Gender-based Violence: Screening

Debate between Baroness Knight of Collingtree and Earl Howe

Monday 9th March 2015 Lords Chamber

[Earl Howe]

I do agree. Sexual health and HIV services are already sensitive to the risk of domestic violence, including gender-based violence, in their routine consultations. One of the most important elements in that is to have an environment and atmosphere that is welcoming, comfortable and calm, so that it engenders a sense of trust. Most sexual health clinics have developed local templates to identify those at risk of domestic violence, with signposting and referral to police and other support services if needed.

[Baroness Knight of Collingtree (Con)]

My Lords, could there be a greater example of gender violence than the acceptance that it is perfectly legal to abort an unborn child who is a girl? There is so much disagreement about that—I know my noble friend agrees that it is a wrong policy and ought to be illegal—but the fact is that abortion nursing homes do it every day, and there is great uncertainty about whether this is illegal or not. Ought it not to be quite clear that it is an illegal practice?

[Earl Howe]

My noble friend has emphasised an issue which I am sure all noble Lords feel equally strongly about. The Department of Health has been quite clear that abortion on grounds of gender alone is illegal. We reissued that guidance last year in no uncertain terms. It is a pity if there is any misconception about that.

NHS: Accident and Emergency Services

Debate between Baroness Knight of Collingtree and Earl Howe

Wednesday 7th January 2015 Lords Chamber

[Earl Howe]

I recognise that issue. Having said that, we currently have a record number of A&E doctors in the NHS, which is good, and across the system we have 1,800 more doctors and 4,700 more hospital nurses than we had a year ago. However, being an A&E doctor is a stressful occupation, and doctors are sometimes tempted to go overseas. We are concerned about the loss of any A&E doctor, and that is being looked at in conjunction with the royal colleges and the BMA.

[Baroness Knight of Collingtree (Con)]

My Lords, there can be no doubt that the figures which we have been given by the Minister need to be looked at very carefully. It would be a miracle if this enormous demand could be faced with no financial troubles at all. However, does he recognise that there is quite a bone of contention, and that the argument is building up that those who bear the heat and the burden of the day working in A&E departments seem to get a fairly small salary compared to the enormous sums that are paid out to managers within the health service? I do not know whether it would be possible to rein that back a little, but if that is the case, it seems very unfair.

[Earl Howe]

I am grateful to my noble friend. Of course, rates of pay are a sensitive matter, and it is true that the constraints on pay rises over recent years have had an effect on the attractiveness of particular careers in the health service. We can do little about that in the short term, but there are ways and means of improving the work-life balance and working lives of those who work in the health service, even if we cannot increase their pay at the current time.

Abortion (Sex-Selection) Bill

Debate between Baroness Knight of Collingtree and Earl Howe

Tuesday 16th December 2014 Lords Chamber

[Baroness Knight of Collingtree]

To ask Her Majesty’s Government what action they intend to take following the First Reading of the Abortion (Sex-Selection) Bill in the House of Commons on 4 November.

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

My Lords, abortion is traditionally an area where there is a free vote on Private Members’ Bills. We have made it clear on numerous occasions that abortion on the grounds of gender alone is illegal. We take this issue very seriously and will continue to monitor birth ratios and consider any evidence that comes to light.

[Baroness Knight of Collingtree (Con)]

My Lords, did my noble friend note that at the end of the First Reading debate on the Bill 181 MPs voted for it and only one voted against it and the tellers counting the vote against insisted that their votes be counted in favour of the Bill? Does he consider that this indicates acceptance of the evidence that abortion for gender reasons is going on and is causing very grave concern? Even a Minister saying in this House that this is illegal does not make it so: only a parliamentary Bill can do that. If gender equality means anything at all, surely the protection of the lives of baby girls is a matter of urgency.

[Earl Howe]

My Lords, the legal position is not in doubt. It is illegal to abort a foetus based solely on its gender. The Abortion Act states that two practitioners have to be,

“of the opinion formed in good faith”,

that the woman had grounds for an abortion. It is for doctors, in line with any guidance from their professional bodies, to satisfy themselves that they are in a position to give the opinion and to defend it if challenged. We refreshed the guidance in May of this year to make the position crystal clear.

Health and Social Care Act 2012: Risk Register

Debate between Baroness Knight of Collingtree and Earl Howe

Wednesday 9th July 2014 Lords Chamber

[Earl Howe]

The Government of which the noble Lord was such a distinguished member took the same approach to risk registers. Of course, transparency is an important principle in health and care. It is important to drive up performance and expose institutional failure, and I believe there is a revolution taking place in the level of transparency and access to health and care information. I am sure we are agreed on that. The point that I sought to make earlier is that when it comes to policy-making within government, Ministers and civil servants are entitled to some safe space, so the principle of transparency has to be moderated to a certain extent. That is the balance that we have struck.

[Baroness Knight of Collingtree (Con)]

My Lords, is it not the case that a recent independent Commonwealth Fund report said that Britain had the best and safest healthcare system of all the 11 wealthiest nations? Since we know that the NHS is the biggest organisation and business of its kind in Europe, with all the opportunities for it to go wrong, is this not an extremely telling assessment of the real situation?

