Recycling

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 13th December 2017 Lords Chamber

[Baroness Gardner of Parkes (Con)]

My Lords—

[The Minister of State, Ministry of Defence (Earl Howe) (Con)]

My Lords, I think the House would wish to hear from the representative of the Green Party.

War Pensions: Uprating

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 11th January 2016 Lords Chamber

[Earl Howe]

As I have explained, we do uprate the war pensions scheme, in line with the CPI, which is exactly the measure used by the DWP for all disability benefits, so those people are not disadvantaged.

[Baroness Gardner of Parkes (Con)]

I had a past interest as the first chairman—I suppose that was my title—of the War Widows’ Association. Indeed, my noble friend Lady Fookes is now in the same position and has been very successful in that regard, as have other Members of this House. Can the Minister tell me whether the wonderful change, brought in by a Conservative Government, whereby war widows can marry again without losing their pension, is affected in any way, or will they still be able to live whatever life they choose as the widow of a war pensioner?

[Earl Howe]

My Lords, a change was introduced. As from 1 April last year, those who are widowed and have a war widow’s pension can keep that pension whether or not they subsequently marry. However, regarding cases that fall before that cut-off point, it has been the policy of successive Governments that changes or improvements to all public service pension schemes should not be applied retrospectively, so there are no plans to reinstate war widows’ pensions for war widows who remarried between 1973 and 2005. However, from 1 April last year, those who have already surrendered their pension due to remarriage or cohabitation can apply to have their pension restored for life, should that relationship end.

Autism

Debate between Baroness Gardner of Parkes and Earl Howe

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]

Debate between Baroness Gardner of Parkes and Earl Howe

Friday 23rd January 2015 Lords Chamber

[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.

Meals on Wheels

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 19th January 2015 Lords Chamber

[Earl Howe]

My Lords, I do not recognise the figure of 40 million that the noble Baroness mentioned; perhaps she and I could confer after this Question. I think that what matters here is that those with eligible needs receive the service they require. It is up to local authorities to determine eligibility criteria, but the latest available data from ADASS show that all local authorities are setting their eligibility criteria to ensure that they meet at least critical and substantial levels of need.

[Baroness Gardner of Parkes (Con)]

My Lords, some years ago I was a chairman of social services, and many elderly people did not like the meals that came. I wonder whether that is still the position. I also wonder whether the position in hospitals is similar, as we have found that more people suffered from malnutrition after they had been in hospital than before. That happened because people could not feed themselves adequately and the maid or carer who delivered the food to them would come in and say, “Oh, you didn’t like your lunch, dear”, and take it away. Of course, they have found ways round that, but have they found ways to ensure that people are getting meals that they like, and is someone seeing that they actually eat them?

[Earl Howe]

My noble friend makes a series of important points. I do not have information on how many people dislike their meals on wheels, but the fact that many purchase them must indicate that the quality of those meals in many areas is of a high standard. There is also charitable provision, which I should have mentioned as well. The context here is surely the new regime that will be ushered in by the advent of the Care Act, which builds support around the individual and their needs and preferences.

HIV

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 15th January 2015 Lords Chamber

[Earl Howe]

The noble Baroness is absolutely right. If we were to single out three things that are important in this context, they would be prevention, testing and tackling stigma and discrimination. The NHS, local authorities, government, community and faith groups, the media and individuals themselves all have a part to play in eliminating HIV-related stigma. Our framework for sexual health improvement is clear that action needs to continue to eradicate prejudice based on sexual orientation. That depends on building an open and honest culture where everyone can make informed decisions and responsible choices about relationships.

[Baroness Gardner of Parkes (Con)]

My Lords, is it not a fact that there has been a great change in attitudes about HIV, and not only because of the treatments that are now available? I recall the days when people went into a hospice because it was a terminal condition. I have sat on various inquiries and know that people used to hide—in the fridge, for example —any evidence that they had HIV because they were frightened of other people knowing. Because that no longer applies, there is a great opportunity for people to have testing without any embarrassment at all.

[Earl Howe]

My noble friend is right. I think that we have come a long way since my noble friend Lord Fowler was Secretary of State, when stigma and discrimination were very apparent in virtually all sections of society. We do not see that so much now, I am glad to say, as evidenced by the fact that we are reporting a continuing reduction in late diagnosis. It was down to 42% last year from 47% in 2012, and that is a key indicator in this context.

NHS: Dermatology Services

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 17th December 2014 Lords Chamber

[Earl Howe]

My Lords, the Government have mandated Health Education England to provide national leadership on education, training and workforce development. Dermatology is currently a key part of the generalist undergraduate medical curriculum and a component of GP training. The General Medical Council requires that the undergraduate medical curriculum should provide enough structured clinical placements to enable students to demonstrate the outcomes for graduates across a range of clinical specialties, including dermatology.

[Baroness Gardner of Parkes (Con)]

My Lords, with my typical Australian fair skin and the strong sunlight there, I had a skin cancer some years ago. I have to go back and be checked and I consider that I am being looked after very well. However, the one thing that the consultant always says when he sees me on this annual basis is that there is a lot of unhappiness about the research money. When people apply for research funding, it tends not to go to those who are actually doing the work, but to someone who carries the name of being the research officer in the department. The money is spent on administration rather than on actual research. Can my noble friend tell me whether that has improved since I last raised this point, which must be about two years ago?

[Earl Howe]

My Lords, the National Institute for Health Research’s clinical research network is currently recruiting patients to more than 60 studies in dermatology. Specifically, it funds a wide range of research on skin cancer. It has awarded £1 million for research on GP and patient interventions to improve early diagnosis of malignant melanoma in primary care. Another NIHR award is on understanding the experiences and support needs of patients with melanoma and their carers, and patients are being recruited to 18 melanoma studies. I will take away my noble friend’s point about administrative costs but clearly any research project carries such costs, which must be covered somehow. Unless the balance is wholly wrong, I do not think we should be worried that some funding goes towards administration.

Learning Disabilities: Health and Care Services

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 3rd December 2014 Lords Chamber

[Earl Howe]

My Lords, that is a very interesting idea; the noble Baroness is right to draw attention to the Dementia Challenge programme, which has been hugely successful. At this point, once we and the system have delivered on our Transforming Care and concordat commitments we will consider how the lessons learnt from the Dementia Challenge programme might be applied in the next programme delivery phase, and indeed in other policy areas as well.

[Baroness Gardner of Parkes (Con)]

My Lords, I declare an interest as I have a grandson in this position. Is the Minister aware of just how extremely difficult it is to get any action at all in these cases? When someone in their early 20s who is no longer a child has to give up whatever educational establishment they have been at, parents find themselves confronted by a situation where everyone is saying, “Yes, you need mental health services”, but none are available. Do I understand correctly that the suggestion made by the noble Baroness might help that situation? If so, I strongly support it.

[Earl Howe]

My Lords, the report contains a number of important recommendations which we will consider. This report was commissioned by NHS England for NHS England, to make recommendations for a national commissioning framework under which local commissioners would secure community-based support for people with learning disabilities and/or autism. It is an important report, it is right that we take a bit of time to digest it, and, together with NHS England, we are looking carefully to do just that.

Medical Innovation Bill [HL]

Debate between Baroness Gardner of Parkes and Earl Howe

Friday 24th October 2014 Lords Chamber

[Baroness Gardner of Parkes]

Can I seek some clarification? I wonder whether anyone could make clear for the Committee whether, if the doctor says that he does not want to do the innovative treatment, there is a defence in court on the grounds that he thought that it would be unwise or unsatisfactory. I say this because everyone seems concerned about the effect of not doing something innovatory.

[Earl Howe]

I can reassure my noble friend on that score that a doctor’s clinical judgment not to go ahead with something innovative would be something that the doctor would be able to cite in court, if necessary, as being the most reasonable course to take in the circumstances.

