Human Fertilisation and Embryology: Regulation

Baroness Thornton Excerpts

Wednesday 13th October 2010 Lords Chamber

[Earl Howe]

My Lords, I need to make it clear that our proposal is not to bring the regulation in house; it is to distribute the regulatory function between several different bodies. I also emphasise that there is absolutely no suggestion that we are changing the special status of the embryo. We have no plans to re-examine those parts of the legislation which recognise that status. We fully recognise the role which the HFEA has played in establishing the UK as a world leader in this area, but times change and so has the way in which we regulate the delivery of healthcare. That is the basis on which we have looked at this.

[Baroness Thornton]

My Lords, when I was a government Minister and the BMA, the Royal College of Obstetricians and Gynaecologists, the Royal College of Pathologists and the Royal College of Nursing ganged up on me, I always thought it was wise to listen. All those bodies have expressed very serious concerns about the government proposal. Has the Minister had meetings with the royal colleges and the BMA about their concerns? Has he discussed in particular the real risk to loss of specialist expertise and public confidence and the risk to patient safety?

[Earl Howe]

My Lords, we intend to engage fully with all interested parties on this matter but it is early days. The noble Baroness quite rightly raises the specialist expertise available to the HFEA. We fully recognise that. We are very keen that the expertise is not lost but is made available to the CQC or to the new research regulator, if we set up one. I understand that, where a function of one organisation transfers to another organisation, it is customary for the relevant staff to transfer as well. I emphasise that matters are at a very early stage.

Health: Neurological Conditions

Baroness Thornton Excerpts

Monday 11th October 2010 Lords Chamber

[Baroness Thornton]

My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Gardner of Parkes, on initiating this debate. I suspect that there would have been more takers for it had there been more notice, although it is clear that the quality of the debate has not suffered as a result. On balance, the fact that important issues are getting an airing because the Government do not seem to have got their head around scheduling legislation for the House is definitely of benefit to some of us.

I am grateful to the Motor Neurone Disease Association, Parkinson’s UK and the MS Society for their comments on this important issue. Those organisations and many others care about this issue with great passion and with great experience. It is my understanding that around 15.4 million people in the UK are living with long-term conditions and that of them 8 million have neurological conditions. I note that other speakers have given different figures, but it is a very large number and I am sure that the Minister will have the most up-to-date and accurate figures to give us.

I want to take a moment to look at the vital role that allied health professionals play in the care of those with motor neurone disease. The Motor Neurone Disease Association research carried out between 1996 and 2000 found that having a multidisciplinary motor neurone disease clinic extended survival for people with that disease by 7.5 months. We know that specialist MDT care can significantly improve the quality of life. The complexity of the symptoms presented by motor neurone disease means that a large number of health and social care professionals may be involved in the care of someone. It is common to have up to 18 professionals involved in caring for a person with motor neurone disease at any time. Therefore, examples of good practice in co-ordinating this care take a variety of different forms and different models suit different local situations. The models that work best for the people with motor neurone disease are typically those that involve a designated key worker—often themselves a clinical nurse specialist, a motor neurone disease care centre co-ordinator or other specialist clinician—co-ordinating care across different services. The key worker often achieves the best results by bringing together and co-ordinating a multidisciplinary team to care for the person with motor neurone disease.

That co-ordination of care and treatment is vital. If the treatment is poorly co-ordinated, untimely and without specialist knowledge of motor neurone disease, it can result in treatment being missed, the person’s condition becoming more acute more rapidly—in fact, the kind of issues that the noble Baroness, Lady Finlay, talked about earlier—leading to greater expense and suffering as more intensive treatment and care is then needed.

Parkinson’s UK sent me some case studies which definitely bear repeating:

“With occupational therapists, physios and speech and language therapists, it would be very beneficial to be able to access regular, routine follow-up rather than being ‘signed off’ at the end of a treatment”.

That was said by a person with Parkinson’s disease, who also went on to say,

“I have worked hard to get counselling with a qualified, experienced psychologist … my GP has been very helpful but the waiting time has been many months”.

Parkinson's UK conducted a case study into the value of physiotherapists in the system; as we have already noted, they provide a high-quality, cost-effective service, especially those who specialise in conditions such as Parkinson’s. They offer an immensely important service and patients can often see them in place of a medical consultant, which is a significant cost saving. According to one physiotherapist:

“Condition-specific exercise classes are a wonderful way of maintaining people’s fitness initially and building confidence to then carry on at a gym, or out with the family”.

