Health: Mental Health

Baroness Pitkeathley Excerpts

Tuesday 28th October 2014 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, following on from the noble Earl’s question, does the Minister agree that in the context of child mental health—and many of us are increasingly concerned about the younger and younger age at which people are being diagnosed with mental illness—prevention is as important as treatment, particularly in view of today’s news that less is being spent on prevention?

[Earl Howe]

I agree with the noble Baroness. This is a crucially important area. She may like to note that in the current year we are investing an additional £7 million to end the practice of young people being admitted to mental health beds far away from where they live, or being inappropriately admitted to adult wards.

NHS: Cancer Diagnosis and Treatment

Baroness Pitkeathley Excerpts

Monday 13th October 2014 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness makes a number of important points. In August, my right honourable friend the Secretary of State announced a joint piece of work with Cancer Research UK and Macmillan, which will see GPs offered more support to ensure that cancers are diagnosed as quickly as possible. More generally, NICE is updating its referral guidelines for suspected cancer to ensure that they reflect the latest evidence. GPs already have a guide related specifically to direct referral for diagnostic tests, for which we have provided extra money, and early last year the department part-funded a six-month pilot run by Macmillan of an electronic cancer decision support tool for GPs. That pilot is being evaluated, but Macmillan is working with IT software companies to disseminate an updated version of that tool.

[Baroness Pitkeathley (Lab)]

My Lords, given the importance of early diagnosis and of the significant role that GPs play in that, is the Minister concerned that some patients facing the problems that many now have of finding a GP quickly will be put off presenting with those early symptoms? That will thus get in the way of the early diagnosis that is so important.

[Earl Howe]

My Lords, I am aware that in some areas of the country access to GPs is proving problematic and a number of work streams are under way to address that. But we are confident in the light of the statistics that patients are not holding back in presenting to their GPs. As I said, referrals have gone up dramatically over the last few years and the NHS is treating a record number of patients.

Health: Midwives

Baroness Pitkeathley Excerpts

Tuesday 22nd July 2014 Lords Chamber

[Earl Howe]

My noble friend makes two important points. As I said, we attach great importance to each mother being able to have throughout the care pathway a named midwife. Improving diagnosis and services for women with pregnancy-related mental health problems is one of our objectives for maternity care. The mandate from the Government to NHS England includes an objective for NHS England to work with partner organisations to reduce the incidence and impact of postnatal depression through earlier diagnosis and better intervention and support. We are clear that midwives have a key role to play in that.

[Baroness Pitkeathley (Lab)]

My Lords, what have we done to address demographic inequalities in the experience of childbirth, particularly for black and minority ethnic women, who often express a great lack of satisfaction with the treatment they receive during labour?

[Earl Howe]

My Lords, helping commissioners to reduce unwarranted variation in service delivery is one of the key roles of maternity and children strategic clinical networks, which are being established and supported by NHS England. We know from experience that these networks have a tremendously beneficial effect in ironing out inequalities in access.

NHS: District Nurses

Baroness Pitkeathley Excerpts

Thursday 10th July 2014 Lords Chamber

[Earl Howe]

These matters are locally determined by commissioners, but my noble friend makes a valid point. It is important to understand that district nursing services involve qualified district nurses leading and supporting multidisciplinary teams which often include staff nurses, community nurses and healthcare assistants, working with allied health professionals. We also need to recognise that social care relies on the same pool of registered nurses for local authority-funded care, and in fact nurses employed by local authorities are not counted in the statistics.

[Baroness Pitkeathley (Lab)]

My Lords, I recently came across a district nursing service which had been contracted out to the private sector, to the considerable confusion of some of the patients using it. Does the Minister have the figures for how many district nursing services have been contracted out in this way?

[Earl Howe]

I do not have the figures, but of course this process started under the previous Government with the “Transforming Community Services” programme, which very often hived off the community provision into social enterprises. If I have statistics on this I will gladly send them to the noble Baroness.

Health: Secondary Care

Baroness Pitkeathley Excerpts

Thursday 26th June 2014 Lords Chamber

[Earl Howe]

My Lords, I agree with the noble Baroness that early diagnosis is vital for just about every condition one can think of, particularly cancer. I am not aware that GPs are being penalised. I am very concerned to hear that, and if I may I will take the point she has made back with me and write to her about it. I would be very concerned if that practice was taking place. Particularly on cancer, we are keen to see GPs referring more. Indeed, that is what they have been doing, quite markedly, over the past four years: there was a 51% increase in cancer referrals over that period.

