Health: Multiple Sclerosis

Baroness Gardner of Parkes Excerpts

Monday 30th June 2014 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what plans they have to introduce new treatment for relapsing-remitting multiple sclerosis.

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

My Lords, it is important that people are able to access the innovative and effective new treatments they need. Many thousands of people in England with multiple sclerosis have benefited from the medicines recommended by the National Institute for Health and Care Excellence or covered by the MS risk-sharing scheme.

[Baroness Gardner of Parkes (Con)]

My Lords, I thank the Minister for that reply. People with multiple sclerosis consider that specialist MS nurses are the key health professionals for providing responsive, person-centred, co-ordinated and integrated care. The latest MS Trust report assesses the provision of MS nurses across the UK and considers that there is a shortage of around 200, and that more specialist nurses are required to ensure that everyone has access to a specialist nurse. The new draft NICE guidelines offer only limited support for this specialist role. Given the scarcity of neurologists in the UK, is it not important that this chain of nurses is in place to ensure that emergencies do not develop, which of course costs the National Health Service very much more? Can my noble friend assure me that he will take action to ensure the continuance of MS nurses?

[Earl Howe]

My Lords, I am pleased to say that the number of specialist nurses for multiple sclerosis in the UK has risen from 80 in 2002 to 245 currently. I hope that my noble friend will agree with our view that local healthcare organisations, given their knowledge of the healthcare needs of their local populations, are the people best placed to determine the workforce needed to deliver safe and effective patient care within the available resources. However, it is of interest that NHS England’s service specification for specialised neurology does specify that nurse specialists should be involved in the care of people with multiple sclerosis.

Health: Secondary Care

Baroness Gardner of Parkes Excerpts

Thursday 26th June 2014 Lords Chamber

[Earl Howe]

We have said that preparations for the better care fund in 2015-16 should most definitely include a dialogue between commissioners and providers, and that there should be a whole system approach to incentivising the treatment of patients in the community. Of course, that will involve hospitals such as that of the noble Baroness, which I had the pleasure of visiting this week, informing themselves on how they can assist in the effort to do what we all want to do, which is to see patients treated in the best environment possible.

[Baroness Gardner of Parkes (Con)]

At a time when GPs seem to be very budget conscious and worried about everything, can the Minister assure me that there are no perverse incentives that would tend to deter them from making these secondary referrals early? That is very important.

[Earl Howe]

I am not aware of any disincentives in that sense. Indeed, the rate of referrals has gone up dramatically, particularly for cancer, which seems to indicate that GPs are not afraid to refer when they feel that they need to.

Health: Rheumatoid Arthritis

Baroness Gardner of Parkes Excerpts

Monday 16th June 2014 Lords Chamber

[Earl Howe]

My Lords, we are concerned by reports of patients having difficulty accessing their GPs. That is why a whole range of work is currently going on in NHS England to look at the issue, to see how general practices can be helped and to enable them to see more patients. However, more generally, we in the Government have amended the GP contract to free up GPs’ working time. We have abolished well over a third of the QOF indicators precisely to do that. The Prime Minister’s Challenge Fund—£50 million-worth of funding—enables GPs to open up different ways of working; for example, consulting patients on Skype and working hours other than nine to five.

[Baroness Gardner of Parkes (Con)]

My Lords, although it is very important for GPs and even patients to be aware of early symptoms, does the Minister acknowledge that the real answer as to how to deal with this condition will be in research? Can he tell us whether the Government are supporting such research?

[Earl Howe]

I am grateful to my noble friend. Expenditure on musculoskeletal disease research by the National Institute for Health Research has increased from £15.5 million in 2009-10 to £23.1 million in 2012-13. The NIHR is investing over £21 million over five years in three biomedical research units in musculoskeletal disease. They are all carrying out vital research on rheumatoid arthritis. The NIHR is currently investing £2 million in a programme of research on treatment intensities and targets in rheumatoid arthritis therapy.

