Department of Health: Arm’s-length Bodies

Baroness Hussein-Ece Excerpts

Tuesday 16th November 2010 Lords Chamber

[Earl Howe]

My Lords, we will obviously have an opportunity to debate these matters in Committee on the Public Bodies Bill, but I would just make a couple of general points. There are clear synergies between some of the functions performed by the HFEA, the HTA and the Care Quality Commission—they all license treatment. In addition, there is significant read-across to the potential scope of a new research regulator. All political parties at the election were agreed that we have too many of these bodies—too many quangos—and we have to reduce the cost of administration across government as a whole. We can debate at greater length the merits, and perhaps demerits, of the Government’s proposals. I look forward to that debate.

[Baroness Hussein-Ece]

My Lords, will my noble friend give an assurance that the necessary functions of these bodies will continue and, importantly, will they be more accountable?

[Earl Howe]

My Lords, the key point to make about our proposals around the HFEA and the HTA is that we are not proposing to change the functions or alter the provisions of the underlying statutes. All we are doing is proposing to transfer various functions in different directions. As for the independence of the advice, I see no reason at all why the current independence should not be maintained under the new arrangements.

Health: Diabetes

Baroness Hussein-Ece Excerpts

Thursday 4th November 2010 Lords Chamber

[Baroness Hussein-Ece]

My Lords, I thank the noble Lord, Lord Harrison, for securing this debate on a very important health issue, and I also pay tribute to him for the eloquent way in which he has shared his extensive experience and knowledge.

We all know of someone affected by diabetes. Those alarmingly high numbers of people who are more likely to develop type 2 diabetes are over three times more likely to go on to develop serious complications of diabetes which include stroke, kidney damage and heart disease. People living in deprived areas who are socially disadvantaged are two and a half times more likely to develop diabetes. They are more likely to have problems with late diagnosis and have poor lifestyles and poor care, which often compound the difficulties in managing their condition. That, of course, includes poor foot care.

The overwhelming evidence demonstrates that reducing health inequalities in deprived areas and for people from disadvantaged backgrounds, including those with mental illness, would almost certainly lead to more prevention and better management of diabetes. I want to talk about how this condition disproportionately affects people from black and minority ethnic communities, which was mentioned earlier.

Diabetes is increasingly recognised as a public health problem of potentially enormous proportions. This poses significant clinical and economic challenges for the NHS. According to UK studies, the prevalence of diabetes is significantly higher in some minority ethnic groups, which are six times more likely to develop diabetes. Figures suggest that up to 20 per cent of people from south Asian backgrounds and 17 per cent of people who are black African-Caribbean are living with type 2 diabetes, compared with some 3 per cent of the general population. I know from my own background that people from the Turkish community are also at greater risk of developing diabetes. Both my parents developed type 2 diabetes in later years and I confess that that has given me greater first-hand experience in caring for someone with diabetes and the importance, which I never realised before, of good foot care and healthcare generally.

Whereas within the general population type 2 diabetes usually occurs over the age of 40, people from black and minority ethnic communities can get it from the age of around 25. Getting treatment early can reduce the risk of developing complications such as stroke, blindness, heart disease and amputations. There are a number of factors why it impacts disproportionately on black and minority ethnic communities, which include genetic differences in how the body processes fat, but poor knowledge of services, poor housing and social deprivation are huge factors. I was pleased to read how in some parts of the UK with significant numbers of ethnic minority communities, the health services are responding and proactively working with organisations such as Diabetes UK to address some of these unmet needs.

For example, in the past few months NHS Haringey, in partnership with Diabetes UK, has developed the community champions training courses. People from minority ethnic communities, health trainers and religious and community leaders attend sessions about what type 2 diabetes is, who is at risk, signs and symptoms, myths and misconceptions—of which there are many—complications and the NHS services that are available. After qualifying, the community champions then spread the word about diabetes in their local communities by organising stands, talks and healthy-living days. To date, more than 30 community leaders, nutritionists and NHS health trainers in Haringey have qualified as diabetes community champions and they are keen to raise awareness at community events^. Several more training projects are planned in other parts of London. When I was working in the NHS in north London in the 1990s, projects on simple foot care such as nail clipping for older people were done at daycare and health centres. They were simple and cost-effective, and helped many vulnerable people with their foot care.

