Health: Neurological Conditions

Baroness Greengross Excerpts

Monday 11th October 2010 Lords Chamber

[Baroness Greengross]

My Lords, first, I congratulate the noble Baroness, Lady Gardner. I found her initial comments, as always, very informative and very moving. I am so pleased that we are able to have this short debate.

Often allied health professionals are under-recognised but their role is absolutely key to the way in which patients, particularly those living with neurological diseases, are cared for. Many of them with progressive and incurable diseases such as motor neurone disease, multiple sclerosis, Huntingdon’s disease or Parkinson’s disease face very long-term physical and psychosocial challenges, which can last for years or decades with long periods of dependency.

The role of allied health professionals must be better recognised. They can ensure that people with a neurological condition receive adequate nutrition; that their communication skills are maintained; that cardiac and respiratory functions are maintained, as the noble Baroness, Lady Finlay, has identified; and that respiratory functioning, bowel motility and skin integrity can be dealt with. They often co-ordinate care within a multidisciplinary team, which is very important. They are also frequently the first contact practitioner who can access the range of care which a patient needs over a long period.

In community settings, hospitals, residential care or wherever, dieticians also have a key role to play. They can often prevent a problem that can cause significant complications, and can compromise quality of life and lead, as has been said, to considerable cost for the health and social care system.

I am privileged to head up a think tank, the International Longevity Centre, in the UK, which looks at the implications of demographic change and ageing on our society. The IRC has often tried to raise awareness among policy-makers and the general public to the risk of malnutrition and dehydration for many of the most vulnerable members of our society. In the next couple of months, it will publish work on the importance of speech therapists. From a summary of the literature, it is clear to me that the vast majority of policy initiatives relating to speech and language therapy focus on children and younger people, which is terribly important, but despite our growing ageing population only 20 per cent of speech therapists currently focus on older people. I hope that the Minister can look at this issue, as it demonstrates an imbalance.

The IRC will highlight the need for an increased number of speech and language therapists for older people with neurological conditions. I would also like to highlight, as has the noble Baroness, Lady Finlay, the importance of occupational therapists, who very often enable older people who have suffered a stroke or who have dementia to regain some of the skills they previously had in daily living. The importance of that cannot be overemphasised. I declare an interest as president of the College of Occupational Therapists.

Just because we cannot alter the disease progression of many neurological conditions, we must not assume that nothing more can be done. It is because of that inevitability that we must do everything possible to alleviate the symptoms and offer appropriate psychological and spiritual support to patients. Allied health professionals have a key role to play in that respect.

We also need to ensure that we adequately support this group of healthcare professionals. Some neurological diseases, particularly those that apply to older people, can evoke rather negative attitudes. That is perhaps because they are linked to our mortality—we would rather not think about them and rather that they went away. Given the growing number of people who suffer from dementia, it is important that we raise awareness of this type of condition across the sector. It is also important that those who work in the allied health professions have the basic training in dementia care, among other neurological conditions, and know how to manage these difficult diseases as they progress in the huge number of patients who suffer from them. Training in dementia care and in the management of dementia should form an integral component in all the training for allied health professionals and for their career development. We must recognise the crucial importance of their work and ensure that they can meet the difficult situations that they will face with appropriate skills, training and recognition.

NHS: Pain Management Services

Baroness Greengross Excerpts

Wednesday 7th July 2010 Lords Chamber

[Baroness Greengross]

My Lords, I, too, thank the noble Lord, Lord Luce, for introducing this important debate. Pain can last for many years and some people have life-long symptoms. Sometimes it starts after a specific injury, but it is not always clear why people suffer in this way. As we have heard, some people suffer with continuing low back pain, pain related to joint inflammation or pain related to a nerve injury. Pain can follow an operation or an amputation, or even after what seems to be a not- very-serious infection, such as shingles.

We know that the effects of chronic pain can be disastrous and many people will need support in managing their symptoms. While specialist services are available in the community and in hospitals, I am aware that many people spend far too long without appropriate treatment. We are talking about large numbers of people and the accompanying huge costs spent in welfare benefits when people have to leave work and stop being productive in the community. We also know that death by suicide in chronic pain patients is double that of the general population and that severe chronic pain is associated with an increased 10-year mortality.

