NHS: Medical Records

Baroness Pitkeathley Excerpts

Wednesday 7th September 2011 Lords Chamber

[Earl Howe]

This is a commitment that we have made. We fully support the concept of patients having full access to their medical records online. A great deal of work is going on at the moment to make sure that the protocols are sound, because clearly the one thing one does not want is for the wrong people to access the wrong patient data. If we can achieve that and do it in a simple way, we shall roll the programme out as soon as we can.

[Baroness Pitkeathley]

I take on board what the noble Earl says about engaging local commitment and the failure that there has been in that so far, but does he agree that one of the most important things about local commitment is that different localities may have different systems? As far as the patient is concerned, it is absolutely essential that the systems can talk to each other. How will that be ensured if we go down the local route?

[Earl Howe]

The noble Baroness makes a very good point. I said that the top-down approach to local service provision has not worked when it has come to local service provider systems. We think that local requirements are best judged and best met by decisions being taken locally but that does not mean that they will be left on their own. There will be the necessary support from the centre wherever needed. She is again right that the key will be that these local systems must be interoperable.

Reform of Social Care

Baroness Pitkeathley Excerpts

Monday 4th July 2011 Lords Chamber

[Earl Howe]

My Lords, this area was not overlooked by the commission. Indeed, the commission has made a specific recommendation as regards the cap on costs, which it believes should be, as a generality, somewhere between £25,000 and £50,000, although it has come down in favour of a £35,000 figure. That figure is lower for those who require long-term care at a much earlier age. The noble and learned Lord is right that this area should not be neglected, and I am sure will not be neglected.

[Baroness Pitkeathley]

My Lords, does the Minister agree that although the sum of £2 billion mentioned by Andrew Dilnot may strike fear into the heart of the Treasury at a time of financial constraints, it is a puny sum when you compare it with the £119 billion contributed by the main providers of care—the family carers? Therefore, I am sure he agrees that the support offered to family carers in the report is extremely welcome. Will he reconfirm the Government’s commitment to continuing to work with the stakeholder groups, as the Dilnot commission has so admirably done, particularly as the advice and information service for families is developed as we go forward?

[Earl Howe]

My Lords, I cannot stand here and claim that an additional £2 billion is a trivial amount of money; it clearly is not. That is why it was made clear in the Statement that we need to make some difficult decisions over priorities in public spending. As regards carers, for whom the noble Baroness has done so much in her career, I am sure she will accept from me that we recognise the value and contribution that carers make. We recently published Recognised, Valued and Supported: Next Steps for the Carers Strategy, which announced an additional £400 million over four years for PCTs to pool with local authorities to provide carers’ breaks. In our carers strategy we indicated that assumptions should not be made about who will provide care and to what extent. There has been a 21 per cent increase in the number of carers receiving information. We want to see greater flexibility and portability of assessments for carers. The agenda in this area is proceeding and we shall not forget it amidst the concerns over funding. It is every bit as important as getting the funding system for paid residential long-term care right.

Health: Multiple Sclerosis

Baroness Pitkeathley Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My noble friend makes an important point. The guide that I have just referred to in answering the noble Lord, Lord Walton, emphasises the important role of specialist nurses in the care of patients with neurological conditions. However, the key in the future will be better commissioning at a local level joined with better workforce planning at a provider level. If those charged with training and workforce planning tap into the commissioning plans that commissioning consortia determine, we will have a genuinely joined-up system that is also informed by the patient’s point of view.

[Baroness Pitkeathley]

My Lords, does the guide to which the Minister referred have anything to say about keeping records? MS patients, their families and carers always report that because it is an illness with long periods of remission—sometimes lasting years—the difficulty of keeping the records up to date causes them distress.

[Earl Howe]

The noble Baroness makes a very important point, and she is right. I will have to check whether the guide refers to that issue. I would be surprised if it did not. However, the central point that she makes is quite correct. The key to this, as so often, is good communication between those providing care at every stage of the care pathway. Sometimes, unfortunately, that breaks down.

Health: Hospital-acquired Infection

Baroness Pitkeathley Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

The noble Baroness is quite right that delayed discharge poses a risk, not only in terms of infection but in terms of mobility and other issues that affect the elderly. We are clear that if this problem is to be eased, further funding is required at local authority level, which is why we have made available up to £1 billion over the period of the spending review to ensure that the issue is addressed.

[Baroness Pitkeathley]

I declare an interest as a recoverer from MRSA. Is the Minister making any assessment of the effectiveness of preventive measures, such as hand sanitisers and making sure that doctors do not wear ties, which droop in wounds, and so on?

[Earl Howe]

My Lords, the noble Baroness will know that a code of practice was issued some time ago, which the CQC uses to ensure that the registration requirements of a provider have been complied with. It is clear that the decline in numbers of hospital-acquired infections has coincided with the issue of that guidance. We believe that it has made a material difference. I am not aware that there has yet been systematic evidence-gathering of whether the guidance has had an effect, but it appears that it has.

NHS: Standards of Care and Commissioning

Baroness Pitkeathley Excerpts

Thursday 31st March 2011 Lords Chamber

[Baroness Pitkeathley]

My Lords, I thank my noble friend Lord Turnberg and declare two interests as chair of the Specialised Healthcare Alliance and as chair of the Council for Healthcare Regulatory Excellence.

