Health: Mental Health Strategy

Baroness Thornton Excerpts

Monday 14th February 2011 Lords Chamber

[Baroness Thornton]

My Lords, the noble Baroness, Lady Murphy, has provided us with an opportunity to discuss this important issue, for which we should all be grateful. The Government published their new mental health strategy, No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages, on 2 February. It is designed to set the framework for the policy and development of mental health services for at least the next five years. It is accompanied by a call for action to set out the principles of change and urge co-ordinated action in delivering the strategy. I join other noble Lords in saying that this is an aspirational document and there is no doubt that it makes a powerful case. However, as is this Government’s habit, it does not contain goals and target-setting as a means to reach its objectives.

I welcome the strategy’s acknowledgement that mental health problems cost England £105 billion every year and that this burden spreads beyond health services to education, employers, the social security benefits system, housing, the criminal justice system, and families and communities. I also welcome its demonstrating how effective interventions and initiatives can reduce that burden and prevent needless suffering to individuals and their families.

I think that we are all familiar with policy documents that are excellent and long on analysis of the problem in question but unfortunately bring to bear solutions that lack the same passion, drive and specificity. I think that I am not alone in expressing this concern—the noble Lord, Lord Newton, and my noble friend Lord Patel are but two of the others who have done so. In the same week that the Government launched their mental health strategy, the Commons debated the revolution in the NHS that is the Health and Social Care Bill and the uncertainties that it may bring. At the same time, hundreds and thousands of people with a mental health problem will face a test of their incapacity evidence which is already suggesting great unfairness and causing great distress. If one adds to this the local cuts which threaten services that are vital to many, one concludes that the Government must expect a level of anxiety about the deliverability of the strategy.

I commend the work of the voluntary sector in this area. I did a trawl through the websites of Mind, SANE and Rethink to see what they had to say about the Government’s plans. I also had a look at their blogs to gauge their members’ reactions. Like most noble Lords and me, they give a general welcome to the strategy. However, I shall quote what someone on the Mind website said:

“The county council will cease to provide funding for our local branches of Mind, or indeed for any services for people will mental health problems. We, (mental health service users who attend any of the pitifully few groups or agencies available) were told that this is so we can all have more ‘choice’ by opting to fund organisations ourselves with personal budgets. In reality, people with life-long mental health problems are being weeded out at every stage of trying to access these budgets and will therefore be unable to attend anything. Centres such as those provided by local Mind charities may well have to close if there are no longer people who can afford to attend them. So much for ‘choice’. The future health and stability of those now left unsupported does not appear to concern the council. At a time when council budgets are being slashed, social care is under a great threat. Any talk of a ‘strategy for mental health’ is somewhat meaningless in the circumstances, particularly for anyone with long term problems”.

That is a point of view that the Government need to take very seriously.

Will the Government’s strategy work? For people who experience mental health problems, I suggest that it has to work. It is legitimate to ask questions about how it might be delivered. I agree with the noble Baroness, Lady Hollins, on the lack of mention of funding for research in the document. I make two points. First, multidisciplinary commissioning is vital for pathways of care. Some of the matters will fall within the remit of the public health authorities, some with the NHS Commissioning Board and some with GP consortia. This may risk fragmentation of provision. If co-ordination and co-operation are so important, why are the Government abolishing the National Mental Health Development Unit as part of their rationalisation of the arm’s-length bodies?

The second point is the greater societal challenge. We have to recognise that cuts will bring restrictions to education opportunities, unemployment and debt. The impact on people’s lives and their mental health cannot be underestimated. Debt and the risk of homelessness and family breakdown will have a huge, spiralling effect on stress and anxiety levels. There will be an even greater need for these services to be got right.

In recent times under the Labour Government, we saw the start of a positive change in public attitudes. Evidence clearly showed that we need to support people in the workplace and the wider community. I will be very interested to learn from the Minister the answer to the questions that the noble Baroness, Lady Murphy, and others have posed in this debate.

