Health: HIV Strategy for England

Baroness Masham of Ilton Excerpts

Tuesday 15th January 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness raises an extremely important issue about violence against women. There is a great deal of activity in my department designed to bear down on that and I should be happy to write to her about it. On the issue that she specifically alluded to at the end of her question, we think that, as most HIV is transmissible sexually, it makes much more sense to build that dimension into a sexual health strategy which embraces not only HIV but all transmissible sexual conditions.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that there are many commissioning bodies for various aspects of HIV, such as CCGs, a commissioning board, local authorities, community nurses and voluntary organisations? Does he therefore agree that it is most important to have some strict guidelines and a strategy so that there is not a muddle?

[Earl Howe]

The noble Baroness makes a very good point. I can tell her that the sexual health policy document, which we will be publishing shortly, will set out our plans for improving sexual health generally, as well as our plans for offering support to women facing unwanted pregnancy. It is an important document. It is crucial that we take the time to get it right and make it clear that, as she points out, all the commissioners in the system need to work together with the benefit of advice not only from the commissioning board but from local health and well-being boards at a local level.

NHS: Research and Development

Baroness Masham of Ilton Excerpts

Monday 17th December 2012 Lords Chamber

[Earl Howe]

I share the concern of my noble friend, although he will be pleased, I am sure, to know that through its integrated academic training programme, the NIHR has taken a lead in reversing the decline that we have seen in recent years in clinical academic careers. Around 250 NIHR academic clinical fellowships and 100 NIHR clinical lectureships are now available annually for medics, which is good news. I also think that intercalated degrees play a very important part in developing the next generation of clinical academics, as does the INSPIRE programme from the Academy of Medical Sciences.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that some exciting research is being done, such as that which treated a paralysed dachshund with stem cells and enabled it to walk?

[Earl Howe]

The noble Baroness is absolutely correct. Some exciting research is going on in the field of regenerative medicine and the NIHR has a funding stream to support that.

NHS: Clinical Networks

Baroness Masham of Ilton Excerpts

Wednesday 12th December 2012 Lords Chamber

[Earl Howe]

My Lords, yes. National guidance is being produced by the NHS Commissioning Board, setting out the different areas of focus for academic health science networks, health and well-being boards, local education and training bodies and clinical senates. The defined geographies of the 12 network support teams have been developed precisely to gain close alignment and therefore promote close relationships and co-operation with the other structures in the new system—including academic health science networks.

[Baroness Masham of Ilton]

My Lords, how are clinical network members recruited? Are they advertised?

[Earl Howe]

My Lords, in some cases, yes, but we anticipate that many members of existing networks will be transferred across into the new ones.

Care Services: Winterbourne View

Baroness Masham of Ilton Excerpts

Monday 10th December 2012 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Baroness for what she has said. She is right to point out that the patient pathway is integral to any proper planning process for individuals, and that it should be built around the particular individual’s needs and preferences if possible. This brings us back to the role of an assessment and treatment centre: namely, as its name implies, to assess the needs of a person and to define what their care plan should be over a future period of time. As I mentioned, the care plan is best when it is drawn up with the benefit of advice from the individual, their family and their carers. Therefore, if we want more community care, we need to ensure that there is the capacity in the community to deliver good patient pathways to individuals. We are clear that some areas of the country are ill equipped to do that. Part of the task of the joint improvement programme will be to look at the facilities and resources that are required in local areas to enable commissioners to plan those patient pathways with confidence.

On the issue of the training of care assistants, I take the noble Baroness’s point. I think that it is common ground between us that those who lack a recognised qualification should nevertheless be enabled to upskill themselves and get themselves on a register to prove that they are familiar with and abiding by a code of conduct that has been recognised, with the register itself being duly accredited. Our position is that the system of voluntary registration, almost by definition, will result in an upskilling of the workforce, but it is not the whole story. There is a role for employers to ensure that there is proper supervision of care assistants, and that proper delegation takes place that does not require a person to do more than he or she is skilled to do. There is no single answer here, but I believe that voluntary registration is a good start.

[Baroness Masham of Ilton]

My Lords, following from the question about registration and regulation, is the Minister aware that people such as nurses and care assistants who have been sacked for dishonesty or undertaking dangerous procedures with patients can take a job anywhere as a care assistant? Without regulation, how will he control the matter? It is very dangerous for vulnerable patients because these establishments are so hard-pressed to get staff to work in their centres that they will take almost anyone, without even taking up references.