NHS: Ambulance Response Times

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 21st July 2014 Lords Chamber

[Earl Howe]

My Lords, patients have the right to a high-quality urgent and emergency care service whenever they call upon it, and we expect ambulance trusts to provide that. We are aware that independent or voluntary ambulance services may be used to support NHS ambulance services because they can help manage peaks in demand. Individual NHS ambulance services have got to ensure that 999 calls are attended by staff who are properly trained and adequately equipped. Indeed, since 2011 the providers of independent ambulance services have had to register with the Care Quality Commission, which monitors, inspects and regulates all services.

[Baroness Gardner of Parkes (Con)]

My Lords, is it not a shame that London has only one air ambulance, which is run by a charity, when Sydney and Paris have six and four respectively? Does the Minister not think that it would be to the advantage of patients to have more air ambulances operating in London, because at least they can deal with any major traffic problems?

[Earl Howe]

My Lords, we owe a great deal to the air ambulance services across the country, all of which, I think I am right in saying, are organised as charities. However, it is the case that in every instance the NHS pays for the clinical staff on those ambulances while the charity pays for the helicopter and the pilot. That is the balance we have struck and successive Governments have taken the view that it is the most cost-effective model for the NHS. However, that is not to downplay the very important role that ambulances perform in our society.

NHS: Hospital Waiting Times

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 10th July 2014 Lords Chamber

[Earl Howe]

My Lords, I do not believe that that is a fair comment. In the past four years, since the Government came to office, we have substantially reduced the numbers of patients waiting longer than 18, 26 and 52 weeks to start treatment. Those numbers are lower than at any time under the previous Government. However, we need to address the build-up in patients waiting and, as a result, we are directing extra support and money for hospitals to do more than 100,000 additional operations over the next few months to meet the extra demand.

[Baroness Gardner of Parkes (Con)]

My Lords, is it not a fact that the statement made this morning by the new president of the Royal College of Surgeons makes quite a lot of sense, and that most people would agree with it? People who need life-saving operations urgently should have priority, and people who have conditions that will not deteriorate—I am spreading more words than she actually said—may be asked to wait longer to give that priority to the more urgent cases. Does my noble friend not think that that first ever woman president of the Royal College of Surgeons is talking common sense?

[Earl Howe]

Yes, she is. I have known the new president of the royal college for some years. She is a very considerable surgeon, and I agree with what she has said. Clinical priority is the main determinant of when patients should be treated, and should remain so. Clinicians should make decisions about the patient’s treatment and patients should not experience undue delay at any stage of their referral, diagnosis, or indeed treatment. That is why we have moved away from targets to standards—to signal the importance of clinical priorities, which doctors should always feel able to act on.

Health: Cancer

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 9th July 2014 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government why the number of National Health Service patients treated for cancer by stereotactic ablative radiotherapy has fallen since April last year.

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

My Lords, before NHS England began commissioning specialised services in April 2013, many local arrangements that were in place were outside recommendations issued by the National Radiotherapy Implementation Group, the NRIG. Since April 2013 a consistent national policy has been in place, backed by robust clinical evidence. In line with this evidence, the number of SABR indications commissioned has reduced. It is important to ensure that treatments commissioned are supported by robust evidence of their benefit to patients.

[Baroness Gardner of Parkes (Con)]

I thank the Minister but, as recently as February this year, I asked him a question on another form of very specifically targeted radiotherapy. He replied that access would be guaranteed to innovative radiotherapy. My Question today relates to another innovative form, one that targets the particular cancer without damaging the surrounding tissues. Can the Minister explain why the figures have fallen and whether these machines, which are very valuable, are being left unused? If they are, is it because of the lack of people being trained to use them? Do we have enough skilled staff to allow patients to benefit from what is greatly improved radiotherapy?

Health: Multiple Sclerosis

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 30th June 2014 Lords Chamber

[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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 6th May 2014 Lords Chamber

[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: Midwives

Debate between Baroness Gardner of Parkes and Earl Howe

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.

Health: Multiple Sclerosis Nurses

Debate between Baroness Gardner of Parkes and Earl Howe

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: Folic Acid

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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.

Health: Flour Fortification

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 21st January 2014 Lords Chamber

[Earl Howe]

My Lords, I am not aware of that study but I shall of course make myself familiar with it. I do not doubt that it will feature in the consideration that we give to this issue, which I can assure the noble Lord we will do as speedily as we can. It is important to say that adding to the list of fortificants would be a major step and we need to be absolutely sure that it is the right one.

[Baroness Gardner of Parkes (Con)]

My Lords, is it not a fact that in the United States bread is already fortified not only with folic acid, which of course prevents spina bifida in newly born children, but also vitamin D? At present there is a great deal of concern here that none of us is getting enough vitamin D due to the lack of sunlight in winter. Would it not be a good thing for us to have that benefit? Can the Minister also assure me that if this applies to wheat it will cover wholemeal as well as ordinary loaves, as we recommend people to eat those?

[Earl Howe]

On my noble friend’s last question, we are slightly jumping ahead of ourselves because we need to decide on the principle before we decide on which types of wheat might be fortified. However, I recognise my noble friend’s main point. Indeed, the Scientific Advisory Committee on Nutrition, in recommending mandatory fortification of flour with folic acid, sought to highlight the benefits of fortification as well as the risks. It was a balanced recommendation. We value it and we will look at the advice very closely indeed.

World Innovation Summit for Health

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 16th December 2013 Lords Chamber

[Earl Howe]

My Lords, the principles espoused at WISH do indeed apply with equal force to mental health services in this country. Those principles are several, but I would draw the noble Lord’s attention to the need to draw on evidence-based practice; to strive for universal mental health coverage; to respect human rights and to take a life-course approach. We try to embody all those things in our mental health services. Regarding DfID, I can tell the noble Lord that there are a number of multilateral and bilateral programmes which are in train and supported by the Government. We are supporting work in the Caribbean and Bermuda and promoting work in a number of countries in sub-Saharan Africa. I would be happy to write to the noble Lord with a complete list of these.

[Baroness Gardner of Parkes (Con)]

Is dementia included in this?

[Earl Howe]

My Lords, in broad terms, dementia falls outside the scope of mental health but it is, of course, closely allied. Many of the principles that apply to good mental health care apply equally to dementia. We are, again, doing our best, in responding to the Prime Minister’s challenge on dementia, to ensure that those who contract this dreadful condition are looked after with dignity and respect in the appropriate setting.

Tobacco: Packaging

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 28th November 2013 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Lord, who has indeed been a consistent champion for plain packaging over the years. I also appreciate his endorsement of the choice of Sir Cyril Chantler to lead this review. Noble Lords will know that Sir Cyril has a very distinguished record as an academic and paediatrician. As regards the timeline, I cannot be definite at this stage. All I can say is that, should the Government decide to lay regulations in the light of Sir Cyril’s recommendations, we believe that, taking into account a period of consultation and the statutory provisions surrounding European law, we would be able to introduce the regulations within a reasonable time.

[Baroness Gardner of Parkes (Con)]

My Lords, is the noble Earl aware that in Australia plain packaging has been very effective? They say that that is, above all, because it is no longer “cool” for young people to smoke. The noble Earl mentioned age as being effective, and that is very relevant.

[Earl Howe]

It most certainly is relevant, which is why we are taking the legislative opportunity in the Children and Families Bill to drive home that very point. My noble friend is right.

Health: Tuberculosis

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 21st November 2013 Lords Chamber

[Earl Howe]

The noble Lord is absolutely right. That is one reason why we are placing a particular focus on research into multidrug-resistant TB and diagnostics in that area. We fund UNITAID, which aims to triple access to rapid testing for MDRTB and to reduce drug prices for treating the condition. We have made a 20-year commitment to UNITAID of €60 million a year, subject to performance.