[Baroness Pitkeathley (Lab)]

My Lords, would the Minister agree that one of the essential elements for early diagnosis was time—time to spend with the patient and hear exactly what their symptoms are? How does that tie in with the current reports about pressure on GP surgeries and time?

[Earl Howe]

The noble Baroness makes a very good point. We know that GPs in many areas of the country are under pressure and we know how hard they are working. It was with that knowledge that we agreed with the profession that we would remove from the GP contract for 2014-15 more than a third of the quality and outcomes framework’s indicators, which GPs told us were taking up too much time and resulting in a bureaucratic burden. The aim of that was to free up more time for GPs. On top of that we have the Prime Minister’s challenge fund of £50 million, which will test out new ways for GPs to give access to patients—for example, through innovative means such as Skype and e-mail.

National Health Service

Baroness Pitkeathley Excerpts

Tuesday 17th June 2014 Grand Committee

[Baroness Pitkeathley (Lab)]

My Lords, there are few Members of your Lordships’ House who know as much as the noble Lord, Lord Crisp, about the NHS, so I am grateful to him for his focus on citizen and patient power—and indeed, carer power, which he mentioned, something with which I have been concerned for much of my working life. I declare an interest as the current chair of the professional standards authority, which prides itself on being patient-centred and public-centred and being a strong, independent voice for patients in the regulation of healthcare professionals throughout the United Kingdom.

However, I want to start with a personal experience about changes in attitudes to patient involvement. I started in the mid-1980s, when I was first diagnosed with cancer. A young registrar came to my bedside and, with no preparation whatever, told me that the tumour they had removed was cancerous but that I was absolutely not to worry because almost 40% of his patients made a full recovery. I gathered my wits and asked him what I could do to ensure I was in this 40% and he leaned across, patted my arm and said, “There is nothing you can do, my dear, just leave it all to us”. I think I got better to spite him.

Contrast that with my next experience in the early 2000s when, during a prolonged stay in hospital of over six months, nothing was ever done to me by doctors, nurses or therapists without seeking permission, asking if it was okay and what my view of it was. All right, you could say that that was about me being an assertive patient, which I am, and there not being many Baronesses on NHS wards. But, as far as I could see, the same respect and attempts to involve the patient were offered to every patient, regardless of their age, background or ability to communicate. Of course, the odd consultant swept in with an entourage and attempted to talk about me as though I was not there, but that was far from general. Therefore, my personal, as well as my professional and parliamentary experience, tells me that much progress has been made. I was very glad to hear the noble Lord, Lord Crisp, confirm that.

We all know about the reports that put patients first. We know their names and could write them in our sleep. We are all familiar with the phrases—patients first, patient at the centre, listen to patients and more patients. Yet patient involvement is not the same as patient power. “How far have we have really come?” is the question that we must ask ourselves, especially in the wake of the Francis report; patients manifestly had no power at all and those who blew the whistle on behalf of the patient—their carers and their families but not the professionals who should have been concerned—were not only not believed but ignored and vilified.

It is striking that, even with the emphasis we all embrace on patient-centred care, it is still on the whole the health professionals who lead and the patients who follow. That is in spite of the welcome growth in patients’ organisations in the voluntary sector, of which there are many, as your Lordships will know. I speak as a founder member of National Voices, which has made an important contribution in that regard.

The ideas as regards patient leaders were developed by two long-term service users, David Gilbert and Mark Doughty. They asked why patients cannot lead rather than always follow the professionals when it comes to power. With that in mind, they set up the Centre for Patient Leadership to give service users the skills and confidence to lead change and not just be the beneficiaries of it. We all know how disempowering it can be to be the only patient representative on a committee—we might say the token representative. Not only is there no one to support that representative, but they do not know how the committee will work. They would not have had any input to the agenda or any idea of what is expected of them, and so on. They would know that they are there to represent the patients’ interests but would not be sure whether to represent their own interests, those of groups of patients or those of patients with particular disabilities and so on. That is a very disempowering role in which we frequently put patients and their representatives.

However, patient leaders have developed the skills and confidence to lead change. They take control of changes and improvements in healthcare, and shape and help drive that change. They become real partners in care because they share power with professionals. I commend that approach because it helps both patients and professionals to see the benefits that can be gained in terms of patient care.

Power must go with responsibility. Patients must understand that they must keep their appointment times, must let someone know if they cannot attend and must take medication in the prescribed and agreed way. Giving patients power means professionals have to give some away. That is how the power balance works. We know that many are still reluctant to do that but there can be no let-up in our efforts to make progress in this area because of the benefits which can be gained, as the noble Lord, Lord Crisp, reminded us.