[Earl Howe]

My Lords, the noble Baroness raises another important point. In this country we have a list that acts as a check on those who have abused or otherwise maltreated adults or children and have been dismissed on that basis, to ensure that the scenario that she has painted in which someone who has committed such an offence is re-employed cannot occur in practice. I am not sure that I recognise the situation that she outlined because the POVA system is designed to ensure that dangerous people are not employed to look after the vulnerable. However, I will gladly drop her a line in writing to set out what we propose in this area.

Health: HIV

Baroness Masham of Ilton Excerpts

Thursday 29th November 2012 Lords Chamber

[Earl Howe]

My noble friend is quite right. As he will know, this is National HIV Testing Week. We support the Terrence Higgins Trust and its partners in this important new initiative. The NHS medical director has written to all medical directors about the week and the importance of healthcare professionals being alert to the need to offer HIV testing. As regards self-testing, we agree that the current regulations are not sustainable, which is why we are reviewing our policy on banning the sale of home HIV testing kits. We support repeal but we are required to do a short consultation setting out our reasons. We plan to do that early next year.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that we have some of the best services in the world for HIV/AIDS? Can he give an assurance that, with the changes in the National Health Service now, there will not be a dilution of these services?

[Earl Howe]

My Lords, yes. We believe that the complex needs of people with HIV will be best served by the work being done by the HIV national clinical reference group of the NHS Commissioning Board. The board will commission these services in the future, and that will drive greater consistency and quality throughout the system.

NHS: Diabetic Services

Baroness Masham of Ilton Excerpts

Thursday 29th November 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I thank the noble Lord, Lord Harrison, for raising the issue of the need for good managed services for people with diabetes today. I consider the noble Lord to be the expert patient for diabetes in your Lordships’ House.

The All-Party Parliamentary Group on Diabetes is very active and effective, keeping parliamentarians from both Houses up to date with the many needs of people of all ages living with diabetes. Diabetes spans several government departments—first, the NHS—but it is also a serious public health issue. With many aspects of diabetes going over to local authorities, I hope Public Health England will take diabetes as a priority. Unless primary and secondary care services work closely together, the treatment of diabetes will suffer.

I cannot stress enough the importance of the diabetic nurse and I am glad that that has already been stressed by the previous two speakers. Diabetic nurses can be the important link between primary and secondary care. They teach patients and their carers about diabetes and also community nurses. They are a vital resource for the management of diabetic services. When there are problems with insulin and patient stability, the diabetic nurse is often at the end of the telephone to give advice.

Diabetes often causes extra complications. Some years ago, a well known and well liked television presenter, Richard Whiteley, from Yorkshire, who hosted the programme “Countdown”, went into hospital for a heart operation, but sadly died due to complications because he was diabetic. More research needs to be undertaken into the causes of type 2 diabetes. I read in the press yesterday of a link between type 2 diabetes and food sweeteners:

“A sweetener used in food manufacture could be partly to blame for rising rates of type 2 diabetes … Countries that use large amounts of high fructose corn syrup (HFCS) have higher rates of the disease than those that consume little, says a new study”.

Professor Stanley Ulijaszek from Oxford University, who co-led the study, said:

“This research suggests that HFCS can increase the risk of type-2 diabetes, which is one of the most common causes of death in the world today”.

The syrup is widely used in drinks and processed foods because it acts as a sweetener, helps to keep food moist and is cheaper than regular cane sugar. Tim Lobstein, director of policy for the UK-based International Association for the Study of Obesity, has said that,

“if HFCS is a risk factor for diabetes—one of the world’s most serious chronic diseases—then we need to rewrite national dietary guidelines … and foods should carry warning labels”.

Diabetes can be a very complex condition. During this time of change in the NHS, many people are unsure of where their services will be coming from. There is dismay when people hear of the closure of A&E departments and walk-in clinics. Evenings, weekends and bank holidays mean that for long periods it is impossible to see a GP. There are real risks for people living with diabetes when things go wrong. They may have a hypo and need urgent help. Diabetes has become a ticking time bomb with increasing rates of the condition in many places around the world. When we were on holiday in Barbados some time ago, a taxi driver told us that he took the day off every Sunday in order to bicycle from one end of the island to the other. But he also said that the sugar workers used to slash the sugar cane manually, using much sweat and energy. Today they sit on tractors and everything is done mechanically. Diabetes has hugely increased in modern life.