There is no doubt that, as Parkinson's UK states, providing access to a range of therapies and other services is cost-effective. It helps people with Parkinson's to stay independent longer, preventing costly admissions to hospital and care homes. Existing clinical guidelines, including those from NICE and the royal colleges, of the various therapies recognise how important that is.

Allied health professionals must form part of a specialist, multidisciplinary Parkinson’s team that looks at the full range of therapies needed by someone with Parkinson's. In order to treat the individual patient, not just the condition, it is important that each patient receives the therapies they need at the right time to ensure the best management of their condition. This will prevent unnecessary deterioration and reduce the burden on the health and social care system.

The Multiple Sclerosis Society, along with many other organisations concerned with long-term neurological conditions, supported the NHS outcomes framework and believes that insufficient resources have been dedicated to the implementation of the NSF for long-term conditions, resulting in patchy neurological services across the country. The recent report, Half-way Through—Are We Half-way There?, which considers the progress of the national framework on long-term conditions, shows that there is still a great deal to do. I am anxious that the progress that has been made will be lost under the new regime proposed by the Conservative Government. The previous Government initiated the 10-year strategy and, in January this year, published what I thought was a great document about the commissioning of such services.

I have spent the past few months talking to organisations and individuals about what they think about the Government's proposals for the NHS and how those proposals might affect the issue with which they are concerned. I must say that great concern is being expressed across the piece. I went into some detail about the kind of integrated care required for those neurological conditions because it begs the question: how will it be maintained and developed under the new regime? That is at the heart of my final remarks.

I heard the Secretary of State, Andrew Lansley, on Radio 4 at the weekend saying that although people had raised justifiable questions in the consultation, he could not see that there was real opposition to the Government's proposals. He is behaving something like an ostrich, because every day there are more and more appeals to the Government to slow down. Doctors, nurses, royal colleges and many organisations concerned with things such as long-term neurological conditions are saying, “Please slow down. We are confused and anxious about what is going to happen to the issue with which we are concerned”. When the solution lies, as it does with long-term neurological conditions, in pathways dependent on teamworking across disciplines of health and social care, they are right to be concerned. It is a long process to secure the right services for people with long-term neurological conditions. How will that be maintained within the new structure? It is not clear where and how, for example, the care of people with motor neurone disease will be commissioned and how effective it will be. There are significant risks of deteriorating standards of care and spiralling costs if the wrong choices are made over the next few years.

In conclusion, it is clear that the work of allied health professions is integral to the successful care of and prospects for those with long-term neurological conditions. Organisations that work with those who have such conditions have a right to be concerned about where the funding for those conditions will sit. I note, for example, that in its submission on the White Paper one of them asked whether its condition would be commissioned at a specialist care level by the commissioning board or whether it would be done by GP commissioners, and how the integrated pathways will be assured under those circumstances. I searched the Department of Health website in vain for some enlightenment about those questions. Perhaps the Minister will be able to shed some light on them.

Health Protection Agency

Baroness Thornton Excerpts

Thursday 7th October 2010 Lords Chamber

Asked By

[Baroness Thornton]

To ask Her Majesty’s Government how they will ensure that emergencies and pandemics are dealt with properly in the period before the abolition of the Health Protection Agency.

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

The Health Protection Agency is one of many resources used by the Government to prepare for emergencies and pandemics. We propose to abolish the HPA as a statutory body but its functions will continue as a key part of the planned public health service. The Government continue to prepare and strengthen the UK’s resilience to emergencies, and we will ensure that this is maintained both before and after the HPA’s functions are incorporated into the public health service.

[Baroness Thornton]

I thank the Minister for that Answer but I am not sure it offered the reassurance that I was seeking. I raise the issue of the independent expert advice of the HPA, which from time to time might be uncomfortable for Ministers to hear. How will the Government ensure that the independence of the HPA is guaranteed, and will the scientific advice be made publicly available? For example, scientific advisory committees such as the one on dangerous pathogens are obliged to publish their agendas, minutes and papers and to have a dedicated website. If these committees are subsumed into the department, will they lose their independence? This is a very important matter and the Government need to provide some clarity.

[Earl Howe]

My Lords, transparency is one of the aims of our proposals. As regards independence, the Government will continue to rely on their scientific advisory committees, the members of which, as the noble Baroness knows, are drawn from the foremost experts in their respective fields. The fact that the scientific secretariat to each committee is provided by experts formerly within the department, instead of within the HPA, will not prevent the committees reporting as they judge to be appropriate.