NHS: Clinical Commissioning Groups

Baroness Gardner of Parkes Excerpts

Monday 9th June 2014 Lords Chamber

[Earl Howe]

My Lords, I fully endorse the comments of the noble Baroness about the importance of carers. They play a crucial role as partners in care for the well-being of those they look after. I saw that report and of course it is important that GPs are aware of their role in supporting carers. We set out our vision for this in a document we published, Transforming Primary Care. That recognises the importance of involving and supporting carers. It sets out an expectation for GPs to identify carers as a matter of course. As I said in my original Answer, CCG plans will be assured by NHS England, including the important element of carers’ support and recognition.

[Baroness Gardner of Parkes (Con)]

My Lords, is the Minister aware that, at last, carers who work by going from one person to another will be paid for their travel time? I have drawn attention in this House before to the fact that people who were self-employed under such care systems were earning £2-something an hour. Does the Minister agree that that will be a great benefit to both the clients and, in particular, the carers who rely on that income?

[Earl Howe]

I do agree with my noble friend, but I would point out to her that the thrust of the noble Baroness’s Question is about unpaid carers, of whom there are 5.4 million in this country, 1.4 million of whom work more than 50 hours a week as unpaid carers. It is to support those people that the attention of NHS England is being rightly directed.

Health: Liver Disease

Baroness Gardner of Parkes Excerpts

Tuesday 6th May 2014 Lords Chamber

[Noble Lords]

My Lords—

[Baroness Gardner of Parkes (Con)]

Can the Minister identify more clearly for me his definition of liver disease? He cited various things. Do his liver disease figures include the metastases from cancers, which are often a terminal condition? Are they treated separately or classified as part of the existing numbers?

[Earl Howe]

My Lords, there are over 100 types of liver disease, which together affect at least 2 million people in the UK. The main ones are derived from alcohol misuse, viral infection, being overweight and obesity, and there are conditions that are inherited as well as those which attack the immune system. As regards metastases, I would need to be advised but I would imagine that that falls under the general heading of “liver cancer”, which is certainly included in my remarks to the noble Lord opposite.

Health: Multiple Sclerosis Nurses

Baroness Gardner of Parkes Excerpts

Wednesday 5th March 2014 Lords Chamber

[Earl Howe]

I am aware of those variations. Making the NHS more responsive to the needs of people with long-term conditions such as MS is a key government priority. We have committed to it in the NHS mandate, the NHS constitution and the outcomes framework. Strategic clinical networks have a key role to play in providing expertise and guidance and to smooth out the variations that the noble Baroness mentions. She may be aware that NHS England has appointed David Bateman as the first national clinical director for neurological conditions, whose job it will be to look at the very issues that she has raised.

[Baroness Gardner of Parkes (Con)]

My Lords, I declare an interest as I have a daughter with multiple sclerosis. I think that I mentioned this some time ago, but is my noble friend aware that the Chelsea & Westminster Hospital waited years to get an MS nurse but had her for only a short time before she was poached by the Royal Free? Then no replacement MS nurse was even considered; the next vacancy on the list was considered and, as far as I know, the MS nurse has still not been replaced. Is there some problem? Is there a shortage of MS nurses? How was one so easily poached from one hospital by another? Is it a case of no one really wanting to spend the money on that and wanting to treat it is as a general thing, comparing it to all other jobs in a hospital? Can anything be done about that?

[Earl Howe]

My Lords, something can be done. First, patient groups can speak up and can speak to commissioners. As I said in my original Answer, we are committed to putting patients right at the centre of services, which means giving them a voice in the services that are commissioned. I am not aware of the situation in the Chelsea & Westminster Hospital, but my noble friend may like to know that there are now more than 3,300 more nurses working on NHS hospital wards than there were in 2010. That is a positive trend.

Health: Midwives

Baroness Gardner of Parkes Excerpts

Wednesday 5th March 2014 Lords Chamber

[Earl Howe]

My Lords, I am very interested to hear what the noble Earl says about the Australian experience. The mandate that the Government issued to NHS England, published in November 2012, states that women should receive better care during pregnancy and have a named midwife responsible for ensuring personalised, one-to-one care throughout pregnancy and childbirth, as well as postnatally. As part of that, we want NHS England to work with partner organisations to ensure that women are able to make informed and safe choices about where to have their baby. However, it is probably too soon to commit to a ratio of one midwife to one expectant mother.