[Earl Howe]

I agree completely with my noble friend. The Commonwealth Fund report covers the period from 2011 to 2013—exactly when we were in the middle of reforming the NHS. The findings of the report were a credit to all those working on the front line of the healthcare system throughout that period of change.

Abortion

Debate between Baroness Knight of Collingtree and Earl Howe

Wednesday 12th February 2014 Lords Chamber

[Baroness Knight of Collingtree]

To ask Her Majesty’s Government what action they intend to take in the light of recent analysis of the ratio of boys and girls in United Kingdom families suggesting that sex-selective abortion is taking place.

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

My Lords, it cannot be concluded from the recent analysis in the Independent newspaper that sex-selective abortions are taking place. We are absolutely clear that abortion on the grounds of gender alone is against the law and completely unacceptable.

[Baroness Knight of Collingtree (Con)]

My Lords, does my noble friend recall that when I last asked a Question on this matter in October, the House was informed that it was impossible to prosecute doctors known to be aborting on gender grounds because the evidence was not strong enough? However, has the Minister noted the findings of the national census of 2011, which show that between 1,400 and 4,700 fewer girls have been born recently? This, it was said, can be explained only by the fact that termination of girl babies is going on, even though my noble friend has said this morning and NHS spokesmen have warned that such operations are,

“against the law and completely unacceptable”.

When are the Government going to stop this practice, and what are the implications if they do not do so?

[Earl Howe]

My Lords, the analysis recently reported in the Independent newspaper was based on census data, as my noble friend pointed out, for households with usually-resident dependent children. The gender balance of dependent children in these households is affected by a number of events that occur after birth, such as the age at which dependent children leave the parental home. As there are a number of alternative explanations for these observations, it cannot be concluded from the Independent’s analysis that sex-selective abortions are taking place. The best available data on which to base gender ratio analysis continue to be births data, which were the basis on which we did our analysis last year. I can tell my noble friend that that analysis will be updated on an annual basis when new data are available.

NHS: Mid Staffordshire NHS Foundation Trust

Debate between Baroness Knight of Collingtree and Earl Howe

Tuesday 19th November 2013 Lords Chamber

[Earl Howe]

My Lords, I completely agree with the noble Baroness that the voice of the patient is an essential part of maintaining a culture of safety in the NHS. Improving the way in which the NHS manages and responds to complaints will be critical in shaping a culture that listens to patients and learns from them and ending a culture of defensiveness or, at worst, a culture of denial about poor care. That is why we welcome and accept the spirit of the review of the NHS hospital complaints system by Ann Clwyd MP and Professor Tricia Hart and the principles behind their recommendations.

On whistleblowers, the amendments to the NHS constitution have enhanced the protection for whistleblowers, but we are not complacent and we are already considering whether there is a need for more developments both to protect whistleblowers and to ensure that action is taken, where necessary, in response to concerns. We are looking, with the national regulators, at how whistleblowing concerns are dealt with at the moment and, where appropriate, we will introduce improvements to systems in the future.

[Baroness Knight of Collingtree (Con)]

My Lords, much of what my noble friend has said has given us satisfaction, but it is perfectly true, as we have already been reminded, that troubles were going on not only in the Mid Staffordshire area but all over the place. It is also true that it is not just the whistleblowers who warned time and time again about what was going on and who should have been listened to. I spent four or five years raising cases of people who had written to me. On one occasion I presented the then Minister, the noble Lord, Lord Hunt of Kings Heath, with a dossier of some 25 cases, all of which had been checked very carefully. All the details were correct, all the patients, or their relatives, had given permission for these cases to be raised and they were raised in this House. I am not blaming the noble Lord for failing to take these cases forward, or failing to listen to the arguments put out clearly in this House, because I think that he passed them on, but they were never properly investigated.

It is upsetting that for such a long period warnings were being given and were allowed somehow to filter into the ground and away, or into the past. I particularly warned about the practice, which was fairly unknown at that time, of failing to feed patients because food was put too far away from them and other examples. I worry about the people who suffered for those long years when something could have been done if those responsible at the grass roots had taken care of what was being said in this House. I beg the Minister not to leave aside the really serious point that cases raised with great sincerity and truth in this House should be regarded and not just pushed aside in the future.

[Earl Howe]

My Lords, my noble friend should be listened to with great care. Of course, I remember those cases. I was not the Minister in charge at the time she submitted those cases to the Department of Health, but she shared them with me, and I share her concerns, which are, of course, directly relevant to the matters we are discussing today. We have the new duty of candour and in April the Enterprise and Regulatory Reform Act strengthened the main whistleblowing legislation introduced by the Public Interest Disclosure Act so that an individual who suffers harm from a co-worker as a result of blowing the whistle now has the right to expect their employer to take reasonable steps to stop this. The idea is to ensure that people do not feel intimidated from speaking up. The Care Quality Commission is using staff surveys and the whistleblowing concerns it receives as part of the data in its new intelligent monitoring system. That data will guide the CQC about which hospitals to inspect. Since September, the commission’s new inspection system includes discussions with hospitals about how they deal with whistleblowers and handle them.