Much remains to be done with chronic pain management generally. I am particularly concerned about the status of older people in this regard. The recent National Audit Office health inequalities audit stated that much progress remained to be made on the issue, which would not be surprising as older people usually experience discrimination in the form of health inequalities, but also in poorer chronic pain management targets. Given the current austerity programme that the public sector is facing and the even greater importance of value for money, I hope that the Minister can assure the House that this aspect will be considered in terms of where any cuts will fall—bearing in mind that while we have been reassured that the NHS budget is ring-fenced, in fact that promise includes an existing £20 billion cut in expenditure.

In a survey, the BMA found that 43 per cent of those trusts which responded to it stated that there was a freeze on recruiting doctors and nurses and that many treatments, including varicose vein operations and blood tests, were being rationed. Set against this background, it is hard to see how the parlous state of chronic pain management services will be speedily remedied.

Finally, evidence strongly suggests that a human rights approach could have a practical role to play in this new era of austerity, breathing life into the Government’s promise to protect the most vulnerable and enabling us to interpret large sums into consequences for human beings. Public bodies have a duty to protect people who are suffering from inhuman and degrading treatment, and prolonged pain is in fact a category that would come under that heading. In their review of the Human Rights Act, the Government have said that they will keep these obligations intact, so an approach involving human rights could help public sector staff to remain aware of the huge human costs involved in chronic pain management. For example, the Mersey Care Trust has pioneered the use of human rights to give people with mental health problems and learning disabilities a meaningful role in the organisation, and there have been positive results. Service users and carers are involved in staff appointments, and this has led to a greater emphasis on finding staff with empathy and understanding as well as good technical skills. Perhaps such an approach to joined-up chronic pain management could reap enormous dividends.

Carers

Baroness Greengross Excerpts

Wednesday 16th June 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness draws our attention to an extremely important area. Supporting vulnerable children is a priority for the Government. I would say that many young people are happy to help to care for a family member; it helps them to develop a sense of responsibility. However, inappropriate and excessive levels of caring by young people can put their education, training and health at risk and prevent them from enjoying their childhood. We are therefore very mindful of this area of need.

[Baroness Greengross]

My Lords—

[Baroness Massey of Darwen]

My Lords, young carers are often overlooked. Is the Minister prepared to meet young carers and organisations that represent them to discuss their needs? We have done this in the past and, while some of the issues have been resolved, some have not.

[Lord Tebbit]

My Lords, is my noble friend aware—

[Baroness Greengross]

My Lords, will the Government collect information to help the growing numbers of young, usually working-class grandparents who need to work and who increasingly care nearly full-time for their grandchildren, as well as, frequently, for their ageing parents at the same time?

[Earl Howe]

My Lords, the noble Baroness raises another important area. One thing that we propose to introduce is greater scope for flexible working, as I said in my original Answer, to enable all employees to avail themselves of that. It will allow greater scope for grandparents in particular but it will also allow neighbours and friends to engage in caring on a much wider scale than they can at the moment.

Health: Government Spending

Baroness Greengross Excerpts

Monday 14th June 2010 Lords Chamber

[Earl Howe]

My Lords, the simple answer is that we have a duty to ensure that every pound that we spend is spent efficiently, wisely and with value for money at the end of it. As my noble friend will know, the cost of healthcare in this country has traditionally risen at a faster rate than inflation, so even if we are advantaged in the sense of being a protected department, we still have to find savings in order to continue to ensure that we can deliver quality care at an acceptable price.

[Baroness Greengross]

My Lords, I declare an interest as a member of the Equality and Human Rights Commission. Can the Minister assure the House that public authorities will be able to meet their mandatory equality duties, including carrying out equality impact assessments for all relevant policies and decisions, in spite of the difficult financial constraints?

[Earl Howe]

My Lords, I can reassure the noble Baroness that the imperative to ensure that quality and equality are considered is uppermost in our minds as we proceed with this exercise, and indeed as we go forward into what will be a very difficult financial year next year.

Health: Dementia

Baroness Greengross Excerpts

Thursday 3rd June 2010 Lords Chamber

Asked By

[Baroness Greengross]

To ask Her Majesty’s Government what are their plans to implement the National Dementia Strategy.

[Baroness Greengross]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as a member of the advisory committee on dementia research.

