Atrial Fibrillation

Baroness Gardner of Parkes Excerpts

Wednesday 4th November 2015 Lords Chamber

[Baroness Gardner of Parkes (Con)]

My Lords, I suppose I should declare an interest. Some years ago I was told that I had mild atrial fibrillation—it might have been named intermittent. Now, it is clearly stated that I have permanent atrial fibrillation. I am aware of this diagnosis and the fact that it means my heart is less efficient. Noble Lords have heard everything from everyone else about that. I take Warfarin daily to keep my international normalised ratio within appropriate levels recommended by my cardiologist. It seems to be effective, but regular monitoring through blood tests is required to ensure that my INR remains as it should. The test is straightforward and involves a finger prick to obtain a blood sample, which is put into a reading system that provides the answer. The dosage of tablets is then increased or decreased to correct an unsuitable reading. It is the sort of test that people with diabetes—particularly type 2—need to carry out several times a day.

Yesterday, I discussed this with a distinguished Member of your Lordships’ House who has been in exactly this position—as a type 2 diabetic—for some years. He said he gets warnings: when he feels that he is getting muddled, that means that his blood sugar is low and it is time for another test. If he is feeling slothful and lethargic, his blood sugar is high. He has to do this test up to five times a day and carries out these procedures himself; he has no problems with this. Why is it that individuals requiring very similar blood tests for atrial fibrillation are not able to do their own tests in this same way?

Over the years, I have raised this question, especially with my noble friend Lord Howe. In his days as Health Minister, he told me that it would be logical for those who wished to self-test to do so. I was informed that this would help to reduce National Health Service workload, and sure enough, the INR clinics are always very busy and in demand in most of the major hospitals and in many general practices. The NHS supported self-help, according to my noble friend. In that case, why is there not more self-monitoring for atrial fibrillation? Is this still the case?

For some years, manufacturers of self-test appliances have provided demonstrations in the House of the simplicity and effectiveness of the process. There would be considerable savings for the NHS if patients bought their own machines—I believe that many would—and the NHS provided the small disposable items needed for the tests, such as finger-prickers and solutions. At present, different areas of the NHS provide others with different items. In some areas, the situation is very unsatisfactory for those who feel they should have access to these items. If there were just one system and all the patients therefore had the same choices, there would be a considerable saving.

Mention has been made of the drugs that could be taken instead of Warfarin. My cardiologist said, “Don’t do that”, because the good thing about Warfarin is that its effects are reversible if you suddenly find that your reading is much too high or too low. However, the effects of these new tablets—which have been referred to as NOACs—are not reversible. You have to wait until the body gets rid of them, so there is a time-lag and the situation could become quite dangerous.

In Australia, children born with heart conditions have such machines loaned to them, so that all the treatment can be administered at home. Again, that is very important. My noble friend Lord Black mentioned the difficulty a lot of people face in getting to a hospital. I hope the Minister will support the view that there should be access to self-monitoring.

Health: Global Health

Baroness Gardner of Parkes Excerpts

Monday 26th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I agree with all the sentiments that the noble Lord mentioned—and, perhaps, one other, which is that in a number of other pioneering areas, such as genomics, dementia and antimicrobial resistance, the UK is very much at the forefront. The Government are following up the “Health is global” strategy that was initiated back in 2008 and will be reporting back in detail in 2016. I assure the noble Lord that we will take fully into account the findings of the all-party parliamentary group.

[Baroness Gardner of Parkes (Con)]

My Lords, does the Minister think it would be wise for us still to be learning from other countries, instead of learning only globally? For example, we have an appalling record on pancreatic cancer compared with many other countries. Is it not time for us to improve those things, and then we will be better able again to help others?

[Lord Prior of Brampton]

I agree with the noble Baroness that there is always plenty that we can learn from other countries. She cited one example, and I am sure there are many others. There is never any room for complacency. Other parts of the world are also making huge advances. One of the findings of the all-party parliamentary group’s report is that we face increasing competition not just from countries such as America, but from South Korea and Singapore, for example. The noble Baroness is right: we must always learn from others.

