Health: Flu Vaccine Research

Baroness Knight of Collingtree Excerpts

Wednesday 23rd November 2011 Lords Chamber

Asked By

[Baroness Knight of Collingtree]

To ask Her Majesty’s Government whether they propose to fund research into more effective flu vaccines, in the light of the recent report in The Lancet.

[Earl Howe]

My Lords, research on the development of new flu vaccines is being actively carried out by academic departments in universities, biotechnology companies and vaccine manufacturers. There are number of improved vaccines in the final stages of development and licensed products may become available over the next few years. The department does not fund the development of new vaccines, but does support some work on basic research and research to inform policy in this area.

[Baroness Knight of Collingtree]

My Lords, did the Lancet report not warn that the currently used vaccine is effective for only six out of 10 of the persons receiving it, and that the virus can actually change to outwit that vaccine? Has my noble friend studied a more recent report from the chief virologist at Barts and the Royal Hospital about a new vaccine which not only gives lifelong protection in only one jab but also overrides the virus changes? Would it not be a real boon for patients if this were looked at more carefully, and perhaps brought in? It would save a lot of money for the NHS.

[Earl Howe]

My noble friend is extremely well informed. I have not seen the report that she mentioned. The only licensed vaccines currently supplied to the UK are inactivated trivalent influenza vaccines, but it is expected that within the next few years others will become available, including a live attenuated trivalent intranasal vaccine next year. In the future, an adjuvanted vaccine and a quadrivalent vaccine may also become available. The JCVI—the Joint Committee on Vaccination and Immunisation—has looked at some of these new vaccines and believes that they present exciting prospects for greater efficacy.

NHS: Hinchingbrooke Hospital

Baroness Knight of Collingtree Excerpts

Thursday 10th November 2011 Lords Chamber

[Earl Howe]

My Lords, as part of the franchise, Circle is committed to maintaining the current level of services, including accident and emergency and maternity services, as long as commissioners continue to purchase them for local patients—a commitment made following a consultation in 2007. Any proposals for a significant change to the services provided at the hospital will be subject to public consultation, as with any NHS hospital.

[Baroness Knight of Collingtree]

My Lords, am I correct in deducing from what my noble friend has said that the choice was either no easy future for this hospital or the course that is now being adopted?

[Earl Howe]

My Lords, so serious were the problems of Hinchingbrooke, both clinically and financially, that frankly the alternative to a franchising solution might have been closure of the hospital. I think that Ministers in the previous Administration reached that conclusion. It is one of the largest accumulated deficits that we have ever seen in any hospital. The problems facing Hinchingbrooke are therefore very significant.

Care Homes

Baroness Knight of Collingtree Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My Lords, I do not agree with that. For many years, successive Governments have relied upon private care providers in social care. In general, this has been entirely satisfactory. It has given people wide choice in the care available and Governments have encouraged that. Financial issues for one provider—albeit a major one, I concede—do not undermine the entire principle of independent care provision.

[Baroness Knight of Collingtree]

Will my noble friend the Minister confirm that the original principle, stated to be the main aim of all these reforms, is unchanged in spite of the very necessary talks he is having with several different bodies? Is it still to be the case that nothing is more important than the care, treatment and curing of the patient, and the patient’s dignity and comfort, including being fed in hospital?

[Earl Howe]

I am grateful to my noble friend. That is entirely the aim of the modernisation programme for the NHS that we have laid out. It must be a much more patient-centred and user-centred service. As regards Southern Cross, we have said that there will be effective protection for the residents involved; no one will lose out. We are clear that we are putting the interests of residents first.

Health: Cancer

Baroness Knight of Collingtree Excerpts

Tuesday 10th May 2011 Lords Chamber

[Earl Howe]

My Lords, there are drugs which NICE has recommended for kidney cancer, so Afinitor is not the only drug on the menu. GPs have a crucial role to play if we are to achieve earlier diagnosis of cancer and meet our ambition of cancer outcomes that are among the best in the world. The National Cancer Director, Professor Sir Mike Richards, is working with pathfinder GP consortia to understand how we can support them in commissioning services that deliver the best outcomes. He is clear, as are we, that cancer networks will have a central role in the reformed NHS as a place where clinicians from different sectors come together to improve the quality of care across integrated pathways.

[Baroness Knight of Collingtree]

My Lords, has my noble friend made any assessment of the difficulties of treating cancer patients, when the trouble is with the kidneys, because of lack of spare parts?

