Terrorist Attacks

Debate between Baroness Hussein-Ece and Earl Howe

Tuesday 5th December 2017 Lords Chamber

[Earl Howe]

I am grateful to the noble Lord for his suggestions; indeed, they resonate very closely with comments made by David Anderson in his report, when he talked about the need for the public sector and the private sector to work together rather more than they do to keep the public safe. I would go further. The Government cannot and should not seek to carry out their work without drawing on the significant expertise that the private sector and, indeed, private citizens can offer. This is not about spying on innocent people; it is about enlisting the support of retailers, for example, both online and physical, to report any suspicious activity. We know that schemes such as Neighbourhood Watch have been extremely successful in their own way in preventing household crime. Perhaps that is something that could be developed rather further to encompass the kinds of crime that we are now discussing.

[Baroness Hussein-Ece (LD)]

My Lords, one of the terrorists, Khuram Butt, is reported to be an acolyte of Anjem Choudary, who virtually became a household name. He was given the oxygen of publicity and a platform to carry on spewing his vile hatred. That is something that we need to take into account and stop.

Unfortunately, preachers inspired by the Wahhabi faith are still coming over from Saudi Arabia and preaching in mosques up and down the country. That is going on. I spoke recently to the family of a young man who is now distant from the family. He has been groomed and cut off from his family. He has dropped out of university and all he does is go round preaching. I am not saying that he would go out and do something but he has been groomed. What is being done to monitor the situation? These imams are coming over from Saudi Arabia and being given platforms in British mosques where they should not be and have no business. What is being done? Are they being monitored, and what is being done to prevent them entering the country in the first place?

[Earl Howe]

My Lords, whenever there are reports of imams or anyone else preaching seditious material or any other kind of malicious doctrine, those reports are followed up. As the noble Baroness will know, the full force of the law is there to bear down upon them. The challenge is to find out where these people are and who they are. That is something that the community as a whole can play a part in highlighting. It cannot solely be for the police to do that. Indeed, it is important that communities should not feel that they are being spied upon all the time.

Mental Health Services

Debate between Baroness Hussein-Ece and Earl Howe

Wednesday 26th November 2014 Lords Chamber

[Earl Howe]

My Lords, I fully agree with the noble Lord. He may like to know that my department is currently working with the Department for Education to revise the statutory guidance on promoting the health and well-being of looked-after children. We plan to consult on this later this month and to publish the final guidance early next year. It will make it clear that the CCGs and local authorities are responsible for providing services for looked-after children to give equal importance—parity of esteem—to their mental and physical health and to follow the concordat that I referred to.

[Baroness Hussein-Ece (LD)]

My Lords, my noble friend will be aware that early diagnosis in terms of getting support for children is very important, but very often these children are excluded from school—they end up in pupil referral units and are just generally not in school when they really need help. Is he satisfied that local authorities are doing what they can to make sure that these children who are excluded are getting mental health support?

[Earl Howe]

My noble friend raises a very important point. My department has invested £3 million in MindEd, which provides clear guidance on children and young people’s mental health for any adult working with children, young people and their families so that, for example, school teachers and those working with children in schools can recognise when a child needs help and can make sure that they get that help early.

NHS: Ambulance Response Times

Debate between Baroness Hussein-Ece and Earl Howe

Monday 21st July 2014 Lords Chamber

[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.

[Baroness Hussein-Ece (LD)]

My Lords, will the Minister give an assurance that, when ambulances are called out for patients who are having prolonged epileptic seizures, there will be qualified paramedics in attendance and that we shall not go back to the situation we had of several tragic cases where paramedics were not in attendance and patients with prolonged epileptic seizures died before they got to hospital?

