Disabled People: Dementia

Baroness Pitkeathley Excerpts

Monday 11th October 2010 Lords Chamber

[Earl Howe]

My Lords, an informed and effective workforce is clearly central to the delivery of the dementia strategy. The Department of Health has recently published reports which map the current level of training, and these have been widely disseminated to key bodies involved in providing education and training. Professor Alistair Burns, who is the National Clinical Director for Dementia, is chairing an advisory group that will aim to ensure the development of proper education and training for all staff involved, and he will be engaging with all the key organisations in doing so.

[Baroness Pitkeathley]

My Lords, the Minister will be aware that family carers have two main concerns about dementia services. The first is that they are patchy and are not uniform across the country and the second is that they are not co-ordinated across acute voluntary, independent and family care. How will the Minister ensure that those two issues are better addressed under the proposals in the White Paper?

[Earl Howe]

My Lords, there are several prongs to the strategy which will be needed to meet the concern of the noble Baroness. One is to drive up quality standards through a proper tariff for these services and another is better regulation of providers. As the House will know, the NICE quality standard was published in the summer, which will improve commissioning to deliver greater efficiencies, not simply in a financial sense but also to deliver a better pathway of care for patients, with a focus on outcomes.

Health Protection Agency

Baroness Pitkeathley Excerpts

Thursday 7th October 2010 Lords Chamber

[Baroness Pitkeathley]

My Lords, I know that the Minister is always very concerned about the needs of patients. Will he assure the House how two things will be addressed: first, how the patients themselves will be protected during the inevitable turbulence of a period of transition; and, secondly, how the Government intend to deal with the possibility of the leaching away of scientific expertise during such a period of turbulence?

[Earl Howe]

My Lords, I should emphasise that the functions of the Health Protection Agency will be transferred into the department. In the mean time, we intend to make it business as usual throughout the transition process, with an emphasis on the smooth transition both of functions and of individuals on whom we rely to give advice. The functions of the HPA will not be lost in the wake of its abolition. It will continue to contribute to the Government’s response to emergencies and other areas of responsibility. I assure the noble Baroness that we have her concerns very much in mind.

NHS: Pain Management Services

Baroness Pitkeathley Excerpts

Wednesday 7th July 2010 Lords Chamber

[Baroness Pitkeathley]

My Lords, like other noble Lords, I want to confine my remarks to my own experience of pain and pain relief and to speak solely as a patient. Unlike the noble Lord, Lord Luce—I thank him for securing this debate—my experience is more of acute rather than chronic pain, and I am happy to say that I am now pain free. However, the principles I want to set out apply equally to both. While I endorse absolutely the view that co-ordination is all-important and a multi-disciplinary approach entirely the right one, when it comes to pain relief, I believe that these must be supplemented by the very best of communication.

This communication must have two aspects, the first of which is communication between professionals—the doctors and nurses, of course, but also the professionals ancillary to medicine such as the physiotherapists, radiographers and dieticians. If the medication for pain relief means that my feet are too numb to enable me to do the walking practice that the physiotherapist has recommended, what help is that to my recovery? If I can take absolutely nothing by mouth, and everything has to go by a Hickman line, the staff administering pain relief have to be very aware of it. I must put in a plea here for the extra services so often provided by volunteers in hospitals which all contribute to patient recovery but are not necessarily prescribed. I remember how, at a time of the most awful physical pain, the most relief I experienced did not come from drugs but from a nice young man who gave me a foot massage with scented oils.

Communication between departments is also vital. When you come out of intensive care, especially when coming back on to a ward, as I did four times in one hospital, there is nothing more frustrating than to lie there in pain with no one able to give you relief because your notes are caught up somewhere in the system. This applies particularly at night. Many patients still experience being in severe distress, but because far fewer doctors are available during those hours, they have to wait for someone—and at that point you feel that anyone would do—to administer some pain relief. So communication between professionals and between departments is vital, but in my view, no communication is more vital than that between the person administering the pain relief and the patient.

It is fine for an anaesthetist to say that an epidural is best for severe abdominal surgery, but if the epidural means that incontinence is a result, many a patient would prefer to endure the pain. Similarly, if the result of self-administered measured doses of morphine—in theory an excellent idea—is severe nausea to the point of exhaustion, surely the patient should be allowed to decide on other forms of relief. In one stay in hospital that lasted for about seven months, my worst memories are not about the pain, awful though it often was, but about the times when my wishes regarding pain control were ignored. However, I am happy to record that it is to the great credit of the NHS that those occasions were mercifully few. The best memories always centre around the way that caring people were prepared to consider me as an individual, and even to depart slightly from the rules; to discuss with me how drugs could be administered when I was unable to swallow anything for five months; and to maintain my dignity when those drugs had to be administered in most undignified ways. I recall also people like the young Nigerian charge nurse who would himself shed tears of sympathy when trying to find somewhere to inject me that did not cause excruciating pain to a body already like a pin cushion from repeated injections. As in many things, nothing can substitute for good communication when it comes to pain relief, either for chronic or acute pain.

