Abortion

Baroness Knight of Collingtree Excerpts

Thursday 6th June 2013 Lords Chamber

Asked by

[Baroness Knight of Collingtree]

To ask Her Majesty’s Government what steps they have taken to cease the practice of terminations of pregnancy in NHS hospitals that are not compliant with the Abortion Act 1967.

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

My Lords, in 2012 the Secretary of State instructed the Care Quality Commission to inspect NHS and independent abortion providers to ensure compliance with the Abortion Act 1967. The Chief Medical Officer also wrote to all providers of abortion services, reminding them of their obligations under the Act. All allegations of illegal abortions are taken very seriously and should be reported to the police, who will, if appropriate, conduct a criminal investigation.

[Baroness Knight of Collingtree]

My Lords, is it not the case that early last year the Government’s own care quality inspectors found, in a number of abortion clinics, piles of forms signed by doctors authorising abortions for women they had never seen, let alone examined? Was it not also reported that other abortions were being done for non-medical reasons such as that the child coming was a girl? Why has so little been done to stop these happenings when they are so blatantly against the law of the land?

[Earl Howe]

My Lords, the Care Quality Commission has put in place procedures to identify pre-signing or other instances of non-compliance, and they are confident that these would now be picked up during inspections. However, my noble friend is right; there was a concern early last year that this pre-signing was happening. Since then, however, the CQC has been working directly with providers who are registered to provide termination of pregnancy services to ensure that they are complying with the requirements of the Act. It is beginning to explore how it can strengthen the registration process alongside its regular inspection activities. I therefore suggest to my noble friend that it is not a case of nothing having happened.

On sex selection, we have no evidence at all of gender-related abortions in the UK. Again, concerns were expressed about this in the press, but analysis has been done that shows that the UK birth ratio is within normal limits.

NHS: GP Dispensing

Baroness Knight of Collingtree Excerpts

Thursday 16th May 2013 Lords Chamber

[Earl Howe]

My Lords, there is a balance of interests here, not least the interests of the patient. We therefore need a set of rules which reflects those interests. Patients who live in a rural area can be dispensed to by their GP if there is no pharmacy within 1.6 kilometres of where the patient lives, or within 1.6 kilometres of the GP practice. Without these rules, it would rarely be viable for new pharmacies to open to serve rural areas. That would deprive people living in rural areas of the opportunity to benefit from the more comprehensive health service that a combination of a GP practice and a pharmacy can provide.

[Baroness Knight of Collingtree]

My Lords, can my noble friend say whether all elderly people who have difficulty over this matter are clearly informed that they can ask to have their prescription given by the doctor? For those who have no car and live in areas where buses are not frequent, it is sometimes extremely difficult to manage.

[Earl Howe]

My noble friend makes a good point. There is a special provision that allows a patient who has serious difficulty in getting to a pharmacy by virtue either of the distance involved or lack of means of communication to receive dispensing services from a doctor. Any patient is eligible to receive these services; they do not have to live in a rural area to do so.

NHS: ECMO Machines

Baroness Knight of Collingtree Excerpts

Monday 22nd April 2013 Lords Chamber

[Earl Howe]

I am fully aware of that. Glenfield has been leading the development of ECMO services. It is one of the biggest ECMO centres in Europe. It is currently the largest provider of children’s ECMO in the country, treating about 70 paediatric ECMO patients a year, and now provides an adult service.

[Baroness Knight of Collingtree]

My Lords, can my noble friend clear up a point of confusion that may have arisen about his first Answer to this Question? It was reported in the Times newspaper by the science editor that people could be brought back from the dead up to seven hours after their hearts had stopped. Is that a report on which we can lay much credence?

[Earl Howe]

My Lords, my advice is that in most cases of cardiac arrest that is not possible. Where there has been circulatory arrest in the particular conditions that I described, such as immersion in very cold water, the heart can in some circumstances be restarted, but I would not wish to excite noble Lords’ interest in this technique without proper evidence. I am afraid that the article, which I did see, raises people’s hopes perhaps unfairly.

Care Quality Commission

Baroness Knight of Collingtree Excerpts

Thursday 14th March 2013 Lords Chamber

[Earl Howe]

My Lords, strengthening adult safeguarding arrangements is a key priority for the Government. We are committed to preventing and reducing the risk of abuse and neglect to adults who are in vulnerable situations and generally to supporting people to maintain control over their lives. As the noble Baroness may know, we are legislating to put safeguarding adults boards on a stronger statutory footing. That will better equip them both to prevent abuse and to respond to it when it occurs.

[Baroness Knight of Collingtree]

My Lords, does my noble friend recall occasions within recent years when the Care Quality Commission discovered blatant breaking of the law and was unable to take any steps? What happens when that occurs and no repercussions follow?

[Earl Howe]

My Lords, the Care Quality Commission has a full range of powers open to it which enables it to take action where it discovers a major failing in the quality of care. We are not aware that that menu of options needs to be expanded. I will write to my noble friend as regards specific instances, having consulted the CQC, but I do not think that there is a general call to expand the CQC’s powers in this area.