NHS: Mental Health Funding

Debate between Baroness Hussein-Ece and Earl Howe

Wednesday 2nd April 2014 Lords Chamber

[Earl Howe]

My Lords, as the noble Lord will know, the tariff for mental health services is determined locally. Having said that, we are clear that it is important that these tariffs and the priority given to mental health are scrutinised very carefully indeed, which is why my honourable friend the Minister of State for Care and Support has said he will do just that in the case of every single clinical commissioning group. If he determines that the plans are unsatisfactory, we as Ministers will work with NHS England, which we do regularly, to ensure that there is indeed that progress to parity of esteem that we all want to see throughout the country.

[Baroness Hussein-Ece (LD)]

My Lords, is my noble friend aware that there is significant evidence that two-thirds of local authorities have reduced their child and adolescent mental health service budgets since 2010, draining money from early intervention services, which, I think he will agree, is short-sighted and stores up problems for the future? Will he ensure that NHS commissioners and councils provide comprehensive services to address the deepening damage caused by further cuts to children and young people’s mental health services?

Health: Local Healthwatch Funding

Debate between Baroness Hussein-Ece and Earl Howe

Wednesday 19th March 2014 Lords Chamber

[Earl Howe]

I do not believe that anybody has nicked £10 million, my Lords. The issue here is the one raised by the noble Lord, Lord Harris, and others: the absence of ring-fencing should not be seen as something negative. It has enabled councils to take a strategic approach to allocating their resources, in line with local needs and priorities. It has given them freedom to deploy their resources across the piece to achieve value for money. It is now, as I said earlier, up to local communities, but also local Healthwatch itself, to hold their local authority to account and thereby to demonstrate the impact that they are having, and make the case for more money if they feel that they merit it.

[Baroness Hussein-Ece (LD)]

My Lords, the Minister said that this was about transparency, which of course it is. However, is it not also about consistency? There must be regions, boroughs or councils that are not using the money that has been allocated, which is surely to the detriment of the local community and to patients there. Surely we need to know where that money is not being spent and where patients and users of the health service are being sold short.

[Earl Howe]

We do need to know if people are being sold short. I would say to my noble friend that that is one of the reasons why local Healthwatch has a seat at the table of the health and well-being board, where it is eminently able to make its voice heard if it feels that it does not have sufficient resources to do the job which local authorities are legally obliged to commission.

NHS: Clinical Commissioning Groups

Debate between Baroness Hussein-Ece and Earl Howe

Wednesday 27th November 2013 Lords Chamber

[Earl Howe]

We give no steer. As I said to the noble Lord, Lord Hunt, the principles on which NHS England should operate are clearly of concern to Ministers—namely, equal access for equal need, the need to take account of health inequalities in an area, and not destabilising the NHS. We also believe that NHS England should be transparent in whatever it does. Those are legitimate concerns for Ministers, but we do not seek to steer NHS England in any particular direction.

[Baroness Hussein-Ece (LD)]

Will the Minister reassure me that child and adolescent mental health services will be given sufficient weight in these discussions?

[Earl Howe]

My Lords, ACRA has recommended that CCG mental health services allocations should be set using the same overall approach as that for other hospital and community health services. That means that a large part of the allocation is linked to the diagnoses reported for people registered with each GP. That makes the formula very sensitive to need. It has the potential to improve the way we allocate resources for mental health services, in particular.

NHS: West London Hospitals

Debate between Baroness Hussein-Ece and Earl Howe

Thursday 28th February 2013 Lords Chamber

[Earl Howe]

My Lords, we believe very firmly as a general principle that the reconfiguration of services works best when there is a partnership approach between the NHS, local government and the public. That is why we are strengthening local partnership arrangements through the health and well-being boards. To answer the noble Lord’s question, it is entirely possible for a reconfiguration decision to be referred upwards to the Secretary of State by the overview and scrutiny committee of a local authority, and in that event it is customary practice for the Secretary of State to receive independent advice from the independent reconfiguration panel. However, we have not reached that stage yet. We have agreement locally as to what these arrangements should look like and I think that we should wait to see how the plans develop.