Food: Regulation and Guidance

Baroness Thornton Excerpts

Thursday 7th October 2010 Lords Chamber

[Baroness Thornton]

My Lords, I congratulate my noble friend Lord Whitty on obtaining this important debate and I congratulate all the other speakers. On 30 July 1999, during the winding up of the Second Reading debate on the Food Standards Bill, the late and much loved Lord Carter, the Chief Whip at the time and an enthusiastic farmer and fruit producer, said on behalf of the Government:

“We have had a wide-ranging debate on this Bill and the related issues concerned with the food standards agency. We feel that the Bill represents a major step forward. It shows how the Government are continuing to give public health and the interests of consumers the high priority they deserve. The proposals have from the start been exposed to the fullest scrutiny and comment, despite what some noble Lords have said. We feel that the Bill is now a well developed piece of legislation, with three rounds of consultation having shown what consumers want … The painstaking process of consultation, with two years of hard work by Ministers and officials, have laid the ground for these major changes”.—[Official Report, 30/7/1999; cols. 1819-20.]

I was a bit player at the time and made a speech in that debate as well as participating in debates throughout the passage of the Bill. I mention that because of the contrast with the approach that this Conservative Government have taken in introducing their proposals to change the work of the FSA. Given the number of times that the Minister has chided me over the past few years for what he called a lack of evidence base for the various proposals that the Labour Government brought forward, it is a bit rich and a great contrast to the way that the Secretary of State announced major changes to the FSA and its work. We are entitled to ask: where is the evidence base that food labelling will do better back at Defra, since some will argue that it did not do so well before the creation of the FSA, and where is the evidence base that national policy on nutrition will be improved by putting it in the English and Welsh departments?

On the FSA website, I found a rather sad message. It said:

“If you wish to look at our old content on nutrition you can see it on the National Archive website. Nutrition research reports remain in our research repository”.

I suggest that the Minister visits this website as it is a marvellous library of the evidence of the food-base archive that has underpinned some of the campaigns that the FSA has led in the past 10 years or so, setting targets, as it did, for reductions in salt, sugar and fats in food. In May 2009, the FSA published revised salt-reduction targets for 2012 for 80 categories of food. They are more challenging than the previous targets for 2010. Will they be maintained? I know that the reduction of salt in food is work in progress. Indeed, I have very vivid memories of when I worked for the Co-operative movement when the Food and Drink Federation was violently opposed to any suggestion that government or a government body might interfere or comment on food manufacturers’ right to put pretty much what they liked in our foodstuffs. I am glad to say that they have modified their practices over the intervening years. Perhaps I may suggest that they do not take the proposed reduction in the FSA’s remit in this area as a signal that they can revert back to their bad, unhealthy habits. However, I have to say to your Lordships’ House that, after remarks like those from the Secretary of State when he said that he will scale back public funding for Change4Life and is asking the food industry to fill the gap in return for,

“an expectation of non-regulatory approaches”,

we have a right to be anxious.

I should like to explore a little further the powerful medical health case for salt reduction put forward by the noble Lord, Lord Patel. In 2006, the FSA published the original voluntary salt reduction targets for 85 categories of food as guidance for the food industry. The agency committed to review the target in 2008 to formally assess progress to date and to establish what further reductions were necessary to maintain progress towards a six grams daily intake target, as mentioned by the noble Lord.

The setting of the targets, backed by scientific and nutritional evidence, gave the exercise credibility and led to some serious improvements. For example, salt has been reduced by one-third in pre-packed sliced bread. There has been a 44 per cent reduction in branded breakfast cereals and a reduction of between 16 per cent and 50 per cent in cakes and biscuits. There has been up to a 55 per cent reduction of salt in snacks and crisps, 50 per cent less salt in UK white cheese and a 32 per cent reduction in retail standard cheese slices. I am sure that the noble Earl, Lord Erroll, probably will disapprove of this, but I think that this is great progress and that our food manufacturers should be congratulated. Huge progress is still to be made, but it is a success story. How does the department propose to maintain reductions of salt in food?

As my noble friend Lord Whitty said, it is no exaggeration to say that there is a crisis in children’s diet. The National Diet and Nutrition Survey found that 92 per cent of children consume more saturated fat than is recommended, 86 per cent consume too much sugar, 72 per cent consume too much salt and 96 per cent do not get enough fruit and vegetables. As my noble friend Lord Giddens said, the Chief Medical Officer has compared this to a health time-bomb which we have to diffuse.

The history of the previous Conservative Government in this matter is truly abysmal, so the Minister should not be surprised at the anxiety and scepticism being expressed today. For years, school meals services suffered from neglect and underinvestment with kitchen and canteen facilities in many schools removed or allowed to deteriorate. The previous Conservative Government removed any guidance about nutrition for children’s school meals. Staff were not given proper training to allow them to prepare food from scratch. Their job was reduced to heating up and serving pre-prepared food delivered from large catering firms. Menus in many schools were limited to a regular selection of processed and deep-fried foods, including pizza, chips and the infamous turkey twizzlers. Such options tended to be high in fat, salt and sugar, and contained little fruit and vegetables or other fresh ingredients. Junk food and unhealthy soft drinks were widely available in vending machines and tuck shops.