Human Fertilisation and Embryology Authority/Human Tissue Authority

Baroness Thornton Excerpts

Tuesday 1st February 2011 Grand Committee

Asked By

[Baroness Thornton]

To ask Her Majesty’s Government how they will maintain public confidence and patient safety following the abolition of the Human Fertilisation and Embryology Authority and the Human Tissue Authority.

[Baroness Thornton]

My Lords, it seems appropriate that we are having a short debate on the proposed abolition of the HFEA and the HTA, as one might say that it is a sort of warm-up for the debates that we will be having when the Public Bodies Bill restarts its Committee stage, which I hope will be soon.

This morning, the British Heart Foundation announced that it is spending £50 million on stem cell research in the hope that one day it will be as easy to recover from a heart attack as it is to repair a broken bone. A year ago, the groundbreaking partnership was announced between the Multiple Sclerosis Society and the UK Stem Cell Foundation to pump-prime and speed up stem cell research. This perhaps reflects science’s fast-moving progress in relation to stem cell research and the wonders that it might bring to medicine over the next few years. Right now, the HFEA is conducting a consultation on the ethics of sperm and egg donation. This issue is often in the media, which is unsurprising given what donation involves—that is, making children who may not be genetically related to their parent or parents.

As medical science advances, there seem to be more, not fewer, ethical issues to address in this area. To underline this point, not long ago—in fact, in March last year—the noble Earl the Minister and I were dealing with the regulations arising out of the Human Fertilisation and Embryology Act 2008 relating to the disclosure of information for research purposes and parental orders regarding the adoption of children born of surrogate mothers, among other matters. These are both highly sensitive and important issues concerning ethical and safeguarding matters and both rest in the hands of an HFEA accountable to the Minister and to Parliament.

In preparing for this debate, I used as my starting point what both organisations do and I tried to work out how these functions might be undertaken in the new regime that the noble Earl kindly outlined to some of us not long ago. The HTA licenses and inspects organisations that store and use human tissue for purposes such as research, patient treatment, post-mortem examinations, teaching and public exhibitions. It also approves organ and bone marrow donations from living people. Its work covers anatomy, stem cells, cord blood, public display—that is, the public display of human body parts in various forms—post-mortems, coroners and transplants. It is clear to me that the HTA covers a wide but related range of competencies, as well as the ones that were behind the organisation being established with such care some years ago.

The ethical issues that arise all the time as a result of the advances in science throw up new and sometimes very complex issues. Public indignation at the cavalier use of body parts for research without the knowledge or consent of patients and their families was huge and many in your Lordships’ House will recall the thought and time that were given to creating a regulatory framework that would command public confidence. The Bill was given more than 100 hours of direct parliamentary scrutiny in both Houses, not counting pre-legislative scrutiny or investigation by Select Committees. I fail to see what has changed that can allow any slackening off of the responsibility that the HTA bears for the uses of human tissue.

The HFEA is the UK’s independent regulator of treatment using eggs and sperm and of treatment and research involving human embryos. It sets standards for and issues licences to centres; provides authoritative information for the public, particularly for people seeking treatment, donor-conceived people and donors; and, very importantly, determines the policy framework for fertility issues, which are sometimes ethically and clinically complex. The Human Fertilisation and Embryology Act 2008 includes provisions for research on different types of embryos and changes the definition of legal parenthood for cases involving assisted reproduction. More than 200 hours were spent scrutinising this and previous legislation in both Houses, not counting the need for Select Committees and pre-legislative scrutiny. I make this point to emphasise that Parliament took its time to get these things right. It seems to me that, if Parliament is going to change the HFEA and the HTA, it needs to take time to do that also.

The Government argue that the HFEA’s licensing function could be moved and that its very sensitive records should become a responsibility elsewhere. I remind noble Lords that, on every occasion that Parliament has discussed human fertility since the 1980s, it has agreed that human embryos have a unique status and that their use for treatment and research requires special oversight.