We know that prevention is often better than cure. That is why we need a more consistent public health strategy across areas with the greatest need and risk. Early diagnosis of those at greatest risk and better management would prevent the acute conditions that far too many people go on to develop, which result in greater risk to the individual and their families, the need for more intensive health services and hospital admission.

The problems are often not just about diagnosis, but about continuing care and managing the condition after diagnosis. Unfortunately, people from deprived backgrounds, including people from ethnic minorities, are less likely to have annual or regular health checks for blood pressure and cholesterol, for example, and, worryingly, many primary care trusts have not had strategies in place to deal with this.

I would like to see more consistent work to raise the profile of diabetes care within minority ethnic groups; strengthen leadership at national and local levels, particularly with GPs; improve practices and change general attitudes through the delivery and uptake of effective and appropriate training; and support a wider community development approach by going out into communities to listen to and involve people in the pathways of their diabetes care. The level and type of services should not necessarily rely on where you live or how involved your GP may be. There should be consistency and equal access to support and services regardless of your background or where you live.

Healthcare

Baroness Hussein-Ece Excerpts

Thursday 28th October 2010 Lords Chamber

[Baroness Hussein-Ece]

My Lords, I, too, will focus on what we mean by patient-led healthcare, which others have mentioned before me. In November 2005 a best-practice document called Now I Feel Tall: What a Patient-Led NHS Feels Like was published. It said:

“I strongly encourage all NHS organisations to take a close look at how they deliver their services and to ask their patients if their emotional needs are being met as well as their physical ones”.

It goes through what patients should look for. This includes,

“getting good treatment in a comfortable, caring and safe environment, delivered in a calm and reassuring way … having information to make choices, to feel confident and feel in control … being talked to and listened to as an equal; and … being treated with honesty, respect and dignity”.

The core and developmental standards for the NHS were set out in seven domains, the fourth of which is patient focus. It says:

“Health care is provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choices, and in partnership with other organisations … whose services impact on patient well-being”.

It therefore requires,

“healthcare organisations to have systems in place to make sure that staff treat patients, their relatives and carers with dignity and respect”.

Healthcare organisations must monitor their performance with regard to treating patients and carers with dignity and respect. The evidence has always been clear that if the NHS listens to what patients are saying, it can result in new ideas, better value for money and better care. How do you measure targets in an area such as patients being treated with dignity and respect, and being listened to, when trusts will point to the often relatively low number of complaints as a measure?

There have been numerous inquiries and other pieces of legislation setting out how to empower both individuals and communities in shaping health and social care services. Since community health councils were abolished in 2003—a great mistake in my view, and I declare an interest as I previously worked as the chief officer of a community health council—we have seen numerous attempts to make the NHS more meaningful and accountable. The establishment of local government overview and scrutiny committees with new duties went a long way to bringing accountability to healthcare services and in my view, as a previous chair of an overview and scrutiny committee, shone a welcome light into areas of healthcare services that had not previously been scrutinised. It brought about the need for greater partnership and collaborative working between local government and health. However, again, it relied on local PCTs and other healthcare trusts welcoming and being open to this scrutiny and accountability.

I welcome the Government’s plans to create local government health and well-being boards, but there have been problems on the ground in the way local government and the NHS have to work to bring about greater public and patient involvement in the NHS. In my own area, the local PCT last year took the decision to close a much loved and important health centre, in the most deprived part of the borough—the Finsbury Health Centre. The health and well-being committee scrutinised this decision in some detail and at considerable length, hearing evidence from patients, the public and clinicians. Eventually, after careful consideration, it presented its findings to the PCT, which fairly quickly rejected them. It found itself at loggerheads with the whole health and well-being committee, the council and the overview and scrutiny committee. It did not allow, for example, the chair of the committee to address or present its findings to the PCT board. As a result, the relationship between elected councillors and an unelected board of rather anonymous people, led by the chief executive, who had no accountability to the public, suffered. So, too, did local community confidence in the PCT.