[Earl Howe]

I think I shall need to clarify with my noble friend what she means by spare parts in this context. I am aware that if we look at treatment options for kidney cancer, neither chemotherapy nor radiotherapy is generally appropriate. Usually, surgery is the preferred course of treatment. If my noble friend will allow, I will speak to her afterwards and investigate as appropriate.

Health: Care and Compassion?

Baroness Knight of Collingtree Excerpts

Thursday 3rd March 2011 Lords Chamber

[Earl Howe]

My Lords, I understand and applaud the noble Lord’s reason for making that suggestion. I will overlook the issue of cost, but I am not sure that his idea would necessarily have the desired impact. What is needed here is for local leaders to take charge. That is why the chief executive wrote to every chairman and chairwoman in the NHS asking them to share the report with every member of their board, so that they can examine the services in their particular organisation and assure themselves that these situations are not happening on their watch. Nevertheless, I am certain that boards around the country will wish to take heed of the noble Lord’s suggestion.

[Baroness Knight of Collingtree]

Does the Minister recall the number of legitimate complaints that were made during the period of office of the previous Government about bad treatment within the health service? Nothing was done with urgency. Will he recognise that when there are legitimate complaints, delay causes deaths and great suffering? When there are such complaints, they should be dealt with speedily and deeply.

[Earl Howe]

My Lords, I am sure the whole House will recognise the contribution that my noble friend has made to raising awareness of these very troubling issues, and I pay tribute to her. She is right, which is why our proposals for the NHS place a great deal of emphasis on strengthening accountability at every link in the chain, so that the complaints that she has referred to are dealt with speedily and someone is held accountable for what has happened.

Homelessness: Tuberculosis

Baroness Knight of Collingtree Excerpts

Tuesday 1st March 2011 Lords Chamber

[Earl Howe]

My Lords, I very much see the force of the noble Lord’s point. We are very much committed to preventing homelessness and to protecting the most vulnerable. We have maintained the funding for the homelessness grant at the levels of the current year— £400 million over the spending review period, which is £100 million over each of the next four years. We are specifically providing £18.5 million a year to support the voluntary sector. This is a priority, but I will take away the point that he has made about Westminster City Council.

[Baroness Knight of Collingtree]

My Lords, is it possible for a person who has no fixed address to have a doctor or to get immediate medical attention?

[Earl Howe]

My noble friend puts her finger on a key difficulty with this group of people, who are often very difficult to keep track of. I heard of one case where a patient required 800 interventions, sometimes with the police involved. Clearly a lot of effort has to go into this group. However, it is possible, if the patient is willing, to register that person with a GP. The challenge is whether they actually return to complete their treatment, which of course extends over many months.

NHS: Prebiotics

Baroness Knight of Collingtree Excerpts

Wednesday 17th November 2010 Lords Chamber

[Earl Howe]

My Lords, my advice is that best practice guidance on the diagnosis and treatment of Clostridium difficile infection is clear and is available. The management of the infection requires the isolation of cases, hand-washing with soap and water and the use of the antibiotics metronidazole or vancomycin.

[Baroness Knight of Collingtree]

My Lords, the Minister said that there was not enough evidence to be sure that prebiotics are effective. Can he say whether any active efforts will be made to get that evidence, or does he mean that people must wait until a request has been made before such efforts are embarked upon?

[Earl Howe]

My Lords, we regard the departmental budget as being there to enable those who have good-quality and well-designed research projects to bid for those funds. I will take on board my noble friend’s implicit suggestion that the department should pursue the issue but, in doing so, I bear in mind that these products are commercially produced and that it is really for the manufacturers to come up with robust clinical data.

Healthcare

Baroness Knight of Collingtree Excerpts

Thursday 28th October 2010 Lords Chamber

[Baroness Knight of Collingtree]

My Lords, we need to retrieve the excellent reputation which Britain once had in the healthcare stakes. Not long ago, we were the envy of the world in those stakes but we are not today. Recently, I read a list of figures which showed how far we had slipped back in survival rates, standards of care and so forth. We used to be top and we are now sixth, seventh or even lower. This Government are resolved to do better and, even in the truly desperate financial state in which the previous Government left us, they are safeguarding the NHS budget. I think the figures are a little better than stated earlier by the noble Baroness.