Some say that IVF treatment has become so common that its regulation should be normalised in some way. I point out that, although public opinion has indeed moved, there are still powerful forces wishing to stop or limit the use of assisted conception and there are still the unscrupulous who would wish to profit from, for example, the longing of parents to have a baby. In addition, there is a very real danger that important research will be frustrated by people who have strong and hostile views should the responsibility for ethical review be removed from the responsible but supportive environment fostered by the HFEA.

The HFEA plays an important role in actively improving standards by, for example, being responsible for several consultations on issues of best practice, such as the ones to which I have referred. Reducing multiple pregnancies by limiting the number of embryos transferred has been and remains an important part of its work. My question is whether the Care Quality Commission will take on the important role of ensuring that clinics’ results are not achieved regardless of the perinatal mortality associated with multiple pregnancy.

The Human Fertilisation and Embryology Act is the focus for interactions between doctors, nurses and scientists. I suppose that these interactions could take place elsewhere. However, all the disciplines have vested interests and I point out, with the greatest respect, that organisations such as the Royal College of Obstetricians and Gynaecologists, the Royal College of Nursing, the Association of Clinical Embryologists and the British Fertility Society do not have the same impartial image enjoyed by the HFEA. The public have learnt to trust the HFEA and, indeed, the HTA. These bodies act as a bulwark between the sensational headlines in the less responsible press and those who are working in the field. Who would take on that role if either of these bodies was abolished? Would Andrew Lansley, or indeed the noble Earl, be prepared to act as that bulwark?

UK legislation on these matters is the envy and the blueprint for the world. In Australia, for example, the states of Victoria, South Australia and Western Australia have legislated to establish statutory oversight bodies. In 2000, the Singapore Cabinet appointed a bioethics advisory committee to examine the ethical, legal and social issues arising from biomedical research and development. Again, that is not a government department but a stand-alone, arm’s-length body.

I am not opposed to change and improvement and I am not opposed to these proposals for the sake of it. I support change to make organisations more effective—for example, by sharing back-office functions or other facilities, by changing regulatory functions or by testing to see whether functions could be performed more effectively elsewhere. It might be that the proposals that the Government have suggested so far for the HTA and the HFEA will provide efficient regulation of some of their functions through the CQC and possibly through the still-to-be-created academy of medical science. However, none of the proposals answers the question that is the subject of this debate: where would the ethical and safeguarding issues that are at the heart of the work of both these bodies sit?

I am aware that the Government have said that there is no intention to revisit the ethical and safeguarding provisions in the HFE Act or the principles of consent underpinning the HTA, but they have so far failed to address how the ethical and safeguarding functions might satisfactorily be carried out were these organisations not to exist. I cannot see the CQC or an academy of science being an appropriate body. That leaves us the Secretary of State and the Government, which is where we came in all those years ago with Alder Hey and the challenges posed by the new embryo and fertility advances of the 1980s. I suggest that public confidence in this area is best established through the independence of the bodies that regulate—the HTA and the HFEA—and that the Government need to rethink their proposals.

Health: Influenza Vaccination

Baroness Thornton Excerpts

Thursday 20th January 2011 Lords Chamber

[Earl Howe]

We have not reached a view on this because the JCVI’s advice remains unchanged. In fact, current evidence shows that children under five are not the age group with the highest risk of death. The age group with the highest risk of death from the flu that is circulating currently is middle-aged adults. Nevertheless, those with risk factors have the highest risk of severe disease and death from flu compared with healthy age groups. However, I can tell my noble friend that nothing is set in stone. We do not wish to constrain the JCVI in any way and we will listen to its advice, as we always do.

[Baroness Thornton]

My Lords, during the H1N1 pandemic, two organisations stood out as being essential to delivering a pandemic strategy: the Health Protection Agency, for its science, strategic planning and advice; and the PCTs, for their support and co-ordination on the ground. Both are due to be abolished in the next two years. Can the Minister inform the House about the Government’s pandemic plans, including, for example, the ordering of sufficient vaccine, both after the abolition and during the transition?