People increasingly want to be able to exercise choice and control over their care. To do this it is clear that people must have the right to reliable information to help them make choices. Things have improved dramatically in some areas over recent years but what has not improved is the consistency across the NHS. My family’s experience of the NHS has been patchy. Three years ago my father spent seven weeks in hospital, suffering from terminal cancer. I saw at first hand how this 87 year-old man was gradually stripped of his dignity. While some of the nursing staff were enormously professional and provided excellent healthcare, others did not. He was not treated with the respect and dignity he should have expected. He was left in pain, with bed sores, little personal care, and alone on the floor after a fall in his room. This was a proud man, who would not leave the house without a shirt and tie, reduced to tears of humiliation just days before he sadly died. After my father’s death, I decided to complain formally about the senior member of nursing staff who had been so unprofessional to my father and my family. I was perhaps not surprised to learn that there had been a number of complaints about this individual, but none had been taken very far, due to the sheer difficulty, time and bureaucracy involved. This is not an easy time for families and carers.

I welcome the fact that patients will have more choice in terms of their GP. I hope the reforms will underpin not only greater choice but more consistency across healthcare services, so that people like my father have a better experience of the NHS.

[Baroness Northover]

I remind noble Lords that this is a time-limited debate. There is another important debate following ours. We need to give noble Lords in that debate the courtesy of being able to start and finish on time. I remind people that when the clock reaches four minutes, noble Lords have spoken for four minutes. There is also somebody who wants to speak in the gap.

Contaminated Blood (Support for Infected and Bereaved Persons) Bill [HL]

Baroness Hussein-Ece Excerpts

Friday 22nd October 2010 Lords Chamber

[Baroness Hussein-Ece]

My Lords, I am grateful to be able to contribute to this debate on this important Bill. Unfortunately, I see from recent debates in Hansard that this is a long-running and much debated issue that has not yet been concluded. More importantly, the victims and families affected have not had the justice that they deserve.

As a new Member of your Lordships’ House, I come to this matter with a fresh outlook, and have been surprised and disappointed at the apparent lack of urgency and what seems like prevarication over successive Governments and over the intervening decades in coming to a fair and just settlement. I pay tribute to the noble Lord, Lord Morris, and the noble and learned Lord, Lord Archer, for their tireless and exemplary work on this.

It is even more unfortunate, in my view, that a resolution was not arrived at in previous years, as the noble and learned Lord has just mentioned, when we did not face the economic pressures that we face today. The treatment of patients with contaminated blood has been described as one of the most tragic episodes in the history of the NHS; it has also been described as the “contaminated blood scandal”. It is hard to argue with either of these descriptions; through no fault of their own, patients were treated with contaminated blood products and many have subsequently suffered poor health, needing specialist help, treatment and support. Many more have sadly died. We also know that many have suffered, and are still suffering, exceptional hardship.

I was, however, a little heartened to read the public health Minister’s statement in the other place last week that, while ruling out a suggestion to match the compensation to those in the Irish Republic, as was mentioned earlier, she would look again at some aspects of the report of the noble and learned Lord, Lord Archer, and would report by Christmas this year. Although we know that this will disappoint many families and campaigners, at least it provides some movement and hope, and I welcome the review.

I feel that we have arrived at the last chance saloon, and that a resolution needs to be negotiated with the assistance of sufferers of hepatitis C, their families and carers and other interested parties. It cannot be right that we have such a disparity between sufferers who contracted HIV and those who contracted hepatitis C. We know that HIV has become a much more manageable disease than it once was, while hepatitis C is treated by a gruelling six to 12 months of antiviral therapy, which can have severe side effects comparable to chemotherapy and successfully clears the virus in only around 50 per cent of cases. We know that sufferers can develop cancer and other serious medical conditions.

As we heard earlier, many sufferers face continuing hardship and rely on handouts from charities. This is not sustainable or acceptable in the long term. For many, it means a lack of access to insurance, crippling prescription charges and a reliance on social care services, which have to be paid for, depending on their circumstances. Any form of compensation should be awarded on the basis of a needs assessment.