[Baroness Gardner of Parkes (Con)]

Following the comments of the noble Lord, Lord Walton, is the Minister aware that point of entry is very important? When I was involved in a health issue as a local councillor, we had a case of someone detected at Heathrow. It took two weeks to track him down, by which time he had infected 40 other people because he had moved into very limited accommodation where many people were all living in one room. This situation is developing again. What facilities are available at the airport now to pick up these cases?

[Earl Howe]

My Lords, there are regulations covering ports and airports which provide a contingency for when a passenger on a ship or a plane enters the UK, is suspected of having a notifiable disease and perhaps refuses to seek medical attention. The regulations include provisions for notification of such a case to the destination port health authority and for the detention of that person for the purposes of a medical examination. There are also quite flexible powers for local authorities to deal with incidents or emergencies where infection or contamination presents or could present a significant risk to public health.

Health: Local Healthwatch Organisations

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 5th November 2013 Lords Chamber

[Earl Howe]

No, my Lords. As the report from Robert Francis identified, the patient voice has to be at the heart of the health and care system, and Healthwatch plays a crucial role in supporting that as the new consumer champion for health and social care. It is very easy to get fixated on the amount of money that is going into Healthwatch. One additional consideration could be the investment that a local authority may be making in other areas to ensure that the voice of service users and the public is heard—for example, through the voluntary and community sector. Surely what matters are the outcomes that are achieved for service users and the quality of those services.

[Baroness Gardner of Parkes (Con)]

My Lords, are good activity and good results really coming out of these Healthwatch groups? In particular, have they done anything to help stroke victims or underprivileged or autistic children? Can the Minister give us an update on what good they are doing and whether they should be continued?

[Earl Howe]

I am grateful to my noble friend. The first annual report from Healthwatch England was laid before Parliament on 9 October and it outlined some encouraging progress at both a national and a local level. There are already examples of the impact that local Healthwatch is having—for example, the work of Healthwatch in Peterborough, which is looking at how to improve health outcomes for offenders. My noble friend mentioned autism. I am aware that Healthwatch Cornwall uncovered a gap in the services meant to deliver a diagnosis of autism in children. That work resulted in a really practical solution so that families could access a diagnostic service without losses to other services in the area.

Care Bill [HL]

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 16th October 2013 Lords Chamber

[Baroness Gardner of Parkes (Con)]

My Lords, I particularly wish to speak on Amendments 83A and 84, but I could just as easily have spoken on any one of these amendments—there is such a big group of them—because the issue that I wish to raise is my concern over this care issue falling down between this Bill and the Children and Families Bill. The timing of these two Bills makes it very difficult unless the Minister, having heard all these debates that everyone will give now, and the comments on these issues, gives us an undertaking that he will liaise with the noble Lord, Lord Nash, and that between them they might try and sort out where it is going to go. This is what worries me: that it will end up going nowhere or come up from the noble Lord, Lord Nash, in a form that will make it too late to bring back here, unless the Minister says that he will look at everything said today and bring back an amendment—or at least accept an amendment if we could all agree on one.

So much of what has been said made sense. The comments of the noble Baroness, Lady Finlay, were fascinating, and the noble Lord, Lord Patel, put it all very clearly. The noble Baroness spoke more on issues about which I am particularly concerned. My eldest grandson is a Down’s child. His Down’s is fairly severe. He has been fortunate in having wonderful care at a Mencap home. He is 22 and this is his last year of receiving full support. He was very happy at the home for some years, until a glitch appeared in the past year. In his unit, a number of residents are put together to live a normal life and to learn how to go out and live in society. Unfortunately, a very aggressive boy was put into the group. No one knew that he was aggressive. He attacked the staff quite violently. As a result, others—I do not know whether it was just my grandson, or whether it was others as well—copied him. This is a terrible risk. If we do not supervise people and have continuing care and assessment of them, how do we know that they will not meet a violent person who behaves in this way, either deliberately or for some other reason—for example, because they are violent and cannot help trying to impose violence on everyone else? It is a real worry not only for the person but for society and the community.

The noble Baroness, Lady Finlay, spoke about the parents who care so much. The parents of this boy are both very clever doctors. One of his siblings is just starting medicine and the other hopes to in the next year or so. So he has siblings who would be able to care if his parents die before him. However, people with Down’s syndrome can live to a considerable age. I have met people of 50 and 60 who have the syndrome. In many cases, their parents will not be alive. It is a huge responsibility to pass on to siblings. Therefore, it is important that, as far as possible, these people should be brought into society to live as normally as they can. As they grow older, they usually grow bigger and stronger. Therefore, they are more of a worry to themselves and to other people. It is terribly important that the assessment of cases for continuing care should be made, and should continue to be made—and not just at 25. If people are going to live to 50, they may need support until then.

A number of the amendments put down by the noble Earl, Lord Howe, cover that issue, but without defining it clearly. This is why I am speaking in general on the amendments in this group. It is important that this should be clear. I have added my name to an amendment of the noble Lord, Lord Rix, in the Children and Families Bill. It is in response to the implication that the Government are thinking of taking out care completely: that once education finishes, nothing more will follow. That is why it is so important to be assured in this Bill that something else will follow.

My daughter tells me—and she has sent me a letter from another parent—that there is great concern that parents are not listened to nearly as much as other people are. The noble Earl’s Amendment 84 does not really cover anyone except a remote person in a local authority who will be responsible for needs. There is nothing to say that they will consult, or even consider the views of, parents or the person who is doing most of the caring for the person concerned. None of the amendments in this group quite reaches what is necessary to cover the issue. I hope that when the Minister sums up, he will give an assurance that will leave the way open for this to be considered at Third Reading. The rules on what can be brought back at Third Reading are very specific. If today we all ended up either winning or losing on some particular thing, it would not necessarily mean that we could modify it in a way that we all thought was better and brought a better answer. I support Amendment 83A and probably quite a number of others, but I will not go into the details because my argument applies both for and against so many of these amendments and I do not want to waste the House’s time by speaking more than once.

[Earl Howe]

My Lords, I am pleased that I have been able to table amendments that significantly strengthen these important provisions, and I am grateful to noble Lords for acknowledging that. Currently, assessment under the transition provisions has to be requested and I sympathise with the concern that in some instances, people who are unaware that they can request an assessment may lose out.

Amendments 84, 87, 89, 92, 94, 96, 98, 102, 103, 106, 108 and 113 remove the need to request the assessment. I have also tabled Amendments 85, 95, 99 and 104. They will replace provision that local authorities may assess a child, a child’s carer or a young carer when it appears to them that it will be of significant benefit to the individual to assess and where they are likely to have needs once they turn 18, with a duty that a local authority must assess in these circumstances.

Amendments 110 and 111 reflect an amendment to the young carer’s amendment to the Children and Families Bill. This is an example of the detailed work undertaken to ensure that the two Bills work together. I want to reassure my noble friend Lady Gardner in that context that we have done a great deal of work over the summer to make sure that that is indeed the case. Amendments 83A, 84A, 89A, 93A, 94A and 94B, tabled by the noble Lord, Lord Patel, and the noble Baroness, Lady Finlay, reflect concern that a local authority may leave it too late to carry out an assessment. I need to be very clear about this. The amendments I have tabled place a duty on local authorities that they must assess at the time where it appears to them that there is likely to be a need when the young person turns 18, and it is of significant benefit to that individual to assess at that time. My noble friend Lady Gardner was worried that the government amendments might not be sufficiently precise or prescriptive. The clauses are formulated in this way precisely so that assessments happen at the right time, whether that is before or after the age of 14, depending on the individual. The Bill approaches transition planning with a firm focus on assessing at the right time for the individual by the new duty to assess where it would be of significant benefit to the individual. I am not persuaded that the interests of young people are best served by prescribing when assessment should take place.