[Baroness Hussein-Ece]

My Lords, is my noble friend aware that the Whittington Hospital, which serves a densely populated area of Islington and of Haringey, where there is no other hospital, suddenly announced in January without any proper consultation its major plans for reconfiguration, including changes to buildings and services? Those plans include the downgrading of the A&E department of the hospital, where I have spent many an unhappy hour with my children and other family members but receiving an excellent service, to an emergency care service. Does he think that it is appropriate to do this without proper consultation and explaining the plans to local people?

[Earl Howe]

My Lords, I cannot comment specifically on that particular set of proposals. However, I can say that we made it very clear nearly three years ago that reconfiguration proposals, wherever they arise, should be underpinned, as should the arising decisions, by four reconfiguration tests. Local plans must demonstrate support from GP commissioners; a strengthening in public and patient engagement, which is the issue raised primarily by my noble friend; clarity on the clinical evidence base for whatever is proposed; and support for patient choice. We expect that where proposals of this kind arise, those four tests need to be met.

Health: HIV Strategy for England

Debate between Baroness Hussein-Ece and Earl Howe

Tuesday 15th January 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is right to draw attention to the need for targeted prevention messages in this area. Following a competitive tender last year my department awarded the Terrence Higgins Trust a contract worth £6.7 million for three years. Known as HIV Prevention England, the programme targets gay men and African communities, the groups that remain the most at risk of HIV in the UK. That work includes promoting HIV testing through the Think HIV campaign; primary prevention messages, which we must get to the right audiences; and developing the evidence base on what works in HIV prevention. That DoH programme, I emphasise, is in addition to work funded by the NHS and local authorities.

[Baroness Hussein-Ece]

My Lords, the Minister will be aware of the links between HIV and tuberculosis, and of how important it is that when we talk about HIV we also talk about TB. Are there any plans in the strategy that is mentioned to include TB, given that cases of both HIV and TB are on the rise?

[Earl Howe]

My noble friend is absolutely right to mention the connection between HIV and TB. The complexities that arise from comorbidity of that order are fully taken account of in the approach taken by both the health service and local authorities to the testing and treatment of HIV patients. The individuals attending a TB clinic are offered and recommended an HIV test as part of their routine care. This is applicable to all patients irrespective of age. NICE has issued guidelines which recommend the use of a specialist test for people with HIV, and if the test is positive a clinical assessment will be performed to exclude TB and consider treating latent TB infection.

Health: Neurological Conditions

Debate between Baroness Hussein-Ece and Earl Howe

Monday 27th February 2012 Lords Chamber

[Earl Howe]

My Lords, I pay tribute to the noble Lord’s extensive work in Parliament on behalf of those with neurological conditions. We have taken the view that the appointment of a tsar or a clinical specialist in this area should be one for the NHS Commissioning Board. It is satisfied with that position and we must await its determination on that.

[Baroness Hussein-Ece]

My Lords, the report also highlighted important indicators that the quality of care for people with neurological conditions in some instances had worsened. For example, the number of people admitted to hospital as an emergency had increased significantly and, indeed, emergency readmissions after spending a night in hospital have increased for patients with Parkinson’s disease, multiple sclerosis and motor neurone disease, to give three examples. What are the Government doing to address this?

[Earl Howe]

My noble friend is quite right. We know that people with long-term neurological conditions are high users of NHS services and, as the NAO report identifies, they often have high levels of unplanned admissions to hospital. To help to provide personalised care and to support better-planned care, there is quite a deal of evidence—of the generic kind, but nevertheless very useful—out there for neurological patients. It focuses on the individual, on planning, on supported self-care and on how patients themselves can improve their own outcomes. We are building a strategy on that model to set out how local authorities, the voluntary sector and government agencies can work together to prevent the kind of emergency admissions to which my noble friend refers.

Health: Smear Tests

Debate between Baroness Hussein-Ece and Earl Howe

Monday 13th February 2012 Lords Chamber

[Baroness Hussein-Ece]

To ask Her Majesty’s Government whether they have any plans to reduce the age at which women in England first undergo smear tests, to bring it into line with that in Scotland, Wales and Northern Ireland.