[Earl Howe]

The noble Baroness asks an important question. The Government’s plans are to create what we are calling Public Health England, which will be the new public health service based centrally, linked closely to public health efforts in local authorities with local directors of public health. A pandemic vaccination campaign would be mobilised through those channels. I am clear that we have proper plans for the transition, which the noble Baroness rightly mentions as being a time when we need to have a specific focus on public health protection. The present plan, as she knows, is to bring the Health Protection Agency functions within the Department of Health so that there is a clear line of accountability from the Secretary of State downwards. I am clear that that is right. We will still have the expert advice that we do now from the people who are currently employed in the Health Protection Agency. That is an additional safeguard.

NHS: Front-line and Specialised Services

Baroness Thornton Excerpts

Thursday 13th January 2011 Lords Chamber

[Baroness Thornton]

My Lords, I congratulate my noble friend Lord Turnberg on this debate. Indeed, of all the speakers who have contributed today I particularly welcome the noble Baroness, Lady Jolly, to our debates and our deliberations for the future. I also need to congratulate all the speakers who have contributed today, because we have had a really excellent debate. We probably needed about two or three hours longer than we have had; maybe we need to do that.

I want to raise two matters, one strategic and one specific. Since June we have debated or had Questions on, among other things, cancer, diabetes, chronic pain, Parkinson’s disease, epilepsy, social care, COPD, neurological conditions, dementia and many others. I cannot recall a single debate or Starred Question where the issue of how services would be either safeguarded or delivered under the proposed reforms of the NHS was not raised in one way or another. The Conservative-led Government have been telling us this comforting notion that your family doctor will commission the services that you need—and who better to do so? I am on the record as saying that I support that in principle. However, Conservative MP Sarah Wollaston rather let the cat out of the bag when she wrote in the Guardian on 4 January:

“I know many GPs who are keen to tackle the redesign of care and even the issue of failing colleagues, but I know none that are interested in EU competition law. If commissioners cannot design care pathways free from the spectre of lawsuits from private providers, they will hand over to commercial commissioners prepared to take the rap”.

I think that that means that private commissioners may turn to private providers at the expense of NHS providers because of the intimidation, or their interpretation, of EU competition law. Will the Minister confirm the role that EU competition law will play in the forthcoming reforms? For example, will GP commissioners be able to choose NHS providers where they offer the best quality and comprehensive service even if they are not the cheapest, without fear of legal challenge from private enterprise cherry-picking the most lucrative contracts? The Minister will know that I have long been a supporter of choice and diversity within the NHS, but the question of how we achieve that might lead to a fundamental dividing line opening up between us.

The EU competition rules being used as a regulator for NHS services through Monitor provide us with a huge problem. The problem, if I might put it in shorthand, is that health-providing companies owned by shareholders and hedge funds are not independent providers; they are accountable to owners who want to see a profit. So patients and organisations that promote the interests of long-term conditions, for example, are correct to be asking how health services owned and run by these people will have their long-term interests at heart. These are the questions that we will need to answer when we look at the NHS Bill that is promised next week.

What role does the Minister envisage for the market, for competition and for the private sector as a result of these proposed reforms? Does he believe that collaboration or competition is the best way to run our health service? I promise noble Lords that the noble Baroness, Lady Finlay, and I have not collaborated in asking that question. These are very big issues to which, as I have said, I suspect we need to return for longer and deeper consideration.

I conclude by raising a specific issue—in many ways, a perfect example of the anxieties that are being raised in all quarters. This concerns GP commissioning and the future of cancer expertise in the new system, and I thank both Cancer Research UK and Macmillan Cancer Support for drawing this to my attention. Before I go on, I add my congratulations to the noble Lords, Lord Crisp and Lord Kakkar, who asked questions that drilled down into the detail that we are going to have to address, as indeed did my noble friend Lord Winston.

As the Minister will know, the cancer networks have been an absolutely integral and important tool in improving outcomes for cancer patients. The Government have said in the new cancer strategy, Improving Outcomes: A Strategy for Cancer, published yesterday, that cancer networks will continue to be funded during the transition period to GP commissioning. How will GP consortia make use of the expertise currently available in cancer networks to help in the effective commissioning of high-quality and seamless cancer services? How will the Government ensure that the functions currently provided by networks are not lost and standards compromised under the new commissioning regime? Will the Government ensure that cancer networks are funded throughout the transition period until 2014? Will that funding include funding that cancer networks receive from PCTs at the moment as well as directly from the Department of Health? How will GP consortia be incentivised to ensure that the critical functions of cancer networks are still carried out as they commission cancer services?