Tobacco Products Directive

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 15th October 2013 Lords Chamber

[Earl Howe]

My Lords, the tobacco products directive, as the noble Lord will know, does not seek to introduce standardised packaging. As he will also know, the Government have decided to wait before making a final decision on that issue but we want member states to have the flexibility to make further progress on domestic tobacco control measures in certain key areas that go beyond the new directive. We have been helping to shape the final text of article 24 to achieve that objective.

[Baroness Gardner of Parkes (Con)]

Is my noble friend aware that in this country people who have suffered even major amputations are still so addicted to tobacco that they will ask the doctor to hold up the cigarette to their mouth? I have had this report from doctors. Does he not think that what we really have to aim at is stopping smoking among the young? Is he aware that in Australia it is no longer cool to smoke if you are young? Apparently, that is more effective than any of the health warnings.

[Earl Howe]

My noble friend, as ever, makes some very wise comments. The good news is that the most recent figures on smoking prevalence are going in the right direction. It is undoubtedly true that we can never do enough to raise our game on smoking cessation measures, one of them being nicotine-containing products. That is of course a major focus for Public Health England.

Health: Anorexia and Bulimia Nervosa

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 11th July 2013 Lords Chamber

[Earl Howe]

My Lords, the mental health of children and young people is a major priority for the Government. Half of those with lifetime mental illness first experience symptoms by the age of 14 and three-quarters before their mid-20s. That is precisely why we are investing a large sum of money—£54 million—over the four-year period 2011-15 in the Children and Young People’s Improving Access to Psychological Therapies programme. We know, as the noble Baroness rightly emphasises, that those talking therapies can make the most difference, particularly if early intervention is achieved.

[Baroness Gardner of Parkes]

My Lords, is it not so that very often parents do not realise what is happening to their child? As for cancer or any other condition, early diagnosis is the secret. What can be done to speed that up? When I was chairman of a hospital, we had a whole ward full of people with this problem, but their condition had been recognised too late and therefore treatment was extremely difficult.

[Earl Howe]

My noble friend is absolutely right. However, it is encouraging to see that in recent years a range of information and support has become available. The Royal College of Psychiatrists has published a fact sheet on eating disorders, which is aimed not just at the profession but particularly at parents, teachers and young people themselves. It is called Mental Health and Growing Up. The fact sheet discusses the causes of eating disorders, how to recognise them and gives advice on how to cope with a child who has an eating disorder.

Public Health England Advisory Board Membership

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 4th July 2013 Lords Chamber

[Earl Howe]

We are very mindful of that, but I come back to the point that these appointments were made on merit in accordance with the published criteria. That is not to say that the unsuccessful candidates lacked merit, but we did not operate a policy of positive discrimination and I do not think that anyone would wish us to do that. Having said that, we are mindful in the department of the need to have gender balance whenever we can in public appointments. Our record is not bad; we are in the region of 44% of appointment rates for women appointed to public positions, which is quite high up in the departmental league table.

[Baroness Gardner of Parkes]

My Lords, does the Minister recall a famous speech of Baroness Thatcher’s, when she was Mrs Thatcher, when she said that the experience that women gain in life generally is not to be underestimated? It is all very well to have everyone with all the experience and qualifications in the world, but does he not think it is also important to have some women who could bring basic common sense to the board?

[Earl Howe]

My Lords, yes.

Medicine: Experimental Drugs

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 10th June 2013 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government whether they will enable the use of new experimental drugs by terminally ill patients who are prepared to waive their right to sue pharmaceutical companies in order to assist the development of new drugs and ease their own condition.

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

My Lords, there are existing provisions under medicines legislation for access to unlicensed medicines without requiring changes to the law. The Government are committed to ensuring access to new and promising medicines for patients while ensuring that medicines continue to meet high standards of safety, efficacy and quality. This is why the Government have been taking forward work on an early access scheme, adaptive licensing and promotion of clinical trials in the UK.

[Baroness Gardner of Parkes]

I welcome that Answer as it means that many valuable drugs might come to the market much earlier and be available for patients. Does the Minister agree that many elderly patients with a terminal condition will definitely get treatment that they may not particularly want themselves but that hope is terribly important in all our lives? Any of the new, experimental drugs can provide this valuable ingredient of hope to such patients.

[Earl Howe]

My Lords, I agree with my noble friend, and it is one of the reasons why the NHS constitution contains a pledge to inform patients of research studies in which they may be eligible to participate if there is a promising new medicine in the pipeline.

Emergency Services: Paramedics

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 15th May 2013 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government under what circumstances unsupervised, unqualified paramedics may be sent to respond to an emergency call.

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

My Lords, ambulance trusts have a range of staff with different skill levels who are able to respond to patients depending on the severity of their illness or injury. It is the responsibility of individual ambulance trusts to determine how best to deploy those resources, ensuring that suitably qualified, skilled and experienced staff are sent to respond to calls.

[Baroness Gardner of Parkes]

Will the Minister tell me, therefore, whether he thinks that it was just an individual case or whether a general principle was at fault in the case of Sarah Mulenga, which has been widely publicised? The coroner ruled that neglect contributed to her death and found,

“a gross failure to provide basic medical attention”.

That was when two unqualified paramedics went to her call and, apparently, did not take her to hospital or even register her normal condition. How often does that sort of thing happen? Is it necessary to change the training system so that there will be more people qualified and trained?

[Earl Howe]

My Lords, the London Ambulance Service has advised that the article in the Sunday Times was slightly misleading, in that the two members of staff who attended that particular patient were student paramedics in their third and final year of training and so were sufficiently qualified to work unsupervised. It is inaccurate to call them “unqualified”. The issue in this case was that, despite their qualifications and experience, the crew did not act in accordance with their training or the procedures that were laid down. That has been acknowledged by the London Ambulance Service, which has said that it believes that the failings are not reflective of the hundreds of ambulance staff who provide a high level of patient care to Londoners every day.

NHS: ECMO Machines

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 22nd April 2013 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government whether extra-corporal membrane oxygenation (ECMO) machines that are capable of restoring heart functions some hours after an apparently fatal heart attack are in use in any NHS hospitals; and, if not, what consideration is being given to their installation.

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

My Lords, the equipment and facilities to undertake cardiac ECMO support are available in all five NHS adult cardiothoracic transplant centres in England and in the five national respiratory ECMO centres, three of which share a location. Provision of cardiac ECMO support is a complex intervention with significant risks attached to it. A cardiac ECMO service requires a fully trained team to be available around the clock and does not consist of simply purchasing the medical equipment.

[Baroness Gardner of Parkes]

That is very good news and I thank the Minister for it. It is desirable to have these facilities available. Does he agree that the group which would benefit most of all from this would be young people who die suddenly and unexpectedly, often in the sporting field? This is a much greater tragedy for families than the more usual cardiac attack at a later age. Should not more publicity be given so that people involved in those activities know that such facilities are available? You could get a young person by helicopter to one of those centres within the number of hours that your life would be prolonged for.

[Earl Howe]

My Lords, there is, I understand, no intervention capable of restoring heart function some hours after a heart attack. The only exception is not applicable to heart attacks but to people who have had circulatory arrest due to hypothermia—for example, people who have been buried in avalanches or immersed in very cold water. That area is currently being researched. It is only in a very limited number of circumstances that ECMO support can improve a patient’s chances of survival following cardiac arrest—usually in patients who suffer in-hospital cardiac arrest following surgery.

Homeopathy

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 19th March 2013 Lords Chamber

[Earl Howe]

My Lords, the best way I can answer the noble Lord is to refer him to the page on NHS Choices that explicitly refers to the placebo effect. As he will know, the 2010 House of Commons Science and Technology Committee report on homeopathy said that homeopathic remedies perform no better than placebos. It is important to emphasise that message. On the other hand, many people have found benefit from homeopathic medicines and, in a way, that is their privilege and right.