Finally, the noble Lord, Lord Crisp, tempted me to talk about carers. If you engage with carers and empower them, unbelievably, you get cost savings. All the research shows that they habitually ask for less support than the professional thinks is necessary. Progress towards that kind of empowerment makes very sound economic, as well as moral, good judgment.

Health: Transition to Adult Health Services

Baroness Pitkeathley Excerpts

Wednesday 11th June 2014 Lords Chamber

[Earl Howe]

The noble and learned Baroness is quite right, and as she well knows, this has been a long-standing issue. Our document, Closing the Gap: Priorities for Essential Change in Mental Health, which we published recently, identifies the transition from child and adolescent mental health services into adult services as a priority for action. We are supporting the work of NHS England to develop the service specification which I have just referred to. CCGs and local authorities will be able to use that specification to build excellent person-centred services that take into account the developmental needs of the young person, as well as the need for age-appropriate services.

[Baroness Pitkeathley (Lab)]

My Lords, problems arising at the transition stage are often reported by the parents of these young people because they are their carers. Does the Minister agree that standards of care must include support for those much-needed parent carers?

[Earl Howe]

I fully agree. I think that much of this will succeed only if services work together around the needs of young people as well as their families and carers, and if the families and the young people themselves feel involved in the way in which their care is being organised and planned.

Healthcare Professions: Regulation

Baroness Pitkeathley Excerpts

Tuesday 10th June 2014 Lords Chamber

[Earl Howe]

Yes, my Lords, we are working with the GMC to develop secondary legislation that will strengthen and protect the separation of the GMC’s investigation and adjudication functions by establishing the Medical Practitioners Tribunal Service in statute, as well as modernising the adjudication procedures, and to address a number of lacunas in the legislative framework. We are seeking to have the Section 60 order on the GMC’s fitness-to-practise processes in place before the general election.

[Baroness Pitkeathley (Lab)]

My Lords, I declare an interest—

[Lord Walton of Detchant (CB)]

My Lords, I declare an interest—

[Baroness Anelay of St Johns (Con)]

My Lords, there are many with an interest but it is the turn of the Opposition.

[Baroness Pitkeathley]

I declare an interest as chair of the Professional Standards Authority. The authority has already done preparatory work for the Department of Health on which changes to Section 60 orders would be in the interests of public protection and cost-effectiveness. Can the Minister say that the Government will take account of this work and the views of the regulators as they consider their next steps?

[Earl Howe]

My Lords, yes, I can give that assurance. In fact, there is a range of Section 60 orders that are at various stages of development, which we hope to introduce over the coming months.

NHS: Clinical Commissioning Groups

Baroness Pitkeathley Excerpts

Monday 9th June 2014 Lords Chamber

[Earl Howe]

I do agree with my noble friend, but I would point out to her that the thrust of the noble Baroness’s Question is about unpaid carers, of whom there are 5.4 million in this country, 1.4 million of whom work more than 50 hours a week as unpaid carers. It is to support those people that the attention of NHS England is being rightly directed.

[Baroness Pitkeathley (Lab)]

I thank the Minister for pointing that out and saving me having to do so. We are talking about so-called informal, unpaid carers in this Question. My noble friend’s Question has underlined how much progress is still to be made in bringing the needs of carers to the attention of local CCGs and health professionals. Will future versions of the carers strategy action plan address that issue?

[Earl Howe]

My Lords, yes. The action plan will of course be reviewed, as it needs to be, at regular intervals. I am sure that the noble Baroness will know that the action plan needs to be informed by the various legislative changes that we have recently made through both the Care Act and the Children and Families Act, both of which immeasurably strengthen the rights of carers and what they can expect from the system.

NHS: Mental Health Funding

Baroness Pitkeathley Excerpts

Wednesday 2nd April 2014 Lords Chamber

[Earl Howe]

I can only repeat what I already said to the noble Lord, Lord Hunt. We have expressed our dismay at ministerial level about that decision and will therefore scrutinise local commissioning plans to ensure that, if cuts are implemented and there is freedom not to do so, outcomes and access to services are not damaged.

[Baroness Pitkeathley (Lab)]

My Lords, there are three times as many deaths from suicide as from road accidents. The prescription of antidepressants went up by 10% last year and still only one-quarter of people with a mental illness are in treatment. Are the Government satisfied with the level of funding for preventive and psychological support services?

[Earl Howe]

This is the very reason that we have placed such emphasis on the IAPT programme, into which £400 million is going over the course of this Parliament. I am pleased to say that we are broadly on track to deliver a step change in access to those services.