Recently we saw an interesting presentation about the diabetic leg. We were told that the West Country is the worst region for amputations due to infections in the leg as a result of circulation problems caused by diabetes. Specialist centres in London ensure that people’s legs can be saved through expert vascular surgery. There seems to be a postcode lottery in different parts of the country.

This week, international attention is focused on HIV and AIDS. When someone has HIV/AIDS and diabetes, sometimes along with other co-infections, treatment can be very complicated, and some HIV drugs can encourage the development of diabetes. I have discussed this with Dr Jane Anderson, a marvellously dedicated HIV specialist who works at the Homerton University Hospital. She has seen co-infected patients with problems. These patients need the expertise of endocrinologists and HIV specialists to sort out their complications.

For good management, all those who are involved with those who have diabetes must be well educated about the condition. They may be teachers, medical personnel, or those involved in sports and leisure or food and drink, but it is diabetics themselves and the people closest to them who are the most important of all. The aim should be to keep fit within the community and to lead happy and healthy lives.

Care Quality Commission (Healthwatch England Committee) Regulations 2012

Baroness Masham of Ilton Excerpts

Wednesday 21st November 2012 Lords Chamber

We should remind ourselves that the aim of all this is to enhance the collective voice of patients in the NHS. You will succeed in doing that only if the public at large have confidence in the structures that you have created. If you build into them the appearance of subservience and potential conflicts of interest, you are weakening that voice. That cannot in any way be in line with what either your Lordships would expect to see from this, or indeed with what I believe Ministers’ intentions to be as far as Healthwatch England is concerned.

[Baroness Masham of Ilton]

My Lords, the Explanatory Memorandum to these regulations states:

“The instrument also places a requirement on the chair to ensure that arrangements for the selection and appointment of persons take into account the principles of openness and transparency”.

The votes this evening illustrate that people want openness and transparency, and I commend this. I would like an assurance from the noble Earl, Lord Howe, that the members of Healthwatch England and the local Healthwatches will be treated well. As volunteers, LINks members have not been given enough support. It is disappointing that Healthwatch England will not be independent. It must not become a puppet of the CQC, which has had problems, and the local authorities that host it.

There is an immense amount to do to keep patients safe in the health service—those in care homes and those with mental problems. One hopes that Healthwatch England will support local Healthwatches. When there is so much fragmentation and so much to do, will the CQC and Healthwatch manage to cope? I hope there will be spot checks, otherwise inspections do not mean very much, as has been shown in the awful problem of the care home near Bristol. I hope that the Minister, who I think believes in independence in his heart, can give us some assurances tonight.

[Lord Whitty]

My Lords, I do not want to repeat the arguments that have been made. I was going to repeat the arguments that I made about the history of consumer representation in other sectors, but time is against us. The conclusion from that would be that independence and the perception of independence are vital for all the reasons that my colleagues have spelt out today. The Act is there, and the regulations will be there after tonight, but the Minister at least ought to be prepared to say that he will review the situation after, say, two years. If he were prepared to say that tonight, I would give Anna Bradley, who I have great respect for, and the other members the chance to prove that this situation works, but it might also show up some strains in it. If the Minister could say that, I would walk away tonight a happier man.

NHS: Death at Home

Baroness Masham of Ilton Excerpts

Thursday 8th November 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I congratulate the noble Lord, Lord Warner, on instigating this most timely debate.

It is in memory of my late husband that I find it important to speak to your Lordships today. I know that he would have wished to have died at home, but it was not to be. My husband, in his last years, had several complicated conditions. He was diabetic; he had had strokes; he had Parkinson’s disease; and a wound that would not heal due to a tumour that was cancerous.

I live in a rural area, and I take this opportunity to say that rural healthcare is different from urban healthcare. I think that that should be recognised in the NHS Constitution. So many health problems seem to happen at weekends, and one is dependent on the out-of-hours service. I feel that there should be a register in each out-of hours-area of people with long-term complicated conditions, so that the out-of-hours doctors know which patients are at risk. There is no way to retrieve individual health records at weekends or at night.