[Baroness Gardner of Parkes (Con)]

My Lords, I am sure we all support the position of the midwives, but I would like to bring up the financial aspect again. Last week, we had a debate on how people would manage to finance their care in care homes and I mentioned that there are many difficulties, including the fact that no one will now give bridging finance for anything. I understand that all the midwives are asking for is contingency support to enable them eventually to run this as an independent scheme. They simply need the finance to get it off the ground. If that is the case, I remind the Minister of all the difficulties involved in raising funding for anything.

[Earl Howe]

My Lords, any bridging loan requires to be repaid, and that is one of the issues that we are looking at.

Care: Financial Services Industry

Baroness Gardner of Parkes Excerpts

Wednesday 26th February 2014 Lords Chamber

[Baroness Gardner of Parkes (Con)]

My Lords, I am delighted to join in this discussion, particularly as the noble Lord, Lord Lipsey, has made many important points. I am glad to hear that he is on the Equity Release Council’s advisory board. Equity release is something people know very little about; they are suspicious of it and distrust it because they do not understand it. Equity release schemes will have to prove themselves if they are to satisfy people.

I first debated a cap in connection with care costs years ago and I think that the relevant figure at that time was less than £10,000, which shocked me a bit. Even now it is less than £24,000, so it is appropriate that Dilnot has proposed a much more realistic figure for our times. However, a great difficulty arises as regards financial products and older people. In earlier times, older people could get a bridging loan from their bank. Now it does not matter what your assets are, the banks will give nothing at all if you are over 75, and some banks will not give anything to people over 70. They do not want to know you if you are in that age group. They will give you a loan if you want to buy something to rent but, if you want to use the money to cover your own future needs, despite the fact that they can easily recoup it from the sale of the property when you die, they do not want to know.

In many parts of the country, particularly London, many elderly people are capital-rich but have only a very small income. If they wish to remain in their own home, they have to find a means to raise money. At the moment, equity release or insurance seem to be the only two available options. Kensington and Chelsea is cited as having more people who have lived in their home for more than 50 years than anywhere else in the UK. When I came to London, I rented a flat near Portobello Road. The porter of the block lived in a small house in Portobello Road. Those houses were selling in the 1950s for £750. As a sitting tenant, the porter was offered his for £450, which, sadly, he could not afford. Today, those same houses are selling for well over £2 million. If a mansion tax is introduced, the residents will be liable for that tax. Tremendous social upheaval would be caused if people who have been in their house for 50 years suddenly have to find ways to release cash in order to stay there. I have asked equity release organisations whether those people could use equity release for that purpose and was told that they could. However, if they do so, there will be less money available to pay for their care. Moreover, the relevant bodies are willing to provide only a certain amount given that risk is the big factor in all financial transactions now. Everyone wants to avoid risk and we want to be sure that the banks are sound. They are risk-averse, so the whole thing is very difficult.

As I say, the public do not know enough about equity release, and regulation is very important. I was interested to hear the comments of the noble Lord, Lord Lipsey, on regulation. There are good regulations in this field—for example, the regulated home reversion plans, sale and rent back plans and home purchase plans. The ombudsman scheme to which he is referred is, I am pleased to say, free for the complainant, which is important. People are still a bit rattled by what happened at the Co-op, which everyone had thought was so sound. However, the regulator regulates standards of behaviour, not of pricing. We need to be sure that equity release does not end up like the payday loan scheme and rip people off in a big way.

The Financial Services Authority was replaced in April last year by the Financial Conduct Authority and the Prudential Regulation Authority, so a lot of these matters are still regulated, but are the Government satisfied that the systems in place are sufficiently hands-on to cope not only with existing problems but those that might arise when the schemes to which I have referred get going?

I meet people who bought their flats years ago in what were then council blocks—some, indeed, who did so in the days of Mrs Thatcher. Obviously, the value of those flats has increased hugely over that time. However, when the right to buy council flats was introduced, purchasers had the right to sell their flats back to the council if they needed money. The councils were happy to buy those flats as it cost them less to do that than to build new ones. However, no such provision is available now. The flats have all been farmed off to housing associations and housing organisations that operate schemes for the local councils, which has made life much more complicated. I hear of people who are on a pension of £170 a week but are required to pay their share of roof repairs costing £12,000 or £13,000, which is more than their income, so these issues are difficult to assess. It is tremendously difficult for people to assess whether or not they can afford to meet the costs of their care, their daily living costs and the costs of staying in their own home. Furthermore, elderly people in particular know their way round their own property and are safer in their own property than when they move to another one. People do not fall down and break a hip in a place they have lived in for years; that happens in the new place they move to. Therefore, if people do not require full-time residential care, there is great merit in staying in their own home.

