapy—PDT. It is then for primary care trusts to consider whether to fund that treatment, taking into account the available evidence. The National Institute for Health and Clinical Excellence has issued interventional procedure guidance on photodynamic therapy for nine cancer indications, including oral cancer.

--- Later in debate ---

[Baroness Gardner of Parkes]

I thank the Minister for that reply. Does he agree with me that the most important thing, whatever the type of cancer, is early detection? Will he encourage the research that I hear is being done and which we read about in all the newspapers, which entails a very simple blood test that detects cancer at the earliest stage?

[Earl Howe]

My noble friend is absolutely correct. It is now generally agreed that the most important reasons for the lower survival rates in England compared with other European countries are: low public awareness of the signs and symptoms of cancer, delays in people presenting to their doctors, and patients having more advanced disease at the time of diagnosis. We are looking very carefully at how best to achieve earlier diagnosis. There are some key messages on the NHS Choices website and the national awareness and early diagnosis initiative has been under way since 2008. As for my noble friend’s second question, on the blood test, the newspaper reports in recent days have been extremely exciting in terms of the potential. However, it is clear that researchers will have to demonstrate improved clinical outcomes for patients before any large-scale rollout can be applied.

First Aid

Baroness Gardner of Parkes Excerpts

Thursday 17th June 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Lord asks several questions there. As I have indicated, we are extremely grateful to organisations such as St John Ambulance, the Red Cross and the British Heart Foundation for the extensive and excellent work that they do. As a general approach, we are clear that the NHS locally is best placed to assess and address what is needed in its areas, as indeed in other areas of healthcare. However, we encourage NHS providers to consider the kind of partnerships that work so well.

As regards schools and PSHE, as the noble Lord will know, first aid is included in the PSHE part of the school curriculum. It is not a mandatory module, though it is often included in key stages 3 and 4. What I can do is convey the noble Lord’s concerns to my colleagues in the Department for Education.

[Baroness Gardner of Parkes]

My Lords, can the Minister assure me that emphasis will still be placed on the continuing need to educate the public about when to call an ambulance? I strongly support making people more aware of first aid, but there are many conditions, such as strokes, which it is too late to treat unless it is done within a certain timeframe. The ambulance service, as I learnt when I had a fall recently, is very good when you call at sorting out exactly what your symptoms are and whether you need an ambulance. Will the Government ensure that the public remain aware of that situation?

[Earl Howe]

My Lords, my noble friend is absolutely right. The kind of basic first aid provided by community first responders, as they are called, is extremely important, not least in terms of operating defibrillators. However, that sort of service should be seen as complementary to and supportive of ambulance responses to emergencies. It is not a substitute for emergency ambulance response, and it is right that my noble friend should raise that distinction.