I am happy if the Minister wants to write to me about those questions; it is unfair to expect him to answer them in detail at this moment. But they are very important, and I look forward to his remarks.

Health: Influenza

Baroness Thornton Excerpts

Tuesday 11th January 2011 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what is the reported increase in the incidence of influenza since the end of November; and how many adults and children suffering from influenza were admitted to hospital or died in December.

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

My Lords, influenza-like illness, or ILI, has increased from 13 to 98 GP consultations per 100,000 people since November. The department does not currently collect data on hospital admissions. As of 6 January, there were 783 patients with ILI in critical care beds in England, and 50 flu- related fatal cases verified by the Health Protection Agency in the UK.

[Baroness Thornton]

I thank the Minister for that Answer. Last June, I asked him about the 50 per cent cut in the communications budget for the Department of Health. He said that,

“every programme of communication or marketing has to be justified by the evidence that it will do some good”.—[Official Report, 30/6/10; col. 1798.]

We know that pregnant women are particularly vulnerable to the H1N1 strain of influenza, and HPA’s data show that the risk of mortality for pregnant women is sevenfold greater than that for non-pregnant women. Even so, midwives received a letter from Andrew Lansley, dated 16 December, encouraging them to vaccinate pregnant women. Does the Minister think that it is possible that, had the Government acted earlier and had a public campaign, had they not cut their public health communications budget, and had Andrew Lansley sent a letter in October rather than December, the lifes of at least one pregnant woman might have been saved?

[Earl Howe]

My Lords, it is quite difficult to substantiate that suggestion, because the immunisation figures do not bear out the noble Baroness’s argument. The level of vaccine uptake in the over-65s is 70 per cent, which is better than in most countries of Europe. Among the at-risk under-65s, it is 45.5 per cent, which is comparable to the past two years. Therefore, it is not clear that a generalised campaign would have added value.

On the question of pregnant women, the normal procedure is for the Chief Medical Officer to write to all GPs in the summer, setting out all the at-risk groups. She did that in June. We were then alerted in December by the Health Protection Agency to a worryingly high number of pregnant women who had contracted influenza, so we wrote to both the BMA and the Royal College of Midwives to emphasise the desirability of encouraging that group of patients to get vaccinated. We did the right thing, which was to respond to emerging data.

Blood and Blood Products

Baroness Thornton Excerpts

Monday 10th January 2011 Lords Chamber

[Baroness Thornton]

My Lords, perhaps I may start by wishing the Minister and other noble Lords a very happy new year and by commending the Minister for his patience: he finally got to make the Statement. I welcome the Statement and congratulate the Minister and his colleagues on making progress in building on the work that the noble Lord knows we were trying to do on this important and tragic matter, to which I had a personal commitment. Of the haemophiliac community, almost 2,000 of the 5,000 infected people have died in the intervening period. For those with hepatitis C, it has become more urgent that the ex gratia payments should be reviewed.

This is a campaign about which we know people feel strongly. One of the saddest documents that I have read recently was a letter to the Prime Minister, written in October on behalf of the campaign for all those infected. It described how about 100 people travelled to London to listen to a debate and to lobby for the day. A number of them were very sick, including a double liver transplantee. There were widows, young people who had lost their fathers and another person whose son had died only weeks before. They felt very aggrieved by the business in the other place, which did not produce the results that they had expected. A shocked and saddened group of people struggled down the stairs from the Public Gallery to leave Parliament. The letter concluded by saying:

“It is not an Act of Parliament that is needed, but an act of political will”.

To an extent, that is what has happened today. Indeed, their disappointment was added to before Christmas when they were expecting the announcement that we now have before us. I particularly welcome the extra amounts of money available and the fact that these will not be taken into account for the purposes of taxation and means-tested residential social care support, but I have some questions for clarification.