I suggest that we need a free, independent advice service. However, that is no good unless skilled staff run it. It is useless if people think that they are getting good advice only to find that the person to whom they are talking knows less about the issue than they do themselves. This issue is a huge project for the future. The Government cannot think that it is resolved, all sorts of problems will come up that we do not even envisage now. The financial services can, and should, do a lot more in this area and should adopt a positive approach. It is a difficult situation as anyone running a financial services organisation is torn between satisfying the Government that they are risk-free and have plenty of spare capital, and satisfying the people who would like to avail themselves of funds from a reliable source, who then find the whole issue is much more complicated than they thought.

I am told that there is far greater confidence in the equity release market at present. Recent figures indicate growth of 12% since last year, with £473 million of housing wealth unlocked in the first six months of last year. There is currently £251 billion tied up in home equity that could be released under equity release products. That is interesting and the release of that money makes sense, but only if it can be handled in a sound way that protects the consumer and helps people. I think that the Government support the Dilnot report, and I certainly strongly support it. We want to see it come into force and benefit people.

Health: Folic Acid

Baroness Gardner of Parkes Excerpts

Monday 24th February 2014 Lords Chamber

[Earl Howe]

My Lords, in recommending the fortification of flour with folic acid, the Scientific Advisory Committee on Nutrition also advised that action should be taken to reduce levels of voluntary fortification, which, as the noble Lord knows, is applied to a number of breakfast cereals, for example. That is no easy matter. It would be necessary to avoid folate levels exceeding recommended limits and to put action in train to achieve that. There are other conditions and advice attached to the SACN recommendation; it is not quite as straightforward in practice as the noble Lord might suggest, although I recognise that the recommendation from SACN is there.

[Baroness Gardner of Parkes (Con)]

My Lords, I am very disappointed by these answers today. I thought that this matter was signed and sealed when we heard my noble friend’s answers some weeks ago. In reply to my question, he just said that I was a bit premature in asking whether it could be put in brown bread as well as white. Really, the facts have been established that in order to have an overdose you would have to eat two or more full loaves of bread, and I think that the danger of any pregnant woman doing that is pretty small.

[Earl Howe]

My Lords, my noble friend always raises some extremely valid points and, of course, I take them. However, I would just gently point out that SACN is concerned about overdosing, which is why it urged that action should be taken to reduce levels of voluntary fortification. Mandatory fortification of a staple food is, I would suggest, a serious matter for the nation, and these decisions have to be reached in a robust and responsible way.

NHS: Cancer Treatment

Baroness Gardner of Parkes Excerpts

Wednesday 29th January 2014 Lords Chamber

[Earl Howe]

My Lords, I agree. The noble Lord may recall that in December 2012 we worked on a project with Macmillan Cancer Support and Age UK to improve uptake of treatment in older people. That established some key principles for the delivery of age-friendly cancer services. In December 2013, NHS England published an analysis of chemotherapy uptake in older people, and that report reaffirmed those principles and set out some new recommendations around improving the uptake of chemotherapy.

[Baroness Gardner of Parkes (Con)]

My Lords, in the previous reply the Minister said he had looked at figures for chemotherapy for older people. Has he looked at the figures for radiotherapy for cancer patients of an age, in particular for intensity-modulated radiotherapy, which is not reaching its target but is considered a great improvement on the previous type of radiotherapy being used for cancer cases?

[Earl Howe]

My Lords, the Government invested £23 million aimed at increasing the capacity of radiotherapy centres in England to deliver intensity-modulated radiotherapy. The latest analysis shows that the median average of IMRT activity in England is at 29%, with the vast majority of centres delivering at 24% or above. That 24% was the magic figure recommended a few years ago by the national radiotherapy implementation group. We continue to monitor progress and local action plans closely.