NHS: Liverpool Care Pathway

Baroness Knight of Collingtree Excerpts

Tuesday 15th January 2013 Lords Chamber

Asked By

[Baroness Knight of Collingtree]

To ask Her Majesty’s Government what procedures will be adopted in carrying out the NHS inquiry into the Liverpool Care Pathway announced on Monday 26 November 2012.

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

My Lords, as we announced today, the noble Baroness, Lady Neuberger, has been appointed to oversee the review of the Liverpool care pathway and is currently determining its procedures. The review will examine how the Liverpool care pathway is used in practice, and will look in particular at the experience of the Liverpool care pathway by patients, families and health professionals, as well as considering the role of financial incentives in its use. It will report by the summer.

[Baroness Knight of Collingtree]

My Lords, there will be very much satisfaction at the appointment of the noble Baroness concerned as chairman. Does my noble friend agree that this inquiry was set up following the receipt of more than 1,000 complaints from relatives of patients who had been put on the Liverpool care pathway, and that the Government are not ignoring their complaints, as those about Stafford were avoided some time ago? Is it acceptable that, out of 130,000 people who die yearly on the pathway—everyone who is put on it—only half are told that they are being put on it and neither they nor their relatives are allowed to know or complain that that is the case?

My noble friend the Minister is very widely respected for his fairness. Will he now consider attending a meeting sponsored by five Peers and a Bishop and addressed by two professors, two consultants and patients’ representative, to hear the case against what is going on?

[Earl Howe]

My Lords, I am grateful to my noble friend for her endorsement of the appointment of the noble Baroness, Lady Neuberger, whom the whole House greatly respects. She is right that after seeing recent criticisms in the media and having received a great many letters in the department, the Minister of State for Care and Support, my honourable friend Norman Lamb, held a meeting at the end of November with patients, families and professionals, both supporters and opponents of the Liverpool care pathway. At that meeting, he announced his decision that there would be an independent chair to oversee a review of the experience of the pathway. However, it is important to emphasise that the pathway itself has not been called into question but, rather, how it is being used. My noble friend is right to draw attention to the concerns around the lack of engagement with patients and their families, which is often a feature of the complaints received.

Abortion

Baroness Knight of Collingtree Excerpts

Tuesday 4th December 2012 Lords Chamber

Asked by

[Baroness Knight of Collingtree]

To ask Her Majesty’s Government what steps they will take to prevent illegal abortion operations.

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

My Lords, an abortion may take place only on grounds under the Abortion Act 1967, as amended. Allegations of illegal abortions are taken very seriously by the Government and anyone suspected of acting outside the law will be referred to the police for investigation. It is for the Crown Prosecution Service to decide whether to prosecute individuals and for the courts to determine whether there has been a breach of the law on abortion.

[Baroness Knight of Collingtree]

My Lords, is my noble friend aware that Parliament passed the Abortion Act 1967 on very firm assurances that clear medical reasons would have to be agreed by two doctors, who examined the patient before an abortion could take place, and that abortion on demand would not happen? Is he aware that if Parliament had known that abortions would occur because the coming child was a girl when the mother wanted a boy, the Act would not have gone through? Did he note the Government’s Care Quality Commission’s findings that some doctors who have never even seen the patient are signing blank forms and leaving them in a handy place for use by colleagues, while others are aborting girl babies unwanted by the mother for no medical reason at all? What is being done to stop these illegal acts?

[Earl Howe]

My Lords, my noble friend raises some extremely important questions. The House will remember that reports came to light in February of pre-signing of the HSA1 forms—the approval forms that have to be signed by two doctors—and the CQC carried out a serious of unannounced inspections of all abortion providers in the light of that story to uncover any evidence of pre-signing. As a result, 14 NHS trusts were found to be non-compliant and clear evidence of pre-signing was identified. We await the outcome of investigations by the Metropolitan Police on that issue. Of course, as a department, we take it very seriously indeed.

On the issue of sex selection, my noble friend is absolutely right. The Act stipulates specific circumstances in which termination of pregnancy is permitted. Gender selection is not one of those circumstances. It is illegal for a practitioner to carry out an abortion for that reason alone, unless the certifying practitioners consider that an abortion is justified in relation to at least one of the Section 1(1) grounds in the 1967 Act. My noble friend will also be pleased to know that the Chief Medical Officer for England has written to all clinics and hospitals undertaking abortions to remind them of the provisions of the Abortion Act.

NHS: Liverpool Care Pathway Inquiry

Baroness Knight of Collingtree Excerpts

Monday 5th November 2012 Lords Chamber

Asked By

[Baroness Knight of Collingtree]

To ask Her Majesty’s Government what procedure will be adopted in carrying out the proposed NHS inquiry into the Liverpool Care Pathway.

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

My Lords, there is no procedure, as there is no such inquiry. A number of organisations, led by the National End of Life Care Programme, Dying Matters and the Association for Palliative Medicine, are looking into complaints, patient experience and clinical opinion on the Liverpool Care Pathway. We do not make policy decisions based on anecdote. If the work in hand suggests cause for concern, we will respond on the basis of that evidence.