[Baroness Gardner of Parkes]

My Lords, is the Minister aware that homeopathy started at a time when the one treatment they gave people was to bleed them? It was effective because they did not bleed them and allowed them to recover normally; I was on the board of the Royal London Homeopathic Hospital for a good many years, where I learnt that. Does the Minister not think that, faced with a situation where antibiotics have been used too casually, it is time to look at what we should not be taking? Does he think it important that patients should have the right to whatever treatment they choose provided that homeopathy does not allow them to escape proper diagnosis for cancer or some other tragic condition, which could be overlooked if it is not combined with ordinary medicine?

[Earl Howe]

My noble friend makes an important point. We are clear in recommending that patients should talk to their GPs before stopping any treatment that has been prescribed by a doctor in favour of homeopathy and before they start taking homeopathic remedies. It is important that people understand that homeopathy may not be effective in many situations.

NHS: Healthcare UK

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 14th February 2013 Lords Chamber

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

My Lords, Healthcare UK will focus on high-value opportunities internationally for both industry and the NHS. Where NHS expertise is used, those NHS organisations will benefit financially, with the income being reinvested into patient care for patients here in the UK. Furthermore, any activity undertaken by Healthcare UK will be overseen by a board, which will be jointly administered by the Department of Health, UKTI and the NHS Commissioning Board.

[Baroness Gardner of Parkes]

Can the Minister tell me whether, with the establishment of Healthcare UK, there is a danger that some areas of this country might be advantaged at the expense of other areas of this country?

[Earl Howe]

My Lords, we are determined that that should not happen. We recognise that the whole of the UK healthcare sector, both private and public, has a great deal to offer internationally. This does not just apply to a few elite organisations. We want to support any NHS organisation that wants to work internationally by helping it to build its capacity and capability to do so. We also want to help industry. In doing that, I stress that we view it as of paramount importance that any work undertaken in no way harms or compromises the quality of patient care here in the UK.

Health: Healthcare Assistance

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 13th February 2013 Lords Chamber

[Earl Howe]

My Lords, we have made it clear that each and every one of Robert Francis’s recommendations will be considered extremely carefully, including the recommendation in relation to healthcare assistants. However, it is worth noting that while the Health and Care Professions Council has signalled some potential limitations to a statutory regulator holding a voluntary register, and we take account of that, nevertheless that does not mean that these potential limitations would apply to other organisations wanting to set up a voluntary register. Our view is that that avenue should be explored. The HCPC also flagged up some major limitations in attempting to regulate healthcare assistance. Those messages bear thinking about.

[Baroness Gardner of Parkes]

I ask the Minister again—I have asked him this so many times—whether he will ask the Nursing and Midwifery Council to look again at some intermediate training level, which I think is sadly needed since the abolition of the SENs, for which you could qualify without having to have academic university entrance.

[Earl Howe]

My Lords, the policy on nursing is clear: there is general acceptance that nursing should be a graduate profession. The problem with giving responsibility to the NMC for healthcare assistance is that that is not currently within its remit, and I think it would say that it has enough on its plate to deal with, without that added dimension as well.

Health: Cancer

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 14th January 2013 Lords Chamber

[Earl Howe]

The noble Lord is absolutely right about the importance of earlier diagnosis. I can give two examples of work running this year to assist GPs in the assessment and earlier diagnosis of cancer patients, including those with pancreatic cancer. Rolling out from March, Macmillan Cancer Support, with funding from the department, will be piloting an electronic cancer decision support tool for GPs to use as part of their routine practice in order to help identify and assess more effectively patients with possible cancer. The initial pilot will cover a number of cancers, including pancreatic cancer. Further, the National Action Cancer Team is supporting the distribution of further desk-based versions of risk assessment tools for use in general practice, and these include a pancreatic cancer risk assessment tool.

[Baroness Gardner of Parkes]

My Lords, is the Minister aware that people think that there is no effective treatment for pancreatic cancer—we are always told that lung and pancreatic cancer are the two worst—but other treatments are being given in other countries? A very dear relation of mine in Australia has benefited from having radium pellets injected directly into the secondary lesions and is progressing very well indeed in the second year since her treatment. Her symptoms are much improved. Can he give an assurance that we will give people in this country hope that we will look at treatments being used in other countries that are improving pancreatic cancer outcomes and ensure that we are not left behind in this area?

[Earl Howe]

My Lords, I am very interested to hear about the treatment mentioned by my noble friend and I can remind her, although I am sure she needs no reminding, that one of the key roles of NICE is to keep evidence of new treatments under review. I do not doubt that as a result of my noble friend’s intervention, it will wish to look at that particular treatment. Pancreatic cancer can grow initially without any symptoms and it is possible that people might not recognise the symptoms. That is why the “Know 4 sure” campaign, which I have mentioned, highlights four key symptoms including loss of weight and pain, which can be symptoms of pancreatic cancer.

World Sepsis Declaration

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 19th December 2012 Lords Chamber

[Earl Howe]

My Lords, on the research on antibiotics, the noble Lord alights on a real problem. There is a dearth of such research; I am aware of at least one company engaging in it but in view of the increasing prevalence of antibiotic resistance it is a real issue. As the noble Lord will know, there are extensive guidelines to ensure that there is responsible prescribing of antibiotics. I am not aware of the Southampton example which he quotes, although I shall look into it and write to him as appropriate. He may like to know that the department has been developing a five-year antimicrobial resistance strategy—an action plan. It has an integrated approach and builds on a range of initiatives, such as the 2000 UK strategy and the 2011 EU strategic action plan.

[Baroness Gardner of Parkes]

My Lords, I believe it was the same report from Southampton that said the public have no idea of the difference between sepsis and septicaemia, which of course is a fatal condition if not treated. In view of the success of educating the public on strokes and how effective that has been, does the Minister think that as well as educating professionals there should also be a wider publicity campaign given to the general public to make people aware of the very important differences between these conditions?

[Earl Howe]

My noble friend makes an important point. Public awareness is a key focus of the Global Sepsis Alliance’s declaration. On raising awareness, the NHS Choices website has extensive information about sepsis, its causes, symptoms and treatment. I do agree, however, that it is important to empower both patients and the public to ensure that everybody is on their guard against this very serious illness.

NHS: Research and Development

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 17th December 2012 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what proportion of funding allocated by the National Health Service for research and development at major teaching hospitals is provided to (1) the researchers themselves, and (2) administrators of funding.

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

My Lords, the National Institute for Health Research awards funding transparently and competitively for research of high scientific quality that has relevance to the NHS and represents value for money. We therefore expect that the maximum is spent on research rather than on administrative overheads. Trusts with teaching hospitals received a total of £500 million from the NIHR in 2011-12.

[Baroness Gardner of Parkes]

I appreciate that funds go directly to the researchers from the body that the Minister mentioned and from the Medical Research Council. What I am concerned about is that I am told by those working, and possibly doing research, in these teaching hospitals that the bulk of the money is paid to the person doing the governance of research and development, and not a penny of that money is actually going to the researchers, who are funded in the way that the Minister has said. Ever since 2006, when that was set up, there has been a great growth of these people doing nothing but checking on the work of the real researchers.

[Earl Howe]

My Lords, every NHS trust or foundation trust has to oversee the governance of the research taking place within it. That is an inescapable part of the process. I do not think there is any confusion in anyone’s mind between support for research governance and the actual research itself, which is done by academics and clinicians working in academic and clinical departments. It is up to each trust to determine how its budget for research is allocated, but I can reassure my noble friend that the money is getting to where it needs to go.

NHS: Accident and Emergency Services

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 23rd October 2012 Lords Chamber

[Baroness Gardner of Parkes]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as a local resident.

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

My Lords, the reconfiguration of front-line health services is a matter for the local NHS, and any decisions regarding changes to services will be taken locally. I understand that the local NHS has worked closely with Transport for London and also with the London Ambulance Service in developing its proposals for the future shape of health services across north-west London under the Shaping a Healthier Future programme.