As it was on a Friday evening when my husband had problems, I got the out-of-hours duty doctor to come out. She had to make the 24 mile journey from Harrogate and, because my husband had a swallowing problem, she prescribed a liquid antibiotic. We had great difficulty finding a supermarket which could provide that and, over the weekend, his swallowing became more difficult. On Saturday, I spoke to another out-of-hours doctor who did not come out and rather inferred over the telephone that all was all right. On Sunday, I had to represent my husband at his church lunch, which he would have gone to. On my return, things had got worse. After another agonising wait for another out-of-hours doctor to ring back, an ambulance was sent and my husband was taken to hospital with me and my helper following behind by car.

I have tried to get an antibiotic given to him by drip, but this was not to be and is still not available in the community in a rural area. I had carers for my husband who could have managed a drip.

He died in the A&E department with me with him. If only more help was available in the community, all the stress and trauma would be removed. As it was, two young and inexperienced police officers arrived at the hospital and nobody seemed to know what to do. My husband died of pneumonia, which can develop very quickly.

I tell this story as I hope that more people can die at home with the comfort of knowing that all that can be done to help is forthcoming. With the economic situation, this is very doubtful but I was pleased to read over the weekend that the Secretary of State for Health is doing something which I hope will give hope to people who have become very concerned at the treatment and care of the dying because of the Liverpool care pathway. I cannot think of a more cruel practice than being denied fluids or food if one wants them. I often wake in the early hours with a very dry mouth and I keep a bottle of water next to my bed. To keep the mouth moist and clean should be a basic care need. Many people now fear having to go to hospital and many doctors feel guilty at having used the Liverpool care pathway, which seems to have gone down the wrong road and, instead of care, it has become a way of speeding up death in an underhand way.

I hope that the Secretary of State for Health, Jeremy Hunt, will make it clear, with his colleagues, that not only should everyone concerned be involved in end-of-life care but that the patient should not be starved to death. They should be allowed to die in as much comfort as possible when their time comes. This should be made clear in the NHS Constitution and I agree that there should be no decision made about me without me, be it in the community or hospital.

Health: Cancer

Baroness Masham of Ilton Excerpts

Wednesday 7th November 2012 Lords Chamber

[Earl Howe]

We will certainly be monitoring the outcomes in the field of cancer, but I would just like to impress upon the noble Lord that the creation of the clinical support teams—the network support teams—will ensure that the whole service is more efficiently delivered. By having 12 support teams there to underpin all the networks, we will ensure that we have a more cost-effective system.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that our cancer outcomes are not as good as those in some other countries in Europe? What is the reason for that? Does he agree that it would be a very retrograde step if the cancer networks lost expertise which we badly need?

[Earl Howe]

I agree with the noble Baroness, and it is part of the reason why we felt that the recent health service reforms to align clinical decision-making with financial decision-making were so important. The reason why this country lags behind has been clearly set out in a number of documents and, broadly speaking, it is because patients do not present early enough with their symptoms and doctors do not refer early enough to specialist consultants for treatment. There is a lot of work to do there, and I am sure that the noble Baroness will be reassured to know that there will be no let-up in that area.

NHS: Accident and Emergency Services

Baroness Masham of Ilton Excerpts

Tuesday 23rd October 2012 Lords Chamber

[Earl Howe]

My Lords, I apologise. The Question on the Order Paper relates to north-west London, so I do not have pan-London figures in front of me. The answer to the question is as I gave it in my initial response: those decisions are subject to local determination. That is right, because it is only local commissioners and providers who can assess the situation on the ground properly. As the noble Baroness will be aware, there is a system for escalating decisions—ultimately to the Secretary of State, if necessary, who takes advice from the Independent Reconfiguration Panel in the most extreme cases—but normally, we hope and expect those decisions to be resolved on the ground in the local area.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that many patients have difficulties accessing their GPs and out-of-hours services? Does he realise that the only resource might be the A and E department? In a case of meningitis, that could be a death sentence if they cannot get that access.

[Earl Howe]

My Lords, I agree with the noble Baroness. That is exactly why the Government are planning to roll out the 111 service, which will run alongside the 999 service for emergency calls. But where the situation falls short of an emergency, the 111 service will instantly direct the patient to exactly the right service, without a call back being necessary. I am pleased to say that that programme is on track and should be rolled out next year.