There is no question that we have Jamie Oliver to thank in part for what happened next, which is why the Secretary of State’s remarks to the BMA on 30 June about Jamie Oliver’s efforts to provide healthy schools were singularly inappropriate. Combining his other utterances on these issues with the facile comments from his colleague, Anne Milton, about obesity and calling people fat instead of obese, creates legitimate concerns about the seriousness that exists within the ministerial team to deliver on this agenda and their willingness to do so.

When the Labour Government established the Schools Food Trust, a non-departmental public body, in 2005, new standards for the type and nutritional quality of school food were introduced in primary and secondary schools. After the success of campaigns, such as the schools food campaign and Jamie Oliver, we need to thank them for their efforts. The new rules for food in schools ensure that school lunches are free from low-quality meat products, fizzy drinks, crisps and chocolate. Deep-fried items are restricted to no more than two portions a week. Schools have also ended the sale of junk food in vending machines and tuck shops, including confectionery, chocolate and fizzy drinks. The School Food Trust now works with schools and vending operators to promote the sale of healthy snacks and drinks such as water, milk, fruit juices and yoghurt drinks. In addition to the school food standards, a series of measures have been put in place to,

“embed the school food revolution for the long term and help tackle childhood obesity”.

This includes investment in healthy ingredients, training kitchens, the entitlement to learn to cook, a specific fund for building kitchens in addition to the £1 billion Building Schools for the Future programme, as well as increasing tendering opportunities for small and local producers. I pay tribute to the work of the trust and ask the Minister how he intends to deliver good health for the nation’s children if the Government withdraw their support.

It is important to look at what third parties have to say about these proposals. The chief executive of Which?, Peter Vicary-Smith, has said:

“The Food Standards Agency has revolutionised the way that food issues are handled in the UK, so we’re pleased today’s announcement ensures it can continue to independently monitor food safety. Unfortunately, some issues that would be best handled by the FSA have been moved to other departments. With these changes the government must ensure the interests of consumers remain at the heart of food policy”.

Tam Fry of the National Obesity Forum has said that it is “crazy” to dismember the FSA:

“It had a hugely important role in improving the quality of foodstuffs in Britain and it was vital to have at the centre of government a body that championed healthy food. This appears just the old Conservative party being the political wing of business”.

Tom MacMillan of the Food Ethics Council has said:

“The agency was set up to earn public trust after a succession of food scares. Its wobbles, like the latest row over GM foods, have come when that commitment has wavered. Any departments absorbing the FSA’s role should heed that lesson carefully, doing even more to invite scrutiny and banish the slightest whiff of secrecy, or the new government could face another BSE”.

Patrick Holden, director of the Soil Association, the organic food standard bearer which had several run-ins with the first chair of the FSA, the noble Lord, Lord Krebs, has said:

“Many NGOs campaigning on food thought for a long time the food industry has an unhealthy degree of influence over the Department of Health, so the great risk is the corporate vested interests of the food industry will have too strong an influence on future policy”.

How will the noble Earl respond to the fact that so many respected organisations are worried about what the future holds? Indeed, his noble friend Lady Miller believes that food regulation needs more teeth, so will his department be delivering on that?

I am grateful to the noble Baroness, Lady Finlay, for her wise words and for reminding the House about Every Child Matters. She underlined the importance of diet for pregnant women. I thank also my noble friend Lord Giddens for his analysis of the separation of food production and consumption. His words filled me with dread at the challenges ahead, and I cannot see how the Government’s proposals will add to the solution. I enjoyed the speech of the noble Earl, Lord Erroll, but I wondered if he had been at the e-numbers recently. My noble friend Lord Rea was right to remind us of the roots of our public health regime, and of how hard vested interests work, but not only for consumers.

In conclusion, the FSA is neither overstaffed nor overresourced, and it has made significant economies over recent years. Will the Minister inform the House how his honourable friend has responded to the letters he received from my noble friend Lord Rooker, the current chair of the FSA, in June and July? The letters are on the public record and are available on the FSA website. My noble friend says:

“The core principles of the FSA are to put the consumer first; making policy in an open and transparent environment; operate independently; and be science and evidence-based. The FSA Board is concerned that these principles, which have served consumers well in the food policy environment since 2000, would be at risk by moving nutrition and dietary health work from a non-political to a political department”.