The first question concerns how the money will be distributed. The Statement says that a new trust is going to be established. Will the Minister expand on how the money is to be distributed through that trust? Will the trust be like the ones that exist at the moment or do the Government envisage something new and different? I should like some information about how the money will be made available and how it will be distributed. I would also like some clarification on prescription charges, because the Government’s decision to abandon free prescription charges for people with long-term conditions has obviously impacted on the groups that we are referring to. I know that the Minister suggested that the prescription charges will be mitigated, but can he clarify whether that will cover, for example, those in the early stage of hepatitis C, not only stage 2? Will it cover everyone encompassed by the different stages of these conditions?

The areas that I feel are less welcoming concern the issues that have been discussed in this House on many occasions to do with considerations about mortgages, life insurance and travel insurance for people affected by these conditions. I cannot see anything in the review that suggests that consideration has been given to these matters. They form part of the completion and closure that is needed. I would also like an assurance from the Minister about support for the Haemophilia Society, particularly as I understand that the Government will be working with the society to help to deliver the information programme that is going to be necessary to ensure that people in this community take advantage of the benefit that the Government are offering.

My final questions concern where the money to fund this is coming from. If the Government are successful in persuading Scotland and Wales to expand this scheme, which I hope sincerely they will be, how is that to be funded? That is the question that those Administrations will be addressing. However, I very much welcome this Statement and I congratulate the Minister and his colleagues on the progress that they have made.

Health: Parkinson’s Disease

Baroness Thornton Excerpts

Monday 10th January 2011 Lords Chamber

[Baroness Thornton]

My Lords, I congratulate my noble friend on initiating this debate, and thank her for her commitment to Parkinson’s disease and for chairing the important all-party group’s report. I doubt I shall address a question to the Minister that someone else has not already asked. None the less, as is traditional in your Lordships’ House, I shall continue to speak.

As noble Lords will know, Parkinson’s is a long-term degenerative neurological condition. Symptoms can include stiffness of movement, pain, incontinence and dementia, which fluctuate from day to day, as noble Lords have mentioned, and worsen over time. It has a profound impact on people who have it, their families and their carers. I might be the first person in this debate to mention that one of the key problems with Parkinson’s disease is the stigma that goes with it. People may not recognise that people have Parkinson’s. They might think that they are drunk or that there is something else wrong with them. That is an additional burden that people with Parkinson’s disease have to carry with them.

The background to this debate is the brilliant report Please Mind the Gap, which took evidence from 360 people with Parkinson’s, their carers, health and social care professionals and representatives of public bodies, royal colleges and the Government. It brought to light many of the geographical inequalities in availability of services across the UK.

We know that the timely intervention of a specialist nurse or a physiotherapist and proper access to services can reduce hospital admissions and greatly improve quality of life. We have discussed this. We could substitute many conditions for Parkinson’s disease. We know that is the case. We know, therefore, that getting the provision of services for people with Parkinson’s disease right is not only right but cost effective.

Take, for example, Parkinson’s nurses. As a result of the investment from Parkinson’s UK, which pump-primes nurses for two-year periods and to which I pay the highest tribute, there are more than 300 Parkinson’s nurses. I have to say that I agree with other noble Lords: there must be a question mark over their future. I ask the Minister whether there can be some monitoring of what happens to these nurses. As pressures increase on primary care trusts and reform moves forward, what happens when you lose a Parkinson’s nurse? How many more people are admitted to hospital? The Government need to look at what evidence there is.

The same applies to allied health professionals, such as physiotherapists, occupational therapists, speech and language therapists, psychologists and specialists in neurology. They are all vital in treating Parkinson’s and other neurological conditions. The Minister will not be surprised to hear me ask how such coherent and co-ordinated provision will be made available under the proposed changes to the NHS commissioning structures. Parkinson’s UK is extremely worried that it will mean a worsening of access to Parkinson’s nurses, as well as all the other allied health professionals that are needed. Indeed, Parkinson’s UK reports that it is hearing of posts remaining empty following retirement.