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

My Lords, there are no plans at this time to extend cervical screening in England to women who are aged under 25. In England, cervical screening starts at age 25 in line with the recommendations of the World Health Organisation and the independent advisory committee on cervical screening.

[Baroness Hussein-Ece]

I thank the Minister for that reply. He will be aware that in Scotland and Wales the age when women are first called for a smear test remains 20. Is he further aware that around 1,000 women a year die from cervical cancer? Does he think that there is a real problem that not going for cervical screening is one of the biggest risk factors in developing this cancer, and almost half the women who develop it have never had a cervical screening test? Does he agree that while it is not possible to lower the age at this time of budgetary constraints, far more needs to be done to raise awareness to ensure that more women survive and these deaths are prevented?

[Earl Howe]

My Lords, I should make clear that it is not budgetary constraints that have prevented a lowering of the age but clear clinical advice. However, my noble friend is right about uptake. We are working with the NHS cancer screening programmes and stakeholders to refine the information that we provide to women when they are invited for screening so that all are fully supported to make an informed choice to attend. To tackle the issue of low uptake among women, particularly younger women aged 25 to 29, the National Institute for Health Research health technology assessment programme has recently commissioned a study, the strategic trial, to determine which interventions are effective at increasing screening uptake among women receiving their first invitation from the programme. This is work in train and we await the results with interest.

Tobacco

Debate between Baroness Hussein-Ece and Earl Howe

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, I can reassure the noble Baroness that my right honourable friend the Secretary of State, and indeed all Ministers in the department, have had no direct dealings—or indeed indirect dealings—with the tobacco industry since coming to office. However, I am sure that the noble Baroness’s message will be very warmly received by my colleagues.

[Baroness Hussein-Ece]

Is my noble friend aware that almost 50 per cent of loose tobacco sold in the UK comes from illicit and illegal traders on the streets, which makes it more affordable for children and young people? What progress is being made in cracking down on the illicit tobacco trade? As my noble friend will know, it is an industry controlled and funded by an international network of organised crime gangs.

[Earl Howe]

My Lords, Her Majesty’s Revenue and Customs and the UK Border Agency published a renewed strategy in April last year to tackle the illicit trade in tobacco products. Our tobacco control plan complemented that strategy by stressing the importance of cracking down on illicit tobacco sales, which will in turn reduce tobacco consumption and organised crime, and support legitimate retailers. In fact, the latest figures show that fewer and fewer people are using illicit tobacco. The market for illicit cigarettes was down to 10 per cent in 2010 from 21 per cent in 2000.

Health: Breast Cancer

Debate between Baroness Hussein-Ece and Earl Howe

Thursday 12th January 2012 Lords Chamber

[Earl Howe]

My Lords, I understand the point that the noble Baroness is making, but I think that most people would agree that it would be wrong to let private providers off the hook. In the first instance, we are saying that the woman, if she has been treated privately in the circumstances the noble Baroness has described, should seek advice from her private clinician. Only then, if the clinician or the clinic let her down, will she be able to have recourse to the National Health Service. I think that that is fair.

As regards the replacement of the implant, we do not think that other NHS patients should be disadvantaged in this way. Every time the NHS picks up the tab for the private sector, we are displacing patients of the NHS who are in need. Therefore, there is a balance to be struck here and we have made our decision on a very good basis.

[Baroness Hussein-Ece]

My Lords, how is it that these PIP implants, which are now declared unsafe and substandard, were given the European CE mark—the safety kitemark? Does the Minister share my concern and dismay at the Harley Medical Group’s announcement yesterday? This is a group which for years and years has ruthlessly advertised, sold and fitted these substandard PIP implants to nearly 14,000 women and is now saying that it will not replace them. Is it not time to take action against these unscrupulous—it seems—private practitioners to make them take some responsibility?