[Baroness Knight of Collingtree]

My Lords, is my noble friend aware that large numbers of people with personal experience of how the LCP is now operating complain that their relatives were denied hydration in hospital and died in acute pain and discomfort, with no knowledge whatever or agreement of having been put on this pathway? Is he aware that patients often survive if relatives step in in time and give their dear ones help and water? One rang me a few days ago and she is now going on a cruise. Will my noble friend assure us that there will be an inquiry, which has been promised and announced in the press, and that it will be truly independent and not carried out by those who have vested interests? Nothing else will do.

[Earl Howe]

My Lords, there is never any cause for complacency in a matter of this kind, and I can reassure my noble friend that the Government will keep this issue under review. At the same time, I hope she will allow me to respond in slightly more forthright terms than I normally do, because there has been an enormous amount of misreporting and misinformation around the Liverpool Care Pathway, which has been endorsed publicly in a consensus document by 22 of the leading professional organisations and patient organisations in this area, including Marie Curie. We cannot ignore that. As I mentioned in my Answer, some of those organisations are looking carefully at the reports to which my noble friend alluded. It is notable that not a single complaint has reached the regulators in this area, which I suggest indicates that there may be less substance to some of these stories than may first reach the eye. However, I emphasise that there is no complacency.

NHS: Dental Care

Baroness Knight of Collingtree Excerpts

Tuesday 26th June 2012 Lords Chamber

[Earl Howe]

I am pleased to tell my noble friend that since May 2010 over 1.1 million more patients have been seen by an NHS dentist, which is very good news. Nevertheless, we are clear that access is a priority—56.6% of the population has seen an NHS dentist within the past two years. We wish to design the new dental contract, which is currently being piloted, in a way that encourages access.

[Baroness Knight of Collingtree]

My Lords, does my noble friend recall that last month he told the House that he was giving attention to the possibility of access online to dental prices. Has he anything to report since he said that?

[Earl Howe]

My Lords, I referred earlier to NHS Choices, the website that patients and the public can access. It contains the most up-to-date information on dental treatment costs and entitlements. The dental section of NHS Choices was updated at the end of February following suggestions and comments submitted by the public through the website itself and these changes include new pages that clearly explain dental charges and exemptions and inform patients how to get help with dental costs.

NHS: Liverpool Care Pathway

Baroness Knight of Collingtree Excerpts

Wednesday 20th June 2012 Lords Chamber

Asked By

[Baroness Knight of Collingtree]

To ask Her Majesty’s Government whether use of the Liverpool care pathway in NHS hospitals is consistent with the outcome of parliamentary debates and votes on euthanasia.

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

My Lords, the Liverpool care pathway is an internationally recognised framework to guide the delivery of high-quality care for people in their last hours or days of life. It is not a means of euthanasia and is therefore entirely consistent with the outcome of parliamentary debates and votes on the subject. The Liverpool care pathway helps to ensure that people die with dignity, respect and minimum distress.

[Baroness Knight of Collingtree]

My Lords, is my noble friend aware, however, that although the Liverpool care pathway is certainly not intended to be a tool for euthanasia, that is what a growing number of people now believe it to be, judging by their own experiences? Is he aware that consultants are not always informed that their patients have been put on this pathway, and that invariably neither those patients nor their relatives are told? Will he look into what is happening, since the very name “pathway” indicates that they are shortly to face induced death, as indeed they do?

[Earl Howe]

My Lords, I recognise that some people who have been on the Liverpool care pathway have received poor care. The pathway is not of itself a guarantor of best-quality care. It has been consistently made clear in the guidance for the implementation of the Liverpool care pathway that it is in no way a replacement for clinical judgment and should not be treated as a simple tick-box exercise. Rather, it should be seen as a useful framework to guide the delivery of care in a way that complements the skill and expertise of the practitioner using it.

Health: Influenza Vaccination

Baroness Knight of Collingtree Excerpts

Tuesday 10th January 2012 Lords Chamber

[Earl Howe]

The noble Baroness makes a very valid point. Those types of patient are in the most vulnerable category—the immunocompromised—and it is, I understand, a feature of the normal contract to ensure that those patients are protected to the maximum extent.

[Baroness Knight of Collingtree]

My Lords, does my noble friend recall a recent report from experts that stated that the present flu vaccine is very much less than universally good for the job that it is trying to do and that further experts reported that work was being done on a more effective vaccine that needs to be given only once a lifetime and that would do the job properly? Is there any further news about that possible development?

[Earl Howe]

My Lords, the Joint Committee on Vaccination and Immunisation issued a statement in November last year saying that there is good evidence that some new vaccines are demonstrably more effective in children in particular than the non-adjuvanted inactivated vaccines that are currently available. The JCVI concluded that,

“the live attenuated intranasal vaccine and adjuvanted inactivated intramuscular vaccine once available should be the vaccines of choice for use in children according to their market authorisations”.

However, it also said that a further review of data would be needed on the safety of these vaccines in certain groups, including asthmatics and those who are immunocompromised. There is further work to do in this area.