Care Bill [HL]

Debate between Baroness Knight of Collingtree and Earl Howe

Tuesday 29th October 2013 Lords Chamber

[Earl Howe]

I tried to explain that there is none. There is no primary duty in statute on the National Health Service to promote spiritual well-being, which is why we are trying to make the Bill entirely consistent with that position. We have aimed for a system built around individuals and I have tabled my amendment to make absolutely clear that a person’s beliefs, spiritual or otherwise, should be taken into account in this personalised approach to care.

As noble Lords may expect, I asked my officials to consider my noble friend’s proposal and whether anyone could benefit under his amendment who would not do so under the Government’s amendment. The advice that I received is clear that no such example can be found. I struggle to understand why my noble friend might feel it necessary to divide the House on this matter if he is minded to do so.

[Baroness Knight of Collingtree (Con)]

Does my noble friend appreciate that only very recently we were given a sharp lesson? Unless a law is clear in its wording for those who have to live by it, any interpretation can be put on it. He will well remember what has happened regarding the Abortion Act. Because it was not thought necessary at the time to put certain wording in, it is assumed that it is legal to ignore it.

[Earl Howe]

I agree with my noble friend, which is precisely why I am resisting the word “spiritual”. I do not think that that is a concept that is well defined in law and I think that it could give rise to enormous confusion. It is for that very reason that I am resisting the suggestion of my noble friend.

I hope that noble Lords will agree that my amendment achieves the aim of ensuring that a person’s beliefs, including those of a spiritual nature, are taken into account where that is important to the individual concerned. I propose that local authorities may promote an individual’s spiritual well-being by taking their beliefs into account, while avoiding any negative consequences. I hope that the House will agree not to follow my noble friend in this instance.

NHS: Foundation Trusts

Debate between Baroness Knight of Collingtree and Earl Howe

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

My Lords, there is no doubt—and we have never denied this—that there will be a hard core of organisations which will be very difficult, if not impossible, to bring to foundation trust status. For those trusts, it is necessary to look at other options, including, for example, mergers. That work is being taken forward. Although some trusts are in deficit, the NHS TDA is working very hard to mitigate those deficits in-year and when the first quarter board papers are published in September we will know what its predictions are for all trusts for the current year. I will come back to the noble Lord on the report of Sir Ian Carruthers because all FOI decisions are reviewed at regular intervals to make sure they are current. I want to make sure that there is a plan to release that information in due course. I am sure that there is.

[Baroness Knight of Collingtree]

My Lords, following yesterday’s Written Statement, in which the Government indicated total support for the review carried out so expertly by the noble Baroness, Lady Neuberger, on the Liverpool Care Pathway, can my noble friend the Minister confirm that the trusts will take immediate action to implement its recommendations?

[Earl Howe]

My Lords, I hope my noble friend will allow that that is a little wide of the Question on the Order Paper, which is about bringing trusts to foundation trust status. Nevertheless, I refer my noble friend to the Written Answer which was published in Hansard yesterday and which sets out the immediate steps we have taken to instruct all hospitals to review all patients currently on the Liverpool Care Pathway and to make sure that there is a named, responsible clinician for every patient at the end of life.

Abortion

Debate between Baroness Knight of Collingtree and Earl Howe

Thursday 6th June 2013 Lords Chamber

[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

Debate between Baroness Knight of Collingtree and Earl Howe

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

Debate between Baroness Knight of Collingtree and Earl Howe

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

Debate between Baroness Knight of Collingtree and Earl Howe

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

Debate between Baroness Knight of Collingtree and Earl Howe

Tuesday 15th January 2013 Lords Chamber

[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

Debate between Baroness Knight of Collingtree and Earl Howe

Tuesday 4th December 2012 Lords Chamber

[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

Debate between Baroness Knight of Collingtree and Earl Howe

Monday 5th November 2012 Lords Chamber

[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

Debate between Baroness Knight of Collingtree and Earl Howe

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

Debate between Baroness Knight of Collingtree and Earl Howe

Wednesday 20th June 2012 Lords Chamber

[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

Debate between Baroness Knight of Collingtree and Earl Howe

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.

Health: Flu Vaccine Research

Debate between Baroness Knight of Collingtree and Earl Howe

Wednesday 23rd November 2011 Lords Chamber

[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

Debate between Baroness Knight of Collingtree and Earl Howe

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

Debate between Baroness Knight of Collingtree and Earl Howe

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

Debate between Baroness Knight of Collingtree and Earl Howe

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?

Debate between Baroness Knight of Collingtree and Earl Howe

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

Debate between Baroness Knight of Collingtree and Earl Howe

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

Debate between Baroness Knight of Collingtree and Earl Howe

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.

Mid Staffordshire NHS Foundation Trust

Debate between Baroness Knight of Collingtree and Earl Howe

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—