NHS: Mental Health Patient Assessment Needs

Baroness Gardner of Parkes Excerpts

Monday 12th October 2015 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what consideration they are giving to creating an NHS pathway for patients in need of urgent assessment who, due to mental health conditions, are unable to tolerate tests such as scans or blood tests without a general anaesthetic.

[Baroness Gardner of Parkes (Con)]

I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest, as my grandson is a severe case of autistic Down’s syndrome.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we have not considered creating such a pathway. We would expect a patient’s mental and physical health needs to be taken into account when they access NHS services.

[Baroness Gardner of Parkes]

I thank the Minister for his formal Answer but I should go on to explain that my grandson, Christopher, now 23, has no speech and is unable to explain what is happening to him. He has changed from an apparently happy boy and a loving family member to a person suffering violent outbursts, in which he hits his head as if in pain or he attacks others. His increasingly erratic behaviour results in him being excluded from the health groups from which he has benefited so much in the past. Clinicians have already identified the need for a scan but this must be done under general anaesthetic. They are unable to access any NHS team able to do this as there is no clinical pathway, and in some cases patients known to these clinicians have had to wait up to two years. Why should any mentally disadvantaged child—as he was but he is now growing up—not be able to access a full and necessary examination within weeks rather than years?

[Lord Prior of Brampton]

It is obviously not possible for me to comment on an individual case but it sounds like a very tragic and a very difficult case. Of course, someone in that kind of position ought to have access to normal NHS facilities and care, and I am at a loss to know why my noble friend’s grandson has not been able to get proper access. The fact that a general anaesthetic is required, and has been said to be required by a clinician, should not make it any more difficult to access that kind of care. I am very happy to look at this as an individual case and, if it is not just an individual case but an example of a broader problem, I shall be very happy to meet my noble friend outside the Chamber to pursue the matter with her.

Health: Skin Cancer

Baroness Gardner of Parkes Excerpts

Wednesday 22nd July 2015 Lords Chamber

[Lord Prior of Brampton]

Health Education England is aware that insufficient time is spent on dermatology issues in the training of junior doctors, and it is considering that very seriously.

[Baroness Gardner of Parkes (Con)]

My Lords, as someone who had skin cancer 40 years ago, I have a check-up every year. The services are excellent but the most important thing in the context of this Question is that we are now getting the early diagnosis. Does the Minister agree that the most important thing is to raise public awareness, as has been done in Australia, where malignant melanoma, it is believed, can pretty well be eliminated? The important thing is to raise public awareness so that the public go to their doctors and demand to be referred. That is how we will continue to catch more cases at a stage when they can be treated.

[Lord Prior of Brampton]

I agree with my noble friend. What is needed is a combination of public awareness and early diagnosis.

Police: Ambulance Support

Baroness Gardner of Parkes Excerpts

Thursday 16th July 2015 Lords Chamber

[Lord Paddick (LD)]

My Lords, would the Minister—

[Baroness Gardner of Parkes (Con)]

My Lords, I am sitting next to a living example of the situation that we are discussing about the police helping. We are all delighted to welcome back my noble friend Lady Knight. She was found in her garden by her gardener, who was convinced that she was dead. He was terrified and immediately decided to call the police. Eventually she got to hospital by ambulance in enough time, but under those circumstances, when you call the emergency services, how much time does it take to decide who you are going to send—the police or an ambulance? Naturally, if she had been dead, the police would have been the most appropriate people.

[Lord Prior of Brampton]

I am sure that my noble friend will never die; she is clearly immortal. When you dial 999, the ambulance service has eight minutes to respond in such a serious matter as my noble friend has described. Then a fully equipped ambulance must arrive within 19 minutes. In the last two months, 75% of all such “A Red” calls have been met by the ambulance services.

National Institute for Health and Care Excellence

Baroness Gardner of Parkes Excerpts

Monday 13th July 2015 Lords Chamber

[Lord Prior of Brampton]

I think it might be worth while for the House if I read out four lines from the NICE guidance on safe staffing:

“There is no single nursing staff-to-patient ratio that can be applied across the whole range of wards to safely meet patients’ nursing needs. Each ward has to determine its nursing staff requirements to ensure safe patient care. This guideline therefore makes recommendations about the factors that should be systematically assessed at ward level to determine the nursing staff establishment”.