[Baroness Gardner of Parkes]

I thank the Minister for that Answer. My Question could really apply to anywhere in the country. The general principle is how long it takes to get patients to hospital, particularly in emergencies, when it is a matter of life and death in some cases. In London, there is only one air ambulance; I understand that in Paris, there are four and in Sydney there are six. We cannot rely on one air ambulance to deal with the problem. Will the Minister consider the general principle of a national view of traffic in relation to access for ambulances?

[Earl Howe]

My noble friend makes some important points. As a general point, it is important to say that each ambulance service should plan to provide appropriate resources to meet local demand, because demand varies according to where you are in the country. Planning assumptions in meeting that demand should take into account the likelihood of severe traffic congestion. Plans of that kind may well include resources in addition to traditional ambulance provision, for example, using rapid response vehicles and motorbikes as well as utilising staff such as community paramedics or emergency care practitioners.

Care Services: Elderly People

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 17th October 2012 Lords Chamber

[Earl Howe]

My Lords, we recognise that there is a need to drive up standards in this area. More care workers will be trained, including an ambition to double the number of care apprenticeships by 2017. We have commissioned Skills for Health and Skills for Care to develop, before the end of January next year, a code of conduct and minimum training standards for healthcare support workers and adult social care workers in England. We expect that these will cover minimum training or induction standards for a range of support tasks, including personal care and other activities. Through the Health and Social Care Act 2012 we are creating a system of external quality assurance for voluntary registers.

[Baroness Gardner of Parkes]

My Lords, is the Minister aware that it is not just an issue about criminals, but an issue about the total shortage of care, which the previous question addressed very clearly? Does he not think that in general care and healthcare we are sadly missing the SENs, and is it not time to develop additional levels of training to fill the gaps both in care homes and the National Health Service?

[Earl Howe]

My Lords, we need to focus on a mixture of things. As my noble friend rightly says, we need to look at workforce numbers and capacity. We need to look at minimum training standards, which I have referred to, and we need to look at quality. We are doing that by targeting for the first time personal assistants and their employers with greater support and learning through the Workforce Development Fund, which will help with recruitment and retention. We need better leadership because high-quality leadership is essential for the delivery of all the proposals in the care and support White Paper, and we are setting up a new leadership forum to bring together expertise. I should add that we need better intelligence on the ground as well, and that we shall see from the local Healthwatch organisations when they are established.

NHS: Walk-in Centres

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

My Lords, I am sorry to hear of the experience of the noble Baroness’s friend. I asked my officials to let me know which walk-in centres were available within striking distance of this building. There are, in fact, five NHS walk-in centres in or very near central London. I am aware of another privately run centre as well. A quick search on NHS choices will bring you to a menu of options.

[Baroness Gardner of Parkes]

My Lords, will the Minister tell me whether all general medical practitioners have surgeries where you can walk in at some time of the day? That would take quite a load off people. Is that an obligation? My practice has this and it is marvellous. You can go in at 8.30 on any morning and will be seen if you are an emergency. Is that common? Is there a need for more of that?

[Earl Howe]

Many GP surgeries have extended opening hours. Some have walk-in centres attached to them but there is no general rule about that. The decision to open on an extended-hours basis is voluntary for GPs.

Health: Diabetes

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 25th July 2012 Lords Chamber

[Earl Howe]

My Lords, I am aware of several local initiatives that are doing great work in accessing those in both black and minority-ethnic communities along the lines mentioned by the noble Lord. We have made important progress in strengthening our approach to promoting equality in health and social care and in tackling these inequalities that exist. That is especially important in relation to the Asian community. I am thinking in particular—the noble Lord mentioned the need to roll out initiatives—of the NHS Heath Check programme supported by the guidance on prevention issued by NICE and the Change4Life Programme, which now has a bespoke element to it targeted specifically at ethnic-minority communities.

[Baroness Gardner of Parkes]

My Lords, are separate statistics kept about ethnic groups? If not, would it not be an advantage to do so in terms of research, particularly as type 2 diabetes is very much dependent on diet and might be quite different in different sections of the community? What is the prevalence of diabetes in the ethnic community as opposed to other communities and what is the prevalence of type 1 diabetes as opposed to type 2 diabetes?

[Earl Howe]

My advice is that type 1 diabetes is not a particular issue in ethnic-minority communities. We are talking about type 2 diabetes, which is five times more common in black and ethnic-minority groups, six times more common in south Asian ethnic groups, and three times more common in areas of social deprivation than in the rest of the population. There are particular clinical risks associated with those from ethnic minority communities who have diabetes. Complications include particularly heart disease—south Asian people are 50% more likely than the general population to die prematurely from coronary heart disease—and the prevalence of stroke is also much higher in African, Caribbean and south Asian men.

Social Care: Sustainable Funding

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 17th July 2012 Lords Chamber

[Baroness Gardner of Parkes]

My Lords, in view of the answers to the previous supplementary question and to the first Question, which stated that decisions should never be made purely on grounds of cost, is the Minister aware of a case in one of the London boroughs where a woman who has had multiple sclerosis for years and has been cared for by a very loving husband has now been told that she may be obliged to go into a care home because providing her care package at home is costing £79,000, while a care home could be provided for £71,000? That would perhaps not destroy, but put a terribly unfair strain upon, her marriage after all these years. Can the Minister assure us that in the Government’s plans for health and social care, factors other than cost will be considered?

[Earl Howe]

My Lords, on behalf of noble Lords, I wish my noble friend a very happy birthday.

Carers: In Sickness and in Health

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

I shall have to ask the noble Baroness to be patient for a few more minutes regarding the Statement I am about to make. However, I can tell her that the White Paper and the draft Bill will make a reality of our vision for transforming care and support both for carers and for the people they look after. As for the noble Baroness’s first point, she is absolutely right to flag this up as a concern. In the last financial year, we provided funding of almost £1 million to the Royal College of General Practitioners, Carers UK and the Carers Trust to take forward a range of initiatives, of which I am sure she will be aware, to increase awareness in primary healthcare of carers of all ages, including better training for GPs, and also to look at how we can build on that for the future with the medical colleges and nursing organisations and in hospitals and community health services. The NHS Health Check programme could be a very important ingredient in making sure that the health of carers is monitored and taken fully into account.

[Baroness Gardner of Parkes]

The Minister is aware of the great debt that we all owe to carers, particularly family carers. Can he assure me that respite care for those people, or those for whom they are caring, will be possible and will continue? It makes a very big difference if people can have even a small respite break.

[Earl Howe]

My noble friend is quite right. My department has allocated an additional £400 million to the NHS over four years, 2011 to 2015, to provide carers with breaks from their caring responsibilities. The 2012-13 NHS operating framework makes it clear that PCTs, local councils and local voluntary organisations should work together on plans to support carers. Those plans have to be published by 30 September at the latest. They must make clear the amount of money to be made available to support carers and separately identify the amount to be made available for carers’ breaks.

NHS: Definition of Exceptional Case

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 2nd July 2012 Lords Chamber

[Earl Howe]

My Lords, under the NHS Constitution, all patients have the right to an individual review of a decision not to fund a particular treatment if they and their doctor believe that it would be appropriate. They also have the right to an explanation of the basis of the decision. The commissioner must in turn have a process to enable such individual funding requests to be considered, so the watchwords here are transparency and publishing an explanation.

[Baroness Gardner of Parkes]

Does the Minister agree that there are other decision-making bodies? I refer in particular to the UK National Screening Committee. Is he aware that, probably correctly, it makes its decisions only on research results? Why does it claim that it does not have the money to spend on research into Streptococcus B infections, when international research shows a clear choice for screening as opposed to risk assessment? That change that has been made in other countries has resulted in reductions of strep B infections in children of 80% in the USA, 60% in Spain, 82% in Australia and 71% in France. The screening of pregnant mothers could prevent that very serious condition, which can be fatal, being passed to a small number of babies.