I hope that the Minister will be able to endorse the importance of communication when any new policies are being developed.

Health: Stroke Treatment

Baroness Pitkeathley Excerpts

Wednesday 30th June 2010 Lords Chamber

[Baroness Pitkeathley]

My Lords, I thank the noble Lord, Lord Rodgers, for securing the debate and I heartily endorse what he said about its importance vis-à-vis yesterday’s debate, notwithstanding the difference in attendance. I thank him, too, for his excellent exposition about the support services available to stroke sufferers and his concern about the services available to support them and their families, and especially the sustainability of such services.

I am as concerned as he is about these issues, and especially about the negative effects that some of these developments may have on families and carers. I have spoken many times in this House about carer issues and the House—and, indeed, the Minister—will be familiar with most of them. So far as stroke is concerned, carers have two difficulties which make their plight extremely serious. The first is the sudden onset of most strokes, with very little warning or time to prepare. This means that carers are even worse off than many others because they are trying to get information about help and support at a time when they and the sufferer are in most distress and most worried and are therefore less able to find the time or the attention to get in touch with helping agencies. Carers always find a difficulty with accessing information and in these circumstances it is even more of a problem.

The second major problem for carers is the length of time the caring process goes on. Unless you die during the stroke itself you are probably going to live quite a long time, sometimes with a great degree of disability and sometimes with your ability to communicate severely impaired. This means that all the problems of shortage of finance, the threat to their own health, both physical and mental, and the sheer emotional stress of caring for someone who is disabled, and sometimes suffering a change of personality into the bargain, are not only acute but chronic.

As the Public Accounts Committee report reminds us,

“it is in the months and years after discharge that … their families and carers will experience the full impact of the stroke”.

Add to that the fact that if the carer is a spouse, it is likely that they themselves are rather elderly and frail. We have to remember that as well. So support services are vital and frequently make the difference between the carer being able to continue and being unable to, however great their desire to do so.

I am the first to acknowledge that much progress has been made not only with the treatment of strokes, as the noble Lord has reminded us, but also with the support of the carers and families. The fact that there is a national strategy in position for carers as well as stroke sufferers and their families is only one aspect of the progress made. These are cross-party issues that are of concern to the whole of society. While I pay tribute to the previous Administration for the fact that carers can never any longer be ignored, as was once the case, I acknowledge too the commitment of other political parties and of individuals such as the Minister himself.

I want my intervention today to focus on two particular issues because of my experience with carers when funding was not ring-fenced and my experience of the community, charitable and voluntary sector in the provision of services. I remind your Lordships that as part of the national carers strategy £150 million was allocated to primary care trusts to provide respite care for carers. Everyone rejoiced; this was a way of getting health professionals—especially GPs, who are so important to carers—to take their responsibilities seriously and to have money specifically allocated to them to help carers. However, the money was not ring-fenced. As a consequence, only 10 per cent of that money was ever spent on respite for carers. The rest disappeared into the black holes of PCT deficits and budget problems. This is what happens if you do not ring-fence money, and it will happen to the money for stroke as well—of that there is no doubt.

In the light of that, I wonder what assurances the Minister can give that stroke support services developed by local authorities in response to the national stroke strategy will be sustained this year and in the future, now that that ring-fencing has been removed. Does he feel that the ending of ring-fencing for stroke grants sends a rather unfortunate message to local authorities—that this kind of support is no longer a top priority?

In view of that, do we need to worry about other forms of support that are made available to those in need? For example, is the £200 million given to local authorities under the local authority settlement to support carers also under threat? I would be pleased to hear the Minister’s reaction to that.

As with carers, much progress has been made with support services for stroke sufferers. Much of the improvement and innovation in these services has been spearheaded by the voluntary and community sector, such as the Stroke Association, at both local and national level. Many of these services have been funded under contract from local authorities with the ring-fenced allocation. Noble Lords will know that local authorities are under considerable pressure at present, and this is likely to get worse in the next year. If the money is not ring-fenced, the likely outcome is that services will wither on the vine. The services that you get from the voluntary and community sector are extremely good value but they are not cost-free, and unless they have that kind of support they will not go on being provided.