British people love the health service and gladly support it with their taxes, but they expect to get value for their money and a good standard of healthcare when they need it. In thousands of cases, the previous Government failed them. A system grew up in which the individual patient did not matter. The most significant and important of all the new aims is that every patient will matter. You can have brilliant accountants, business experts and superb organisers running the health service, but if the welfare of patients is not a top priority, you will not have a worthwhile service.

In recent years I have raised scores of cases where patients have been treated extremely badly in hospitals and most died. Not once did any of those patients receive an apology and many of the cases I put forward were not investigated at all. The only response I ever received from hospital trusts was outrage that I should have had the barefaced cheek to criticise them at all. What on earth did mere patients matter? I am mightily relieved that this is to change. If the noble Lord, Lord Winston, thinks that there has been just one tiny case of bad treatment of patients since this Government took over, I will gladly give him my files of the other cases I have mentioned.

I am very relieved that this is to change because it seems to me that doctors and surgeons still sometimes retain their status as being one step down from the Almighty. I absolve every Member of this House from behaving anything like that, but some still do. Of course they are wonderful people and they are true saviours in many cases, but they should not treat patients as inanimate, deaf and blind objects to be discussed as if they were not there. I hope that we shall reach a situation where patients are addressed correctly and not by their Christian names, unless they have asked to be so addressed and they should not be questioned about it. I hope that they will not be put in mixed wards, unless it is an intensive care ward. I also hope that cases such as my noble friend Lady Masham brought forward will mean that we shall have switches that cannot be switched off unless there is clearly someone to turn them on again or switches that will not go off. I ask my noble friend if these vital improvements might perhaps be achieved in less than three or four years, as the report indicates. We need them so much.

Mid Staffordshire NHS Foundation Trust

Baroness Knight of Collingtree Excerpts

Wednesday 9th June 2010 Lords Chamber

[Earl Howe]

My Lords, as ever, the House will listen to the noble Baroness with great attention and respect, knowing that she works in the midst of an important and active part of the NHS. I hope that she is wrong and that the seriousness of the malpractice at Mid Staffordshire is rare, but we have to be vigilant. There could be another instance of a failing trust out there. The House may want to know that the Care Quality Commission has announced the registration status of 378 NHS trusts to provide healthcare services from 1 April. Only 22 of those are registered with conditions, but the CQC has said that those trusts are safe to provide services to patients. No trusts were refused registration, which is an important point.

On the question of openness within trusts, the noble Baroness is right: a culture of openness and willingness to learn from mistakes is essential to a health service that wishes to improve. There is a requirement on hospitals to inform regulators about serious errors, but that requirement does not extend to informing patients, so we are looking at how that can be addressed.

[Baroness Knight of Collingtree]

My Lords—

[Lord Warner]

My Lords, I think that it is this side’s turn—

[Noble Lords]

Order.

[Baroness Knight of Collingtree]

My Lords, I believe that it is our side’s turn.

[Lord Astor of Hever]

My Lords, there is plenty of time for both sides. I think that it is this side’s turn.

[Baroness Knight of Collingtree]

My Lords, I shall be brief. I have never felt so much gratitude towards a Minister as I feel at this moment. He has created a first in my parliamentary life. Never before in 44 years have I had the requests placed so clearly in a speech met six days later: care for patients, an understanding that non-medical people are not always the people to make decisions, and safeguarding what whistleblowers have to say. In fact, there were other hospitals—Maidstone and several others come to mind—where serious problems had arisen. I have raised such cases many times with dates and all details and had no answers given as to why patients were treated so badly. In the case of Stafford, the chief executive of that hospital, who had been in command for the whole of the time during which that terrible record was amassed, was then given a very senior position with as much responsibility elsewhere. Will the Minister look at that, because we must safeguard patients, wherever they may be?

Queen's Speech

Baroness Knight of Collingtree Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Knight of Collingtree]

My Lords, it has been a delightful and somewhat unusual experience to sit here hour after hour today hearing a deluge of praise and kindness showered upon my noble friends on the Front Bench. Every word was said with such meaning. I appreciate it very much and would like to make it clear that we on this side of the House are just as delighted to see my noble friends on the Front Bench in government as members of the Opposition have kindly suggested.