It is clear that proposals to transfer commissioning powers from PCTs to GPs are of great concern, not only to Parkinson’s UK but to many organisations that deal with long-term and complex conditions. I agree with the noble Lord, Lord Walton of Detchant, that there must be a question mark over the ability of an NHS commissioning board to make sure that these services are delivered adequately by GP commissioning when we are not even sure how many GP commissioning boards there will be. One needs to ask: how will those consortia be able to commission the expertise to supply the support for this and the other neurological conditions mentioned by the noble Lord, Lord Walton of Detchant?

How will the Government ensure that the GP consortia involve the third sector in the delivery of these services? This question is being asked not just by Parkinson’s UK. I happened to be at a meeting attended by the Multiple Sclerosis Society and the Motor Neurone Disease Association and they expressed the same concern about the ability of the consortia to commission the right services at the right level at the right time for patients when a doctor may only ever see two patients with Parkinson’s disease as it is such an uncommon disease. We know that you effect change in the NHS through leadership. How can the Government ensure that the leadership for this condition will continue and develop? The NICE guidelines are to be reviewed this year. If the Government do not go ahead with that review and do not come forward with robust guidelines, how will they ensure that the leadership for this condition will be maintained?

The Minister cannot have failed to notice that the same questions have been asked with regard to stroke, diabetes, MS and epilepsy. With all those conditions the same level of anxiety is evident about what the future holds under the proposed changes to the NHS. I am merely amplifying what has already been said but we are getting to the point where we need answers about how these conditions will be managed.

NHS: Targets

Baroness Thornton Excerpts

Monday 20th December 2010 Lords Chamber

[Earl Howe]

I am sorry that the noble Lord is a sceptic on these matters. In the field of mental health care, for example, where there is a long-standing position of private sector contestability, we have seen that standards have been driven up. There is no doubt that the foundation trust model has also paved the way for higher quality in healthcare.

[Baroness Thornton]

My Lords, turning to waiting lists for accident and emergency services, which we obviously want to provide the highest possible care, I want to ask how the newly proposed scheme will improve the quality of care. For example, how will the abolition of the 19-minute response time to a 999 call that is not life threatening affect the health outcome for an elderly lady who has slipped and broken her wrist on the ice? Such a slip may not be life threatening, but the elderly lady may wait for quite some time for an ambulance and then wait considerably longer than four hours in accident and emergency. Is the waiting time not an outcome here? If the Government do not intend to introduce a new outcomes framework for two years, would the Government not be better to leave the current guarantees in place because we know that they ensure patient safety?

[Earl Howe]

My Lords, on ambulance response times, the existing eight-minute target will remain in place for category A calls. For category B calls, which are serious but not immediately life threatening, Peter Bradley, who is the national ambulance director, has been working with Professor Cooke to develop a set of 11 clinical quality indicators for the ambulance service. We are clear that those indicators will provide a much better and more rounded set of objectives than a mere 19-minute response time. Of course response times are important, but there are other things that should be focused on as well. We hope to improve standards in this way as from April next year.

NHS: Global Health

Baroness Thornton Excerpts

Monday 20th December 2010 Lords Chamber

[Baroness Thornton]

My Lords, the noble Lord, Lord Crisp, has a passion for this important issue, and I congratulate the noble Lord on initiating this debate tonight, the quality of which has proved his passion to be correct.

Good health in one country cannot be maintained if there is widespread ill health and disease in so many others. I have always felt privileged to be able to participate in debates in your Lordships’ House when such expertise and personal commitment is shown and, as so many noble Lords have said tonight, in a globalised and interdependent world, one in which disease certainly knows no boundaries, health is a global issue. The rich world has a responsibility to the developing world to support the growth of their health infrastructures and the growth of their medical education.