[Earl Howe]

We believe that in many instances private practitioners have a legal duty—certainly a moral duty —to address these matters on behalf of their patients. Eight private companies are offering to replace implants for their patients. We welcome that and are urging the Harley Medical Group to follow suit. I was encouraged to hear that the professional bodies representing cosmetic surgeons have sent out a letter, urging surgeons not to charge for their time when they remove these implants privately.

As regards the first part of my noble friend’s question, it remains to be seen whether there has been a failure of regulation. We are looking here at a deliberate criminal act by the manufacturer of these implants. It is very difficult to see how regulation, however tight and effective, could pick up something such as this, where there has been a deliberate effort to conceal facts from the inspectors.

Health and Social Care Bill

Debate between Baroness Hussein-Ece and Earl Howe

Monday 7th November 2011 Lords Chamber

[Earl Howe]

My Lords, unfortunately, I am not an expert in consumer law. My noble friend Lord Marks might be able to enlighten us on this, but there are, of course, consumer protection laws, which every organisation has to abide by, as provided for in the Consumer Protection Act. I think there are probably consumer protection aspects to contracts relating to healthcare services, but we have to tailor the contracts to ensure that we cover the issues that healthcare gives rise to.

The noble Lord, Lord Warner, asked me about the NHS Redress Act and whether the provisions of that Act were capable of taking forward some of the issues raised in the debate. I understand why he has asked that question, but there is a difference between redress for negligence and openness and it is important to distinguish between the two. As such, some of the issues raised this afternoon fall into the remit of redress and associated legislation rather than being specifically linked to a duty of candour. However, I note that, notwithstanding the long hours that we spent debating the NHS Redress Bill some years ago, the previous Government chose never to bring it into force; it is potentially on the statute book, but it is not in operation.

I shall reflect carefully on the points made in this debate. I hope that I have in some way reassured the noble Baroness, Lady Masham, that we are putting systems in place to introduce the duty of candour. To answer my noble friend Lord Mawhinney, we have a strategy. There are good reasons for the contractual route that we have chosen as well as a real potential downside if we were to go down the statutory route proposed here. So against that background, I hope that the noble Baroness will feel able to withdraw her amendment.

[Baroness Hussein-Ece]

The Minister's comments on mediation prompt me to ask a further question. When I dealt with many of these cases, the complaints procedure was on three levels and the first, immediate level was when the patient or the patient’s representative came forward with a complaint to seek local resolution, and often mediation was used to bring the parties together to give, as far as possible, full information. This is very patchy and I was wondering whether, within the consultation and the contractual duties to which the Minister has referred, that will be extended so that things can be resolved at the first level before they get to the litigation stage. Is that being considered?

[Earl Howe]

I shall have to get back to my noble friend on whether it is specifically mentioned in the consultation. I can say that it is absolutely pertinent to the subject matter on which we are consulting. It would be extremely helpful if some of the response to the consultation covered issues such as mediation. We need to factor that in and perhaps my noble friend, with her experience, will feel able to send us her views on the subject.

Health and Social Care Bill

Debate between Baroness Hussein-Ece and Earl Howe

Wednesday 2nd November 2011 Lords Chamber

[Earl Howe]

There is a hypothesis in my noble friend’s question that I do not necessarily accept but I would be happy to write to her with the figures.

[Baroness Hussein-Ece]

I am sorry to press the Minister on the point I made about homeless families who are placed in different boroughs or areas by their local authority. Under the present system, the GP practice where the family was originally based would wash its hands of that family and say, “You are no longer in my area”. Is the Minister saying that wherever a family has been placed, they would still be able to retain the services of the GP where it originated from or would they have to register with a practice close to the temporary accommodation in which they may have been placed. Such placements can last for many years. Will the family have to seek a GP close to where they have been placed or could they still use the GP services from whence they came?