I could not have put it better myself.

Health: Addiction to Prescribed Drugs

Baroness Thornton Excerpts

Wednesday 6th October 2010 Lords Chamber

[Baroness Thornton]

My Lords, I am very pleased that the noble Earl, Lord Sandwich, has succeeded in securing this debate. His persistence in raising this important issue is to be commended.

Last November, the noble Earl pressed me as the then Minister about this important matter and I assured him that the promised review would report this year, 2010. I understand that this has now been extended to next year. I join the noble Earl in his disappointment, given that we know the scale of the problem. I also join the noble Baroness, Lady Bottomley, in saying that this issue should not fall between the cracks of reorganisation.

I understand that the extended review includes a literature review, an audit of selected PCT prescribing data and a survey of the withdrawal assistance that is available from the voluntary sector. However, many believe the review to be a case of too little, too late. The terms of reference have been shrunk; the completion date is repeatedly extended; and patients have been excluded from the process. This is a far from satisfactory situation and I hope that the Minister will be able to give us more comfort than seems apparent. It is simply not acceptable in these days of sophisticated medication that people should take prescribed drugs in good faith and then find themselves incapacitated when they try to stop taking them.

Given the limitation in the time that we have this evening, I wish to address two areas. The first is in the context of the treatment of depression. As the Minister will know, NICE guidance on the treatment of mild to moderate depression and anxiety disorders recommends cognitive behavioural therapy as the treatment with the strongest evidence base for efficacy. For this reason, the Labour Government invested £173 million in the Improving Access to Psychological Therapies programme to train a new workforce of 3,600 people in cognitive behavioural therapy in the three years to 2010-11. Will the Minister explain what the future holds for psychological therapies? With GP commissioning coming down the track, this seems to be yet another matter that is riven with uncertainties.

I raise, secondly, SSRI antidepressants, which I discussed with the noble Earl before our debate. I think that we agree that this is also a matter that is linked to this discussion. We know that they are effective treatments which have benefited millions of people. Since completion of the review by the expert working group in 2004, every effort has been made to issue updated advice as appropriate, and communications are issued to healthcare professionals via the central alerting system, the MHRA website and the Drug Safety Update. What is the current position on the usage and ongoing reviews of SSRIs? Can we be sure, for example, that no person under 18 is prescribed a drug such as Seroxat? I feel strongly about this issue, because a relative of mine has never recovered from having been prescribed Seroxat when he was 15 years old, many years ago. All companies have a responsibility to patients and should report any adverse data signals to us as soon as they discover them. The investigation into GlaxoSmithKline and the use of Seroxat revealed important weaknesses in the drug safety legislation in force at the time. Can the Minister assure the House that steps being taken to strengthen the law will ensure that there can be no doubt as to companies' obligations to report safety issues?

I urge the Minister to take up this important issue of dependence on benzodiazepines and to ensure that a co-ordinated action plan results from the review now being undertaken.

Health and Social Care Act 2008 (Consequential Amendments No. 3) Order 2010

Baroness Thornton Excerpts

Monday 26th July 2010 Grand Committee

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

My Lords, this order makes a consequential amendment to the Water Industry Act 1991. The amendment is required as a result of the implementation of a new registration system under the Health and Social Care Act 2008, which set out a system of registration for providers of health and adult social care that the Care Quality Commission operates. To manage the registration process, providers are being brought into the new system in stages. The dates for these stages are set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

As of 1 April this year, all NHS providers were subject to the new system of registration. It will cover private and voluntary healthcare providers, and adult social care providers, from 1 October 2010. The providers are registered under the Care Standards Act 2000. Therefore, on 1 October, certain provisions of the Care Standards Act will be repealed. One of these will be the definition, in Section 2 of the Act, of an “independent hospital in England”. A previous order—the Health and Social Care Act 2008 (Consequential Amendments No. 2) Order 2010—made a number of consequential amendments to primary legislation using this definition. Unfortunately, an amendment to the Water Industry Act 1991 was missed, so this order is necessary because of that omission. Anyone who buys, or has bought, the earlier order will be entitled to a copy of this order free of charge.

A further order, subject to the negative parliamentary procedure, has been laid today and will make the necessary amendments to secondary legislation. Schedule 4A to the Water Industry Act 1991 contains a list of premises that should not be disconnected for the non-payment of water charges, including,

“an independent hospital within the meaning of the Care Standards Act 2000”.