The nature of our responsibilities includes without doubt the need for overseas doctors to train in the UK without unacceptable barriers being placed in their way, or expense, and indeed the need for UK doctors to spend time abroad. We recognise that is a legitimate part of their qualifications, as mentioned by the noble Lord, Lord Patel, and others. It also includes the need to prepare our own UK-based doctors for the implications and effect of globalisation in our own health service and the UK population. The noble Lord is quite right—our medical training must encompass this challenge and its complexity.

The previous Government, with no small help, I suspect, from the noble Lord, Lord Crisp, produced Health is global: a UK Government strategy 2008-13 in September 2008. In it there was recognition of the fact that a healthy population is fundamental to prosperity, security and stability. It also linked the Government’s domestic and international objectives to the issue of improving global health. Could the Minister tell the House, therefore, what the Government are doing to continue this work? Has the department embraced the recommendations contained in that strategy?

We can look at the threat that global disease can pose. SARS and swine flu are two of the most dramatic examples where the world had to work together to protect itself. There is no doubt that a weakness in the healthcare in one country can put millions at risk. Nearer to home, however, in the UK, and particularly in London, we only have to think about TB and the communities most at risk. I am reminded of this by the noble Baroness, Lady Masham, who questioned me many times when I was a Minister about this.

Seventy-two per cent of UK cases of TB are among people born abroad, and about 40 per cent of cases in England are in London. It is vital, therefore, that the health service in London understands the nature of this problem, the communities at risk, and what needs to happen. The increase in migration into the UK means that UK doctors treat patients from all over the world, and medical students must be prepared for this change and understand its implications.

The report, Tomorrow’s Doctors, referred to by several noble Lords, has very wise words on these matters. It says that this is,

“leading to demands for greater cultural competency in the doctor-patient interaction”.

That is quite right. It continues:

“Medical students have to be prepared carefully for this change, with curricula exposing them to an understanding of why migration happens and specific migrant health issues as well as how to treat a broad range of diseases not routinely seen in the UK”.

Can the Minister say, therefore, whether TB and other conditions and their management are adequately included in the training of doctors in the UK? Indeed, would the forthcoming change of the Health Education Board mentioned in the document referred to by the noble Lord, Lord Jay, which will be an issue for the House in months to come, encompass the proposal made by the noble Lord, Lord Crisp, and other noble Lords today?

Hospices and Palliative Care Services

Baroness Thornton Excerpts

Wednesday 15th December 2010 Lords Chamber

[Baroness Thornton]

My Lords, I congratulate the noble Viscount, Lord Bridgeman, on securing this short but important debate, which has had many very pertinent contributions. The goal of palliative care is to prevent and relieve suffering and improve quality of life for people with serious and complex illnesses. End-of-life care affects all of us; it is everybody’s business and, as such, must be a central focus of any health, social care and housing reform agenda.

Much of the recent progress in end-of-life care was enabled by its inclusion as one of only eight high-level priorities in the NHS Next Stage Review, which the previous Government brought forward. Indeed, we made end-of-life care a priority; we made a commitment to it and, significantly, we increased funding to hospices. The key challenge facing the Government now is to ensure that end-of-life care continues to be one of the top few high-level organisational priorities at each stage of the forthcoming reforms. The proposals in the White Paper published this summer did not reflect the importance of end-of-life care sufficiently to guard against it being subsumed by other higher profile priorities. That is not just my opinion; it is also the opinion of the Palliative Care Association.

I have glanced at the results of the consultation published today and have yet to find the words “end-of-life strategy”. It may be in the operation strategy document, which is my weekend reading. I echo my noble friend Lord Faulkner in his concern about how the new GP commissioning will deliver palliative care. I suspect that many organisations that have campaigned for end-of-life care so successfully in recent years will be concerned about what comes next. Diluting recognition of end-of-life care as a discrete, high-level priority risks undermining the progress made, and I suggest devalues end-of-life care as a government priority. I should be grateful for the Minister’s comments on this and his reassurance. Surely, if the Government intend to drive cultural change in the NHS, as they say they do, it is essential that they reflect the whole journey of a person’s care throughout their life to their death and into bereavement care for their family and friends. The Minister needs to address some serious worries and concerns raised during this debate.