[Earl Howe]

It would depend how far the family had moved away from the GP practice. What I was trying to say was that the agreement we have reached with the BMA comprises two elements. One is that the outer boundary of a GP practice is going to be flexed in a sensible and pragmatic way so that if you move a few streets away from where you were previously living, you can still be treated in the same GP practice. The other element of the agreement is the pilots that we are looking at. They are only pilots and we will set them up in order to experiment and learn lessons from how they work. It is impossible for me to give my noble friend a generalised statement at the moment because it will depend on the circumstances. At present, the rules will remain roughly as they are other than the flexed boundary rule that I have mentioned.

Health: Obesity

Debate between Baroness Hussein-Ece and Earl Howe

Wednesday 19th October 2011 Lords Chamber

[Earl Howe]

The short answer is the ring-fenced public health budget, which will encourage local authorities to look across the piece at their public health responsibilities.

[Baroness Hussein-Ece]

My Lords—

--- Later in debate ---

[Baroness Hussein-Ece]

My Lords, unlike the noble Lord, Lord Lawson, I have not really been there and done it, but I am full of admiration for him that he has. However, is it not shocking that 25 per cent of children aged between two and 15 are now classified as obese? Does the Minister share my concern that this serious public health problem is not simply a question of celebrity chefs or of parents being lectured about lunch boxes, it is about educating children and families on how to prepare fresh, healthy food? Is there any evidence that this is being done consistently?

[Earl Howe]

I agree with my noble friend that it is about educating both children and parents about healthy diets and healthy eating, and encouraging children at school to take up healthy diets.

Health: Multiple Sclerosis

Debate between Baroness Hussein-Ece and Earl Howe

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

The problem is that, historically, there has been no requirement to publish information on the number of multiple sclerosis nurses. The NHS Information Centre for health and social care extracts data from the electronic staff record and quality-assures the data prior to publication in the non-medical workforce census. The qualified nursing, midwifery and health visiting staff group is broken down only by area of work, so it is quite difficult to keep a handle on this.

[Baroness Hussein-Ece]

My Lords, many people with a long-term condition such as multiple sclerosis are usually in their prime of life and in employment when they are diagnosed. It is therefore important to their well-being that they can continue with that employment as long as they are able to. Can the Minister say whether the government-led initiative Health, Work and Well-being is supporting these people and whether he is satisfied that all employers understand that those diagnosed with multiple sclerosis are protected by the Equality Act and the Disability Discrimination Act, depending on where they live?

[Earl Howe]

My Lords, I am personally involved with Dame Carol Black in a work stream under the Responsibility Deal, which covers health in the workplace. Under that banner, we are emphasising to employers how important it is to understand the circumstances and needs of employees with a long-term condition. I will, however, go back and see whether I can provide my noble friend with a fuller reply.

NHS: Reform

Debate between Baroness Hussein-Ece and Earl Howe

Monday 6th June 2011 Lords Chamber

[Earl Howe]

My Lords, the way we have set out the Health and Social Care Bill means that, wherever possible, decisions on service reconfiguration will be taken at the local level. That will mean that all stakeholders locally, not only the NHS but local authorities, social services and patient groups, will buy in to and contribute to whatever decisions are taken. So my answer to the noble Lord is this: it should be a considered process of decision-making taken locally.

[Baroness Hussein-Ece]

My Lords, as we know, the NHS is the most valued public service in this country. It is one that we all rely on from the cradle to the grave. What are my noble friend’s views about the fact that it is still the most unaccountable public body delivering services that we have? It is still unaccountable to its users. What discussions have been taking place to ensure that the NHS becomes far more responsive and accountable to users?

[Earl Howe]

My noble friend has made a key point. As she will know, patient and public accountability is one of the themes of the listening exercise that we have been conducting. I anticipate that Professor Steve Field and his NHS Future Forum will come forward with some substantive recommendations on how we can improve the arrangements for accountability in the service. I agree with her that it is in practice less than accountable at the moment, and our view is that it should be accountable primarily to patients in the local area but also, crucially, to Parliament as well.