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

My Lords, dementia is one of the most important issues we face as the population ages. We are fully committed to improving the quality of care for people with dementia and their carers. We will accelerate the pace of improvement through a greater focus on local delivery and accountability, and empower citizens to hold local organisations to account.

[Baroness Greengross]

I thank the noble Earl for that encouraging reply. How will the Care Quality Commission be strengthened and aligned with the strategy so that it can support the development of better quality social care, particularly for dementia? As I understand it, there are plans to stop the star rating system in favour of a new registration scheme.

[Earl Howe]

My Lords, the Care Quality Commission is revising its current quality rating system for adult social care and is working closely with the adult social care sector to develop a more user-friendly system that provides people using services with the information they need to make decisions about their care. That is absolutely in tune with the work being done in the department on driving up quality standards in dementia care. Better information for people with dementia and their carers will enable individuals to have a good understanding of their local services, how they compare with other services and the level of quality that they can expect.

Queen's Speech

Baroness Greengross Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Greengross]

My Lords, everyone in your Lordships’ House will welcome the Government’s intention to push forward the reform of health and social care and, in the case of social care, the establishment of an independent commission on the funding of long-term care and the breaking down of barriers between health and social care funding to incentivise preventative action. The greater rolling-out of personal budgets to both older and disabled people and carers will give more control and purchasing power, and the increase in direct payments to carers and better community-based provisions to improve access to respite care will also be warmly welcomed.

As for the health Bill, no one will argue that a sustainable national framework for the NHS which supports a patient focus on outcomes and delivers on the commitment to reduce bureaucracy by strengthening the voice of patients and the role of doctors is not a good thing. I hope that eliminating the top-down structural approach will make doctors and nurses accountable to patients and their carers, rather than to layers of NHS management. However, while welcoming this new accountability and patient focus, and supporting the reduction in bureaucracy, I speculate just how the removal of one quango layer, the strategic health authorities, and their replacement by another, the NHS board, will improve things in the short term. The expanded roles of both Monitor and the CQC should go some way to assuage those concerns, but we need more detail as to exactly how these agencies will work with the new board and I hope the Minister will be able to give us a little more information about that.

While welcoming the fact that the Government are also going to prioritise public health, I look forward to more detailed plans for this area, which I hope will emerge before too long. Whether this Government are able to tackle the economic and social determinants of poor health and reduce health inequalities will be a test of whether they can work effectively across departmental boundaries, something which, sadly, eluded their predecessors.

Often it is older people, in particular, who can find themselves on the front line of experiencing health inequality at first hand. An unacceptable variation in the quality of dementia care on general wards in hospitals across England, Wales and Northern Ireland was identified in a recent Alzheimer’s Society report. Dementia patients with an accompanying physical condition are staying far longer in hospital than those people who go in for the treatment of a physical ailment alone.

Health inequalities, however, are experienced not only by older people but right across the life course. The Healthy Ageing across the Life Course programme, funded by the New Dynamics of Ageing programme, shows that childhood social conditions, as well as adult social conditions, have a long-term impact on physical performance. However, Professor Marmot’s review into health inequalities, Fair Society, Healthy Lives, published earlier this year, reminded us that while health inequalities are traditionally regarded as a problem for the NHS, the NHS is but one player in this task. We must also address the social determinants of health, the housing and neighbourhoods where people live, education, income, standard of living, occupation and working conditions. Clearly the NHS cannot tackle these issues alone; central and local government departments, the third sector and the private sector, as well as individuals themselves, have a key role to play.

The big question is whether we are willing to invest for the future in a fairer society in which we can all enjoy a fuller and healthier life. For some people, particularly older people, the impact of the economic downturn on pension funds may mean that they will have to remain in work longer. Therefore, the proposed removal of the default retirement age must be accompanied by a concerted drive by government, employers and agencies to tackle stereotypes, to extend flexible working opportunities to all workers, and to meet the health, caring and work needs of people who are 50 and over so that they can remain economically active without it being detrimental to their health.

Most well intentioned observers would support the vision described in Our Programme for Government of a reformed health and social care system that puts people in control of their lives. While we all realise that this Government have to find radical, practical and affordable solutions to the issues that we face, the challenge will be to oversee the fair delivery of this reform in this era of new politics, responsibility and opportunity.