As the definition of “independent hospital” in the Care Standards Act 2000 will no longer be applicable in England, this order makes a consequential amendment to the definition in the Water Industry Act 1991. It replaces the current cross-reference to the Care Standards Act 2000 with a new definition of an “independent hospital” for England. This new definition covers the same kinds of premises that were previously covered, but does not rely on a reference to the definition in the Care Standards Act 2000. The definition for Wales remains unchanged. I commend this order to the Committee.

[Baroness Thornton]

I thank the Minister for explaining this small order arising out of Section 162 of the Health and Social Care Act 2008. I suppose that I should apologise to the Committee for the earlier omission, which is why we are here. Section 162 is a part that confers power on the Minister to ensure that the Act is in compliance with existing legislation, and indeed that is what the Minister explained in a more than adequate fashion.

I confess that I was not sure that I could see the necessity of this order until I realised that the healthcare facilities mentioned can have their water cut off as a result of non-payment. Can the Minister confirm whether this has happened in the interim period?

The key matter on which I should like further clarification is the definition of an “independent hospital”. I think that I heard the Minister confirm that this covers the public, private and charitable sectors, any one of which may be providing healthcare as listed in new paragraph (5). Am I right to assume that this does not cover care homes or nursing homes, and that they are covered elsewhere?

Finally, I am relieved that body piercing and tattooing parlours are exempt from the order. I also wonder whether chemical peels, which are fashionable now, are covered under paragraph (5)(e)(iii) and (iv) for the purposes of this order.

This order is otherwise perfectly straightforward and I support the Minister in moving the Motion.

[Earl Howe]

My Lords, I am grateful to the noble Baroness for her questions. The first point to make is that we are in time with this order, because the operative date is 1 October, so there is no retrospective element. There is therefore no question of any hospital having fallen between two stools, so to speak, as regards water disconnection. I am not aware that there has been a problem on that front.

The noble Baroness asked about the definition. Schedule 4A to the Water Industry Act 1991 lists a number of premises that are not to be disconnected for non-payment of water charges. These include, among other premises, NHS hospitals, premises used to provide medical or dental services by registered practitioners, children’s homes, schools and care homes. These premises will continue to be protected from disconnection for the non-payment of water charges. No changes are being made to these parts of the schedule.

The noble Baroness also asked whether chemical peels were excluded under new paragraph (5)(e). As that procedure is not counted as surgery, chemical peels are not included and therefore do not receive protection from disconnection under paragraph (5)(e).

Health: NICE

Baroness Thornton Excerpts

Wednesday 14th July 2010 Lords Chamber

[Earl Howe]

My Lords, I am sure that my noble friend will accept, as I hope I made it clear the other day, that the Government are wholly committed to improving the quality of care for people with dementia and their carers. We are standing fully behind the dementia strategy, instituted by the previous Government. That strategy contains a specific objective of improving the quality of dementia care in hospitals. I take on board what my noble friend says about the absence of adequate research in the psychosocial domain. I shall discuss that point with NICE over the next few weeks as I am aware that it is one of its concerns.

[Baroness Thornton]

My Lords, I welcome the statement that the Minister has made about keeping NICE as an independent voice. That is vital. Will the Government still support NICE in its work not just in medical research, but as regards the broader aspects of disease, social conditions, social care and so on, as mentioned by the noble Lord, Lord Alderdice? NICE has broadened its brief and has taken a much more holistic view about the conditions on which it issues guidance. Will the Government still support it in doing that?

[Earl Howe]

My Lords, as the noble Baroness will know, in 2005, the then Government charged NICE with producing public health guidance as part of its work. As we establish a more integrated and effective public health service, we will look actively at how NICE can contribute to that agenda, and, in particular, how it can contribute to integrated care provided by health and social care combined.

Health: Diet

Baroness Thornton Excerpts

Tuesday 13th July 2010 Lords Chamber

[Baroness Thornton]

They are being abolished. I declare an interest as a former unpaid trustee of the Fifteen training restaurants. Does the Minister think that it was wise of the Secretary of State to attack Jamie Oliver's school meals campaign, particularly given that he was incorrect in saying that the take-up of school meals had gone down when it had gone up? Will the Minister join the rest of the country in applauding Jamie Oliver's campaign to improve the quality and nutrition of school meals?

[Earl Howe]

My Lords, I do not know whether the noble Baroness saw my right honourable friend on television recently talking about this issue, but this is a good opportunity for me to put the record straight. He has not criticised Jamie Oliver’s work on school meals: on the contrary, he has applauded Mr Oliver and the many people who have worked very hard to improve the standard of school meals. The point that he made was that a very important initiative started by Jamie Oliver to make people more aware of what healthy eating is all about turned into a kind of prescriptive, top-down management process from Whitehall—and that is counterproductive.