Mental Health: Children in Local Authority Care

Debate between Baroness Hussein-Ece and Earl Howe

Monday 23rd May 2011 Lords Chamber

[Baroness Hussein-Ece]

Does my noble friend share my concerns that significant numbers of black and minority-ethnic children in the care system suffer from mental health problems, but do not receive the appropriate intervention and support until it is far too late and they have already become involved in the criminal justice system? Will my noble friend tell me what is being done to ensure early intervention, treatment and support for these young people and children?

[Earl Howe]

My noble friend is absolutely right. She will know that minority-ethnic groups appear to be overrepresented in the looked-after population. Around 3 per cent of the child population of Great Britain is from black, black British or mixed groups, but 8 per cent of looked-after children are black and 7 per cent are from mixed groups. She is right that there is a problem. She is also right that early intervention is key. There is a strong emphasis on public mental health in the mental health strategy. The good foundations are down to early intervention, as I mentioned, and we are clear that this is a priority for the Government.

NHS: Waiting Times

Debate between Baroness Hussein-Ece and Earl Howe

Tuesday 3rd May 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness is right to raise the question of consultant numbers. I simply say that one of the clinical indicators that we have set for A&E is that there should be consultant sign-off. That in itself should encourage consultant capacity over time.

[Baroness Hussein-Ece]

My Lords, attendance at A&E has steadily gone up by more than 1.3 million over the past five years. How much is this the result of the lack of access to GP out-of-hours services? Is it not the case that too many people are presenting at A&E who should be seen at a primary care setting?

[Earl Howe]

My Lords, I agree with my noble friend completely. That is why we are quite clear that general practitioners have to take much greater direct responsibility for out-of-hours care. At the moment they can, if they choose, divorce themselves from that responsibility and I think that was a retrograde move. Equally, we are clear that we should encourage general practitioners to look at ways of avoiding unplanned emergency admissions to hospital in the first place. That will reduce pressure on A&E.

Health: Influenza Vaccination

Debate between Baroness Hussein-Ece and Earl Howe

Thursday 20th January 2011 Lords Chamber

[Earl Howe]

My Lords, the main lesson is one to which I referred a minute ago. We are considering bringing back into central procurement the purchasing of the seasonal flu vaccine, which is an exception to the normal rule. We purchase most vaccines centrally, apart from that one. There is a lot to be said for changing the ordering system so that we can keep better track of supplies and, perhaps, have more cost-effective procurement at the same time.

[Baroness Hussein-Ece]

My Lords, I read a report in the media last week saying that, in light of the high incidence of children under five contracting flu, the Government are preparing to examine new evidence from the advisory group that could allow for all under-fives to be vaccinated. Have the Government reached a view on this?

[Earl Howe]

We have not reached a view on this because the JCVI’s advice remains unchanged. In fact, current evidence shows that children under five are not the age group with the highest risk of death. The age group with the highest risk of death from the flu that is circulating currently is middle-aged adults. Nevertheless, those with risk factors have the highest risk of severe disease and death from flu compared with healthy age groups. However, I can tell my noble friend that nothing is set in stone. We do not wish to constrain the JCVI in any way and we will listen to its advice, as we always do.

Health: Influenza

Debate between Baroness Hussein-Ece and Earl Howe

Tuesday 11th January 2011 Lords Chamber

[Earl Howe]

My Lords, it is quite difficult to substantiate that suggestion, because the immunisation figures do not bear out the noble Baroness’s argument. The level of vaccine uptake in the over-65s is 70 per cent, which is better than in most countries of Europe. Among the at-risk under-65s, it is 45.5 per cent, which is comparable to the past two years. Therefore, it is not clear that a generalised campaign would have added value.

On the question of pregnant women, the normal procedure is for the Chief Medical Officer to write to all GPs in the summer, setting out all the at-risk groups. She did that in June. We were then alerted in December by the Health Protection Agency to a worryingly high number of pregnant women who had contracted influenza, so we wrote to both the BMA and the Royal College of Midwives to emphasise the desirability of encouraging that group of patients to get vaccinated. We did the right thing, which was to respond to emerging data.