I read out that paragraph because it is important to realise that every ward is different. Where there are tools to help assess the acuity of patients in wards, those tools will be used. I do not think we are planning to mandate any particular tool at this time.

[Baroness Gardner of Parkes (Con)]

Twice I have raised with the Minister the question of a different standard of training, particularly that of entrants to nurse training. We face this great shortage. He has replied to say that the Government have it in mind to introduce such a thing. Will he tell us more about what they are proposing and when?

[Lord Prior of Brampton]

I am sorry—I did not quite understand the question. I realise that I cannot ask my noble friend to repeat it, so I wonder whether I could pick it up with her outside the House.

National Health Service: Sustainability

Baroness Gardner of Parkes Excerpts

Thursday 9th July 2015 Lords Chamber

[Baroness Gardner of Parkes (Con)]

My Lords, I add my comments to others that it is a great thing that the noble Lord, Lord Patel, has brought forward this debate today. As a former dentist, I was the first woman to be appointed to the former Standing Dental Advisory Committee for England and Wales, and later a member of the General Dental Council. As one of the very few dentists in the House, I felt that I should make one or two remarks about dentistry.

I was very disturbed to see the news that Manchester has a serious problem with children requiring full clearance of their deciduous teeth under general anaesthetic. The cost to the local NHS budget is a serious issue and a bed shortage has been created because these children are being hospitalised for a considerable time. I have suggested in this House that such cases could be dealt with in day treatment centres, but as a result I have received some quite abusive emails about the risks that would be created for these children in substandard clinics. Why should they be substandard? I am suggesting a day centre that really is right up to standard.

I have just had cataract operations in a day surgery and they were splendid. The operations were done in a first-class specialist London hospital, the Western Eye Hospital in Marylebone, although I am sure that there are many such hospitals. Some of the operations are done under local anaesthetic and some under general anaesthetic. As patients we spent a day at the clinic and did not take up any beds. I met some people having their second operation whom I had seen when they had the first one, and when we compared notes we saw that we had all made good recoveries. A day centre that is fully staffed with a competent general anaesthetic specialty available would be so much better, not only in terms of saving money for the NHS, but also for children and their families. It is quite frightening for a small child to be stuck in a hospital for a night, so to do so unnecessarily and at great expense is, I think, really too much.

I want to make one other point about Manchester. When the city gets all these new powers, I hope that it also gets a bit of sense. The real problem with Manchester in dental terms is that there is a great deal of opposition to the fluoridation of the water supply. I ask Questions about this subject all the time. The worst performer in the whole of the UK, according to the decayed, missing and filled teeth index, is Manchester, while Birmingham is the best. The Question I ask every so often to keep it before the House is this: what is the difference in other health patterns between Birmingham and Manchester? There is no difference. The really significant difference is to be found in people’s dental condition. Fluoridation could result not only in much better prevention, as advocated by the noble Lord, Lord Patel, it could also mean the saving of a great deal of money and easing of pain and discomfort for the children who are going through such a bad time at the moment.

I agree with the noble Baroness, Lady Emerton, about nursing—I have always had a bit of a thing about this. State enrolled nurses were a very valuable force in this country. Speaking as a former chairman of one of the big London teaching hospitals, I know that some of our best nurses were state enrolled nurses. They were often people who could never have met the academic standards now required for the only qualification we have for full-time trained nurses. We now believe that they should all be university graduates. This means that we are devaluing the caring element of nursing, but I think that there is a place for it. Everyone wants to be called a nurse; no one wants to be known as a care assistant. We should definitely keep up a medium standard of training. Indeed, the Minister who answered a Question for Oral Answer earlier today said that he had views about this issue and that it probably would come back again. I hope that that is the case.

I would like to have retained free dental examinations. In your Lordships’ House, I won a vote on an amendment on that which then went to the Commons, where they attached financial privilege and we were not allowed to debate it again. Had we retained free dental examinations, we would have picked up so many oral conditions so much earlier. Lots of people would have been saved horrible deaths from mouth cancer and others would have known that it was time to go. Even now, I believe that in any day centre that we have, someone should be looking quickly in your mouth and, if there is something abnormal, telling you to go in for a proper consultation. These things are just handled too casually.