[Earl Howe]

My Lords, the UK National Screening Committee advises Ministers and the National Health Service in all four UK countries on all aspects of screening policy, including for group B Streptococcus carriage in pregnancy. The committee is currently reviewing the evidence for screening for that condition in pregnancy against its criteria. It will take into account the international evidence and a public consultation on the screening review will be opening shortly.

NHS: Dental Care

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 26th June 2012 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government how many dentists are now providing NHS dental care under the general dental services contract introduced in 2006; and what is the annual cost of the care provided and the amount generated in patient charge revenues towards funding this care.

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

My Lords, the latest figures published by the NHS information centre show that 22,799 dentists provided NHS primary dental care in 2010-11. The net allocation for primary dental care in 2010-11, the latest year for which figures are available, was £2,200 million. Patient charge revenue for 2010-11 was £617 million.

[Baroness Gardner of Parkes]

It is good to have the updated figures, but is the Minister aware that the two major concerns for patients now are transparency and availability? Availability is something that we look to the health service to provide. However, the transparency issue has become very important, not only to patients but to other dentists, who are very dissatisfied that dentists are able to put up notices saying, “National Health Service treatment available”, yet after a patient goes to them it emerges that the treatment is very limited. Does the Minister not think that, in the interests of warning the consumer, the present NHS fee charts should show that conditions may apply?

[Earl Howe]

My Lords, I absolutely agree with my noble friend about the importance of transparency of information for NHS patients. NHS Choices, which is the department’s public-facing website, already displays a lot of information about fees, the treatment that should be received and how to make a complaint about NHS dentistry, but more work is being done in this area to improve information on patients’ ratings of different practices, and we are updating the patient leaflet as well. What a dentist should not do is mislead a patient or induce a patient to access the surgery and then not provide the treatment that the patient thought they were going to get. If they cannot provide NHS treatment for whatever reason, they should point the patient in the direction of a practice that can, or else refer him or her to the primary care trust helpline.

NHS: Public Information and Advice

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 12th June 2012 Lords Chamber

[Earl Howe]

My Lords, I share the noble Baroness’s concern. She has highlighted a major area on which Public Health England and local authorities will wish to focus going forward. This is the great advantage of the architecture that we have put in place, with health and well-being boards responsible for determining local needs and the way in which to address them. Public health awareness campaigns have their place but they are not the total answer. The noble Baroness has drawn attention to the importance of having sufficient treatment facilities, and access to them, available. So, with the support of Public Health England at a national level, local authorities should be addressing sexual health as one of their key areas.

[Baroness Gardner of Parkes]

My Lords, as the Minister has said, the situation is constantly being evaluated. Has he looked into the recent problems of patients who cannot see displayed the costs for National Health Service dentistry procedures? Would it not be a good idea to set up an online application so that patients can see the information for themselves, with a simple form to fill in that lets them know what they should be paying before they go? That would remove all the arguments about whether or not there is a notice in the waiting room.

[Earl Howe]

My noble friend is right. Many dentists are good at conforming to the terms of their contract, which means making it clear to patients what it will cost them to have a particular course of NHS treatment. Other dentists, I am afraid to say, are less scrupulous. It is part of the contractual arrangement that dentists should be open on that score and it is an area to which we are currently devoting a good deal of attention.

Social Care: Legislation

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 11th June 2012 Lords Chamber

[Baroness Gardner of Parkes]

My Lords, is the noble Earl telling us that the Bill will be only about funding? Following the point raised by the noble Baroness, Lady Pitkeathley, can he assure us that there will be some sort of new training for those who will be doing a job that is half-way between that of a carer and that of a nurse? By losing the SENs we have lost a very powerful and useful facility that can operate in the middle. Surely there is a need for someone to bridge the gap between health and social care.

[Earl Howe]

My Lords, my noble friend raises an important issue, and I am sure that there will be an opportunity during the Bill’s passage to debate the subjects to which she referred. The draft Bill will be published after the Government publish their White Paper and the progress report on funding, and the Bill will set out the legislative framework for adult social care in the future. I have no doubt that noble Lords will wish to raise issues pertinent to that.

NHS: Health Tourism

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 28th May 2012 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what is the cost to the National Health Service of international health tourism, and whether the Home Office has consulted the Department of Health on appropriate assessments of likely health needs or conditions before issuing visas to visitors to the United Kingdom.

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

My Lords, estimated written-off debt for NHS treatment provided to chargeable overseas visitors in 2010-11 was £14 million. However, this will include debts for visitors requiring unexpected treatment as well as those actively seeking NHS treatment to which they are not entitled. On 21 May, the Home Office announced the introduction of pre-entry screening for tuberculosis for long-term migrants from countries with high TB incidence. The department and the Health Protection Agency worked with the Home Office to review current arrangements.

[Baroness Gardner of Parkes]

That is a considerable increase. In his Written Answer last year, the noble Earl gave the figure for the previous year as under £7 million, so the amount has doubled. I do not know whether the £14 million includes the previous £7 million, but obviously the amount is growing. In the same Written Answer, he said that the Home Office was now consulting. On screening—for TB, for example—does the visa application ask applicants to declare any pre-existing medical condition, as is the case in many overseas countries?

[Earl Howe]

My Lords, the Home Office, with our agreement, drew up a list of high-risk countries where TB was prevalent. In those countries, if someone seeks a visa to come to this country for six months or more, they will have to undergo TB testing. Questions on other medical conditions are not relevant in this context. We do not screen for other things. TB is an exceptional case because it is an airborne disease and poses a public health risk.

NHS: General Practitioners

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 23rd May 2012 Lords Chamber

[Earl Howe]

The noble Lord raises a central issue that is certainly a major part of the Government’s programme—to shift services in general out of acute settings, where appropriate, and into the community. We expect that clinical commissioning groups will wish to engage with health professionals from across the full range of disciplines to design care in better ways, and in particular to ensure that the shift goes on. The noble Lord mentioned patient input, which is another key responsibility of clinical commissioning groups—and a legal duty that we made sure was in the legislation.

[Baroness Gardner of Parkes]

Will the Minister tell me the position on homeopathic medicine? I had a lot of letters this week from patients who were concerned that they might no longer be able to benefit from it, and from GPs who practise homeopathy.

[Earl Howe]

My Lords, the Government have laid down no bar on homeopathic medicine. The prescribing of homeopathic remedies is very much a matter of clinical judgment and we would not wish to fetter that.

Health: Neurological Conditions

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 27th February 2012 Lords Chamber

[Baroness Gardner of Parkes]

Has the Minister seen the reports in the newspaper today about the worry that people have about the shortage of medication for those with Parkinson’s disease, for example? Is it a worry more in the press than in reality? How can the Government ensure adequate supplies of necessary medication for these cases?

[Earl Howe]

There have been shortages of certain medicines over the past two or three years for a number of reasons; there is not a single reason. The Department of Health is working with the medicines supply chain established under the previous Government, and is doing very effective work. It is liaising with manufacturers, wholesalers and the pharmacy trade to ensure that medicines are available when needed. I have not seen the article to which my noble friend refers, but we are not of the view that there is any need for undue concern. However, we are keeping the position under review.

Organ Transplantation

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 27th February 2012 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government how they intend to reduce any waste of organs for transplantation arising from inadequate co-ordination of the process and the extent of out-of-hours and weekend services.

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

My Lords, the National Organ Retrieval Service—NORS—provides continuous 24/7 cover. I understand there have been two exceptional occasions when a NORS team could not be provided. Contingency arrangements enable other teams to stand in when needed or for local kidney transplant centres to be reimbursed for retrieving from kidney-only donors. NHS Blood and Transplant is also considering a tariff to fund National Organ Retrieval Service teams willing to provide additional cover.