NHS: White Paper

Baroness Thornton Excerpts

Monday 12th July 2010 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating the Statement made in the other place. It was certainly a help to me to read the contents of the White Paper in the Daily Telegraph and in other media outlets over the weekend. However, the coalition Government must recognise that it is far from satisfactory that Parliament should be the last place to learn about matters of such importance.

In opposition, the Conservatives promised that there would be no more pointless reorganisations. The Prime Minister gave this promise to the Royal College of Nursing last year. The coalition agreement states:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care”.

However, now it is in government, the coalition proposes the biggest structural upheaval in the NHS for 60 years —for which GPs are unprepared, which NHS staff do not want and about which patients were never asked. Inevitably, my first question to the Minister is: why have the Government broken their word on this matter? The Minister will be aware that I have never said that there was not more that could be done to make the NHS better, or indeed to give more say to patients and clinicians.

In the past two weeks, there have been two sources of independent comment on the effectiveness of today’s NHS. A couple of weeks ago, the Commonwealth Fund said that the changes Labour had made had given the NHS a fantastic rating on quality, and that it was the most efficient health service in the world. I am sure that we all welcome the report published today on the survival rates for sufferers from bowel, lung and ovarian cancer. It shows huge progress and experts have said that this is due to the waiting guarantees that Labour introduced on access to cancer specialists, so that people have their cancers diagnosed early. Of course, that is another part of the system that Andrew Lansley is now wiping away. My question is: why is this great upheaval necessary when we have a health service that is providing good care to the vast majority of people and when waiting times are as low as they have ever been? Does this policy mean that there will be a grave risk that the NHS will go backwards?

This Statement is full of “coulds” and “might bes”: it is remarkably lacking in doing words. If the coalition Government had found an appalling situation, as we did in 1997, they might have had some justification for radical solutions; but this is not the case. The White Paper and the Statement talk throughout of building on the work done by the previous Administration, which is all well and good, and which I welcome, but I am very sorry that, in our view, it has led them to the wrong conclusion.

Today, the NHS is not on its knees. We saved it by investment and commitment to its values. A period of stability is needed so that energy can be focused on the financial challenges ahead and to do that it needs a confident and motivated staff to continue the development of the many services that we initiated; for example, specialist trauma services; the reconfiguration that has been necessary to deliver stroke services; the co-ordination of partnerships to make the best use of expertise for diabetic care at local level; and the investment in and the building of special expertise for kidney dialysis so that more people can look after themselves at home.

What will happen to all those services which require regional and local strategies and—a matter close to the heart of many in this House—how will the many hundreds of GP practices in London cope with the way in which TB manifests itself and spreads in London? A pan-London strategy is needed. How will a bottom-up service cope? It would be unsurprising if people conclude that this White Paper and the proposals that it contains are ideologically driven. That is why there is a betrayal of the promises that were given by the coalition. With that betrayal one also has to take a second glance at the patient voice mantra that we hear from the Secretary of State. We have to question whether that is a convenient cover for a concerted attempt to change completely the way in which healthcare is delivered in this country and is part and parcel of the determination of the Conservative Party to shrink the state. It is best to be honest about such matters and I ask the other partner in the coalition to say whether that is its view too.

Many will believe that this is tantamount to the privatisation of the commissioning function of the NHS. Will there be any restrictions on the use of the private sector to support GPs? Added to that, the Government are bringing in a series of market reforms for hospitals. The Secretary of State has previously admitted that his plans would allow hospitals to go bust. Can he confirm that if a foundation trust got into financial difficulty he would step in to protect it, or would he allow it to fail? Even more important, if all the NHS delivery is done through foundation trusts, what will that mean for patients?

Frankly, I do not believe it is good enough to conduct a huge experiment on an organisation that is delivering for its patients an improving service. The staff of the NHS do not need years of uncertainty about the future of their organisation and their jobs. The NHS needs confident, motivated staff, but today the noble Earl has opened up uncertainty for the 1.3 million people who work for it.

Let us turn to accountability for £80 billion of public expenditure. I ask the noble Earl to confirm that the Treasury also had something to say about accountability in this respect. GP practices are mostly small enterprises; they are small businesses. If, for example, another network of small businesses, such as the Federation of Newsagents, was about to be handed £80 billion of public money from the Treasury and told to spend it how it liked, I suggest there might be some small concern. We support a strong role for GPs but we have to question the wisdom of wiping away oversight and the handing over of £80 billion of public money to GPs, whether they are ready or not.