However devoted we are to the NHS—I speak as one who owes her life to it—we must acknowledge that there are still far too many instances where it falls short. No one could fail to be shocked by the ombudsman’s report to which many noble Lords have referred. The universal standards which we all wish to see, of a compassionate and skilled service, are by no means universal as yet. The dismissive attitudes and indifference to deplorable standards encountered in all too many instances must be addressed and, as far as possible, eliminated. I say “as far as possible” because, as a regulator of healthcare, I know only too well that it is not possible for any form of regulation to bear on every safety or quality concern. We are dependent on the quality of the professionals delivering the service and we must judge this always from the experience of the patient and his or her family.

When we think about commissioning as being about improving health outcomes and reducing health inequalities, let us never forget what that means from the patient’s point of view. Most will have absolutely no idea what “improving health outcomes” means. They only know that they want to be treated safely, with dignity and compassion, and have timely and effective treatment. In all the discussions we are currently having about the reform of commissioning, I am often struck by how remote those discussions seem from the actual experience of patients. The test that we must apply is whether it is better for them, not whether it is better for the Secretary of State, the commissioning board and GP consortia.

It is also striking how removed our discussions are from the facts around patients’ experience, which are not linear but confused and complicated—a mixture of services from health, social care, housing, the voluntary sector and their own families. This complication of experience is little recognised, even now when some of us have been trying for 30 years to get it recognised. The question we have to ask is: will the new commissioning arrangements deliver that recognition? We do not know.

What we do know is that every bit of research ever done about changing institutional structures shows that only a part, and usually a small part, of the objectives are achieved, and the bigger the upheaval, the fewer of those objectives are achieved. Since we are largely dependent for quality outcomes on the skill, commitment and—let us not be afraid to use the word—dedication of our staff, how are we to maximise those and provide them with the support they so urgently need when, for the next two years at the very least, their energy will be directed towards the change itself in the form of applying for their own jobs, learning to work with a new set of partners and so on? Also, the history of co-operation between GPs and social services does not fill me with hope, while the lack of co-terminosity between consortia and local authorities is certainly not going to be helpful.

We know that the commissioning board will issue guidance on commissioning to the consortia, but when is this to happen? Do we not risk a mismatch in timing? Some of the consortia are already willing to go ahead and are following their own rules in the absence of any from the commissioning board. I hope that the Minister will be able to comment on this. Also, from the patient’s point of view, we need a great deal more clarity about what will happen when GP consortia refuse to commission a service that a patient requires. Where is the accountability?

As to the voluntary sector, for so long the provider of good preventive care and services, we hear a great deal about organisations being encouraged to take on a greater share in providing public services and for the commissioners to recognise this. If we are serious about pushing power as close to individuals as possible and for citizens and communities to define the priorities and expectations of public services like the NHS, as the big society concept suggests we should, it is certainly important for the voluntary sector to be involved. However, many organisations are having their funding savagely cut, and more than half of them say they are going to have to cut staff in the next three months. Given that, I doubt their capacity.

Herbal Medicines

Baroness Pitkeathley Excerpts

Thursday 13th January 2011 Lords Chamber

[Earl Howe]

My Lords, again I think that the House is well aware of the noble Lord’s views, which I know are sincerely held, although personally I regret his comments about the Prince of Wales. However, I am sure that, with regard to herbal medicines, he will be aware that there is an international trade in sometimes poor-quality, unregulated and unlicensed herbal preparations. Some of these have been found to contain banned substances, heavy metals or pharmaceutical ingredients or substances from outside the UK that may not be subject to any form of regulation at all, so there is a public safety issue.

[Baroness Pitkeathley]

My Lords, does the noble Earl agree that, while statutory regulation has its place, regulation in healthcare and anything else should always be proportionate? Would he therefore endorse the concept of light-touch regulation, which is promoted by the Council for Healthcare Regulatory Excellence? I declare an interest as its chair.

[Earl Howe]

My Lords, I pay tribute to the noble Baroness for the work that she does and I entirely endorse the approach to regulation that she has outlined. Certainly, we need to adopt a targeted, risk-based approach to regulation.

Autism

Baroness Pitkeathley Excerpts

Tuesday 7th December 2010 Lords Chamber

[Earl Howe]

My Lords, I am very grateful to my noble friend for raising that issue. I can reassure her that under Section 47(1) of the National Health Service and Community Care Act 1990 local authorities have a duty to assess a person who may be in need of community care services. This duty applies to people with autism. The revised Fair Access to Care Services guidance already makes it clear that an assessment of eligibility for care services cannot be denied on the grounds of a person’s IQ. We intend to reiterate this very clearly in the autism statutory guidance.

[Baroness Pitkeathley]

My Lords, does the Minister agree that delivering the vision for people with autism and their families is, in many cases, dependent on local authority resources? Has he any anxiety about that, especially as many of the services are delivered in the voluntary and community sector, which is already reporting major cuts to its grants?

[Earl Howe]

My Lords, clearly, local government grants will come under pressure over the coming years. To my mind, that makes it even more important that decisions about priorities are taken at a local level and the joint strategic needs assessment is, of course, the tool which will enable local authorities to decide on their priorities locally.

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.