Let us not forget that carers often require only a very small amount of support, provided that it is given at the right time. Two hours’ respite given to a carer in a week—that is often all that they ask for, in spite of what people fear they are going to demand—will often result in the carer giving not an extra week or month but extra years of support in return. The return on a comparatively small investment is very great indeed. I have often reminded the House that it makes good economic as well as moral sense to support the families who provide the majority of our health and social care willingly and over long periods. At a time of economic stringency it is even more important to remember that, and I hope that the coalition Government will do so.

NHS: Patient Targets

Baroness Pitkeathley Excerpts

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

My Lords, it is right for me to make clear that the previous Government achieved a great deal in bringing down waiting times—there is no doubt that that was a major worry for patients—and they are to be commended for that. The noble Baroness is concerned that we do not let the situation slip, and I fully share that concern. As I have indicated in brief terms, two main issues will prevent it happening. The first is that the legal duty on commissioners to commission services that comply with operational standards around the 18-week referral time still applies. The second is the NHS constitution, which contains the right to access services within minimum waiting times, as she knows. Those patient rights within the constitution have not been diluted.

[Baroness Pitkeathley]

My Lords, the noble Earl emphasises localism in the NHS, and that is very welcome, but is he aware that patients and their organisations have expressed great anxiety about not having enough people and structures to check how their local services are doing, especially—as patients and their organisations know very well—because there are some conditions for which early diagnosis is essential if cure is to be achieved?

[Earl Howe]

My Lords, the noble Baroness is quite right. For example, on the waiting time targets for cancer referrals, we have made no changes because there is a clinical underpinning to those targets. She is also right to say that there is often insufficient information for patients on which to base decisions. We are very keen to build and develop information channels so that patients can be better informed and are able to make better choices about their care.

Carers

Baroness Pitkeathley Excerpts

Wednesday 16th June 2010 Lords Chamber

Asked By

[Baroness Pitkeathley]

To ask Her Majesty’s Government what plans they have for improving the lives of carers.

[Baroness Pitkeathley]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as vice-president of Carers UK.

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

My Lords, we understand the urgency of reforming both the NHS and the social care system to provide more control to individuals and their carers. The coalition agreement makes it clear that we will,

“extend … personal budgets to give people and their carers more control … We will use direct payments to carers and better community-based provision to improve access to respite care”,

and we will,

“extend the right to request flexible working to all employees”,

including carers.

[Baroness Pitkeathley]

My Lords, I thank the Minister for that helpful reply. In national Carers Week, I am sure that millions of carers will be glad to hear of the Government’s commitment to support all that carers do. In their national carers strategy published in 2007, the previous Government pledged that no carer would be in financial hardship by 2018. Are the coalition Government planning to honour that pledge?

[Earl Howe]

My Lords, I pay tribute to the noble Baroness for all that she has done over the years to highlight the work of carers and their needs—indeed, the Government are very pleased to support Carers Week. We are entirely supportive of the ambitions set out in the previous Government’s strategy. We naturally need to focus on delivering the things that will have the greatest impact on improving carers’ lives. I think that there will be three strands to that. The first is to make sure that carers are able to stay in work if they wish to. The second is to help carers who wish to get back into work to return to employment—Jobcentre Plus has in train a number of initiatives in that regard. The third is the safety net of benefits and we will review the benefits system in a way that encourages, among other things, fairness.

Mid Staffordshire NHS Foundation Trust

Baroness Pitkeathley Excerpts

Wednesday 9th June 2010 Lords Chamber

[Earl Howe]

I fully agree with my noble friend. We have asked the Appointments Commission to set out proposals for a revised person specification for chairs and non-executive directors to ensure that it is aligned with the current priorities and principles of the NHS. We want to continue to deliver high-calibre non-executives, in particular, who are needed to meet the challenges ahead. The general point raised by my noble friend is well made and we shall certainly take it forward.

[Baroness Pitkeathley]

My Lords, I declare an interest as chair of the Council for Healthcare Regulatory Excellence. Will the Minister confirm what I think was the thrust of the Statement, which was that regulation and regulatory activities should always be about patient safety and not about maintenance or promotion of professionals? As the strong and welcome implication of the Statement is about putting patients at the centre, does he expect the inquiry to give any indication as to how patients should be supported in bringing forward their concerns?

[Earl Howe]

On the last point, we are doing quite a lot of work in the department to ensure that patients are supported in an appropriate fashion in their dealings with the health service. Our plans for what we hope to call “health watch” will flesh out that point. I agree that safety lies at the heart of the quality agenda, which was commenced in earnest by the noble Lord, Lord Darzi, when he was a Minister. I have the privilege of being responsible for that agenda, which is being continued with urgency. We are committed to developing the role of the Care Quality Commission to make it a more effective regulator of health services in England. We will bring forward proposals that will focus on the outcomes of the care experienced by patients. The Care Quality Commission will be intimately involved in that.