There is so much that can be done. It can be done sensibly and well, and does not have to cost a fortune. This is an excellent debate today and anything we can do to make the NHS more sustainable is very welcome.

General Practitioners

Baroness Gardner of Parkes Excerpts

Monday 22nd June 2015 Lords Chamber

[Lord Prior of Brampton]

The right reverend Prelate is right. Many GPs are concerned about the level of bureaucracy in their practices. As he probably knows, we have reduced the number of QOF indicators by a third—that is, by 40—from a staggering 120. This is a big concern. NHS England is looking at other ways in which we can reduce the bureaucracy. If the right reverend Prelate’s daughter has any ideas, perhaps she will be kind enough to give me them.

[Baroness Gardner of Parkes (Con)]

What is the position as regards assistants in surgeries? This morning, we heard about the shortage of nurses that we are going to have. The abolition of the SEN position has been fatal, as a lot of the right people who wanted to enter nursing have not done so because they do not have the necessary academic qualifications. However, would not these SENs now be extremely valuable in taking some of the workload, particularly form filling, off GPs, who are burdened with huge amounts of paperwork?

[Lord Prior of Brampton]

My noble friend is quite right. We are looking carefully at introducing a new position of a qualified nurse who would not have to have the same academic qualifications as existing nurses. As she may know, we are also introducing a new position of physician associates, who will be able to take some of the burden off GPs.

Autism

Baroness Gardner of Parkes Excerpts

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness is right that timely diagnosis of autism is extremely important. I am glad she recognises that progress has been made. I believe that to be true but we know that there is more to be done. The update to the autism strategy, called Think Autism, draws specific attention to the needs of BME communities, and there is a specific action point within that document. I can tell the noble Baroness that we will include that specifically in the statutory guidance that follows on from the strategy. That guidance will be issued shortly.

[Baroness Gardner of Parkes (Con)]

My Lords, where I live, the daughter of a very nice man in the supermarket has just been diagnosed at the age of six. The problem is not the diagnosis—that has been made—but the fact that there seem to be no facilities of any sort to help him. He has been referred to the local borough by his Member of Parliament—an opposition Member, I might add, but a very nice man—and he has taken up the matter with the council, but nothing has happened. Is this, again, a problem of treatment as between care and health services, and what can be done to bridge the gap?

[Earl Howe]

My Lords, the answer to my noble friend’s question lies in more professionals being trained in autism and services supporting rather better the needs of children and adults with autism, and a lot of work is going on on those fronts. We are also asking local authorities to focus, in particular, on their own performance and to report back on the progress they are making on autism diagnosis, and indeed on other issues in Public Health England’s national autism self-assessment exercise. That process will draw out the shortcomings that exist in certain parts of the country.

Medical Innovation Bill [HL]

Baroness Gardner of Parkes Excerpts

Friday 23rd January 2015 Lords Chamber

[Lord Winston (Lab)]

My Lords, I shall not detain the House for great length. The amendment in my name and that of the noble Lord, Lord Saatchi, addresses patient safety, an issue which is dear to this Government. One of the concerns expressed again and again throughout the Second Reading and Committee stages of this Bill, and subsequently, has been that some patients might in desperation, for various reasons, seek treatment which is innovative but not properly regulated or properly justified. Particularly in the private sector, patients might be tempted to go into treatments which seem attractive but perhaps are overadvertised as sensible. In the end, they may be more futile than more recognised treatments that may carry known side-effects or perhaps be more frightening. I think that that is the case for cancer in particular.

This amendment is designed to make sure that any treatment given under this Bill would get broad support from responsible medical practitioners. There would be an onus, not only on the person doing the treatment, but on the person responsible for advising that the treatment was reasonable to the operator, the medical practitioner concerned. This would fall within that area. Essentially, there would be a legal onus, a responsibility, for that adviser to give advice which was regarded as serious and acceptable to a broad body of medical opinion in that field. That is the essence of this amendment, which we have discussed.