To pluck out one example, it seems very unfair that the dependants of those who died after 5 July 2004 can apply for support from the Skipton Fund only if the victim had applied to the fund before dying. This does not seem to take into account all the merits of each case. I hope that this can be looked at. I also welcome the intention to establish a proper appeal mechanism for those whose claims may be or have been rejected; that is very welcome.

Like others, I believe that it is the responsibility of the Government to address the needs of their citizens. It is a question not of blame but of doing the right thing—of ameliorating the ongoing suffering and distress. The added challenge in today’s climate is to achieve this within the economic constraints that we find ourselves in. Sufferers and families must be treated with decency and fairness. The many expressions of sympathy that we have heard over many years, and which I have read, have probably been welcome but will no longer pay the bills, offer support or address the exceptional hardship.

I welcome the review and support efforts to establish, within a limited period, a timetable to reach a conclusion to this matter. I hope that we are not going to wait another period of years until the matter resolves itself. The dwindling numbers of sufferers deserve our support; they deserve closure and justice.

Disabled People: Dementia

Baroness Hussein-Ece Excerpts

Monday 11th October 2010 Lords Chamber

[Earl Howe]

My Lords, there are several prongs to the strategy which will be needed to meet the concern of the noble Baroness. One is to drive up quality standards through a proper tariff for these services and another is better regulation of providers. As the House will know, the NICE quality standard was published in the summer, which will improve commissioning to deliver greater efficiencies, not simply in a financial sense but also to deliver a better pathway of care for patients, with a focus on outcomes.

[Baroness Hussein-Ece]

My Lords, can my noble friend tell us whether those with special educational needs have a higher preponderance of dementia? What is being done to address those needs and to drive up standards of care, given that the All-Party Parliamentary Group on Dementia concluded that some care being given to dementia suffers is dehumanising? Can my noble friend please outline what is being done for those people with special needs who are diagnosed?

[Earl Howe]

My Lords, my noble friend has hit on an extremely sensitive and important area. My answer to her is similar to the one I gave on a previous question: we must focus on outcomes. That is the main theme of the recently published implementation paper. This morning, I was speaking to a representative of the King’s Fund, which has done tremendous work in this area. This is one aspect of its work, of which I am sure we shall be hearing more.

Health and Social Care Act 2008 (Consequential Amendments No. 3) Order 2010

Baroness Hussein-Ece Excerpts

Monday 26th July 2010 Grand Committee

[Earl Howe]

My Lords, I am grateful to the noble Baroness for her questions. The first point to make is that we are in time with this order, because the operative date is 1 October, so there is no retrospective element. There is therefore no question of any hospital having fallen between two stools, so to speak, as regards water disconnection. I am not aware that there has been a problem on that front.

The noble Baroness asked about the definition. Schedule 4A to the Water Industry Act 1991 lists a number of premises that are not to be disconnected for non-payment of water charges. These include, among other premises, NHS hospitals, premises used to provide medical or dental services by registered practitioners, children’s homes, schools and care homes. These premises will continue to be protected from disconnection for the non-payment of water charges. No changes are being made to these parts of the schedule.

The noble Baroness also asked whether chemical peels were excluded under new paragraph (5)(e). As that procedure is not counted as surgery, chemical peels are not included and therefore do not receive protection from disconnection under paragraph (5)(e).

[Baroness Hussein-Ece]

I should like to ask my noble friend a couple of questions. I understand completely the need for this order. It is a sensible step and an important one to ensure that the establishments mentioned do not suddenly have their water cut off. However, I want to ask what penalties are in place for water companies that do not follow these regulations and how are they enforced. Further, what review mechanism is in place if other establishments need to be added to the list in due course?

[Earl Howe]

My Lords, as regards the penalties, I am going to have to write to the noble Baroness because, as she will understand, those are a matter for another department. I know that I am here to speak for the Government as a whole, but I am afraid that I do not have that information in my brief. On a review of the list of those premises that are exempt from disconnection, again, I will write to her.