[Baroness Gardner of Parkes]

Can the Minister confirm for me a statement that was made when I was chairman of one of the London teaching hospitals—that when you die your body is no longer your own? That is a highly significant point in the case of people who carry donor cards but whose relatives reject them. Can he also assure me that they will do something to ensure that when potential donors come to accident and emergency at weekends due to accidents, the retrieval team is alerted to the possibility that such organs—each of which is very precious to the recipient—may be available?

[Earl Howe]

My Lords, it is a well established principle of law that there is no property in a corpse. This means that, as a general rule, the law does not regard a corpse as property protected by rights. In other words, there can be no ownership of a dead body. However, the law does prescribe what may lawfully be done with the body of a deceased person. For example, a person can say while they are alive what they would like to happen to their body after death, such as donation of organs. My noble friend raises an extremely important point about A&E. The number of donors from A&E units is improving but it is generally recognised that it had to because performance was not good. Since 2007-08 there has been a 388 per cent increase in donations from emergency medicine, which is good news, but there is much more that could be done. The transitional steering group that we have set up under the chairmanship of Chris Rudge is looking at that area as a priority.

Health: Stroke Care

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 13th February 2012 Lords Chamber

[Earl Howe]

My Lords, I agree with the noble Baroness that the London model has, indeed, been a model for others to follow. All Londoners now have 24-hour access to hyper-acute stroke care regardless of where they live, and London has one of the highest rates of thrombolysis for any large city in the world. It may not be appropriate to replicate precisely a model of care which works well in a densely populated capital as regards more rural areas, but that is where the expertise of the stroke improvement programme is essential in working with stroke networks across the country, sharing best practice and improving outcomes for stroke patients.

[Baroness Gardner of Parkes]

My Lords, is the Minister aware that although the London system is good, London has not always been at the forefront of this area? As the noble Lord, Lord Walton of Detchant, is not here to make the point, is the Minister aware that thrombolysis—the “clot busting” system—was introduced in Newcastle and was used there very effectively long before it reached London?

[Earl Howe]

My Lords, not for the first time, we learn from Newcastle how to treat patients.

Health: Children and Young People

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, it is yet to be decided finally which services will be commissioned at a national level. I cannot give the noble Countess a definitive answer on where services for CFS/ME will be commissioned. However, we are sure that the arrangements will provide much better, more locally responsive ways of commissioning services generally. Whether clinical commissioning groups join together in commissioning services, whether lead commissioners do that or whether commissioning takes place at a higher level, we are clear that in all services this needs to improve.

[Baroness Gardner of Parkes]

Will the Minister tell me what the position is with accident and emergency services? We have all read in the papers that we should not get sick at weekends and how desperately people are treated in some hospitals. Are children’s services as adversely affected as those of adults, or are no figures kept on the difference? What does the Minister propose to do to increase cover, because misdiagnosis is a major worry in some cases?

[Earl Howe]

My Lords, accident and emergency services will be commissioned at a local level. I am afraid that I do not have in front of me detailed information on the split between adult and children's services in an emergency context. If I can get the information, I will be happy to write to my noble friend.

Health: Pathfinders

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 12th January 2012 Lords Chamber

[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: Oral Cancer Detection

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 6th December 2011 Lords Chamber

[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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 19th October 2011 Lords Chamber

[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

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 13th October 2011 Lords Chamber

[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

Debate between Baroness Gardner of Parkes and Earl Howe

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.

Abattoirs

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 4th July 2011 Lords Chamber

[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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

Tuesday 26th April 2011 Lords Chamber

[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

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 24th March 2011 Lords Chamber

[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: Sickle-Cell Disease

Debate between Baroness Gardner of Parkes and Earl Howe

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: Visitor Service

Debate between Baroness Gardner of Parkes and Earl Howe

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: Alcohol Minimum Pricing

Debate between Baroness Gardner of Parkes and Earl Howe

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.

Health: Multiple Sclerosis

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

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: Diet

Debate between Baroness Gardner of Parkes and Earl Howe

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: Budget

Debate between Baroness Gardner of Parkes and Earl Howe

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

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 21st June 2010 Lords Chamber

[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

Debate between Baroness Gardner of Parkes and Earl Howe

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.

Carers

Debate between Baroness Gardner of Parkes and Earl Howe

Wednesday 16th June 2010 Lords Chamber

[Earl Howe]

My Lords, I pay tribute to the noble Baroness for all that she has done over the years to highlight the work of carers and their needs—indeed, the Government are very pleased to support Carers Week. We are entirely supportive of the ambitions set out in the previous Government’s strategy. We naturally need to focus on delivering the things that will have the greatest impact on improving carers’ lives. I think that there will be three strands to that. The first is to make sure that carers are able to stay in work if they wish to. The second is to help carers who wish to get back into work to return to employment—Jobcentre Plus has in train a number of initiatives in that regard. The third is the safety net of benefits and we will review the benefits system in a way that encourages, among other things, fairness.

[Baroness Gardner of Parkes]

My Lords, my noble friend said that respite care is seen as important. Will he assure us that the huge contribution made by so many families who unstintingly give their time, love and care is fully appreciated and that he recognises how essential respite is for them?

[Earl Howe]

My Lords, my noble friend makes a critical point. She would like to know, I am sure, that there is already money in the baselines for primary care trusts to ensure that carers can get breaks. The continuation of the area-based grant, of which the carers grant forms a part, will need to be considered in the wider context of future spending reviews but, at the moment, £256 million is allocated in the budget for the current year.

Health: Isle of Man

Debate between Baroness Gardner of Parkes and Earl Howe

Monday 14th June 2010 Lords Chamber

[Earl Howe]

My Lords, if a UK resident were to travel to the Isle of Man, as I have said, and were to fall ill and need emergency care, they would receive that care free of charge. That is what the agreement currently covers. It was extended by the previous Government in March and will last until the end of September. We are using that window of opportunity to negotiate with the Isle of Man Government and, as I have said, these discussions at official level are proceeding very cordially.

[Baroness Gardner of Parkes]

My Lords, following the question from the noble Lord, Lord Dubs, about reciprocal arrangements in Europe, as I understand it we have to have a card, which we present if asked to do so, if we go for treatment in Europe. What is the position here? Are people coming from mainland Europe asked to present an equivalent card here? We hear so much about NHS tourism that it rather concerns me.

[Earl Howe]

My Lords, the rules are quite complicated. In the case of EEA countries, including the European Union, the UK has an obligation under EU law to pay what it is liable for in healthcare costs. Therefore, visitors from EEA member states are provided with NHS healthcare when visiting the UK and, indeed, vice versa. However, under the same regulations, the UK is entitled to claim the cost of treatment provided to citizens from EEA member states whom it has treated. Similarly, other member states can charge the UK for the cost of treating our citizens.

Health: Dementia

Debate between Baroness Gardner of Parkes and Earl Howe

Thursday 3rd June 2010 Lords Chamber

[Earl Howe]

My Lords, it so happens that only yesterday I received a briefing on the e-learning programme, and I am well seized of the value attached to it by the royal colleges in particular as well as many other professional bodies.

[Baroness Gardner of Parkes]

Does the Minister agree that respite care is extremely valuable, but can he say what help there is for people whose dementia has developed into violence? What can be done for those who wish to keep such patients at home, but find themselves in a very frightening position? Can they be given any respite?

[Earl Howe]

My Lords, my noble friend has raised an important issue, and one which we are giving consideration to. We recognise fully that breaks from caring are one of the top priorities for carers in terms of the sort of help they want. Supporting the physical and mental well-being of carers by giving them breaks obviously enables them to do their job more safely and effectively, and can keep families together. But where violence intrudes, it is often an intractable problem. I hope to be able to give my noble friend more details once we have given this area the thought that it deserves.