[Baroness Hussein-Ece]

My Lords, is it the case that the highest rate of flu has been among those aged one to four? Have the parents of children in that age group been encouraged to have their children vaccinated over and above others? Also, have the Government changed their policy of publicising the need for the flu jab, which they did during last year’s outbreak?

[Earl Howe]

We did see a higher than expected number of under-fives contracting influenza, so we took urgent advice from the Joint Committee on Vaccination and Immunisation in December and asked it to confirm its previous advice that not all under-fives need get vaccinated unless they were in an at-risk group. It confirmed that advice and we have followed it.

Blood and Blood Products

Debate between Baroness Hussein-Ece and Earl Howe

Monday 10th January 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord, Lord Morris of Manchester, to whose efforts I pay particular tribute in the context of this debate, as in many other contexts, has reminded us of the devastating effect of this tragedy on individuals and families. The previous Government recognised this and significantly improved the payments that were available to the victims of this disaster. We felt that there was still further to go, hence today’s Statement. We have arrived at this point following a brief but nevertheless thorough review of the arrangements, informed by a scientific report which is also published today—noble Lords can read the advice that we received—to enable us to understand rather better the suffering that these victims endure in clinical terms as well as in human terms. On the basis of that, we have arrived at the arrangements whose details I have repeated.

We believe that this is a fair and reasonable package of support for these poor victims. We do not intend to revisit it in the future. I acknowledge that some people might have different views on the appropriate level of payments for this patient group, but the package needs to be considered in the context of the whole range of support that is available for the group, especially Department for Work and Pensions benefits, the care available under the NHS and the care available from social services. Having consulted widely, we consider that the sums announced in this package, taken in the round with the other support available to this patient group, are both appropriate and reasonable. So, while I understand the noble Lord’s request, I am not in a position to accede to it at this point.

[Baroness Hussein-Ece]

My Lords, I congratulate my noble friend the Minister on the package announced in the Statement today. We very much welcome both it and, as the noble Baroness, Lady Thornton, said, the huge progress that has been made. Given that the commitment to review the current arrangements was made just last October, the Minister is to be congratulated on the swiftness with which this matter has been brought back to your Lordships' House. I hope that it serves to bring some comfort to those who have for so many years campaigned for justice, and particularly to the relatives of the deceased and the many other victims of this tragic episode.

The Minister announced that there would be a window for posthumous claims until the end of March 2011. There is concern that that is not a very big window and that it does not offer a lot of time to locate people and, for the many who may need assistance, to put a claim together. Perhaps the Minister can say why it is such a small window. Is he satisfied that it is sufficient time in which to track down as many people as possible who may have lost out?

It is not quite clear from the Statement who will receive posthumous payments. Will widows, partners and children be included in the arrangements? I would appreciate clarification on those points.

Autism

Debate between Baroness Hussein-Ece and Earl Howe

Tuesday 7th December 2010 Lords Chamber

[Earl Howe]

The noble Baroness raises a very important point. We know from general practitioners that they feel an absence of knowledge and training in this area. We are talking to the royal colleges about this.

[Baroness Hussein-Ece]

My Lords, how will the Minister ensure that the guidance ties in with the reforms to the NHS, for example, ensuring that the NHS bodies have due regard to any quality standards on autism that will be produced by NICE?

[Earl Howe]

My Lords, when the National Health Service commissioning board is established, it will have a duty to promote quality in the NHS. One way of doing that will be to utilise the quality standards produced by NICE, to produce commissioning guidance based on those quality standards and, in that way, to promote consistency of commissioning across the health and social care sector.

Department of Health: Arm’s-length Bodies

Debate between Baroness Hussein-Ece and Earl Howe

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.

Disabled People: Dementia

Debate between Baroness Hussein-Ece and Earl Howe

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

Debate between Baroness Hussein-Ece and Earl Howe

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.