The stated aims of the Government’s new health Bill are excellent. There has long been a crying need to improve basic healthcare for our citizens. I thoroughly approve of doctors and patients being given greater control. There should be devolution of power and responsibility in the NHS. We all understand that there must be management of the hotel side of our hospitals—the laundry, the cleaning and the cooking—but people who know nothing about medicine are not the ones who should be the captains of the hospital ship, as they often seem to be.

Administrators are not the best people to improve bad standards. They are far more likely to sack a whistleblower than to listen to the complaint and try to do better. Even when I have complained about the disgraceful treatment of patients, the reaction has invariably been outrage that I should dare to criticise and flat denials that anything at all is ever wrong with the treatment of patients rather than what I would have far preferred: an apology and a promise to investigate and do better. I have always been very careful to report only cases where I can give names, dates, witnesses, addresses, ages and the hospital where the incident occurred. Your Lordships will have often heard me speak in this House of such cases. Many have been of patients who have been given neither food nor water, or—and I find that this is extremely common—whose food has quite deliberately been placed too far away for them to reach and has then been whipped away untouched with not even the slightest offer to try to help them with feeding. Those who have no one to watch out or speak up for them are in terrible trouble. Some time ago, an elderly man in exactly that situation was actually filmed on TV as he starved and died.

There are many, many cases of patients being treated without care or compassion. Relations often fear to complain, in my experience. Sometimes they say, “Well, he’s dead anyway, we can’t bring him back, and if I complain I will really be in trouble because that complaint will go down against me and my care may suffer when I need it”. One instance has been cited a number of times by many different sources. A patient begs, even screams, for help to get to the lavatory, but is completely ignored and given no help at all. Eventually, helpless, they let loose in the bed, and what happens? They lie in the mess sometimes for hours before anyone comes to wash and change the sheets. Sometimes the excuse is that there is a wait until the next team comes on in the morning, but often no notice is taken at all of their predicament, which is appalling. I have absolutely no doubt that there are still angels among the nursing fraternity—we have some of them in this House—but I am afraid that they are a lot rarer than they used to be.

Only eight days ago, one major newspaper reported two quite separate examples on two quite separate pages of the lack of the most basic standard of care: one in a private home, and one in the NHS. The former was an 84 year-old man who was placed there because his wife could no longer care for him. He had Alzheimer’s and was both deaf and blind. After only one day, the first family visitor to see him found him on all fours, wearing only a nappy and covered with bruises and dried blood. When he was admitted, he had three bed sores. A few days later he had 18, all of which were covered with dirty dressings. He died six days later as a result of no proper treatment for the sores. The noble Baroness, Lady Masham, spoke of a similar case. Sadly, she knows as well as I do that there are many of them. One can only imagine what agony that poor old gentleman must have endured. As his inquest, the coroner ruled that he had,

“died for want of care by those charged with it”.

In the same newspaper on the same day, a journalist wrote of her treatment in an NHS hospital. She had had surgery on her back and had no complaint about that. The surgeon was excellent and the operation went well—that was all absolutely fine—but the standard of nursing care afterwards was abysmal. “On the ward”, she writes:

“I was treated like a malingering bed-blocker … When I asked for pain relief, it was refused. When I asked for help in moving, it was refused”.

One can imagine that after a back operation she had great trouble trying to move. She went on:

“When I asked for a second pillow so I could sit upright, it was refused”,

even though every other bed had two pillows. She asked for help with another extremely painful condition from which she suffered. That help, too, was refused, although by then she was hallucinating and crying from the extreme pain that she was in. I will draw a veil over the rest of her account, and report only the last words that she wrote. She said:

“what happened to me had nothing to do with money and everything to do with mindset”.

I always came to the conclusion that the previous Government believed that the excellence of care could easily be measured by the number of millions of pounds spent on the health service, a point which has been touched on in this debate. That is wrong—I repeat, wrong. It is not how much money is spent, but how that money is used which is so important. That yardstick took no cognisance of the standard of care a patient received.

Our new Health Minister promises that his Bill will focus on quality and the needs of patients, which we have wanted for years. It seems that new Ministers have watched and learnt. How pleased we were to see only yesterday that details would be made clear about how many patients have died from MRSA. I was staggered to see a report that the number was 8,000. Whether that is accurate or not, we shall soon know. Whatever is or is not done, and however many millions are spent on the health service, if the patient’s well-being is not the first priority, the service fails. That message should be framed and placed on the desk or a nearby wall of every Health Minister.