I am delighted that the noble Lord, Lord Saatchi, has agreed to put his name to this amendment. It is helpful. I hope that it will not prevent people participating in trials, particularly in cancer medicine. I also hope that it will make sure that private medicine is carried out responsibly. We all have reservations about this Bill but it covers most of the issues about which we have been concerned. I am concerned about reproductive medicine because I fear that that is now in a burgeoning private area. It worries me still that quite a lot of reproductive medicine done in the private sector is not properly validated and that patients are paying very heavily for it. Beyond that, broadly speaking, this is the amendment that I would like to see on the statute book. I therefore beg to move.

[Baroness Gardner of Parkes (Con)]

My Lords, I am slightly concerned about the wording of the amendment because I would not want it to become a way of dragging things on forever. How do you decide what is,

“a representative body of responsible medical opinion”?

To lay people such as myself, there seem to be heaps of medical bodies and I wonder how that would be determined. I would be interested to be satisfied on those points. The speech of the noble Lord, Lord Winston, was clear that he does not intend the amendment to represent any of those matters, but I would like someone who is more of an expert on the wording of these things to assure me that it would not be only a preventative technique.

[Baroness Masham of Ilton (CB)]

My Lords, having tabled an amendment to the Bill on patient safety, I am happy to support the amendment.

--- Later in debate ---

[Lord Giddens (Lab)]

My Lords, I strongly support this amendment and hope the Government will take it seriously because we are talking here about not innovation but scientific innovation. Science is a collective enterprise. It depends on the accumulation of evidence. It is crucial that that be recognised formally somewhere in the Bill, with this embodied as part of the advancement of scientific progress more generally.

[Baroness Gardner of Parkes]

My Lords, I support this amendment. I was surprised that the Government took a line similar to my own on the previous amendment because I was greatly reassured by what noble Lords said on that point. In this case, and right from the start of the passage of the Bill, we have all believed it essential to fully record what happens. The whole aim of this has been not only to give hope to people via an innovative treatment but also to have research that will benefit other people in future. No one has for a minute queried the need for recording the cases and results. I would be amazed and shocked if the Government denied that today.

[Lord Ribeiro (Con)]

My Lords, many noble Lords will remember the disasters that occasioned the introduction of laparoscopic cholecystectomy in the 1990s. Quite a few patients suffered as a result of the innovation of our surgeons playing with a new instrument, new tools and a new operation. At the time, I was secretary of the Association of Surgeons of Great Britain and Ireland. In recognising the problems, we introduced a voluntary register of all surgeons undertaking the procedure and got a very good response. Admittedly, it was not compulsory and not every surgeon introduced their data to it, but the net effect was that when we analysed our data we were able to identify where many of the problems lay. That led to further research and proper control trials in the procedure. We were able to turn to that from an innovation used by a succession of surgeons as and when they felt necessary, without any good evidence on how best to use it. On that basis, and mindful of the benefits that we saw in the 1990s, I would very much support some form of register to ensure that, if an innovation is introduced, we have the information, can go back and refer to it again, learn from the mistakes and improve the outcome.

--- Later in debate ---

[Earl Howe]

I would just say that the Bill is not to do with research but with innovative treatment, which is rather different. There is no question of the noble Lord, Lord Saatchi, promoting another form of clinical trial so while I accept the principle that the gathering of data is a very good idea, we must be clear that this is not for clinical research.

[Baroness Gardner of Parkes]

Before the noble Earl sits down, from the outset we have been very clear that this was to be recorded. Everyone has wanted someone reputable to come forward and say that they were going to record it. To see that this will possibly now not happen is just unbelievable because what is the benefit, unless people in the future can benefit from it and it is accurately recorded? I am sorry to say that I cannot accept the view that this amendment should not be accepted by the Government.

[Lord Woolf]

My Lords, before the noble Earl sits down for the last time, I am very conscious of the kind things said by the Minister about my interventions, and I can assure him that I hold his approach to all matters of this sort in equally high esteem, if not higher. He is a lesson to us all in the care with which he approaches these matters.

Just before we leave the subject, I want to draw attention to the words,

“comply with any professional requirements as to registration”.

That is a very important limitation in the amendment because—as I understand it; I did not have anything to do with the drafting—it presupposes that there should be professional requirements. Surely we can rely on the medical profession to put in sensible requirements.