We are not alone in our concerns about this. Michael Dixon, chair of the NHS Alliance, says that only about 5 per cent of GPs are ready to take over commissioning responsibility. So what will happen to the other 95 per cent? Sir David Nicholson has judged that even the best GP practice-based commissioners are only about a three out of 10 in terms of the quality of their commissioning and that is not good enough to give them £80 billion of public money to spend. So what sound evidence does the noble Earl have that 100 per cent of GPs are ready, willing and able to commission services for the entire population?

The Statement talked of rewarding commissioners who hit outcomes. Does that mean yet more money for GPs and, if so, how much?

How many jobs do the Government expect to be lost, and how much money have they put aside for redundancy costs? What guarantees can the Minister give the House that people will not simply be paid off by the NHS to be re-employed, doing the same job, by someone else? Crucially, where is the public accountability and the accountability to Parliament? The Patients’ Association has said that nothing can replace the accountability of the ballot box. I absolutely agree, and I invite the noble Earl to join me in that support.

How will GPs be held to account for the £80 billion of public money for which they will be responsible? Chris Ham of the King’s Fund has questioned whether the independent NHS board, the world's biggest quango, will be able to hold more than 500 GP consortia to account in an effective fashion. What does it mean for the accountability to Parliament if the Government go ahead and set up the NHS board? An annual report is not sufficient. Those of us who work with a lot of voluntary organisations in the health sector know that they will not think that that is sufficient. MPs at the other end of the building will really think that that is not sufficient when they want to raise questions asked by their constituents.

[The Earl of Onslow]

My Lords, the noble Baroness has spoken for nine minutes. I thought, and it has been my experience in 30 or 40-odd years in this House, that you are supposed to ask questions concisely, not to make a 10-minute speech—because I see that she has some more pages to read.

[Baroness Thornton]

We are the Opposition, and the only Opposition here. I have asked five or six questions so far and I have more.

That leads us to look at the bureaucracy involved in the proposals. The White Paper has managed to unite progressive views in opposition to it with the unlikely figure of Melanie Phillips of the Daily Mail. She wrote:

“Oh dear. The last thing that's needed right now is yet another massive reorganisation, which may well incur even greater costs … it could mean yet more paperwork - and that GPs would be likely to demand more money for the additional responsibilities”.

Well, quite.

In my experience, PCTs are staffed with decent, hard-working public servants who care greatly about the NHS and its patients. How does the Minister think that they felt when they read the quote from a senior Department of Health source—I apologise to the House for the language—who anonymously briefed the Health Service Journal this week, and said:

“PCTs are screwed. If you’ve got shares in PCTs I think you should sell”.

Is that any way to treat staff who have served the NHS loyally? What does the Minister think about bureaucracy. The Government may find that what they think of as bureaucracy is the system for accounting for the expenditure of public money. Can the Minister tell me precisely how the replacement of 130 PCTs by more than 500 GP practices and consortia will reduce bureaucracy and paperwork?

The White Paper represents a roll of the dice that puts the NHS at risk in a giant political experiment with no consultation, no piloting and no evidence. The sadness is that the Government are taking an £80 billion gamble with the great success story that our NHS is today. Of course we welcome positive change and benefits for patients. We saved this NHS. At a stroke, this Government are removing public accountability, demoralising NHS staff at a time when we need them. For patients, it opens the door to a new era of postcode prescribing which will vary from street to street. We know that the streets and the patients who will suffer most are those whom we on this side of the House are determined to defend. We will be challenging the proposals along those lines.

Health: Spending Cuts

Baroness Thornton Excerpts

Wednesday 30th June 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness is right to draw attention to this issue, of which I am very conscious. Where we have commissioning, it is important that the population base for a given condition is sufficient for that commissioning organisation to contend with. With regard to specialised conditions, I am working hard to ensure that the model we propose will take them fully into account.

[Baroness Thornton]

My Lords, Hamish Meldrum from the BMA said:

“We urge the government and NHS organisations to focus on those areas where they can truly eliminate waste and achieve genuine efficiency savings rather than adopt a ‘slash-and-burn’ approach to health care with arbitrary cuts and poorly thought-through policies”.

For example, I understand that there is a 50 per cent cut in the communications budget of the Department of Health. Does this include public health information programmes, and are they being dropped? Will they include programmes on smoking cessation, stroke, obesity and various other public health issues? I would have thought that those would have been a priority for this coalition Government.

[Earl Howe]

My Lords, public health is indeed a priority for the coalition Government. However, we are subject to a government-wide constraint on marketing and communications expenditure. That means that every programme of communication or marketing has to be justified by the evidence that it will do some good. That is a good and proper control. It does not mean that we will stop all spending, but we have to justify what we do.